Last data update: May 06, 2024. (Total: 46732 publications since 2009)
Records 1-4 (of 4 Records) |
Query Trace: Hipp HS[original query] |
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Assisted reproductive technology with donor sperm: National trends and perinatal outcomes
Gerkowicz SA , Crawford SB , Hipp HS , Boulet SL , Kissin DM , Kawwass JF . Am J Obstet Gynecol 2017 218 (4) 421 e1-421 e10 BACKGROUND: Information regarding use of donor sperm in assisted reproductive technology, as well as subsequent treatment and perinatal outcomes, remains limited. Outcome data would aid patient counseling and clinical decision-making. OBJECTIVES: To report national trends in donor sperm utilization and live birth rates of donor sperm assisted reproductive technology cycles in the United States, and to compare assisted reproductive technology treatment and perinatal outcomes between cycles using donor and non-donor sperm. We hypothesize these outcomes to be comparable between donor and non-donor sperm cycles. STUDY DESIGN: Retrospective cohort study using data from all United States fertility centers reporting to the Centers for Disease Control and Prevention's National Assisted Reproductive Technology Surveillance System, accounting for approximately 98% of assisted reproductive technology cycles (definition excludes intrauterine insemination). The number and percentage of assisted reproductive technology cycles using donor sperm and rates of pregnancy, live birth, preterm birth (<37 weeks), and low birth weight (<2500g) were the primary outcomes measured. Treatments assessed include use of donor versus non-donor sperm. The trends analysis included all banking and fresh assisted reproductive technology cycles using donor and autologous oocytes performed between 1996 and 2014 (n=1,710,034). The outcomes analysis was restricted to include only fresh autologous cycles performed between 2010 and 2014 (n=437,569) in order to focus on cycles with a potential outcome and cycles reflective of current practice, thereby improving the clinical relevance. Cycles cancelled prior to retrieval were excluded. Statistical analysis included linear regression to explore polynomial trends and log-binomial regression to estimate relative risk for outcomes among cycles using donor and non-donor sperm. RESULTS: Of all banking and fresh donor and autologous oocyte assisted reproductive technology cycles performed between 1996 and 2014, 74,892 (4.4%) used donor sperm. In 2014, 7,351 assisted reproductive technology cycles using donor sperm were performed, as compared to 1,763 in 1996 (6.2% vs. 3.8% of all cycles). Among all autologous oocyte cycles performed between 2010 and 2014, the live birth rate was lower for donor sperm (27.9%) than non-donor sperm cycles (32.5%); however, after adjustment for maternal age, donor sperm use was associated with an increased likelihood of live birth (adjusted relative risk=1.06, 95% confidence interval=1.01-1.10). Per transfer, there was no significant difference in live birth rates for donor versus non-donor sperm (31.9% vs. 36.8%; adjusted relative risk =1.04, 95% confidence interval =0.998-1.09). Per singleton live birth there was no significant difference in preterm birth (11.5% vs. 11.8%; adjusted relative risk =0.98, 95% confidence interval =0.90-1.06); however, low birth weight delivery was slightly lower in donor sperm cycles (8.8% vs. 9.4%; adjusted relative risk =0.91, 95% confidence interval =0.83-0.99). CONCLUSIONS: Donor sperm use in assisted reproductive technology has increased in the United States, accounting for approximately 6% of all assisted reproductive technology cycles in 2014. Assisted reproductive technology treatment and perinatal outcomes were clinically similar in donor and non-donor sperm cycles. |
Severity of diminished ovarian reserve and chance of success with assisted reproductive technology
Kawwass JF , Boulet SL , Hipp HS , Session DR , Kissin DM , Jamieson DJ . J Reprod Med 2017 62 (2) 153-160 OBJECTIVE: To describe the relationship between severe diminished ovarian reserve (DOR) and assisted reproductive technology outcomes. STUDY DESIGN: Retrospective cohort including all United States' fertility centers reporting to the CDC National ART Surveillance System, 2004-2012. Among women aged <41 (504,266 fresh autologous IVF cycles), we calculated cancellation rate/cycle and pregnancy rate/transfer, stratified by age, by maximum follicle stimulating hormone (FSH). Cancellation rate per cycle and pregnancy, live birth, and miscarriage rates per transfer were compared among women with and without DOR. We used multivariable log binomial regression, stratified by age, to calculate adjusted relative risk (aRR) for the association between DOR and these outcomes and, within DOR groups, between stimulation type and outcomes. RESULTS: Cancellation rate/cycle increased with increasing FSH and with DOR severity. For women aged <35 who underwent transfer, aRR for pregnancy and live birth indicated slightly reduced likelihood of these outcomes (severe vs. no DOR); confidence intervals approached the null. Among women with severe DOR, stimulation type was not associated with likelihood of pregnancy or live birth per transfer in any group except women ages 38-40. CONCLUSION: Women with severe DOR are at significantly increased risk of cancellation; however, those who undergo transfer have pregnancy and live birth chances similar to those of women without DOR after controlling for cycle characteristics. |
