#44 : Effects of Optimum (Optimization of Thyroid, Thrombophilia, Immunity, and Uterine Milieu) Treatment Strategy on Euploid Blastocyst Transfer in Advanced Aged Women with Recurrent Reproductive Failure
Background and Aims: Does the Optimization of Thyroid function, Thrombophilia, Immunity and Uterine Milieu (OPTIMUM) treatment strategy contribute to improving pregnancy outcomes after single euploid blastocyst transfer (SEBT) in patients with a history of repeated implantation failure (RIF) and/or...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
World Scientific Publishing
2023-12-01
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| Series: | Fertility & Reproduction |
| Online Access: | https://www.worldscientific.com/doi/10.1142/S2661318223741462 |
| _version_ | 1797237071698460672 |
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| author | Keiji Kuroda Takashi Horikawa Azusa Moriyama Keisuke Shiobara Satoru Takamizawa Yasushi Kuribayashi Koji Nakagawa Rikikazu Sugiyama |
| author_facet | Keiji Kuroda Takashi Horikawa Azusa Moriyama Keisuke Shiobara Satoru Takamizawa Yasushi Kuribayashi Koji Nakagawa Rikikazu Sugiyama |
| author_sort | Keiji Kuroda |
| collection | DOAJ |
| description | Background and Aims: Does the Optimization of Thyroid function, Thrombophilia, Immunity and Uterine Milieu (OPTIMUM) treatment strategy contribute to improving pregnancy outcomes after single euploid blastocyst transfer (SEBT) in patients with a history of repeated implantation failure (RIF) and/or recurrent pregnancy loss (RPL)? Method: Between January 2019 and May 2022, women aged ≥ 40 years with RIF after three or more embryo transfer using morphology good embryos and/or RPL after two or more clinical pregnancy losses underwent preimplantation genetic testing for aneuploidy (PGT-A) and RIF/RPL testing, including a hysteroscopy, endometrial biopsy for CD138 immunostaining and bacterial culture, and serum 25-hydroxyvitamin D3, interferon-γ-producing helper-T (Th1) cell, IL-4-producing helper-T (Th2) cell, thyroid-stimulating hormone, thyroid peroxidase antibody, and thrombophilia screening. We treated chronic endometritis with antibiotics, high Th1/Th2 cell ratios with vitamin D and/or tacrolimus, overt/subclinical hypothyroidism with levothyroxine, and thrombophilia with low-dose aspirin. Of 160 consecutive women who underwent SEBT, we compared 127 and 33 women with and without the OPTIMUM treatment strategy, respectively. Results: RIF/RPL testing identified intrauterine abnormalities in 67 (52.8%), aberrant high Th1/Th2 cell ratios in 38 (29.9%), thyroid dysfunction in 19 (15.0%), and thrombophilia in 24 (18.9%). The clinical pregnancy and live birth rates in the OPTIMUM group was significantly higher than that in the control group (73.9% and 45.5%, respectively; p = 0.005 and 64.7% and 39.4%, respectively; p = 0.01) in women with RIF (Table 1). Whereas there was no significant difference of miscarriage rate in RPL women with and without OPTIMUM (5.5% and 13.3%, respectively; p = 0.58). Conclusion: In the women aged ≥40 years with RIF who underwent PGT-A, the OPTIMUM treatment strategy improved pregnancy outcomes after SEBT. In RPL, however, both PGT-A with and without OPTIMUM resulted in low miscarriage rates and no significant difference was recognized. |
| first_indexed | 2024-04-24T17:13:55Z |
| format | Article |
| id | doaj.art-7dec27f5e70d45b3aa357b519b237657 |
| institution | Directory Open Access Journal |
| issn | 2661-3182 2661-3174 |
| language | English |
| last_indexed | 2024-04-24T17:13:55Z |
| publishDate | 2023-12-01 |
| publisher | World Scientific Publishing |
| record_format | Article |
| series | Fertility & Reproduction |
