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Garcia-Belda A, Cairó O, Martínez-Moro Á, Cuadros M, Pons MC, de Mendoza MVH, Delgado A, Rives N, Carrasco B, Cabello Y, Figueroa MJ, Cascales-Romero L, González-Soto B, Cuevas-Saiz I. Considerations for future modification of The Association for the Study of Reproductive Biology embryo grading system incorporating time-lapse observations. Reprod Biomed Online 2024; 48:103570. [PMID: 37952277 DOI: 10.1016/j.rbmo.2023.103570] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 09/13/2023] [Accepted: 09/19/2023] [Indexed: 11/14/2023]
Abstract
The Association for the Study of Reproductive Biology (ASEBIR) Interest Group in Embryology (in Spanish 'Grupo de Interés de Embriología') reviewed key morphokinetic parameters to assess the contribution of time-lapse technology (TLT) to the ASEBIR grading system. Embryo grading based on morphological characteristics is the most widely used method in human assisted reproduction laboratories. The introduction and implementation of TLT has provided a large amount of information that can be used as a complementary tool for morphological embryo evaluation and selection. As part of IVF treatments, embryologists grade embryos to decide which embryos to transfer or freeze. At the present, the embryo grading system developed by ASEBIR does not consider dynamic events observed through TLT. Laboratories that are using TLT consider those parameters as complementary data for embryo selection. The aim of this review was to evaluate review time-specific morphological changes during embryo development that are not included in the ASEBIR scoring system, and to consider them as candidates to add to the scoring system.
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Affiliation(s)
| | | | - Álvaro Martínez-Moro
- IVF Spain Madrid, Madrid, Spain.; Animal Reproduction Department, INIA-CSIC, Madrid, Spain
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Wang J, Guo Y, Zhang N, Li T. Research progress of time-lapse imaging technology and embryonic development potential: A review. Medicine (Baltimore) 2023; 102:e35203. [PMID: 37746957 PMCID: PMC10519478 DOI: 10.1097/md.0000000000035203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/22/2023] [Accepted: 08/23/2023] [Indexed: 09/26/2023] Open
Abstract
Cultivation and selection of high-quality human embryos are critical for the success of in vitro fertilization-embryo transfer. Time-lapse imaging technology (TLI) provides a stable culture environment for embryos, which can continuously observe and record the development process of early embryos, so that doctors can record embryo development time parameters more accurately. In this study, we review the current observation and research on the main embryo dynamics parameters in TLI and discusses their significance and development for embryo development potential. To analysis and summary, the application and research situation of TLI, we searched PubMed, Web of Science, and China National Knowledge Infrastructure, using TLI, embryo dynamics parameters, embryo development potential as Keywords, cited 50 out of the initial 89 selected literatures and summarized. With comparative analysis and research, we found that the embryo dynamic parameters provided by TLI has been intensively studied in clinical empirical and observational research, extensive experimental data verified its effectiveness and advantages in embryo development potential assessment. TLI provides technical support of embryo dynamic parameters, which may become the quantitative indicators for superior embryos and pregnancy prediction as well. Existing studies have shown that certain kinetic parameters provided by TLI culture can predict embryo implantation, but no parameter has been confirmed as the absolute correlation biological indicators yet. In this review we believe that further research is needed to verify these preliminary and sometimes contradictory results, and explore the predictive significance of various embryo kinetic parameters relying on TLI technology for embryo development potential.
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Affiliation(s)
- JinLuan Wang
- School of Basic Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ying Guo
- Reproductive and Genetic Center, Shandong University of Traditional Chinese Medicine Affiliated Hospital, Jinan, China
| | - Ning Zhang
- Reproductive and Genetic Center, Shandong University of Traditional Chinese Medicine Affiliated Hospital, Jinan, China
| | - TingTing Li
- Shandong University of Traditional Chinese Medicine, Jinan, China
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3
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Zhu Y, Zhang F, Chen H, Sun X, Jiang F. The use of frozen embryos and frozen sperm have complementary IVF outcomes: a retrospective analysis in couples experiencing IVF/Donor and IVF/Husband. BMC Pregnancy Childbirth 2022; 22:776. [PMID: 36258180 PMCID: PMC9578274 DOI: 10.1186/s12884-022-05088-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 09/26/2022] [Indexed: 12/04/2022] Open
Abstract
Background The cryopreservation of sperm or embryos has been an important strategy in the treatment of infertility. Recently studies have revealed the outcomes after IVF (in vitro fertilization) treatment for single-factor exposure either to frozen sperm or embryos. Methods This retrospective study was to uncover the exposure to both frozen sperm and embryo effects using IVF/H (in vitro fertilization using husbands’ fresh sperm) or IVF/D (in vitro fertilization using donors’ frozen sperm) treatment. Results The results showed the clinical pregnancy rate (CPR), live birth rate (LBR) and low birth weight rate (LBW) increased to 63.2% (or 68.1%), 61.1% (or 66.4%) and 15.8% (or 16.2%) after using frozen embryo transfer within Group IVF/H (or Group IVF/D). After using frozen sperm, the high-quality embryo rate (HER) increased to 52% and baby with birth defect rate (BDR) reduced to 0% in subgroup D/ET comparing to subgroup H/ET. While the fertilization rate (FER), cleavage rate (CLR), HER and multiple pregnancy rate (MUR) reduced to 75%, 71%, 45% and 9.2% in subgroup D/FET comparing to subgroup H/FET. Finally, our study found accumulative frozen gamete effects, including both sperm and embryos, led to the significantly increasing in the HER (p < 0.05), CPR (p < 0.001), LBR (p < 0.001) and LBW (p < 0.05) in subgroup D/FET comparing to subgroup H/ET. Conclusion The use of frozen embryos and frozen sperm have complementary IVF outcomes. Our findings highlighted the parent’s distinguished frozen effect not only for clinical studies but also for basic research on the mechanism of cellular response adaptations to cryopreservation.
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Affiliation(s)
- Yong Zhu
- Obstetrics and Gynecology Hospital, Institute of Reproduction and Development, Fudan University, Shanghai, China
| | - Feng Zhang
- Obstetrics and Gynecology Hospital, Institute of Reproduction and Development, Fudan University, Shanghai, China
| | - Hua Chen
- Shanghai Ji Ai Genetics and IVF Institute, Obstetrics and Gynecology Hospital, Fudan University, 200011, Shanghai, China
| | - Xiaoxi Sun
- Shanghai Ji Ai Genetics and IVF Institute, Obstetrics and Gynecology Hospital, Fudan University, 200011, Shanghai, China
| | - Feng Jiang
- Shanghai Ji Ai Genetics and IVF Institute, Obstetrics and Gynecology Hospital, Fudan University, 200011, Shanghai, China.
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Falchi L, Ledda S, Zedda MT. Embryo biotechnologies in sheep: Achievements and new improvements. Reprod Domest Anim 2022; 57 Suppl 5:22-33. [PMID: 35437835 PMCID: PMC9790389 DOI: 10.1111/rda.14127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 04/17/2022] [Indexed: 12/30/2022]
Abstract
To date, large-scale use of multiple ovulation and embryo transfer (MOET) programmes in ovine species is limited due to unpredictable results and high costs of hormonal stimulation and treatment. Therefore, even if considered reliable, they are not fully applicable in large-scale systems. More recently, the new prospects offered by in vitro embryo production (IVEP) through collection of oocytes post-mortem or by repeated ovum pick-up from live females suggested an alternative to MOET programmes and may be more extensively used, moving from the exclusive research in the laboratory to field application. The possibility to perform oocytes recovery from juvenile lambs to obtain embryos (JIVET) offers the great advantage to significantly reduce the generation interval, speeding the rate of genetic improvement. Although in the past decades several studies implemented novel protocols to enhance embryo production in sheep, the conditions of every single stage of IVEP can significantly affect embryo yield and successful transfer into the recipients. Moreover, the recent progresses on embryo production and freezing technologies might allow wider propagation of valuable genes in small ruminants populations and may be used for constitution of flocks without risks of disease. In addition, they can give a substantial contribution in preserving endangered breeds. The new era of gene editing might offer innovative perspectives in sheep breeding, but the application of such novel techniques implies involvement of specialized operators and is limited by relatively high costs for embryo manipulation and molecular biology analysis.
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Affiliation(s)
- Laura Falchi
- Sezione di Cl. Ostetrica e GinecologiaDipartimento di Medicina VeterinariaUniversità degli Studi di SassariSassariItaly
| | - Sergio Ledda
- Sezione di Cl. Ostetrica e GinecologiaDipartimento di Medicina VeterinariaUniversità degli Studi di SassariSassariItaly
| | - Maria T. Zedda
- Sezione di Cl. Ostetrica e GinecologiaDipartimento di Medicina VeterinariaUniversità degli Studi di SassariSassariItaly
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Li S, Nong Y, Wang F, Li Z, Liu W, Xie Y, Peng T, Zhang X, Liu F. Clinical efficacy analysis of oocyte cryopreservation: A propensity score matched study. J Obstet Gynaecol Res 2022; 48:3152-3159. [PMID: 36098236 PMCID: PMC10088013 DOI: 10.1111/jog.15412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 07/21/2022] [Accepted: 08/13/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate the effectiveness of oocyte thawing cycles in the clinical application of assisted reproductive technology (ART). STUDY DESIGN The clinical data of 78 cases who underwent oocyte thawing cycles in our center were retrospectively analyzed. All patients in this study received oocyte cryopreservation for the husband reason. According to patient age at egg freezing, patients were divided into three observation groups (Group A, <30 years old; Group B, 30-34 years old; Group C, ≥35 years old), and the control groups were selected by propensity score matching with fresh cycles. The clinical outcomes of each group were compared, and the clinical efficacy of oocyte thawing cycles was analyzed. RESULTS Clinical pregnancy outcomes of oocyte thawing cycles were not significantly different from that of fresh oocytes, but vitrification affected the number of two pronuclei zygotes developing to cleavage stage and the number of high-quality embryos, and the normal fertilization rate after thawing. The cycle cumulative live birth rate in Group C was significantly lower than those in Groups A and B. The live birth rates per egg of Groups A, B, C were 5.03%, 5.61%, and 3.57%, respectively, and the numbers of eggs per live birth were 13.72, 14.43, and 21.0, respectively. CONCLUSIONS The overall clinical outcomes of oocyte vitrification were similar to that of fresh oocytes, but the cleavage rate and embryo quality of frozen oocytes were slightly reduced. Freezing of oocytes in women over 35 years of age affects the clinical efficacy of ART.
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Affiliation(s)
- Shifen Li
- Reproductive Medicine Center, Affiliated Shenzhen City Maternity and Child Healthcare Hospital of Southern Medical University, Shenzhen, China
| | - Yingqi Nong
- Department of Reproductive Health and Infertility, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China
| | - Fang Wang
- Department of Reproductive Health and Infertility, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China
| | - Zitao Li
- Department of Reproductive Health and Infertility, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China
| | - Wenjuan Liu
- Department of Reproductive Health and Infertility, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China
| | - Yanni Xie
- Graduate School of Guangzhou Medical University, Guangzhou, China
| | - Tong Peng
- Graduate School of Guangzhou Medical University, Guangzhou, China
| | - Xiqian Zhang
- Department of Reproductive Health and Infertility, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China
| | - Fenghua Liu
- Department of Reproductive Health and Infertility, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China
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Olcay IO, Akcay B, Bahceci M, Arici A, Boynukalin K, Yakicier C, Ozpinar A, Basar M. Noninvasive amino acid turnover predicts human embryo aneuploidy. Gynecol Endocrinol 2022; 38:461-466. [PMID: 35481385 DOI: 10.1080/09513590.2022.2068520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Assisted reproduction technology has two significant problems: low success rates and multiple pregnancies. Because of these problems, the priority in IVF clinics is to develop a potential diagnostic test that can be used to select the embryos with the ultimate developmental competence. Aneuploidy screening as embryo selection criteria will ensure that the transferred embryos are euploid and high implantation rate. We hypothesize that aneuploidy in human preimplantation embryos could be discriminated by their amino acid metabolism profile in the spent culture media. Preimplantation genetic testing for aneuploidy results and spent embryo culture medium amino acid content were analyzed for 58 couples. The next-generation sequencing technique was used and coupled with TE biopsy. Forty euploid and 71 aneuploid blastocysts were evaluated. Embryos were cultured individually until day 5 or 6 of embryo development. Spent culture medium was collected after finishing the culture. There was no statistical difference between D3 and D5 embryo morphology between euploid and aneuploid embryos (p > .05). Eight amino acids, including SER, GLY, HIS, ARG, THR, ALA, PRO, and TYR, were detected in the culture medium from the blank control group, euploid group, and aneuploid group. Only TYR amino acid concentration was found significantly higher in the aneuploid group compared to the euploid group (p < .003). Tyrosine amino acid levels equal to and above 76.38 µmol/L could be considered aneuploid. Aneuploid embryos demonstrate altered amino acid turnover in vitro relative to euploid counterparts. A noninvasive method of amino acid profiling will be of value as a tool for routine preimplantation embryo selection among all patient groups.
