Showing posts with label in vitro fertilization. Show all posts
Showing posts with label in vitro fertilization. Show all posts

Sunday, November 19, 2017

Adequate vitamin D levels result in higher live birth rate in women undergoing ART

www.hlbenefits.com


Women undergoing ART with adequate levels of Vitamin D have a 30% increase chances of live birth as compared to women who were found deficient in Vitamin D says the results of a systematic review and meta-analysis published November 15, 2017 in Journal Human Reproduction.

The lead researcher was  Dr Justin Chu, an Academic Clinical Lecturer and Specialist Registrar in Obstetrics and Gynaecology for Tommy's National Centre for Miscarriage Research at the University of Birmingham and Birmingham Women's and Children's NHS Foundation Trust.

It is known that every nearly 20%-50% of women of reproductive age are deficient in Vitamin D and many mechanisms are suggested. This meta-analysis found a higher prevalence of women with Vit D deficiency (34.6%) and insufficiency (34.6%). 

A total of 11 studies conducted over a period of 5 years (2010-2015) were included in the review, amounting to 2700 women receiving ART. Vitamin D levels were labelled as adequate or deficient according to Endocrine Society classification (<50 nmol/l deficient, 50–75 nmol/l insufficient and greater than 75nmol/l replete).

Pooled data from all the study for clinical pregnancy showed that women with more than 75nmol/l of vitamin D levels have 46% higher chances of clinical pregnancy (OR 1.46; CI 1.05–2.02; P = 0.02).
Similarly, these women with replete Vitamin D levels had a 33% increase chance of live birth rate (OR 1.33; CI 1.08–1.65; P = 0.39) and 34% increased chances of biochemical pregnancy (OR 1.34; CI 1.04–1.73; P = 0.28).

No correlation was found between Vitamin D levels and risk of miscarriages.

The main source of vitamin D for people is sunlight. Foods rich in Vitamin D are oily fish, red meat, liver and egg yolks also provide vitamin D, as well as vitamin D supplements

The researchers say the improved ART success in women replete in vitamin D "could be via the actions of vitamin D on the endometrium promoting embryo implantation or as a surrogate marker for general well-being."

Dr Chu, from the University of Birmingham’s Institute of Metabolism and Systems Research, cautioned that the findings do not mean that vitamin D supplementation necessarily improves women’s chances of having a baby following ART as the research can only show an association.

Dr Chu said: “Although an association has been identified, the beneficial effect of correction of vitamin D deficiency or insufficiency needs to be tested by performing a clinical trial.

“In the meantime, women who want to achieve a successful pregnancy should not rush off to their local pharmacy to buy vitamin D supplements until we know more about its effects. It is possible to overdose on vitamin D and this can lead to too much calcium building up in the body, which can weaken bones and damage the heart and kidneys.”

The researchers are calling for large randomizes studies to confirm the findings of other studies and prove causation.

“Testing for vitamin D concentrations is relatively cheap and widely available and its treatment is not costly,” said Dr Chu. “It could be that correcting vitamin D deficiency could benefit women undergoing assisted reproduction treatment, but further research is needed to test this.”

News Release by the University of Birmingham

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Friday, July 1, 2016

Does intentional endometrial curettage before embryo transfer increases the chances of successful outcome?

Clinical pearls:


  • Current research points in favor of performing endometrial scratching between day 7 of previous cycle to day 7 of the embryo transfer cycle resulting in improvement in clinical pregnancy rate and live birth rates in women with more than two previous embryo transfers. 

It is proposed that endometrial scratching or biopsy increases the chances of implantation in women attempting ARTs. With an intention to determine the current practice clinicians across Australia, New Zealand and the UK were given an on-line survey between August to October 2015.  The results of this study was published in the recent issue of Human Reproduction.[1]

In this cross- sectional study spanning 143 private and public fertility centers, 89% of physicians, embryologists and nurses perform the endometrial biopsy or scratching as a part of treatment protocols for couples undergoing IVF.[2]

The most common indication (92%) for the procedure was Recurrent Implantation failure (RIF) while only 3.6% clinicians offered it to patients trying to conceive by natural intercourse or IUI. Although many trials exist documenting the benefit of this procedure in couple trying to conceive naturally. [3]  
It was interesting to see that they all followed different time frame for doing the procedure.
89% of the centers offered the procedure in the luteal phase of the cycle prior to the embryo transfer cycle and none performed it on the day of egg retrieval or embryo-transfer.  
Two- thirds of the responders agreed that it is very useful in RIF undergoing IVF and more than 50% did not think it to be useful before the first IVF cycle.

Currently the most accepted explanation for the success is favorable immune modulation of the endometrium increasing the implantation rate. Other theories are it modulates the gene expression and increases the receptivity. [4]

A review of literature finds many RCTs conducted in the past to gauge the benefit of the procedure.
Results of Cochrane systemic review of 14 Randomized control trial(RCTs) shows that endometrial injury before starting the ovarian stimulation improves the chances of conception and ongoing pregnancy.[5] The evidence is moderate grade and suggests that “Endometrial injury performed between day 7 of the previous cycle and day 7 of the embryo transfer (ET) cycle is associated with an improvement in live birth and clinical pregnancy rates in women with more than two previous embryo transfers.”

With all these evidence pointing in favor of the procedure, a very large and robust study with sufficient power by Yeung et al[6] published in Human Reproduction showed that the procedure does not offer any benefits contrary to the previous beliefs. But, in this study about 70% of the patients received the procedure in their first IVF cycle so the results may not be generalized to patients with RIF.

To conclude, although current evidence is in favor of endometrial scratching, more evidence is needed in the form of large, randomized clinical trials regarding its timing in relation to menstrual cycle, use in women with or without RIF and its use in natural cycles, before this inexpensive and simple procedure can be widely applied in fertility clinics.





[1] http://humrep.oxfordjournals.org/content/31/6/1241.abstract
[2] http://humrep.oxfordjournals.org/content/31/6/1241.full.pdf+html
[3] Gibreel A, Badawy A, El-Refai W, El-Adawi N. Endometrial scratching to improve pregnancy rate in couples with unexplained subfertility: a randomized controlled trial. J Obstet Gynaecol Res 2013;39:680 – 684.
[4] Zhou L,Li RWang RHuang H-xZhong KLocal injury to the endometrium in controlled ovarian hyperstimulation cycles improves implantation rates. Fertil Steril2008;89:1166-1176.
[5] http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD009517.pub3/pdf