| spelling | doaj.art-7dec27f5e70d45b3aa357b519b2376572024-03-28T07:54:18ZengWorld Scientific PublishingFertility & Reproduction2661-31822661-31742023-12-01050433833810.1142/S2661318223741462#44 : Effects of Optimum (Optimization of Thyroid, Thrombophilia, Immunity, and Uterine Milieu) Treatment Strategy on Euploid Blastocyst Transfer in Advanced Aged Women with Recurrent Reproductive FailureKeiji Kuroda0Takashi Horikawa1Azusa Moriyama2Keisuke Shiobara3Satoru Takamizawa4Yasushi Kuribayashi5Koji Nakagawa6Rikikazu Sugiyama7Sugiyama Clinic Marunouchi, Tokyo, JapanSugiyama Clinic Shinjuku, Tokyo, JapanSugiyama Clinic Marunouchi, Tokyo, JapanSugiyama Clinic Shinjuku, Tokyo, JapanSugiyama Clinic Shinjuku, Tokyo, JapanSugiyama Clinic Marunouchi, Tokyo, JapanSugiyama Clinic Shinjuku, Tokyo, JapanSugiyama Clinic Shinjuku, Tokyo, JapanBackground and Aims: Does the Optimization of Thyroid function, Thrombophilia, Immunity and Uterine Milieu (OPTIMUM) treatment strategy contribute to improving pregnancy outcomes after single euploid blastocyst transfer (SEBT) in patients with a history of repeated implantation failure (RIF) and/or recurrent pregnancy loss (RPL)? Method: Between January 2019 and May 2022, women aged ≥ 40 years with RIF after three or more embryo transfer using morphology good embryos and/or RPL after two or more clinical pregnancy losses underwent preimplantation genetic testing for aneuploidy (PGT-A) and RIF/RPL testing, including a hysteroscopy, endometrial biopsy for CD138 immunostaining and bacterial culture, and serum 25-hydroxyvitamin D3, interferon-γ-producing helper-T (Th1) cell, IL-4-producing helper-T (Th2) cell, thyroid-stimulating hormone, thyroid peroxidase antibody, and thrombophilia screening. We treated chronic endometritis with antibiotics, high Th1/Th2 cell ratios with vitamin D and/or tacrolimus, overt/subclinical hypothyroidism with levothyroxine, and thrombophilia with low-dose aspirin. Of 160 consecutive women who underwent SEBT, we compared 127 and 33 women with and without the OPTIMUM treatment strategy, respectively. Results: RIF/RPL testing identified intrauterine abnormalities in 67 (52.8%), aberrant high Th1/Th2 cell ratios in 38 (29.9%), thyroid dysfunction in 19 (15.0%), and thrombophilia in 24 (18.9%). The clinical pregnancy and live birth rates in the OPTIMUM group was significantly higher than that in the control group (73.9% and 45.5%, respectively; p = 0.005 and 64.7% and 39.4%, respectively; p = 0.01) in women with RIF (Table 1). Whereas there was no significant difference of miscarriage rate in RPL women with and without OPTIMUM (5.5% and 13.3%, respectively; p = 0.58). Conclusion: In the women aged ≥40 years with RIF who underwent PGT-A, the OPTIMUM treatment strategy improved pregnancy outcomes after SEBT. In RPL, however, both PGT-A with and without OPTIMUM resulted in low miscarriage rates and no significant difference was recognized.https://www.worldscientific.com/doi/10.1142/S2661318223741462 |
| spellingShingle | Keiji Kuroda Takashi Horikawa Azusa Moriyama Keisuke Shiobara Satoru Takamizawa Yasushi Kuribayashi Koji Nakagawa Rikikazu Sugiyama #44 : Effects of Optimum (Optimization of Thyroid, Thrombophilia, Immunity, and Uterine Milieu) Treatment Strategy on Euploid Blastocyst Transfer in Advanced Aged Women with Recurrent Reproductive Failure Fertility & Reproduction |
| title | #44 : Effects of Optimum (Optimization of Thyroid, Thrombophilia, Immunity, and Uterine Milieu) Treatment Strategy on Euploid Blastocyst Transfer in Advanced Aged Women with Recurrent Reproductive Failure |
| title_full | #44 : Effects of Optimum (Optimization of Thyroid, Thrombophilia, Immunity, and Uterine Milieu) Treatment Strategy on Euploid Blastocyst Transfer in Advanced Aged Women with Recurrent Reproductive Failure |
| title_fullStr | #44 : Effects of Optimum (Optimization of Thyroid, Thrombophilia, Immunity, and Uterine Milieu) Treatment Strategy on Euploid Blastocyst Transfer in Advanced Aged Women with Recurrent Reproductive Failure |
| title_full_unstemmed | #44 : Effects of Optimum (Optimization of Thyroid, Thrombophilia, Immunity, and Uterine Milieu) Treatment Strategy on Euploid Blastocyst Transfer in Advanced Aged Women with Recurrent Reproductive Failure |
| title_short | #44 : Effects of Optimum (Optimization of Thyroid, Thrombophilia, Immunity, and Uterine Milieu) Treatment Strategy on Euploid Blastocyst Transfer in Advanced Aged Women with Recurrent Reproductive Failure |
| title_sort | 44 effects of optimum optimization of thyroid thrombophilia immunity and uterine milieu treatment strategy on euploid blastocyst transfer in advanced aged women with recurrent reproductive failure |
| url | https://www.worldscientific.com/doi/10.1142/S2661318223741462 |
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