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Affiliation(s)
- I Orcun Olcay
- Bahceci Umut Assisted Reproduction Center, IVF Laboratory, Istanbul, Turkey
- Acibadem Mehmet Ali Aydinlar University, School of Medicine, Dept. Medical Biochemistry, Istanbul, Turkey
| | - Berkay Akcay
- Bahceci Umut Assisted Reproduction Center, IVF Laboratory, Istanbul, Turkey
| | | | - Aydin Arici
- Department of Obstetrics & Gynecology, Yale University School of Medicine, New Haven, CT, USA
| | | | - Cengiz Yakicier
- Acibadem Mehmet Ali Aydinlar University, School of Medicine, Dept. Medical Biochemistry, Istanbul, Turkey
| | - Aysel Ozpinar
- Acibadem Mehmet Ali Aydinlar University, School of Medicine, Dept. Medical Biochemistry, Istanbul, Turkey
| | - Murat Basar
- Bahceci Umut Assisted Reproduction Center, IVF Laboratory, Istanbul, Turkey
- Medical Faculty, Department of Histology & Embryology, Biruni University, Istanbul, Turkey
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Glujovsky D, Quinteiro Retamar AM, Alvarez Sedo CR, Ciapponi A, Cornelisse S, Blake D. Cleavage-stage versus blastocyst-stage embryo transfer in assisted reproductive technology. Cochrane Database Syst Rev 2022; 5:CD002118. [PMID: 35588094 PMCID: PMC9119424 DOI: 10.1002/14651858.cd002118.pub6] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Advances in embryo culture media have led to a shift in in vitro fertilisation (IVF) practice from cleavage-stage embryo transfer to blastocyst-stage embryo transfer. The rationale for blastocyst-stage transfer is to improve both uterine and embryonic synchronicity and enable self selection of viable embryos, thus resulting in better live birth rates. OBJECTIVES To determine whether blastocyst-stage (day 5 to 6) embryo transfer improves the live birth rate (LBR) per fresh transfer, and other associated outcomes, compared with cleavage-stage (day 2 to 3) embryo transfer. SEARCH METHODS We searched the Cochrane Gynaecology and Fertility Group Specialised Register of controlled trials, CENTRAL, MEDLINE, Embase, PsycINFO, and CINAHL, from inception to October 2021. We also searched registers of ongoing trials and the reference lists of studies retrieved. SELECTION CRITERIA We included randomised controlled trials (RCTs) which compared the effectiveness of IVF with blastocyst-stage embryo transfer versus IVF with cleavage-stage embryo transfer. DATA COLLECTION AND ANALYSIS We used standard methodological procedures recommended by Cochrane. Our primary outcomes were LBR per fresh transfer and cumulative clinical pregnancy rates (cCPR). Secondary outcomes were clinical pregnancy rate (CPR), multiple pregnancy, high-order multiple pregnancy, miscarriage (all following first embryo transfer), failure to transfer embryos, and whether supernumerary embryos were frozen for transfer at a later date (frozen-thawed embryo transfer). We assessed the overall quality of the evidence for the main comparisons using GRADE methods. MAIN RESULTS We included 32 RCTs (5821 couples or women). The live birth rate following fresh transfer was higher in the blastocyst-stage transfer group (odds ratio (OR) 1.27, 95% confidence interval (CI) 1.06 to 1.51; I2 = 53%; 15 studies, 2219 women; low-quality evidence). This suggests that if 31% of women achieve live birth after fresh cleavage-stage transfer, between 32% and 41% would do so after fresh blastocyst-stage transfer. We are uncertain whether blastocyst-stage transfer improves the cCPR. A post hoc analysis showed that vitrification could increase the cCPR. This is an interesting finding that warrants further investigation when more studies using vitrification are published. The CPR was also higher in the blastocyst-stage transfer group, following fresh transfer (OR 1.25, 95% CI 1.12 to 1.39; I2 = 51%; 32 studies, 5821 women; moderate-quality evidence). This suggests that if 39% of women achieve a clinical pregnancy after fresh cleavage-stage transfer, between 42% and 47% will probably do so after fresh blastocyst-stage transfer. We are uncertain whether blastocyst-stage transfer increases multiple pregnancy (OR 1.05, 95% CI 0.83 to 1.33; I2 = 30%; 19 studies, 3019 women; low-quality evidence) or miscarriage rates (OR 1.12, 95% CI 0.90 to 1.38; I2 = 24%; 22 studies, 4208 women; low-quality evidence). This suggests that if 9% of women have a multiple pregnancy after fresh cleavage-stage transfer, between 8% and 12% would do so after fresh blastocyst-stage transfer. However, a sensitivity analysis restricted only to studies with low or 'some concerns' for risk of bias, in the subgroup of equal number of embryos transferred, showed that blastocyst transfer probably increases the multiple pregnancy rate. Embryo freezing rates (when there are frozen supernumerary embryos for transfer at a later date) were lower in the blastocyst-stage transfer group (OR 0.48, 95% CI 0.40 to 0.57; I2 = 84%; 14 studies, 2292 women; low-quality evidence). This suggests that if 60% of women have embryos frozen after cleavage-stage transfer, between 37% and 46% would do so after blastocyst-stage transfer. Failure to transfer any embryos was higher in the blastocyst transfer group (OR 2.50, 95% CI 1.76 to 3.55; I2 = 36%; 17 studies, 2577 women; moderate-quality evidence). This suggests that if 1% of women have no embryos transferred in planned fresh cleavage-stage transfer, between 2% and 4% probably have no embryos transferred in planned fresh blastocyst-stage transfer. The evidence was of low quality for most outcomes. The main limitations were serious imprecision and serious risk of bias, associated with failure to describe acceptable methods of randomisation. AUTHORS' CONCLUSIONS There is low-quality evidence for live birth and moderate-quality evidence for clinical pregnancy that fresh blastocyst-stage transfer is associated with higher rates of both than fresh cleavage-stage transfer. We are uncertain whether blastocyst-stage transfer improves the cCPR derived from fresh and frozen-thawed cycles following a single oocyte retrieval. Although there is a benefit favouring blastocyst-stage transfer in fresh cycles, more evidence is needed to know whether the stage of transfer impacts on cumulative live birth and pregnancy rates. Future RCTs should report rates of live birth, cumulative live birth, and miscarriage. They should also evaluate women with a poor prognosis to enable those undergoing assisted reproductive technology (ART) and service providers to make well-informed decisions on the best treatment option available.
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Affiliation(s)
- Demián Glujovsky
- Reproductive Medicine, CEGYR (Centro de Estudios en Genética y Reproducción), Buenos Aires, Argentina
| | - Andrea Marta Quinteiro Retamar
- Eggs donation program - Genetics unit, CEGYR (Centro de Estudios en Ginecologia y Reproducción), Buenos Aires, Argentina
| | | | - Agustín Ciapponi
- Argentine Cochrane Centre, Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
| | - Simone Cornelisse
- Department of Obstetrics and Gynaecology, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
| | - Deborah Blake
- Repromed Fertility Specialists, Auckland, New Zealand
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Han EJ, Lyu SW, Kwak IP, Kwon H, Choi DH, Kim JY, Park HM, Kim JW, Chang EM, Lee HJ, Kim MK, Lee HN, Kim JY, Park SL, Lee WS. Efficacy and safety of newly developed ganirelix acetate in infertile women for assisted reproductive technology: a prospective, randomised, controlled study. J OBSTET GYNAECOL 2022; 42:2197-2202. [PMID: 35254199 DOI: 10.1080/01443615.2022.2036955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This study aimed to investigate the efficacy of Ganilever pre-filled syringe (PFS), a newly developed ganirelix acetate, for the inhibition of premature luteinising hormone (LH) surge in in vitro fertilisation (IVF). A prospective randomised controlled study was conducted (NCT03051087). A total of 236 women (Ganilever group: 114, Orgalutran group: 122) were finally analysed. The patients with LH of >10 mIU/mL on the day of human chorionic gonadotropin (hCG) injection were 0 (0.0%) and 3 (2.5%) in the Ganilever and Orgalutran groups, respectively (p= .25). The number of retrieved oocytes from two groups did not show any significant difference (12.0 ± 6.4 vs. 11.8 ± 6.3, p= .73). Furthermore, the two groups did not show significant differences in the number of good-quality oocytes and embryo, and the rate of fertilisation. Similar safety profiles were also observed. In conclusion, Ganilever PFS showed comparable IVF outcomes and safety profile in IVF, as compared to the Orgalutran. Impact StatementWhat is already known on this subject? Premature LH surge during controlled ovarian stimulation results in the induction of luteinisation of the immature follicles. Thus, gonadotrophin-releasing hormone (GnRH) antagonist protocol was suggested as an option for suppression of premature LH surge. Currently, one of GnRH antagonists being widely used is ganirelix acetate (Orgalutran®; Organon, Oss, The Netherlands). Ganilever pre-filled syringe (PFS) is a newly developed GnRH antagonist containing ganirelix acetate as an active ingredient.What do the results of this study add? Our study demonstrated that Ganilever PFS showed comparable IVF outcomes and patient safety profile in infertile women undergoing in IVF-ET, as compared to the Orgalutran.What are the implications of these findings for clinical practice and/or further research? The results of our study will provide another available GnRH antagonist to be used in patients with IVF.
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Affiliation(s)
- E Jung Han
- Department of Obstetrics and Gynecology, Fertility Center of CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, South Korea
| | - Sang Woo Lyu
- Department of Obstetrics and Gynecology, Fertility Center of CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, South Korea
| | - In Pyung Kwak
- Department of Obstetrics and Gynecology, Fertility Center of CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, South Korea
| | - Hwang Kwon
- Department of Obstetrics and Gynecology, Fertility Center of CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, South Korea
| | - Dong Hee Choi
- Department of Obstetrics and Gynecology, Fertility Center of CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, South Korea
| | - Jin Young Kim
- Department of Obstetrics and Gynecology, Fertility Center of CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, South Korea
| | - Han Moie Park
- Department of Obstetrics and Gynecology, Fertility Center of CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, South Korea
| | - Ji Won Kim
- Department of Obstetrics and Gynecology, Fertility Center of CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, South Korea
| | - Eun Mi Chang
- Department of Obstetrics and Gynecology, Fertility Center of CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, South Korea
| | - Hee Jun Lee
- Department of Obstetrics and Gynecology, Fertility Center of CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, South Korea
| | - Min Kyung Kim
- Department of Obstetrics and Gynecology, Fertility Center of CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, South Korea
| | - Hye Nam Lee
- Department of Obstetrics and Gynecology, Fertility Center of CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, South Korea
| | - Jeong Yun Kim
- Clinical Development Department, LG Chem Ltd., Seoul, South Korea
| | - So La Park
- Clinical Development Department, LG Chem Ltd., Seoul, South Korea
| | - Woo Sik Lee
- Department of Obstetrics and Gynecology, Fertility Center of CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, South Korea
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9
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Choi YJ, Hong YH, Kim S, Kim SK, Lee JR, Suh CS. The Experience of Fertility Preservation in a Single Tertiary Center in Korea. Front Endocrinol (Lausanne) 2022; 13:845051. [PMID: 35518927 PMCID: PMC9062070 DOI: 10.3389/fendo.2022.845051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 03/14/2022] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Oocyte (OC), embryo (EC), and ovarian tissue cryopreservation (OTC) are options for fertility preservation (FP) before going through gonadotoxic cancer treatment, or anticipated fertility decline in benign ovarian diseases, or for planned OC. The aim of this study is to report outcomes of FP in a single tertiary hospital in Korea. METHODS This is a retrospective study of OC, EC, and OTC cycles. All patients who visited or were referred to the infertility clinic at the Department of Obstetrics and Gynecology for the purpose of FP between 2010 and October 2021 were included. RESULTS A total of 564 controlled ovarian stimulation cycles were conducted in 416 women. Three hundred fifty-seven women underwent 494 OC cycles. Most patients were diagnosed with breast cancer (22.4%), followed by endometriomas (21.9%), and then by planned OC (20.7%). Cases of OC have increased over the years, peaking at 109 cycles in 2019 compared to one in 2010. Fifty-nine women underwent 70 EC cycles, and breast cancer (50.8%) was the most common indication. Repetitive OC and EC cycles were undergone in 92 and 9 women, respectively (mean number of repetition, 1.37 and 1.19 times in OC and EC, respectively), yielding a maximum number of 33 oocytes or 23 embryos being cryopreserved per patient. The utilization rate was 3.1% (11/357) in OC and 16.9% (10/59) in EC. Twenty-six women underwent OTC, and gynecologic cancer was the most common indication (9/26, 34.6%). One woman had the cryopreserved ovarian tissue retransplanted and successfully generated embryos. CONCLUSION OC, EC, and OTC are possible options for preserving fertility, and these opportunities should be provided for women at risk of fertility decline or those who are eager to protect their future fertility. This is the first report on long-term FP outcomes in a single tertiary center in Korea. We expect that there will be more cases over the years and more women returning to use their gametes or embryos for pregnancy.
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Affiliation(s)
- Yae Ji Choi
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, South Korea
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, South Korea
| | - Yeon Hee Hong
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, South Korea
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, South Korea
| | - Seongbeen Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Seul Ki Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, South Korea
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, South Korea
| | - Jung Ryeol Lee
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, South Korea
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, South Korea
- *Correspondence: Jung Ryeol Lee,
| | - Chang Suk Suh
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, South Korea
- Department of Surgical Oncology, Sheikh Khalifa Specialty Hospital, Ras Al Khaimah, United Arab Emirates
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Current Applications of Machine Learning in Medicine: ART. Artif Intell Med 2022. [DOI: 10.1007/978-981-19-1223-8_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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11
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Jeong HG, Kim SK, Lee J, Youm HW, Jee BC. Injection funnel persistence time and oolemma resistance during intracytoplasmic sperm injection and subsequent embryo development. J Obstet Gynaecol Res 2021; 47:3590-3597. [PMID: 34288279 DOI: 10.1111/jog.14943] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 06/23/2021] [Accepted: 07/07/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study aimed to investigate whether the injection funnel persistence time and oolemma resistance during the intracytoplasmic sperm injection (ICSI) are associated with subsequent embryo quality. DESIGN A prospective observational study at a university hospital. METHODS One hundred and twenty normal-appearing metaphase II oocytes were collected from 54 ICSI cycles. Injection funnel was observed at 0, 30, 60, and 90 s after ICSI, and the injection funnel persistence time was assigned to "no funnel," "0-30," "30-60," "60-90," and ">90 s." The degree of oolemma resistance during ICSI was recorded as "no," "mild," "moderate," and "severe." Subsequent embryos on day 3 after ICSI were evaluated morphologically, and formation of top-quality embryo and embryo score was assessed. We newly developed "oolemma score," based on the injection funnel persistence time and oolemma resistance, and the predictability of top-quality embryo was assessed. RESULTS Among the five groups by injection funnel persistence time, the proportion of top-quality embryo and embryo score (64.3%, 32) was highest in the "30-60 s," but not significant. Among the four groups by oolemma resistance, the proportion of top-quality embryo and embryo score (53.7%, 32) was highest in "no group." The proportion of top-quality embryo in "no group" was significantly higher than "moderate group" (p = 0.012) and "severe group" (p = 0.043). The median embryo score in "no group" was significantly higher than "severe group" (p = 0.041). Newly developed "oolemma score" could predict well the formation of top-quality embryo with a statistical significance (cutoff >14.5, area under the curve 0.695, p < 0.001). CONCLUSION Embryo quality or score is more closely associated with oolemma resistance during ICSI. New "oolemma score" would help to identify embryo developmental potential of each mature oocyte in ICSI cycles.