Extremities of body mass index and their association with pregnancy outcomes in women undergoing in vitro fertilization in the United States
Kawwass JF , Kulkarni AD , Hipp HS , Crawford S , Kissin DM , Jamieson DJ . Fertil Steril 2016 106 (7) 1742-1750 OBJECTIVE: To investigate the associations among underweight body mass index (BMI), pregnancy, and obstetric outcomes among women using assisted reproductive technology (ART). DESIGN: Retrospective cohort study using national data and log binomial regression. SETTING: Not applicable. PATIENT(S): Women undergoing IVF in the United States from 2008 to 2013. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Pregnancy outcomes (intrauterine pregnancy, live birth rates) per transfer, miscarriage rate per pregnancy, and low birth weight and preterm delivery rates among singleton and twin pregnancies. RESULT(S): For all fresh autologous in vitro fertilization (IVF) cycles in the United States from 2008 to 2013 (n = 494,097 cycles, n = 402,742 transfers, n = 180,855 pregnancies) reported to the national ART Surveillance System, compared with normal weight women, underweight women had a statistically significant decreased chance of intrauterine pregnancy (adjusted risk ratio [aRR] 0.97; 95% confidence interval [CI], 0.96-0.99) and live birth (aRR 0.95; 95% CI, 0.93-0.98) per transfer. Obese women also had a statistically decreased likelihood of both (aRR 0.94; 95% CI, 0.94-0.95; aRR 0.87; 95% CI, 0.86-0.88, respectively). Among cycles resulting in singleton pregnancy, both underweight and obese statuses were associated with increased risk of low birth weight (aRR 1.39; 95% CI, 1.25-1.54, aRR 1.26; 95% CI, 1.20-1.33, respectively) and preterm delivery (aRR 1.12; 95% CI, 1.01-1.23, aRR 1.42; 95% CI, 1.36-1.48, respectively). The association between underweight status and miscarriage was not statistically significant (aRR 1.04; 95% CI, 0.98-1.11). In contrast, obesity was associated with a statistically significantly increased miscarriage risk (aRR 1.23; 95% CI, 1.20-1.26). CONCLUSION(S): Among women undergoing IVF, prepregnancy BMI affects pregnancy and obstetric outcomes. Underweight status may have a limited impact on pregnancy and live-birth rates, but it is associated with increased preterm and low-birth-weight delivery risk. Obesity negatively impacts all ART and obstetric outcomes investigated. |
Embryo donation: National trends and outcomes, 2000-2013
Kawwass JF , Crawford S , Hipp HS , Boulet SL , Kissin DM , Jamieson DJ . Am J Obstet Gynecol 2016 215 (6) 747 e1-747 e5 BACKGROUND: Limited published data exist detailing outcomes of donor embryo cycles. Patients and clinicians would benefit from information specific to donor embryo cycles to inform fertility treatment options, counseling, and clinical decision-making. OBJECTIVE: To quantify trends in donor embryo cycles in the United States (US), to characterize donor embryo recipients, and to report transfer, pregnancy, and birth outcomes of donor embryo transfers. STUDY DESIGN: This retrospective cohort study of frozen donor embryo transfers uses data from Centers for Disease Control and Prevention's National ART Surveillance System to quantify trends in the use of donor embryos and corresponding rates of pregnancy and live birth from 2000-2013. For 2007-2013, years reflective of current practice, rates of cancellation, pregnancy, miscarriage, live birth, singleton and twin live birth, and delivery of a full term singleton infant of normal birthweight (>37 weeks, weighing >2500 grams) are reported. RESULTS: Among all frozen transfers between 2000 and 2013 (n=391,662), the annual number of donor embryo transfers increased significantly from 332 to 1,374, however the proportion of donor embryo transfers among all frozen transfers did not change significantly (2.3% to 2.6%). Both overall pregnancy and live birth rates per frozen donor embryo transfer increased significantly (33.3% to 49.1% and 26.5% to 40.8%, respectively) (p<.01). Among all initiated donor embryo cycles between 2007 and 2013 (n=7,289), the overall cancellation rate prior to transfer was 7.1%. Among all transfers between 2007 and 2013 (n=6,773), 3,193 (47.2%) resulted in pregnancy and 2,589 (38.2%) resulted in a live birth. Among all pregnancies, 535 (16.9%) resulted in a miscarriage. Among all live births, 1,929 (74.5%) delivered a singleton of which 1,482 (76.8%) were full term and normal birthweight. CONCLUSION: The increasing availability of donor embryos, low chance of cancellation, and increasing likelihood of achieving live birth can inform consumers and providers who are considering ART options. Collection of data surrounding donated embryo formation would allow for additional studies that can elucidate predictors of success among donor embryo transfers. |
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