RESUMEN
OBJECTIVE: Assisted reproductive technology (ART) is associated with increased risks for the neonate, compared to natural fertility, mainly because of multiple pregnancies and increased maternal age. On the opposite, the impact of paternal factors has been scarcely studied, except for the relationship between surgically retrieved sperms and genetic abnormalities. PATIENTS AND METHODS: This study has been realized using the large French register on in vitro fertilization (FIVNAT) that collects information on 80% of French ART activity. For the study, all the pregnancies obtained from oocyte recoveries between January 1996 and December 2003, for which information on cycles could be linked to the pregnancy were included, i.e. 34223 pregnancies, resulting in 27025 deliveries and 33945 neonates. Sperm quality was defined either according to the semen origin (spouse's ejaculate, epididymis, testis, or donor), or according to the spermiogramme values for concentration, motility and morphology. The statistical analysis included the use of multivariate logistic models, with the main prognostic factors. RESULTS: The delivery, spontaneous abortion and ectopic pregnancy rates were not influenced by semen origin nor by quality, all the 95% confidence intervals including 1. The neonates conceived through surgically retrieved sperms were at a slightly increased risk of hypotrophy (weight under the 10% centile of reference curves) and of malformation (OR=1.18, 95CI: 1.03-1.36 and OR=1.30 [0,95-1,84], respectively). On the opposite, when analysis was restrained to ejaculated semen, no risk was demonstrated. DISCUSSION AND CONCLUSION: The semen quality has little impact on pregnancy issue. Only the semen origin seems to act on hypotrophy and malformation, but these results deserve to be further analyzed for confirmation.
Asunto(s)
Fertilización In Vitro/estadística & datos numéricos , Resultado del Embarazo , Índice de Embarazo , Semen/fisiología , Aborto Espontáneo/epidemiología , Adulto , Femenino , Humanos , Recién Nacido , Modelos Logísticos , Masculino , Progenie de Nacimiento Múltiple , Embarazo , Embarazo Ectópico/epidemiología , Recuento de Espermatozoides , Motilidad EspermáticaRESUMEN
Numerous questions about the efficacy of GnRH antagonists, known for the prevention of undesirable LH surge, have been raised. Al-Inany in 2002 in a meta-analysis, IVF Germany Register and FIVNAT the French data base in 2003, have shown a decrease of the pregnancy rate after antagonists treatment. Among 20761 ART attempts for good prognosis women (<35 years, i.v.f. range 1 or 2) we have compared the clinical and biological parameters after agonists' long protocol versus antagonist treatment. The characteristics of the responses to the stimulation treatment were similar for both groups, whereas the duration of the stimulation and the doses of gonadotrophin used in the antagonist group was lower. The fertilization and embryo development rates were not modified. But we observed a decrease in the number of oocytes retrieved, of embryos obtained and of the pregnancy rate (P < 0.001). These results could be explained by endometrial modifications induced by antagonists but we cannot exclude an impact of oestradiol and LH levels. GnRH antagonists could be an inhibitor of the cell cycle by decreasing the synthesis of growth factors. The interaction of GnRH antagonists and GnRH receptors may compromise the mitotic programme of the cells and induce an alteration of folliculogenesis, embryo quality and implantation. More studies are necessary to understand these results. Using of GnRH antagonists involves specific patient information on the benefits and drawbacks of such treatment before ART.