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Affiliation(s)
- Hye Gyeong Jeong
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, South Korea.,Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, South Korea
| | - Seul Ki Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, South Korea.,Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, South Korea
| | - Jangmi Lee
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Hye Won Youm
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Byung Chul Jee
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, South Korea.,Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, South Korea
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12
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Li X, Zhang X, Cai J, Pang J, Sun P, Chen J, Wang M, Liang X. Granulosa cells apoptosis and follicular fluid hormones: comparison of progestin-primed ovarian stimulation versus GnRH antagonist protocols. Gynecol Endocrinol 2021; 37:609-613. [PMID: 33092415 DOI: 10.1080/09513590.2020.1822802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE To explore the effect of progestin-primed ovarian stimulation protocol (PPOS) on mural granulosa cells (GCs) apoptosis and hormonal profiles in follicular fluid (FF) and efficacy over GnRH antagonist (GnRH-A) protocols. METHODS We performed a prospective cohort study from June through August 2017 at a tertiary teaching hospital. 63 Patients meeting our criteria were recruited in this prospective study voluntarily and stratified to PPOS or GnRH-A group randomly. Mural GCs and FF were collected during oocyte retrieval. Apoptosis of GCs was assessed using the Annexin V-affinity assay by flow cytometry and hormonal profiles in FF were measured using electrochemiluminescence. RESULTS A total of 63 women were assessed for eligibility, with 25 cases in PPOS group and 38 in GnRH-A group. Difference of early stage apoptosis rate, late stage apoptosis rate, and total apoptosis rate did not reach statistical significance between groups. Meanwhile, concentrations of hormones in FF were comparable in two groups. No statistically significant differences were observed in number of oocytes retrieved, mature oocyte rate, fertilization rate, and top-quality embryos rate. No patients experienced premature LH surge in both groups during the study. CONCLUSION Compared to GnRH antagonist protocol, PPOS had comparable laboratory outcomes, GCs apoptosis rate and hormonal profiles in FF. PPOS is an effective and safe alternative option to provide controlled ovarian hyperstimulation (COH).
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Affiliation(s)
- Xiaolan Li
- Reproductive Medicine Research Center, Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, PR China
| | - Xiaoli Zhang
- Reproductive Medicine Research Center, Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, PR China
| | - Jiawei Cai
- Gastrointestinal Surgical Department, Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, PR China
| | - Jiahui Pang
- Reproductive Medicine Research Center, Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, PR China
| | - Peng Sun
- Reproductive Medicine Research Center, Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, PR China
| | - Jianhui Chen
- Reproductive Medicine Research Center, Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, PR China
| | - Meng Wang
- Reproductive Medicine Research Center, Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, PR China
| | - Xiaoyan Liang
- Reproductive Medicine Research Center, Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, PR China
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The presence of cytoplasmic strings in human blastocysts is associated with the probability of clinical pregnancy with fetal heart. J Assist Reprod Genet 2021; 38:2139-2149. [PMID: 34009631 DOI: 10.1007/s10815-021-02213-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 04/27/2021] [Indexed: 10/21/2022] Open
Abstract
PURPOSE Is the presence of cytoplasmic strings (CS) in human blastocysts associated with the probability of clinical pregnancy with fetal heart (CPFH) after transfer. METHODS This case-control study involved 300 single blastocyst transfers. 150 of these resulted in a CPFH (cases) while 150 did not (controls). All embryos were cultured in Embryoscope+ and AI software (IVY) was used to select the blastocyst with the highest score from the cohort for transfer. An embryologist, blind to the transfer outcome, recorded the CS number, location, and duration of their activity. RESULTS There was a significant difference in the number of blastocysts that contained CS, with 97.3% of women's blastocysts resulting in +CPFH containing the CS compared to 88.7% of blastocysts in women who did not have a pregnancy (p = 0.007, OR; 4.67, CI 95% 1.5-14.2). CS appeared 2.4 h earlier in embryo development in the +CPFH group compared to their negative counterparts (p = 0.007). There was a significant difference in the average number of CS/blastocyst with a higher number being present in those that achieved a clinical pregnancy (mean: 6.2, SD 2.9) compared to those that did not (mean: 4.6, SD 3.0) (p ≤ 0.0001). There was a significant increase in the number of vesicles seen traveling along the CS with more seen in the blastocysts resulting in a +CPFH (mean: 4.3 SD 2.1) compared to those in the -CPFH group (mean: 3.1, SD 2.1). CONCLUSION This study has shown that the presence of cytoplasmic strings in human blastocysts is associated with the probability of clinical pregnancy with fetal heart.
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Wu X, Chen Y, Zhou X, Zhang J, Li Y, Li X, Zhang X, Chen S. [Timing of HMG supplementation and clinical outcomes of advanced-age patients with diminished ovarian reserve receiving gonadotropin-releasing hormone antagonist protocol]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2021; 41:412-417. [PMID: 33849833 DOI: 10.12122/j.issn.1673-4254.2021.03.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To assess the effect and timing of human menopausal gonadotropin (HMG) supplementation in advancedage patients with diminished ovarian reserve (DOR) receiving gonadotropin-releasing hormone antagonist protocol. OBJECTIVE A total of 682 patients with DOR aged over 35 years undergoing IVF-ET treatment were included in this study. All the patients underwent a GnRH antagonist protocol, and controlled ovarian stimulation was initiated on day 2-3 of the menstrual cycle with follicle stimulation hormone (FSH). According to the timing of HMG supplementation, the patients were divided into no supplementation group (n=371) without HMG supplementation; early supplementation group (n=139), in which daily HMG supplementation started on the first day till the trigger day; and late supplementation group (n=172), in which HMG supplementation started when the leading follicle reached 10-14 mm in diameter and lasted until the trigger day. The pregnancy outcomes of the patients were compared among the 3 groups. OBJECTIVE The 3 groups showed no significant difference in hCG trigger day E2 and P levels, endometrial thickness, or the number of follicles with comparable fertilization rate and cleavage rate (P>0.05). Gn dose used was the lowest in no supplementation group, and the average number of oocytes retrieved was significantly smaller in early supplementation group than in late supplementation group (P < 0.05). The mean number of mature oocytes and embryos available were significantly higher in late supplementation group than in early supplementation group (P < 0.05). The clinical pregnancy rate of fresh embryo transfer cycle was significantly higher in late supplementation group than in no supplementation group (27.7% vs 45.1%, P < 0.05), but the implantation rate, early miscarriage rate, heterotopic pregnancy rate and live birth rate were comparable among the 3 groups (P>0.05). No significant differences were found among the 3 groups in the implantation rate, clinical pregnancy rate, early miscarriage rate, heterotopic pregnancy rate or live birth rate of the first frozen-thawed embryo transfer cycle with a freeze-all strategy (P>0.05). OBJECTIVE HMG supplementation in the middle and late follicular phase can improve the outcomes of controlled ovarian hyperstimulation and increase the clinical pregnancy rate of fresh embryo transfer cycle in advanced-age patients with DOR undergoing GnRH antagonist protocol.
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Affiliation(s)
- X Wu
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Y Chen
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - X Zhou
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - J Zhang
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Y Li
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - X Li
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - X Zhang
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - S Chen
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
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15
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Scheffer JB, Carvalho RFD, Aguiar APDS, Machado IJM, Franca JB, Lozano DM, Fanchin R. Which ovarian reserve marker relates to embryo quality on day 3 and blastocyst; age, AFC, AMH? JBRA Assist Reprod 2021; 25:109-114. [PMID: 32960526 PMCID: PMC7863095 DOI: 10.5935/1518-0557.20200060] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Objective: The aim of the present prospective study was to evaluate which ovarian reserve marker would be more reliable as the quality of the A + B embryos (day 3 and blastocyst). Methods: We ran a prospective study with 124 infertile women, aged 24-48 years, from 2017 to 2018. The patients were divided into 3 groups according to age and the subgroups were compared for AMH, AFC, number of A+B embryos. New division of the 3 groups was performed based on the AMH, and the subgroups were compared for age, AFC and number of A+B embryos. Finally, we divided the patients into 3 groups, based on the AFC, and we compared the subgroups for age, AMH and number of A+B embryos. P<0.05 was considered statistically significant. Results: When the 124 patients were divided according to age, we found a significant fall in an A+B embryo quality (day3; blastocyst) after 35 years (p<0.038; p<0.035), and more severely after 37 years (p<0.032; p<0.027). When the 124 patients were divided according to AMH, there was a significant fall in A+B embryo quality (day 3; blastocyst), with AMH<1ng/ml (p<0.023; p<0.021). When the 124 patients were divided according to AFC, there was a significant fall in A+B embryo quality (day 3; blastocyst) with AFC<7 (p<0.025; p<0.023). These markers had significant associations with embryo quality (p<0.005). Conclusion: Age, AFC and AMH have significant associations with A +B embryo quality on day 3 and blastocyst.
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Affiliation(s)
| | | | | | | | | | - Daniel Mendez Lozano
- School of Medicine, Tecnologico de Monterrey and Center for Reproductive Medicine CREASIS, San Pedro Monterrey, Mexico
| | - Renato Fanchin
- Professeur des Universites - Praticien Hospitalier en Medecine de la Reproduction, France; Hopital Foch, France
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Guo J, Zeng Z, Li M, Huang J, Peng J, Wang M, Liang X, Zeng H. Clinical outcomes after single-versus double-embryo transfers in women with adenomyosis: a retrospective study. Arch Gynecol Obstet 2021; 304:263-270. [PMID: 33386415 DOI: 10.1007/s00404-020-05924-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 11/25/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Adenomyosis affects the outcomes of spontaneous fertility and assisted reproductive technology. The single blastocyst embryo transfer (SBT) policy is an effective strategy known to minimize the risk of multiple pregnancy for non-adenomyosis women. However, little is known about its applicability to women with adenomyosis. The purpose of this study is to compare pregnancy outcomes between SBT, double-blastocyst embryo transfer (DBT), single-cleavage-stage embryo transfer (SET) and double-cleavage-stage embryo transfer (DET) in the frozen-thawed embryo transfer cycles among adenomyosis patients. METHODS This retrospective study was conducted in all frozen-thawed autologous embryo transfer cycles. 393 frozen-thawed embryo transfer cycles performed in adenomyosis patients were enrolled. The major clinical outcomes were implantation rate (IR), clinical pregnancy rate (CPR), miscarriage rate (MR), multiple pregnancy rate (MPR) and live birth rate (LBR). RESULTS The SBT and DBT groups achieved higher IR (P < 0.001), CPR (P = 0.017), LBR (P = 0.040) and lower MR (P = 0.020) than the SET and DET groups. But the SBT and DBT groups achieved similar CPR and LBR. The SBT and SET groups achieved lower MPR (P < 0.001) than the DBT and DET groups. The average birth weight (BW) of SBT groups was higher than the DBT and DET groups (P = 0.016). When compared with SBT group, low-birth-weight infants were significantly higher with DBT and DET. CONCLUSIONS When performing frozen-thawed embryo transfer cycles among adenomyosis patients, the SBT group has similar IR, CPR, MR, LBR but lower MPR compared to the DBT group. Therefore, SBT might be offered as standard practice.
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Affiliation(s)
- Jiayi Guo
- Reproductive Medicine Center, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510655, China
| | - Zhi Zeng
- Reproductive Medicine Center, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510655, China
| | - Manchao Li
- Reproductive Medicine Center, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510655, China
| | - Jiana Huang
- Reproductive Medicine Center, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510655, China
| | - Jintao Peng
- Reproductive Medicine Center, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510655, China
| | - Meng Wang
- Reproductive Medicine Center, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510655, China
| | - Xiaoyan Liang
- Reproductive Medicine Center, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510655, China
| | - Haitao Zeng
- Reproductive Medicine Center, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510655, China.
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Hong YH, Lee HK, Kim SK, Lee JR, Suh CS. The Significance of Planned Fertility Preservation for Women With Endometrioma Before an Expected Ovarian Cystectomy. Front Endocrinol (Lausanne) 2021; 12:794117. [PMID: 34975763 PMCID: PMC8715896 DOI: 10.3389/fendo.2021.794117] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 11/25/2021] [Indexed: 01/21/2023] Open
Abstract
Endometrioma is known to reduce the ovarian reserve and the extent of the decrease is more severe when ovarian surgery is performed. Therefore, to prevent this decline in fertility, patients with endometrioma are considered candidates for preoperative fertility preservation (FP). In this study, we evaluate the efficacy of FP in women with endometrioma before planned ovarian surgery. A total of 95 cycles in 62 patients with endometrioma, undergoing controlled ovarian stimulation (COS) for FP using a gonadotropin-releasing hormone (GnRH) antagonist protocol before an expected ovarian surgery, were enrolled retrospectively. COS outcomes were compared according to endometrioma laterality. Additionally, first COS cycle outcomes in patients with endometrioma were compared with those in infertile patients, or in patients with a benign ovarian cyst using propensity score matching. When multiple COS cycles were performed, the results of cumulative cycles were analyzed. Embryo quality was worse in the bilateral endometrioma group. Compared with the infertile patient group, the patients with endometrioma had significantly lower Anti-Müllerian Hormone (AMH) and fewer numbers of oocytes retrieved (median, 3.3 vs. 1.2, p<0.001; 7.0 vs. 4.0, p=0.009, respectively). Compared with mature oocytes in infertile patients or patients with a benign cyst, mature oocytes were fewer in patients with endometrioma, but this was not statistically significant (median, 4.0 vs. 3.0, p=0.085; 5.5 vs. 3.0, p=0.052, respectively). The median value of the cumulative number of cryopreserved oocytes or embryos was 14.5 up to the fourth cycle compared to 3 up to the first cycle, with cumulative effect. Women with endometrioma should be counseled for FP before planned ovarian cystectomy. The number of cryopreserved oocytes or embryos can be increased by repeated cycles.
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Affiliation(s)
- Yeon Hee Hong
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, South Korea
- Health Promotion Center, Seoul National University Bundang Hospital, Seongnam, South Korea
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, South Korea
| | - Hyun Kyoung Lee
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Seul Ki Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, South Korea
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, South Korea
| | - Jung Ryeol Lee
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, South Korea
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, South Korea
- *Correspondence: Jung Ryeol Lee,
| | - Chang Suk Suh
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, South Korea
- Department of Surgical Oncology, Sheikh Khalifa Specialty Hospital, Ras Al Khaimah, United Arab Emirates
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18
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Huang P, Yao C, Wei L, Lin Z. The intrauterine perfusion of granulocyte-colony stimulating factor (G-CSF) before frozen-thawed embryo transfer in patients with two or more implantation failures. HUM FERTIL 2020; 25:1-5. [PMID: 32862740 DOI: 10.1080/14647273.2020.1811904] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 03/22/2020] [Indexed: 12/14/2022]
Abstract
The objective of this study was to investigate the clinical benefits of intrauterine perfusion with G-CSF in patients undergoing a frozen-thawed embryo transfer (FET) after at least two previous implantation failures. This was a prospective, randomized, single-blind study. The intervention group received an intrauterine infusion of G-CSF whereas the placebo group was given an intrauterine infusion of physiological saline before embryo transfer. A third (control) group did not receive an intrauterine infusion prior to embryo transfer. The clinical pregnancy rates of both the intervention and placebo group were significantly higher than that in the control group (p < 0.05). But the miscarriage rates of the G-CSF were significantly lower than those of the other two groups (p < 0.05). The intrauterine infusion of G-CSF before frozen-thawed embryo transfer significantly reduced miscarriage rates and improve the live birth rates. While intrauterine perfusion with physiological saline did not reduce miscarriage rates.
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Affiliation(s)
- Pinxiu Huang
- Reproductive Medicine Center, Liuzhou Maternity and Child Healthcare Hospital, Liuzhou, China
- Liuzhou Institute of Reproduction and Genetics, Liuzhou, China
- Affiliated Maternity Hospital and Affiliated Children's Hospital of Guangxi, University of Science and Technology, Liuzhou, China
| | - Chunling Yao
- Reproductive Medicine Center, Liuzhou Maternity and Child Healthcare Hospital, Liuzhou, China
- Liuzhou Institute of Reproduction and Genetics, Liuzhou, China
- Affiliated Maternity Hospital and Affiliated Children's Hospital of Guangxi, University of Science and Technology, Liuzhou, China
| | - Lihong Wei
- Reproductive Medicine Center, Liuzhou Maternity and Child Healthcare Hospital, Liuzhou, China
- Liuzhou Institute of Reproduction and Genetics, Liuzhou, China
- Affiliated Maternity Hospital and Affiliated Children's Hospital of Guangxi, University of Science and Technology, Liuzhou, China
| | - Zhong Lin
- Guangxi Zhuang Autonomous Region Reproductive Hospital, Nanning, China
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Blank C, DeCroo I, Weyers B, van Avermaet L, Tilleman K, van Rumste M, de Sutter P, Mischi M, Schoot BC. Improvement instead of stability in embryo quality between day 3-5: A possible extra predictor for blastocyst selection. Eur J Obstet Gynecol Reprod Biol 2020; 253:198-205. [PMID: 32877773 DOI: 10.1016/j.ejogrb.2020.08.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 08/20/2020] [Accepted: 08/21/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the predictive value of the dynamic morphological development process between cleavage-stage and blastocyst-stage embryos. STUDY DESIGN A retrospective study was executed between 2015 and 2017 at Ghent University Hospital. A total of 996 first fresh IVF/ICSI cycles resulting in a single embryo transfer on day 5 were included. Embryos were scored on day 3 and day 5 as excellent, good, moderate or poor based on Alpha/ESHRE guidelines and Gardner and Schoolcraft scoring-system. If embryos changed category between day 3 and 5, the number of steps (between excellent; good; moderate; poor) in positive and negative direction was expressed. RESULTS On day 5, the ongoing pregnancy rate (OPR) of excellent embryos was 37.4 %. Univariate analyses showed that on day 5, both a higher cell stage, better inner cell mass and better trophectoderm were significantly associated with an ongoing pregnancy. In case of deterioration in quality of individual embryos between day 3 and day 5, the OPR was significantly lower. Conversely, improvement of embryo quality between day 3 and day 5 showed higher ongoing pregnancy rates (overall OPR of good day-3 embryos improving to excellent day-5 embryos: 30 %; moderate day 3 to excellent day 5: 50 %; poor day 3 to excellent day 5: 42 %; poor day 3 to good day 5: 20 %; poor day 3 to moderate day 5: 16 %). When embryos improved from poor on day 3 to excellent day 5 the OPR was significantly higher in comparison with embryos that did not change in quality scoring during development (steady embryos) (OR: 1.785, p < 0.05). CONCLUSION Our results suggest that it is more likely to achieve an ongoing pregnancy when transferring an embryo that has improved in quality between days 3 and 5 as opposed to one that has remained stable.
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Affiliation(s)
- C Blank
- Department of Electrical Engineering (Signal Processing Systems), Eindhoven University of Technology, Groene loper 19, Flux, Postbus 513, Eindhoven, 5600, MB, the Netherlands; Department of Reproductive Medicine, Ghent University Hospital, De Pintelaan 185, Ghent, 9000, Belgium.
| | - I DeCroo
- Department of Reproductive Medicine, Ghent University Hospital, De Pintelaan 185, Ghent, 9000, Belgium
| | - B Weyers
- Department of Reproductive Medicine, Ghent University Hospital, De Pintelaan 185, Ghent, 9000, Belgium
| | - L van Avermaet
- Department of Reproductive Medicine, Ghent University Hospital, De Pintelaan 185, Ghent, 9000, Belgium
| | - K Tilleman
- Department of Reproductive Medicine, Ghent University Hospital, De Pintelaan 185, Ghent, 9000, Belgium
| | - M van Rumste
- Department of Obstetrics and Gynaecology, Catharina Hospital, Michelangelolaan 2, Eindhoven, 5623 EJ, the Netherlands
| | - P de Sutter
- Department of Reproductive Medicine, Ghent University Hospital, De Pintelaan 185, Ghent, 9000, Belgium
| | - M Mischi
- Department of Electrical Engineering (Signal Processing Systems), Eindhoven University of Technology, Groene loper 19, Flux, Postbus 513, Eindhoven, 5600, MB, the Netherlands
| | - B C Schoot
- Department of Electrical Engineering (Signal Processing Systems), Eindhoven University of Technology, Groene loper 19, Flux, Postbus 513, Eindhoven, 5600, MB, the Netherlands; Department of Reproductive Medicine, Ghent University Hospital, De Pintelaan 185, Ghent, 9000, Belgium; Department of Obstetrics and Gynaecology, Catharina Hospital, Michelangelolaan 2, Eindhoven, 5623 EJ, the Netherlands
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20
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Nho EJ, Hong YH, Park JH, Kim SK, Lee JR, Jee BC, Kim SH. Efficacy of dual progesterone administration (intramuscular and vaginal) for luteal support in fresh day 3 or day 4 embryo transfer cycles. Clin Exp Reprod Med 2020; 47:227-232. [PMID: 32829569 PMCID: PMC7482941 DOI: 10.5653/cerm.2020.03489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 03/16/2020] [Indexed: 11/25/2022] Open
Abstract
Objective The aim of this study was to compare in vitro fertilization outcomes between fresh day 3 or day 4 embryo transfer cycles with dual progesterone (P) administration (intramuscular and vaginal) and cycles with single intramuscular P administration for luteal support. Methods We selected 124 cycles from 100 women (under age 40 years) who underwent oocyte pick-up (number of trials ≤ 3, 4–14 oocytes obtained) and transfer of two or three day 3 or day 4 embryos at two infertility centers from January 2014 to June 2019. Dual P (intramuscular P [50 mg] daily+vaginal P) was used in 52 cycles and a single intramuscular administration of P (50 mg daily) was used in 72 cycles. Results Women’s age, infertility factors, number of oocytes retrieved, number of transferred embryos, and mean embryo score were similar between the dual P group and the single P group. Although the number of trial cycles was significantly higher (1.9 vs. 1.5), and the mean endometrial thickness on the trigger day (10.0 mm vs. 11.0 mm) was significantly lower in the dual P group, the implantation rate, clinical pregnancy rate, ongoing pregnancy rate, and miscarriage rate for both day 3 and day 4 transfers were similar between the two groups. Conclusion In fresh day 3 or day 4 embryo transfer cycles, dual P administration did not demonstrate any clinical advantages. Intramuscular P alone appears to be sufficient for luteal support.
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Affiliation(s)
- Eun Jee Nho
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yeon Hee Hong
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Ju Hee Park
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea.,Sarang I Infertility Clinic, Seoul, Korea
| | - Seul Ki Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Ryeol Lee
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Byung Chul Jee
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Seok Hyun Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
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Lv H, Li X, Du J, Ling X, Diao F, Lu Q, Tao S, Huang L, Chen S, Han X, Zhou K, Xu B, Liu X, Ma H, Xia Y, Shen H, Hu Z, Jin G, Guan Y, Wang X. Effect of endometrial thickness and embryo quality on live-birth rate of fresh IVF/ICSI cycles: a retrospective cohort study. Reprod Biol Endocrinol 2020; 18:89. [PMID: 32825835 PMCID: PMC7441697 DOI: 10.1186/s12958-020-00636-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 07/29/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Successful implantation and delivery require both the functional embryo and receptive endometrium in assisted reproductive technology (ART) cycles. However, little is known about embryo-endometrial interaction on live-birth. We aimed to investigate the independent effect and interaction of endometrial thickness (EMT) and embryo quality on live-birth in fresh embryo transfer (ET) cycles. METHODS We conducted a retrospective cohort study including 15,012 ART cycles between 2013 and 2016 in three centers in China. Poisson regression with generalized estimating equations was employed to calculate relative risks (RRs) and 95% confidence intervals (CIs). We estimated the interaction of embryo quality and EMT on live-birth rate (LBR). RESULTS The LBR per cycle was 42.8% overall. LBR increased with increasing EMT and reached a plateau (50.6 to 54.2%) when EMT was 11 mm or thicker. Embryo quality represented by cumulative score was associated with LBR independently of number of embryos transferred and EMT. LBR was not increased with thicker EMT when only Q1 cleavage-stage embryo transferred (aRR 0.95, 95%CI 0.61-1.46). LBR was not increased significantly with thicker EMT with transfer of two good-quality cleavage-stage embryos and any blastocyst combination except Q1 group. There was significant interaction between EMT and embryo quality on LBR for cleavage-stage ETs (P=0.023). CONCLUSIONS This study demonstrated the nonlinear EMT-LBR association and the EMT cut-off value of 11 mm which may be of more clinical significance for predicting live-birth. Embryo quality is an independent prognostic tool for LBR. Our finding of significant embryo-endometrial interaction indicates combination of EMT and embryos quality might improve the prognostic value in clinical practice for live-birth in patients undergoing transfer of 1-2 fresh cleavage-stage embryos.
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Affiliation(s)
- Hong Lv
- State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, 211166, China
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
| | - Xiuzhu Li
- State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, 211166, China
| | - Jiangbo Du
- State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, 211166, China
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
| | - Xiufeng Ling
- Department of Reproduction, the Affiliated Nanjing Maternity and Child Health Hospital of Nanjing Medical University, Nanjing, 210004, China
| | - Feiyang Diao
- Department of Reproduction, the First Affiliated Hospital with Nanjing Medical University, Nanjing, 210029, China
| | - Qun Lu
- State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, 211166, China
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
| | - Shiyao Tao
- State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, 211166, China
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
| | - Lei Huang
- State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, 211166, China
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
| | - Shiyao Chen
- State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, 211166, China
| | - Xiumei Han
- State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, 211166, China
| | - Kun Zhou
- State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, 211166, China
| | - Bo Xu
- State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, 211166, China
| | - Xiaoyu Liu
- State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, 211166, China
| | - Hongxia Ma
- State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, 211166, China
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
| | - Yankai Xia
- State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, 211166, China
| | - Hongbing Shen
- State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, 211166, China
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
| | - Zhibin Hu
- State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, 211166, China
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
| | - Guangfu Jin
- State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, 211166, China.
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, 211166, China.
| | - Yichun Guan
- Department of Reproduction, Henan Medical Maternity and Child Health Care Hospital, Henan, 450052, China.
| | - Xinru Wang
- State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, 211166, China.
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22
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Hong YH, Lee JM, Kim SK, Youm HW, Jee BC. Associations of post-warming embryo or blastocyst development with clinical pregnancy in vitrified embryo or blastocyst transfer cycles. Clin Exp Reprod Med 2020; 47:140-146. [PMID: 32456411 PMCID: PMC7315863 DOI: 10.5653/cerm.2019.03321] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 12/05/2019] [Indexed: 11/23/2022] Open
Abstract
Objective To investigate whether the degree of post-warming embryo or blastocyst development is associated with clinical pregnancy in vitrified embryo or blastocyst transfer cycles. Methods Ninety-six vitrified cleavage-stage embryos and 58 vitrified blastocyst transfer cycles were selected. All transfer cycles were performed from February 2011 to March 2019, and all vitrified embryos or blastocysts were warmed from 4 PM to 6 PM and then transferred the next morning from 9 AM to 10 AM. The scores of the cleavage-stage embryos and blastocysts were assessed at warming and at transfer using the modified Steer method and the Gardner method, respectively. The mean embryo or blastocyst score, score of the single top-quality embryo or blastocyst, and the difference in the score between warming and transfer were compared between nonpregnant and pregnant women. Results In the cleavage-stage embryo transfer cycles, both the top-quality embryo score at transfer and the difference in the score between warming and transfer were significantly associated with clinical pregnancy. A top-quality embryo score at transfer of ≥60.0 (area under the curve [AUC], 0.673; 95% confidence interval [CI], 0.531–0.815) and a difference in the score between warming and transfer of ≥23.0 (AUC, 0.675; 95% CI, 0.514–0.835) were significant predictors of clinical pregnancy. In blastocyst transfer cycles, the top-quality blastocyst score at transfer was the only significant factor associated with clinical pregnancy. A top-quality blastocyst score at transfer of ≥38.3 was a significant predictor of clinical pregnancy (AUC, 0.666; 95% CI, 0.525–0.807). Conclusion The top-quality embryo score at transfer and the degree of post-warming embryo development were associated with clinical pregnancy in vitrified cleavage-stage embryo transfer cycles. In vitrified blastocyst transfer cycles, the top-quality blastocyst score at transfer was the only significant factor affecting clinical pregnancy.
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Affiliation(s)
- Yeon Hee Hong
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Jang Mi Lee
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Seul Ki Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Hye Won Youm
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Byung Chul Jee
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
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Abstract
Culturing of human embryos in optimal conditions is crucial for a successful in vitro fertilisation (IVF) programme. In addition, the capacity to assess and rank embryos correctly for quality will allow for transfer of the potentially 'best' embryo first, thereby shortening the time to pregnancy, although not improving cumulative pregnancy and live birth rates. It will also encourage and facilitate the implementation of single embryo transfers, thereby increasing safety for mother and offspring. Time-lapse technology introduces the concept of stable culture conditions, in connection with the possibility of continuous viewing and documenting of the embryo throughout development. However, so far, even when embryo quality scoring is based on large datasets, or when using the time-lapse technology, the morphokinetic scores are still mainly based on subjective and intermittent annotations of morphology and timings. Also, the construction of powerful algorithms for widespread use is hampered by large variations in culture conditions between individual IVF laboratories. New methodology, involving machine learning, where every image from the time-lapse documentation is analysed by a computer programme, looking for patterns that link to outcome, may in the future provide a more accurate and non-biased embryo selection.
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Affiliation(s)
- Kersti Lundin
- Reproductive Medicine, Sahlgrenska University Hospital, Göteborg, Sweden
- CONTACT Kersti Lundin Reproductive Medicine, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Hannah Park
- Reproductive Medicine, Sahlgrenska University Hospital, Göteborg, Sweden
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Isachenko V, Morgenstern B, Todorov P, Isachenko E, Mallmann P, Hanstein B, Rahimi G. Long-term (24h) cooling of ovarian fragments in the presence of permeable cryoprotectants prior to freezing: Two unsuccesful IVF-cycles and spontaneous pregnancy with baby born after re-transplantation. Cryobiology 2020; 93:115-120. [PMID: 32014535 DOI: 10.1016/j.cryobiol.2020.01.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 01/28/2020] [Accepted: 01/30/2020] [Indexed: 12/24/2022]
Abstract
Cancer is the second major cause of death in the world. The problem of post-cancer infertility plays a significant role, because chemotherapy can be gonadotoxic. Cryopreservation of ovarian tissue before cancer therapy with re-implantation after convalescence is the potential key solution to this problem. The aim of this study was to test the viability of cryopreserved human ovarian cortex after long-term cooling in culture medium composed of permeable cryoprotectants. Ovarian fragments from sixteen patients were randomly divided into two groups. After the operation, tissue pieces assigned to both groups were cooled to 5 °C for 22-24 h, frozen and thawed. Group 1 pieces (n = 32) were cooled before cryopreservation in the standard culture medium, and Group 2 pieces (n = 32) were cooled in the freezing medium (culture medium+6% ethylene glycol+6% dimethyl sulfoxide+0.15 M sucrose). Freezing was performed in standard 5 ml cryo-vials with ice formation at -9 °C, cooling from -9 to -34 °C at a rate of -0.3 °C/min and plunging at -34 °C into liquid nitrogen. After thawing in a 100 °C (boiling) water bath, the removal of cryoprotectants was performed in 0.5 M sucrose with 20 min exposure in sucrose and 30 min stepping rehydration. The effectiveness of the pre-freezing cooling of tissue was evaluated by the development of follicles (histology). Six months after the autotransplantation, oocytes from the twenty-seven-year old, hormonally stimulated patient were retrieved and fertilized with her partner sperm through the intracytoplasmic spermatozoa injection (ICSI). For groups 1 and 2, 93.5 ± 1.9% and 96.4 ± 2.0% of the preantral follicles, respectively, were morphologically normal (P > 0.1) (with a tendency toward increasing in quality in Group 2). Six months after the auto-transplantation, two ICSI cycles resulted in the gathering and transplantation of high quality embryos, but no pregnancy had been established. Thirteen months after the auto-transplantation, the patient became spontaneously pregnant and delivered a healthy baby girl at term. Long-term (24 h) cooling of ovarian tissue to 5 °C before cryopreservation in the presence of permeable cryoprotectants simplifies the protocol of cryopreservation and has a tendency of increasing of the cells viability after thawing.
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Affiliation(s)
- Vladimir Isachenko
- University Maternal Hospital, Research Group for Reproductive Medicine and IVF-Laboratory, Department of Obstetrics and Genecology, Cologne University, Cologne, Germany.
| | - Bernd Morgenstern
- University Maternal Hospital, Research Group for Reproductive Medicine and IVF-Laboratory, Department of Obstetrics and Genecology, Cologne University, Cologne, Germany
| | - Plamen Todorov
- Institute of Biology and Immunology of Reproduction, Sofia, Bulgaria
| | - Evgenia Isachenko
- University Maternal Hospital, Research Group for Reproductive Medicine and IVF-Laboratory, Department of Obstetrics and Genecology, Cologne University, Cologne, Germany
| | - Peter Mallmann
- University Maternal Hospital, Research Group for Reproductive Medicine and IVF-Laboratory, Department of Obstetrics and Genecology, Cologne University, Cologne, Germany
| | - Bettina Hanstein
- University Maternal Hospital, Research Group for Reproductive Medicine and IVF-Laboratory, Department of Obstetrics and Genecology, Cologne University, Cologne, Germany
| | - Gohar Rahimi
- University Maternal Hospital, Research Group for Reproductive Medicine and IVF-Laboratory, Department of Obstetrics and Genecology, Cologne University, Cologne, Germany
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25
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Tang Z, Hong M, He F, Huang D, Dai Z, Xuan H, Zhang H, Zhu W. Effect of endometrial injury during menstruation on clinical outcomes in frozen-thawed embryo transfer cycles: A randomized control trial. J Obstet Gynaecol Res 2020; 46:451-458. [PMID: 32003122 PMCID: PMC7064918 DOI: 10.1111/jog.14193] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 12/31/2019] [Indexed: 12/12/2022]
Abstract
Aim To explore the clinical effect of endometrial injury (EI) on the third day of the menstrual cycle before frozen–thawed embryo transfer (frozen–thawed ET) on patients experienced two or more implantation failures. Methods A total of 200 patients who suffered at least two failed hormone‐replacement therapies and frozen–thawed ET were randomly divided into two groups: EI group and control group (n = 100 in each group). Patients in the EI group received local EI with a Pipelle catheter on the third day of the menstrual cycle before frozen–thawed ET. Primary outcomes were live birth, clinical pregnancy and implantation rates. Secondary outcomes were biochemical, multiple and ectopic pregnancy rates and abortion rates. Results The rate of live birth in EI group (51.00%) was significantly higher than that of control group (36.00%) (P = 0.032). Clinical pregnancy and implantation rates in EI group were significantly higher comparing to control group (64.00% vs 48.00%, P = 0.023 and 46.74% vs 30.11%, P = 0.001). The rate of multiple pregnancy in EI group (37.50%) was significantly higher than that of control group (18.75%) (P = 0.031). No significant difference in ectopic pregnancy rate and abortion rate was observed between EI group and control group. Conclusion Applying EI to patients experienced two or more implantation failures on the third day of the menstrual cycle before frozen–thawed ET can improve clinical outcomes.
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Affiliation(s)
- Zhixia Tang
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Soochow University, Suzhou, China.,Reproductive Medicine Center, Maternity and Child Health Hospital of Anhui Province, The Maternal and Child Health Clinical College, Anhui Medical University, Hefei, China
| | - Mingyun Hong
- Reproductive Medicine Center, Maternity and Child Health Hospital of Anhui Province, The Maternal and Child Health Clinical College, Anhui Medical University, Hefei, China
| | - Fang He
- Reproductive Medicine Center, Maternity and Child Health Hospital of Anhui Province, The Maternal and Child Health Clinical College, Anhui Medical University, Hefei, China
| | - Dayan Huang
- Reproductive Medicine Center, Maternity and Child Health Hospital of Anhui Province, The Maternal and Child Health Clinical College, Anhui Medical University, Hefei, China
| | - Zhijun Dai
- Reproductive Medicine Center, Maternity and Child Health Hospital of Anhui Province, The Maternal and Child Health Clinical College, Anhui Medical University, Hefei, China
| | - Henghua Xuan
- Reproductive Medicine Center, Maternity and Child Health Hospital of Anhui Province, The Maternal and Child Health Clinical College, Anhui Medical University, Hefei, China
| | - Hong Zhang
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Weipei Zhu
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Soochow University, Suzhou, China
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26
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Xiao JS, Healey M, Talmor A, Vollenhoven B. When only one embryo is available, is it better to transfer on Day 3 or to grow on? Reprod Biomed Online 2019; 39:916-923. [DOI: 10.1016/j.rbmo.2019.08.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 07/26/2019] [Accepted: 08/14/2019] [Indexed: 01/01/2023]
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Storr A, Bilir E, Cooke S, Garrett D, Venetis CA. Fine-tuning blastocyst selection based on morphology: a multicentre analysis of 2461 single blastocyst transfers. Reprod Biomed Online 2019; 39:588-598. [PMID: 31515169 DOI: 10.1016/j.rbmo.2019.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 05/16/2019] [Accepted: 06/18/2019] [Indexed: 11/25/2022]
Abstract
RESEARCH QUESTION Which blastocyst morphology parameter is associated with live birth after controlling for female age and endometrial receptivity? DESIGN Retrospective study including fresh single blastocyst transfers (n = 2461) where the value of serum progesterone on day of human chorionic gonadotrophin trigger (PdHCG) was available. Generalized estimating equation regression models evaluated the independent effects of developmental stage (DevSt), inner cell mass (ICM) and trophectoderm grade on live birth rates while controlling for the confounding effects of female age and PdHCG. RESULTS DevSt was strongly associated with the probability of live birth (P < 0.0001) independently of female age (odds ratio [OR] 0.89, 95% confidence interval [CI] 0.87-0.91) and PdHCG (OR 0.80, 95% CI 0.74-0.87). For full blastocysts, expanded blastocysts and hatching blastocysts, addition of ICM and trophectoderm grading in the multivariable analysis suggested that besides female age (OR 0.92, 95% CI 0.90-0.94) and PdHCG (OR 0.80, 95% CI 0.73-0.87), only DevSt (P = 0.001) and trophectoderm quality (P = 0.004) were independent predictors of live birth, while the predictive capacity of ICM was no longer significant. The mean probability of live birth was highest for AA blastocysts (35.0%), followed by BA blastocysts (31.2%) and AB blastocysts (27.7%). CONCLUSION This large study analyses for the first time the independent role of blastocyst morphology in predicting live birth while controlling for female age and PdHCG. Its findings suggest that DevSt and then trophectoderm grade are stronger predictors of live birth over ICM grade when selecting a single blastocyst for transfer.
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Affiliation(s)
- Ashleigh Storr
- School of Women's and Children's Health, UNSW Medicine, UNSW NSW, Australia; Flinders Fertility, Adelaide SA, Australia.
| | - Esra Bilir
- Koç University, School of Medicine Istanbul, Turkey
| | | | | | - Christos A Venetis
- IVF Australia, Sydney NSW, Australia; Centre for Big Data Research in Health and School of Women's and Children's Health, UNSW NSW, Australia
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Namavar Jahromi B, Zolghadri J, Rahmani E, Alipour S, Anvar Z, Zarei A, Keramati P. Effect of low-dose aspirin on the development of ovarian hyperstimulation syndrome and outcomes of assisted reproductive techniques in the women with PCOS, a randomized double-blinded clinical trial. Taiwan J Obstet Gynecol 2019; 58:255-260. [PMID: 30910149 DOI: 10.1016/j.tjog.2019.01.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2018] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE Ovarian hyperstimulation syndrome (OHSS) is a major complication of assisted reproductive technologies (ART). Polycystic ovary syndrome (PCOS) is a risk factor for OHSS. The aim of this randomized clinical trial (RCT) was to study the effect of low-dose aspirin (LDA) on the development of OHSS and ART outcomes in PCOS during ART. MATERIALS AND METHODS This double-blinded placebo controlled RCT was performed on 232 PCOS infertile women in their first ART cycles during 2010-2016. LDA and placebo capsules were prepared, packed and specified by code numbers in similar shapes. One package was given to every woman and asked to take one capsule/day since the 21st day of her cycle prior to the gonadotropin stimulation. Gonadotropin releasing hormone agonist long protocol and triggering by human chorionic gonadotropin were used. Development of moderate to severe OHSS and their ART outcomes were documented then the codes were broken and data analyzed. Chi-square and Mann-Whitney U tests were used for the statistical analyses. RESULTS Eighteen cases that did not follow the study design were excluded. 214 cycles remained for the final analyses with 109 cases in LDA and 105 in the placebo group. Rate of the moderate to severe OHSS in LDA group was 34.9% compared to 30.5% in placebo group (P = 0.494). Fertilization rate was 71.8% vs 65.1% (P = <0.001) and the mean number of grade III embryos were 3.28 ± 3.53 vs 1.46 ± 1.42 (P = 0.014) in LDA and placebo groups, respectively. The mean number of the oocytes in different grades, total and frozen embryos also implantation and clinical pregnancy rates were not different between the groups. CONCLUSION Moderate to Severe OHSS was not decreased but fertilization rate and the mean number of poor quality embryos were increased in LDA arm. REGISTRATION NUMBER IRCT 201105216541N1.
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Affiliation(s)
- Bahia Namavar Jahromi
- Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Department of Obstetrics and Gynecology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Jaleh Zolghadri
- Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Department of Obstetrics and Gynecology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Elham Rahmani
- OB and GYN Ward, Bushehr University of Medical Sciences, Bushehr, Iran.
| | - Shohreh Alipour
- Department of Pharmaceutics, Department of Pharmaceutical Quality Control, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Zahra Anvar
- Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Department of Obstetrics and Gynecology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Afsun Zarei
- Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Department of Obstetrics and Gynecology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Pegah Keramati
- Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Department of Obstetrics and Gynecology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
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Chen TJ, Zheng WL, Liu CH, Huang I, Lai HH, Liu M. Using Deep Learning with Large Dataset of Microscope Images to Develop an Automated Embryo Grading System. FERTILITY & REPRODUCTION 2019. [DOI: 10.1142/s2661318219500051] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The assessment of embryo viability for in vitro fertilization (IVF) is mainly based on subjective visual analysis, with the limitation of intra- and inter-observer variation and a time-consuming task. In this study, we used deep learning with large dataset of microscopic embryo images to develop an automated grading system for embryo assessment. This study included a total of 171,239 images from 16,201 embryos of 4,146 IVF cycles at Stork Fertility Center (https://www.e-stork.com.tw) from March 6, 2014 to April 13, 2018. The images were captured by inverted microscope (Zeiss Axio Observer Z1) at 112 to 116 hours (Day 5) or 136 to 140 hours (Day 6) after fertilization. Using a pre-trained network trained on the ImageNet dataset as convolution base, we applied Convolutional Neural Network (CNN) on embryo images, using ResNet50 architecture to fine-tune ImageNet parameters. The predicted grading results was compared with the grading results from trained embryologists to evaluate the model performance. The images were labeled by trained embryologists, based on Gardner’s grading system: blastocyst development ranking from 3–6, ICM quality as A, B, or C; and TE quality as a, b, or c. After pre-processing, the images were divided into training, validation, and test groups, in which 60% were allocated to the training group, 20% to the validation group, and 20% to the test group. The ResNet50 algorithm was trained on the 60% images allocated to the training group, and the algorithm’s performance was evaluated using the 20% images allocated to the test group. The results showed an average predictive accuracy of 75.36% for the all three grading categories: 96.24% for blastocyst development, 91.07% for ICM quality, and 84.42% for TE quality. To the best of our knowledge, this is the first study of an automatic embryo grading system using large dataset from Asian population. Combing the promising results obtained in this study with time-lapse microscope system integrated with IVF Electronic Medical Record platform, a fully automated and non-invasive pipeline for embryo assessment will be achieved.
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Affiliation(s)
- Tsung-Jui Chen
- Binflux, Inc., Taipei, Taiwan
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
| | | | | | - Ian Huang
- Stork Fertility Center, Stork Ladies Clinic, Hsinchu City, Taiwan
| | - Hsing-Hua Lai
- Stork Fertility Center, Stork Ladies Clinic, Hsinchu City, Taiwan
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Yang SH, Yoon SH, Jung JH, Lim JH, Ko Y. Improvement of embryonic development and clinical outcomes of germinal vesicle stage oocytes using a microvibration culture system. Syst Biol Reprod Med 2019; 65:333-341. [PMID: 31002532 DOI: 10.1080/19396368.2019.1602681] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
In vitro maturation (IVM) has evolved as a clinical treatment option in assisted reproductive technology. However, the poor developmental potential of germinal vesicle (GV)-stage oocytes is still suboptimal. This study's objective was to evaluate the effect of a microvibration culture system (MVC) during IVM and/or in vitro culture (IVC) on the clinical outcomes and the embryonic development potential of human GV-stage oocytes collected from human chorionic gonadotropin (HCG)-primed IVM and fertilization-embryo transfer (IVM/F-ET) cycles of patients with polycystic ovaries (PCO). A total of 206 HCG-primed IVM/F-ET cycles were divided into four groups according to the microvibration and static culture system applied during IVM and/or IVC: Group SS (static system during both IVM and IVC); Group SV (static system during IVM alternated with microvibration system during IVC); Group VS (microvibration system during IVM alternated with static system during IVC), and Group VV (microvibration system during both IVM and IVC). The results indicate that the rates of in vitro MII oocytes per cycle, fertilization, and cleavage were not significantly different between the groups. The rate of good-quality embryos in Group SV tended to be higher than the rate in Groups SS and VS, but there was no significant difference between Group SS and Group SV. Clinical pregnancy, implantation, and live birth rates of Groups SV and VS were slightly higher than those of Group SS. However, the rate of good-quality embryos with at least six cells on day 4, the clinical pregnancy, implantation, and live births in Group VV were significantly higher than those in Group SS. These results indicate that, compared with the static culture system, the MVC system applied for both IVM and IVC seems to improve the clinical outcomes and the quality of embryos of GV oocytes derived from HCG-primed IVM/F-ET cycles in PCO patients. Abbreviations: PCO: polycystic ovaries; HCG: human chorionic gonadotropin; GV: germinal vesicle; MII: metaphase II; IVM: in vitro maturation; IVF: in vitro fertilization; IVC: in vitro culture: MVC: microvibration culture; SC: static culture; ICSI: intracytoplasmic sperm injection; IVM/F-ET: IVM and fertilization-embryo transfer; AMH: anti-Mullerian hormone; OHSS: ovarian hyperstimulation syndrome.
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Affiliation(s)
- Seong-Ho Yang
- a Department of Maria Plus IVF center , Maria Plus Fertility Hospital , Songpa-gu , Seoul , Republic of Korea.,b Division of Biotechnology , College of Life Sciences and Biotechnology, Korea University , Seongbuk-gu , Seoul , Republic of Korea
| | - San-Hyun Yoon
- c Department of Maria Fertility IVF Center , Maria Fertility Hospital , Dongdaemun-gu , Seoul , Republic of Korea
| | - Jae-Hoon Jung
- a Department of Maria Plus IVF center , Maria Plus Fertility Hospital , Songpa-gu , Seoul , Republic of Korea
| | - Jin-Ho Lim
- c Department of Maria Fertility IVF Center , Maria Fertility Hospital , Dongdaemun-gu , Seoul , Republic of Korea
| | - Yong Ko
- b Division of Biotechnology , College of Life Sciences and Biotechnology, Korea University , Seongbuk-gu , Seoul , Republic of Korea
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External validation of a prediction model to select the best day-three embryo for transfer in in vitro fertilization or intracytoplasmatic sperm injection procedures. Fertil Steril 2019; 110:917-924. [PMID: 30316438 DOI: 10.1016/j.fertnstert.2018.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 05/12/2018] [Accepted: 06/04/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the multivariate embryo selection model by van Loendersloot et al. (2014) (VL) in a different geographical context. DESIGN This is a retrospective external validation study of a 5-year cohort of women undergoing in vitro fertilization or intracytoplasmatic sperm injection. SETTING Two outpatient fertility clinics. PATIENT(S) A total of 1,197 women who underwent 1,610 fresh in vitro fertilization or intracytoplasmatic sperm injection cycles with single embryo transfer were included. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) The area under the receiver operating characteristics curve for diagnostic efficacy was used to assess the discriminative value of the model. Calibration for testing the validity of the VL model was performed using the Hosmer-Lemeshow goodness-of-fit test and a calibration plot. RESULT(S) Three hundred thirty-three patients (21%) achieved a viable pregnancy of at least 11 weeks. The area under the receiver operating characteristics curve using the VL model was 0.68. No significant difference between the predicted implantation rate and the observed implantation rates was showed using the Hosmer-Lemeshow (X2= 6.70). The calibration plot showed an intercept of the regression line of 0.34 and the estimated slope was 0.72. CONCLUSION The investigated VL model was able to distinguish between higher and lower implantation potential of embryos in our clinical setting.
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Li F, Yang Q, Shi H, Xin H, Luo X, Sun Y. Effects of obesity on sperm retrieval, early embryo quality and clinical outcomes in men with nonobstructive azoospermia undergoing testicular sperm aspiration-intracytoplasmic sperm injection cycles. Andrologia 2019; 51:e13265. [PMID: 30854691 DOI: 10.1111/and.13265] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 02/06/2019] [Accepted: 02/16/2019] [Indexed: 12/15/2022] Open
Abstract
The objective of this study was to assess the effects of body mass index (BMI) on sperm retrieval, early embryo quality and clinical outcomes in patients with nonobstructive azoospermia (NOA) undergoing testicular sperm aspiration-intracytoplasmic sperm injection (TESA-ICSI). A total of 3,005 infertile couples were evaluated between January 2010 and June 2017, including 1585 normal-weight (BMI < 25 kg/m2 ), 847 overweight (BMI 25-29.99 kg/m2 ) and 573 obese (BMI ≥ 30 kg/m2 ) patients. We found no significant relationship between BMI and sperm retrieval rate (22.4%, 24.3% and 25.1%, p = 0.327) or sperm motility. Among the 705 patients with NOA who underwent TESA-ICSI cycles, obese individuals had lower T levels and higher E2 levels than normal-weight and overweight individuals. However, there were no significant differences in other male hormones (follicle stimulating hormone [FSH], luteinizing hormone [LH], or prolactin [PRL]) among the groups. We also found that the sperm parameters, embryo quality and clinical outcomes of patients with NOA undergoing TESA-ICSI were not influenced by high BMI levels. In conclusion, this study demonstrated a lack of obvious effects of obesity on sperm retrieval, early embryo quality and clinical outcomes in infertile men undergoing TESA-ICSI cycles, although T and E2 levels were affected.
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Affiliation(s)
- Fangyuan Li
- Reproductive Medical Center and Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Qingling Yang
- Reproductive Medical Center and Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hao Shi
- Reproductive Medical Center and Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hang Xin
- Reproductive Medical Center and Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiaoyan Luo
- Reproductive Medical Center and Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yingpu Sun
- Reproductive Medical Center and Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Progestin-primed ovarian stimulation is a feasible method for poor ovarian responders undergoing in IVF/ICSI compared to a GnRH antagonist protocol: A retrospective study. J Gynecol Obstet Hum Reprod 2019; 48:99-102. [DOI: 10.1016/j.jogoh.2018.10.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 10/09/2018] [Accepted: 10/11/2018] [Indexed: 11/20/2022]
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Li XL, Huang R, Fang C, Liang XY. Basal Serum Anti-Müllerian Hormone Level as a Predictor of Clinical Outcomes in Freezing-all Embryo Transfer Program. Curr Med Sci 2018; 38:861-867. [DOI: 10.1007/s11596-018-1954-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 08/29/2018] [Indexed: 01/11/2023]
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Liu YH, Liu XM, Wang PC, Yu XX, Miao JK, Liu S, Wang YK, Du ZQ, Yang CX. Heat shock protein 90α couples with the MAPK-signaling pathway to determine meiotic maturation of porcine oocytes. J Anim Sci 2018; 96:3358-3369. [PMID: 29800308 DOI: 10.1093/jas/sky213] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 05/24/2018] [Indexed: 12/20/2022] Open
Abstract
Heat shock protein 90 (Hsp90) functions as a molecular chaperone in its interaction with clients to influence multiple cellular and physiological processes. However, our current understanding on Hsp90's relationship with mammalian oocyte maturation is still very limited. Here, we aimed to investigate Hsp90's effect on pig oocyte meiotic maturation. Endogenous Hsp90α was constantly expressed at both mRNA and protein levels in porcine maturing oocytes. Addition of 2 µM 17-allylamino-17-demethoxygeldanamycin (17-AAG), the Hsp90 inhibitor, to in vitro mature cumulus-oocyte complexes (COC) significantly decreased Hsp90α protein level (P < 0.05), delayed germinal vesicle breakdown (GVBD) (P < 0.05), and impeded the first polar body (PB1) extrusion (P < 0.01) of porcine oocytes. 2 µM 17-AAG treatment during in vitro maturation also decreased the subsequent development competence as indicated by the lower cleavage (P < 0.001) and higher fragmentation (P < 0.001) rates of parthenotes, whereas no effects on the percentage and average cell number of blastocysts were found. Immunodepletion of Hsp90α by antibody microinjection into porcine oocytes at germinal vesicle and metaphase II stages induced similar defects of meiotic maturation and parthenote development, to that resulted from 2 µM inhibitor 17-AAG. For oocytes treated by 2 µM 17-AAG, the cytoplasm and membrane actin levels were weakened (P < 0.01), and the spindle assembly was disturbed (P < 0.05), due to decreased p-ERK1/2 level (P < 0.05). However, the mitochondrial function and early apoptosis were not affected, as demonstrated by rhodamine 123 staining and Annexin V assays. Our findings indicate that Hsp90α can couple with mitogen-activated protein kinase to regulate cytoskeletal structure and orchestrate meiotic maturation of porcine oocytes.
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Affiliation(s)
- Yun-Hua Liu
- College of Animal Science and Technology, Northeast Agricultural University, Harbin, Heilongjiang, China
| | - Xiao-Man Liu
- College of Animal Science and Technology, Northeast Agricultural University, Harbin, Heilongjiang, China
| | - Pei-Chao Wang
- College of Animal Science and Technology, Northeast Agricultural University, Harbin, Heilongjiang, China
| | - Xiao-Xia Yu
- College of Animal Science and Technology, Northeast Agricultural University, Harbin, Heilongjiang, China
| | - Jia-Kun Miao
- College of Animal Science and Technology, Northeast Agricultural University, Harbin, Heilongjiang, China
| | - Shuai Liu
- College of Animal Science and Technology, Northeast Agricultural University, Harbin, Heilongjiang, China
| | - Yan-Kui Wang
- College of Animal Science and Technology, Northeast Agricultural University, Harbin, Heilongjiang, China
| | - Zhi-Qiang Du
- College of Animal Science and Technology, Northeast Agricultural University, Harbin, Heilongjiang, China
| | - Cai-Xia Yang
- College of Animal Science and Technology, Northeast Agricultural University, Harbin, Heilongjiang, China
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Huang P, Wei L, Li X, Lin Z. Modified hMG stimulated: an effective option in endometrial preparation for frozen-thawed embryo transfer in patients with normal menstrual cycles. Gynecol Endocrinol 2018; 34:772-774. [PMID: 29676585 DOI: 10.1080/09513590.2018.1460342] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
To evaluate the clinical efficacy of modified human menopausal gonadotropin (hMG) stimulated, hormone replacement therapy (HRT), natural cycling and letrozole ovulation induction during endometrial preparation for frozen-thawed embryo transfer (FET) in patients with normal menstrual cycles. This retrospective analysis included a total of 5070 cycles of patients with normal menstrual patterns who underwent FET between October 2009 and September 2015. The patients were divided into four groups according to the method of endometrial preparation for FET: 1838 cycles were natural, 1666 underwent HRT, 340 underwent letrozole ovulation induction and 1226 underwent modified hMG stimulated. Reproduction-related clinical outcomes in the four groups were compared. The clinical pregnancy rates and live birth rates of patients in the modified hMG stimulated group were significantly higher than that in the other groups p < .05. While abortion rates were not significantly different among all four groups (all p >.05). Modified hMG stimulated resulted in a higher pregnancy rate compared to the other treatment groups. Therefore, modified hMG stimulated may be an effective option in endometrial preparation for FET in patients with normal menstrual cycles.
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Affiliation(s)
- Pinxiu Huang
- a Reproductive Medicine Center , Liuzhou Maternal and Child Healthcare Hospital , Guangxi , China
| | - Lihong Wei
- a Reproductive Medicine Center , Liuzhou Maternal and Child Healthcare Hospital , Guangxi , China
| | - Xinlin Li
- a Reproductive Medicine Center , Liuzhou Maternal and Child Healthcare Hospital , Guangxi , China
| | - Zhong Lin
- a Reproductive Medicine Center , Liuzhou Maternal and Child Healthcare Hospital , Guangxi , China
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Simopoulou M, Sfakianoudis K, Antoniou N, Maziotis E, Rapani A, Bakas P, Anifandis G, Kalampokas T, Bolaris S, Pantou A, Pantos K, Koutsilieris M. Making IVF more effective through the evolution of prediction models: is prognosis the missing piece of the puzzle? Syst Biol Reprod Med 2018; 64:305-323. [PMID: 30088950 DOI: 10.1080/19396368.2018.1504347] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Assisted reproductive technology has evolved tremendously since the emergence of in vitro fertilization (IVF). In the course of the recent decade, there have been significant efforts in order to minimize multiple gestations, while improving percentages of singleton pregnancies and offering individualized services in IVF, in line with the trend of personalized medicine. Patients as well as clinicians and the entire IVF team benefit majorly from 'knowing what to expect' from an IVF cycle. Hereby, the question that has emerged is to what extent prognosis could facilitate toward the achievement of the above goal. In the current review, we present prediction models based on patients' characteristics and IVF data, as well as models based on embryo morphology and biomarkers during culture shaping a complication free and cost-effective personalized treatment. The starting point for the implementation of prediction models was initiated by the aspiration of moving toward optimal practice. Thus, prediction models could serve as useful tools that could safely set the expectations involved during this journey guiding and making IVF treatment more effective. The aim and scope of this review is to thoroughly present the evolution and contribution of prediction models toward an efficient IVF treatment. ABBREVIATIONS IVF: In vitro fertilization; ART: assisted reproduction techniques; BMI: body mass index; OHSS: ovarian hyperstimulation syndrome; eSET: elective single embryo transfer; ESHRE: European Society of Human Reproduction and Embryology; mtDNA: mitochondrial DNA; nDNA: nuclear DNA; ICSI: intracytoplasmic sperm injection; MBR: multiple birth rates; LBR: live birth rates; SART: Society for Assisted Reproductive Technology Clinic Outcome Reporting System; AFC: antral follicle count; GnRH: gonadotrophin releasing hormone; FSH: follicle stimulating hormone; LH: luteinizing hormone; AMH: anti-Müllerian hormone; DHEA: dehydroepiandrosterone; PCOS: polycystic ovarian syndrome; NPCOS: non-polycystic ovarian syndrome; CE: cost-effectiveness; CC: clomiphene citrate; ORT: ovarian reserve test; EU: embryo-uterus; DET: double embryo transfer; CES: Cumulative Embryo Score; GES: Graduated Embryo Score; CSS: Combined Scoring System; MSEQ: Mean Score of Embryo Quality; IMC: integrated morphology cleavage; EFNB2: ephrin-B2; CAMK1D: calcium/calmodulin-dependent protein kinase 1D; GSTA4: glutathione S-transferase alpha 4; GSR: glutathione reductase; PGR: progesterone receptor; AMHR2: anti-Müllerian hormone receptor 2; LIF: leukemia inhibitory factor; sHLA-G: soluble human leukocyte antigen G.
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Affiliation(s)
- Mara Simopoulou
- a Department of Physiology , Medical School, National and Kapodistrian University of Athens , Athens , Greece.,b Assisted Conception Unit, 2nd Department of Obstetrics and Gynecology , Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens , Athens , Greece
| | | | - Nikolaos Antoniou
- a Department of Physiology , Medical School, National and Kapodistrian University of Athens , Athens , Greece
| | - Evangelos Maziotis
- a Department of Physiology , Medical School, National and Kapodistrian University of Athens , Athens , Greece
| | - Anna Rapani
- a Department of Physiology , Medical School, National and Kapodistrian University of Athens , Athens , Greece
| | - Panagiotis Bakas
- b Assisted Conception Unit, 2nd Department of Obstetrics and Gynecology , Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens , Athens , Greece
| | - George Anifandis
- d Department of Histology and Embryology, Faculty of Medicine , University of Thessaly , Larissa , Greece
| | - Theodoros Kalampokas
- b Assisted Conception Unit, 2nd Department of Obstetrics and Gynecology , Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens , Athens , Greece
| | - Stamatis Bolaris
- e Department fo Obsterics and Gynaecology , Assisted Conception Unit, General-Maternity District Hospital "Elena Venizelou" , Athens , Greece
| | - Agni Pantou
- c Department of Assisted Conception , Human Reproduction Genesis Athens Clinic , Athens , Greece
| | - Konstantinos Pantos
- c Department of Assisted Conception , Human Reproduction Genesis Athens Clinic , Athens , Greece
| | - Michael Koutsilieris
- a Department of Physiology , Medical School, National and Kapodistrian University of Athens , Athens , Greece
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The association between quality of supernumerary embryos in a cohort and implantation potential of the transferred blastocyst. J Assist Reprod Genet 2018; 35:1651-1656. [PMID: 29974298 DOI: 10.1007/s10815-018-1254-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Accepted: 06/26/2018] [Indexed: 10/28/2022] Open
Abstract
PURPOSE Despite studies focused on the association between embryo morphology and implantation potential, it is unknown how the collective quality of the supernumerary embryos in a cohort is associated with the implantation rate (IR) of the transferred embryo. This study tested the hypothesis that a relationship exists between the quality of the supernumerary cohort and IR. METHODS A retrospective cohort study of first fresh autologous IVF cycles from 05/2012 to 09/2016, with ≥ 3 blastocysts, resulting in a single blastocyst transfer (n = 819) was performed. Cohorts were grouped in two ways: by mean priority score (PS; 1 being best) of supernumerary embryos and by percent supernumerary embryos with low implantation potential. The relationship between cohort quality and IR was assessed using logistic regression. RESULTS As mean cohort PS increased, IR of the transferred embryo decreased (test for linear trend, p = 0.05). When ≥ 75% of the supernumerary cohort was predicted to have low implantation potential, IR of the transferred embryo was significantly lower compared to when < 75% of the cohort was predicted to have low implantation potential (OR 0.71; 95% CI (0.53-0.94)). All associations were attenuated when adjusting for PS of the transferred embryo. CONCLUSIONS Our findings suggest that quality of supernumerary embryos is associated with IR of the transferred embryo, among patients with ≥ 3 blastocysts available on day 5. As cohort quality declines and the proportion of low implantation potential embryos increases, the IR of the transferred embryo declines. These associations are attenuated when controlling for quality of the transferred embryo, suggesting that the relationship between embryo cohort quality and implantation is not independent of the transferred embryo quality.
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Isachenko V, Todorov P, Seisenbayeva A, Toishibekov Y, Isachenko E, Rahimi G, Mallmann P, Foth D, Merzenich M. Vitrification of human pronuclear oocytes by direct plunging into cooling agent: Non sterile liquid nitrogen vs. sterile liquid air. Cryobiology 2018; 80:84-88. [DOI: 10.1016/j.cryobiol.2017.11.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 11/20/2017] [Accepted: 11/21/2017] [Indexed: 11/24/2022]
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Huang P, Wei L, Li X, Qin A. Effects of intrauterine perfusion of human chorionic gonadotropin in women with different implantation failure numbers. Am J Reprod Immunol 2017; 79. [PMID: 29288552 DOI: 10.1111/aji.12809] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 12/07/2017] [Indexed: 12/17/2022] Open
Abstract
PROBLEM The aim of this research was to investigate the effects of the intrauterine perfusion of hCG before a frozen-thawed embryo transfer (FET) in women with different implantation failure numbers. METHOD OF STUDY This was a retrospective analysis of patients undergoing FET who received an intrauterine injection hCG 1000 IU before embryo transfer. The groups included women with their first implantation failure (A group, n = 26), second implantation failure (B group, n = 122), and three or more failures (C group, n = 77). Corresponding control groups (no infusion) were also included. The pregnancy rates were compared among these groups. RESULTS After intrauterine injection hCG, the biochemical pregnancy rates were 92.30%, 63.11%, 49.02%, and the clinical pregnancy rates were 76.92%, 54.91%, 48.05%, in the A, B, and C groups, respectively. The biochemical and clinical pregnancy rates were significantly higher in the A group than in the other groups (P < .05). The clinical pregnancy rates of the A and C groups were significantly higher than in the corresponding (no infusion) control groups (76.92% vs 56.81% and 48.05% vs 33.33%, P < .05). CONCLUSION Pregnancy rates decreased with the number of transplant failures. The intrauterine administration of hCG before FET significantly improved the pregnancy rates, especially after one and three or more implantation failures.
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Affiliation(s)
- Pinxiu Huang
- Guangxi Medical University, Nanning, China.,Reproductive Medicine Center, Liuzhou Maternal and Child Healthcare Hospital, Liuzhou, China
| | - Lihong Wei
- Reproductive Medicine Center, Liuzhou Maternal and Child Healthcare Hospital, Liuzhou, China
| | - Xinlin Li
- Reproductive Medicine Center, Liuzhou Maternal and Child Healthcare Hospital, Liuzhou, China
| | - Aiping Qin
- Guangxi Medical University, Nanning, China.,Reproductive Medicine Center, The first Affiliated Hospital of Guangxi Medical University, Nanning, China
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Increased expression of PGRN protein in follicular fluid and mRNA in granulosa cells in overweight patients with polycystic ovary syndrome. Eur J Obstet Gynecol Reprod Biol 2017; 218:106-112. [DOI: 10.1016/j.ejogrb.2017.09.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 09/07/2017] [Accepted: 09/16/2017] [Indexed: 12/22/2022]
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Spent culture medium analysis from individually cultured bovine embryos demonstrates metabolomic differences. ZYGOTE 2017; 25:662-674. [PMID: 29032784 DOI: 10.1017/s0967199417000417] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Spent culture medium can provide valuable information regarding the physiological state of a bovine preimplantation embryos through non-invasive analysis of the sum/depleted metabolite constituents. Metabolomics has become of great interest as an adjunct technique to morphological and cleavage-rate assessment, but more importantly, in improving our understanding of metabolism. In this study, in vitro produced bovine embryos developing at different rates were evaluated using proton nuclear magnetic resonance (1H NMR). Spent culture medium from individually cultured embryos (2-cell to blastocyst stage) were divided into two groups based on their cleavage rate fast growing (FG) and slow growing (SG; developmentally delayed by 12-24 h), then analyzed by a 600 MHz NMR spectrometer. Sixteen metabolites were detected and investigated for sum/depletion throughout development. Data indicate distinct differences between the 4-cell SG and FG embryos for pyruvate (P < 0.05, n = 9) and at the 16-cell stage for acetate, tryptophan, leucine/isoleucine, valine and histidine. Overall sum/depletion levels of metabolites demonstrated that embryos produced glutamate, but consumed histidine, tyrosine, glycine, methionine, tryptophan, phenylalanine, lysine, arginine, acetate, threonine, alanine, pyruvate, valine, isoleucine/leucine, and lactate with an overall trend of higher consumption of these metabolites by FG groups. Principal component analysis revealed distinct clustering of the plain medium, SG, and FG group, signifying the uniqueness of the metabolomic signatures of each of these groups. This study is the first of its kind to characterize the metabolomic profiles of SG and FG bovine embryos produced in vitro using 1H NMR. Elucidating differences between embryos of varying developmental rates could contribute to a better understanding of embryonic health and physiology.
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Isachenko V, Sterzik K, Maettner R, Isachenko E, Todorov P, Rahimi G, Mallmann P, Strehler E, Pereligin I, Alabart JL, Merzenich M. In Vitro Microvibration Increases Implantation Rate After Embryonic Cell Transplantation. Cell Transplant 2017; 26:789-794. [PMID: 27725062 DOI: 10.3727/096368916x693428] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
In natural conditions the oocyte and embryo are subjected to ever-changing dynamic processes. However, the routine assisted reproductive technologies today involve the use of static in vitro culture systems. The objective was to determine whether there is any difference in the viability of embryos after in vitro culture under static and mechanical microvibration conditions. The viability of embryonic cells (9,624 embryos) generated from 4,436 couples after in vitro culture was evaluated. For groups ≤29, 30-34, 35-39, and ≥40 years, the following rates of high-quality embryos without fragmentation (two to four blastomeres on day 2; six to eight blastomeres and compacting morula on day 3; blastocyst, expanded and hatching blastocyst on day 5) were detected (static vs. vibration, respectively): 65% versus 71%, 44% versus 69%, 67% versus 76% (for statistically significant differences between respective rates in these three groups, p < 0.05), and 67% versus 66% (p > 0.1). The following baby-take-home rates were determined for groups ≤29, 30-34, 35-39, and ≥40 years (static vs. vibration, respectively): 30% versus 31% (p > 0.1, increasing only on the level of tendency), 28% versus 37%, 23% versus 29%, and 9% versus 15% (differences between respective rates in these three groups with p < 0.05). It was concluded that in vitro culture of embryos under microvibration (with a mimic of conditions in nature whereby oviductal fluid is mechanically agitated by the epithelial cilia) significantly increases the baby-take-home rate for patients 30 years and older.
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Lee CI, Lee TH, Huang CC, Chen HH, Liu CH, Lee MS. Detection of early cleavage embryos improves pregnancy and delivery rates of Day 3 embryo transfer during in vitro fertilization. Taiwan J Obstet Gynecol 2017; 55:558-62. [PMID: 27590382 DOI: 10.1016/j.tjog.2016.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2016] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE This study established a simple criterion for improving the pregnancy and delivery rates of Day 3 embryo transfer for in vitro fertilization (IVF) by assessing the early cleavage of two-cell stage embryos. MATERIALS AND METHODS In total, 258 cycle patients undergoing an IVF and Day 3 embryo transfer program were recruited. All cycles were divided into four groups containing viable Day 3 embryos and those (A) with distinct early cleavage (equal-sized blastomeres and ≤10% fragmentation: ECA grade); (B) with indistinct early cleavage (equal sized blastomeres, >2 blastomeres, or >10% fragmentation: ECB grade); (C) without early cleavage [no early cleavage (NEC grade)]; or (D) without early cleavage being assessed (control) at 25-27 after insemination. RESULTS The percentage of viable Day 3 embryos from ECA grade (75.1%, 507/675) was significantly higher than that from ECB grade (19.2%, 151/403) or NEC grade (27.1%, 127/469) embryos (p < 0.01). The pregnancy and delivery rates in the ECA group [65.7% (65/990) and 48.5% (48/990), respectively] were significantly higher than those in the ECB group [30.8% (4/13) and 7.7% (1/13), respectively] or NEC group [36.8% (14/38) and 23.7% (9/38), respectively; all p < 0.01]. The implantation rate in the ECA group (32.3%, 129/400) was higher than those in the ECB (6.8%, 4/59) and NEC (13.0%, 18/136) groups (p < 0.01). CONCLUSION Simple selection using the early cleavage morphology may improve the pregnancy and delivery rates of Day 3 embryo transfer programs.
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Affiliation(s)
- Chun-I Lee
- Department of Obstetrics and Gynecology, Chung Shan Medical University Hospital, Taichung, Taiwan; Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan
| | - Tsung-Hsien Lee
- Department of Obstetrics and Gynecology, Chung Shan Medical University Hospital, Taichung, Taiwan; Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan; Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Chun-Chia Huang
- Division of Infertility Clinic, Lee Women's Hospital, Taichung, Taiwan; Department of Biotechnology, Chungtai Medicine University, Taichung, Taiwan
| | - Hsiu-Hui Chen
- Division of Infertility Clinic, Lee Women's Hospital, Taichung, Taiwan; Department of Life Sciences, College of Life Sciences, National Chung Hsing University, Taichung, Taiwan
| | - Chung-Hsien Liu
- Department of Obstetrics and Gynecology, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Maw-Sheng Lee
- Department of Obstetrics and Gynecology, Chung Shan Medical University Hospital, Taichung, Taiwan; Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; Division of Infertility Clinic, Lee Women's Hospital, Taichung, Taiwan.
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Pallinger E, Bognar Z, Bodis J, Csabai T, Farkas N, Godony K, Varnagy A, Buzas E, Szekeres-Bartho J. A simple and rapid flow cytometry-based assay to identify a competent embryo prior to embryo transfer. Sci Rep 2017; 7:39927. [PMID: 28057937 PMCID: PMC5216337 DOI: 10.1038/srep39927] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 11/29/2016] [Indexed: 11/20/2022] Open
Abstract
Multiple pregnancy is a risk for prematurity and preterm birth. The goal of assisted reproduction is to achieve a single pregnancy, by transferring a single embryo. This requires improved methods to identify the competent embryo. Here, we describe such a test, based on flow cytometric determination of the nucleic acid (PI+) containing extracellular vesicle (EV) count in day 5 embryo culture media. 88 women undergoing IVF were included in the study. More than 1 embryos were transferred to most patients. In 58 women, the transfer resulted in clinical pregnancy, whereas in 30 women in implantation failure. In 112 culture media of embryos from the "clinical pregnancy" group, the number of PI+ EVs was significantly lower than in those of 49 embryos, from the "implantation failure" group. In 14 women, transfer of a single embryo resulted in a singleton pregnancy, or, transfer of two embryos in twin pregnancy. The culture media of 19 out of the 20 "confirmed competent" embryos contained a lower level of PI+ EVs than the cut off level, suggesting that the competent embryo can indeed be identified by low PI+ EV counts. We developed a noninvasive, simple, inexpensive, quick test, which identifies the embryos that are most likely to implant.
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Affiliation(s)
- Eva Pallinger
- Department of Genetics, Cell- and Immunobiology, Semmelweis University, Budapest, Hungary
| | - Zoltan Bognar
- Department of Medical Biology, Medical School, Pecs University, Pecs, Hungary
- János Szentágothai Research Centre, University of Pecs, Hungary
- Endocrine Studies, Centre of Excellence, Pecs University, Pecs, Hungary
| | - Jozsef Bodis
- Endocrine Studies, Centre of Excellence, Pecs University, Pecs, Hungary
- Department of Obstetrics and Gynaecology, Medical School, Pecs University, Pecs, Hungary
- MTA - PTE Human Reproduction Research Group, Pecs, Hungary
| | - Timea Csabai
- Department of Medical Biology, Medical School, Pecs University, Pecs, Hungary
- János Szentágothai Research Centre, University of Pecs, Hungary
- Endocrine Studies, Centre of Excellence, Pecs University, Pecs, Hungary
| | - Nelli Farkas
- Institute of Bioanalysis, Medical School, Pecs University, Pecs, Hungary
| | - Krisztina Godony
- Department of Obstetrics and Gynaecology, Medical School, Pecs University, Pecs, Hungary
| | - Akos Varnagy
- Endocrine Studies, Centre of Excellence, Pecs University, Pecs, Hungary
- Department of Obstetrics and Gynaecology, Medical School, Pecs University, Pecs, Hungary
- MTA - PTE Human Reproduction Research Group, Pecs, Hungary
| | - Edit Buzas
- Department of Genetics, Cell- and Immunobiology, Semmelweis University, Budapest, Hungary
| | - Julia Szekeres-Bartho
- Department of Medical Biology, Medical School, Pecs University, Pecs, Hungary
- János Szentágothai Research Centre, University of Pecs, Hungary
- Endocrine Studies, Centre of Excellence, Pecs University, Pecs, Hungary
- MTA - PTE Human Reproduction Research Group, Pecs, Hungary
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Huang P, Wei L, Li X. A study of intrauterine infusion of human chorionic gonadotropin (hCG) before frozen-thawed embryo transfer after two or more implantation failures. Gynecol Endocrinol 2017; 33:67-69. [PMID: 27449969 DOI: 10.1080/09513590.2016.1207164] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE To investigate the effect of intrauterine infusion of human chorionic gonadotropin (hCG) before frozen-thawed embryo transfer (FET) after two or more implantation failures (TIFs). METHODS The study was a prospective randomized single-blind study of 161 cycles in patients undergoing FET who had TIFs. The intervention group received an intrauterine injection of 1000 IU of hCG before embryo transfer (ET) (n = 62). A placebo group (n = 49) received an intrauterine injection of physiological saline before ET. A control group (n = 50) did not receive an intrauterine injection. Clinical pregnancy rates, abortion rates, and ongoing pregnancy rates were compared between the three groups. RESULTS The clinical pregnancy rates were 59.68%, 53.06%, and 32.00% in the hCG group, placebo group, and control group, respectively. The clinical pregnancy rates were significantly higher in the hCG and placebo groups than in the control group. There were no significant differences in the abortion rates among the three groups. CONCLUSION An intrauterine administration of hCG before FET significantly improved the pregnancy rates after TIFs. But local injury caused by the operation of intrauterine perfusion may play an important role in improving clinical pregnancy rates.
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Affiliation(s)
- Pinxiu Huang
- a Department of Reproductive Medicine , Liuzhou Maternity and Child Healthcare Hospital , Guangxi , China
| | - Lihong Wei
- a Department of Reproductive Medicine , Liuzhou Maternity and Child Healthcare Hospital , Guangxi , China
| | - Xinlin Li
- a Department of Reproductive Medicine , Liuzhou Maternity and Child Healthcare Hospital , Guangxi , China
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Kirkegaard K, Dyrlund TF, Ingerslev HJ. Clinical Application of Methods to Select In VitroFertilized Embryos. Hum Reprod 2016. [DOI: 10.1002/9781118849613.ch7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Kirstine Kirkegaard
- Department of Medical Biochemistry; Aarhus University Hospital; Aarhus Denmark
| | - Thomas F. Dyrlund
- Department of Molecular Biology and Genetics; Aarhus University; Aarhus Denmark
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Scheffer JB, Scheffer BB, de Carvalho RF, Rodrigues J, Grynberg M, Mendez Lozano DH. Age as A Predictor of Embryo Quality Regardless of The Quantitative Ovarian Response. INTERNATIONAL JOURNAL OF FERTILITY & STERILITY 2016; 11:40-46. [PMID: 28367304 PMCID: PMC5215710 DOI: 10.22074/ijfs.2016.4579] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 08/11/2016] [Indexed: 11/23/2022]
Abstract
Background One determining factor of a successful in vitro fertilization (IVF) cycle
is embryo quality. The aim of the present study was to evaluate associations of embryo
quality and reserve markers like age, FSH and AMH. Materials and Methods In this prospective study, 120 infertile women, aged 21-44
years, undergoing routine exploration during an unstimulated cycle preceding assisted
reproductive technology (ART) at our center were studied prospectively, from February
2011 to December 2014. Descriptive parameters and patient characteristics were reported
as mean (SD) or median (range) depending on the distribution. Student’s t test was performed for continuous variables, Wilcoxon and Pearson’s Test were used for not distributed variables and Fisher’s Test was performed for categorical variables. P<0.05 was
considered statistically significant. Results Overall, at the time of investigation, patients had a mean age of 33.03 ± 4.15
years old. On cycle day three, serum anti-Mullerian hormone (AMH) level was 3.50
± 1.54 ng/mL, serum follicle-stimulating hormone (FSH) level was 6.29 ± 1.53 mUI/
mL, at baseline, women had 16.57 ± 7.0 antral follicles. The mean of collected oocytes
was 11.80 ± 5.25, embryo I+II was 2.46 ± 2.11. A greater number of embryos I+II was
observed in young patients. By evaluating 120 patients, a significant relationship was
observed between age and FSH (r=0.24, P=0.01), age with AMH (r=-0.22, P=0.02), age
with collected oocytes (r=-0.23, P=0.03) and age with embryo I+II (r=-0.22, P=0.03).
A significant relationship was also observed between antral follicle count (AFC) and
AMH (r=0.29, P=0.01), AFC and the number of transferred embryo (r=-0.18, P=0.03),
AFC and total dose of the drugs (r=-0.23, P=0.03). Significant relationship of FSH with
total dose of drugs (r=0.19, P=0.02) was also observed. In addition, we determined
significant relationships between AMH and the number of collected oocytes (r=0.38,
P=0.01), AMH and the number of metaphase II oocytes (r= 0.35, P=0.01), AMH and
the number of embryo (r=0.19, P=0.04) as well as AMH and total dose of the drugs
(r=-0.25, P=0.01). Conclusion Commonly used clinical markers of ovarian reserve are reflection of the
ovarian reserve, while the outcome measurements of ART and age are the best predictors
of embryo quality.
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Affiliation(s)
| | | | | | - Joyce Rodrigues
- Brazilian Institute of Assisted Reproduction, Belo Horizonte, Brazil
| | - Michael Grynberg
- Department of Reproductive Medicine, Hospital Jean Verdier (AP-HP), University Paris XIII, and INSERM, Paris, France
| | - Daniel H Mendez Lozano
- School of Medicine, Tecnológico de Monterrey and Center for Reproductive Medicine CREASIS San Pedro Monterrey, México
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Beyer DA, Amari F. Maternal risk factors and neonatal outcomes after ART treatment – A German monocenter experience. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2016. [DOI: 10.1016/j.mefs.2015.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Korsun P, Bals-Pratsch M, Ortmann O, Markus S, Germer U. Antenatal Diagnosis of Dizygotic, Monochorionic Twins Following IVF/ICSI. Geburtshilfe Frauenheilkd 2016; 76:727-730. [PMID: 27365544 DOI: 10.1055/s-0042-101024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Monochorionic twins are usually monozygotic and thus usually have the same sex. A case of monochorionic diamniotic twins following IVF/ICSI and laser treatment of the zona pellucida ("assisted hatching") is presented in which partial embryo amalgamation appears to have occurred. Discordant sex between the twins was suspected on detailed antenatal ultrasound at 13 + 3 weeks gestation and was confirmed on subsequent examinations. The sexual phenotype at birth was female for one twin and male for the other. Placental histology confirmed the monochorionic, diamniotic situation. Cytogenetic analysis of both twins was carried out postpartum on various tissues. On karyotyping of blood lymphocytes the male and female twins each had one mosaic of male and female cells. Oral mucosal cells showed normal male and female karyotypes respectively. Analysis of urothelium showed a normal result for the male infant, and a weak gonosomal mosaic with an XX and XY constellation for the female infant. At least for blood lymphocytes, a diagnosis of chimerism was proven.
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Affiliation(s)
- P Korsun
- Klinik für Frauenheilkunde und Geburtshilfe der Universität Regensburg am Caritas-Krankenhaus St. Josef, Regensburg
| | - M Bals-Pratsch
- Profertilita, Zentrum für Fruchtbarkeitsmedizin, Regensburg
| | - O Ortmann
- Klinik für Frauenheilkunde und Geburtshilfe der Universität Regensburg am Caritas-Krankenhaus St. Josef, Regensburg
| | - S Markus
- Kompetenzzentrum für Humangenetik, Gynäkologie und Laboratoriumsmedizin, Dr. Staber und Kollegen, Regensburg
| | - U Germer
- Klinik für Frauenheilkunde und Geburtshilfe der Universität Regensburg am Caritas-Krankenhaus St. Josef, Regensburg
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