P-195 Do the presence of necrotic foci and/or separate blastomeres, the blastocoele expansion degree affect pregnancy outcomes of frozen-thawed euploid blastocysts transfer cycles?

Study question

Do the presence of necrotic foci and/or the presence of separate blastomeres and the blastocoele expansion degree affect pregnancy outcomes of frozen-thawed euploid embryo transfer cycles?

Summary answer

Significant correlations were observed between pregnancy outcomes and the degree of blastocoele expansion, the presence of necrotic foci or separate blastomeres in the euploid embryo.

What is known already

Implantation failure and pregnancy losses may occur despite the selection of a healthy euploid embryo for transfer and the elimination of other risk factors. Blastocyst morphology is known to affect pregnancy outcomes, but the effect of necrotic foci and/or separate blastomeres in the embryo on pregnancy outcomes needs further investigation.

Study design, size, duration

This is a retrospective cohort study and was conducted at ART and Reproductive Genetics Centre, Memorial, Sisli Hospital, Istanbul, Turkey between January 2017 and September 2021. A total of 2758 frozen-thawed euploid embryo transfer cycles were included in the study.

Participants/materials, setting, methods

After thawing, the embryos were divided into groups according to their morphological grades, whether there were necrotic foci and whether there were separate blastomeres, and were evaluated in terms of pregnancy outcomes. Blastocysts were graded by using Gardner and Schoolcraft’s grading system. Ongoing pregnancy was defined as a pregnancy that had reached 20 weeks. Miscarriage was defined as a pregnancy loss occurring before the 20th gestational week.

Main results and the role of chance

Our data showed that the presence of necrotic foci in the inner cell mass or trophectoderm reduced the ongoing pregnancy rates and increased the miscarriage rates. The ongoing pregnancy rate was lower (41.0%, vs 60.0%, p < 0.001) and the miscarriage rate was higher (27.3% vs 19.8%, p < 0.05) in the group with necrotic foci than in the group without necrotic foci.

The presence of separate blastomeres decreased the ongoing pregnancy rates (50.3% in the group with separate blastomeres, 61.8% in the group without separate blastomeres) (p < 0.001) and increased the miscarriage rates (25.3% in the group with separate blastomeres, 18.8% in the group without separate blastomeres) (p > 0.004).

The ongoing pregnancy rates for blastocoele expansion degrees of 2, 3, 4, 5, and 6 were 39.5%, 38.3%, 59.3%, 59.8%, and 61.4%, respectively and the miscarriage rates for blastocoele expansion degrees of 2, 3, 4, 5, and 6 were 35%, 33.3%, 21%, 21.2%, 18.4%, respectively. Embryos with degrees of expansion grade ≤ 3 had lower ongoing pregnancy rates and higher miscarriage rates than those with degrees of expansion > 3 (p < 0.01).

Limitations, reasons for caution

Retrospective study.

Wider implications of the findings

When choosing the embryo to be transferred in cases with more than one euploid embryo, the selection should be made by considering the blastocoele expansion degrees and the presence of necrotic foci and separate blastomeres in the embryo.

Trial registration number

not applicable

Partial regression of a hydatiform mole with coexisting live fetus in a twin gestation: case report

Pregnancies resulting in viable fetuses are extremely rare in accompanying a hydatiform mole, often due to the development of maternal complications, including preeclampsia and vaginal bleeding. The risk for gestational trophoblastic neoplasm is another concern because of the delayed evacuation of the molar tissue. In this paper, the authors present a case of complete mole hydatiform with a live co-twin fetus (CHMLF) resulting in the delivery of a healthy male infant with the partial regression of the molar tissue and the decline of serum beta human chorionic gonadotropin (P-hCG) during the pregnancy. In the management of CHMLF, each patient must be considered individually and eligible patients can be followed in the absence of serious maternal complications. Serial ultrasound examinations and close clinical and laboratory surveillance of the mother are certainly indicated.

Characteristics and prognosis of ovarian metastatic tumors: review of a single-institution experience

BACKGROUND

To evaluate the clinico-pathological characteristics and role of surgery in patients with ovarian metastasis.

MATERIALS AND METHODS

Clinical data from 51 patients with pathologically confirmed ovarian metastasis were reviewed.

RESULTS

Ovarian metastasis accounted for 14% of all malignant ovarian neoplasms (51/364). Of the 51 metastatic ovarian tumor cases, 24 originated from gynecologic malignancies, while 27 originated from non-gynecologic malignancies. Optimal cytoreduction was performed in 88% and 37% of patients with metastases of gynecologic and non-gynecologic origin, respectively. Patients with ovarian metastasis had a two-year survival rate in 82% of the gynecologic group and 70% of the non-gynecologic group (p = 0.35). The five-year survival rate of patients with non-gynecologic tumor origin (29%) was significantly worse (p = 0.04) than the survival rates of those with tumors of gynecologic origin (61%). In the non-gynecologic group, the five-year survival rates were significantly different between patients who were performed optimal cytoreductive surgery vs those without this procedure (42% and 20%, respectively; p = 0.04).

CONCLUSION

Although complete surgical resection is not achievable in approximately two-thirds of patients with metastases of non-gynecological origin, optimal tumor cytoreduction appears to improve survival, which is statistically significant in all patients with ovarian metastatic tumors.

[Surgery for neuroendocrine tumors of the gastroenteropancreatic system (GEP-NET)]

Surgical treatment is still the only curative treatment proven for patients with neuroendocrine tumors (NET) of the gastroenteropancreatic system. In addition to the therapy of incidental findings, the treatment of NET with variable aggressiveness and often good long-term prognosis requires a thorough preoperative assessment and a surgical procedure that is based on each individual case. Treatment can be surgery alone (if the disease is locally confined) or can be combined with other therapies. Early NET of the stomach and rectum can be cured endoscopically without further diagnostics, while early findings of the appendix can be treated by an appendectomy. Functionally active pancreatic NET and NET of the small intestine are often preoperatively diagnosed based on symptoms. Thus, it is possible to refer the patient to a NET center, if necessary. Stratification of the necessary treatment combination can be made early. An alternative to radical surgical treatment is the operative reduction of the tumor size and hormone production in metastasized NET, which can lead to improved life expectancy and quality of life. Combination with other treatment forms is absolutely necessary in these patients. It has been proven useful to divide the large group of NET based on the different tumor locations, hormone activity, and the degree of differentiation of the tumor. Early forms, locoregionally limited tumor stages, and tumor stages with distant metastases are considered separately.

Exaggerated placental site reaction detected during caesarean delivery: a case report

Exaggerated placental site (EPS) reaction is an exuberant physiologic process in which intermediate trophoblasts infiltrate the underlying endometrium and myometrium at the implantation site. During a caesarean section, we noted a polypoid well shaped smooth lesion, about 3 cm in diameter on the anterior wall of the uterus apart from the placenta. The histopathologic examination revealed an exuberant proliferation of trophoblastic cells in the placental site, a low Ki-67 labelling index and the absence of mitotic activity. Distinguishing EPS reaction from the other intermediate trophoblastic tumours is critical, as the latter may likely involve surgical intervention and/or chemotherapy, although no specific treatment and follow-up is required for EPS reaction. It is necessary to be aware of this pathology and take biopsies from suspicious lesions in the placental site for pathologic examination.

[Insulinoma associated with pregnancy]

HISTORY AND CLINICAL FINDINGS

A 42-year-old woman was found by her husband with unconsciousness and seizure at night three weeks after delivery of her fifth child. At a blood glucose level of 25 mg/dl, she received an intravenous infusion of glucose by the called emergency physician, leading to a rapid improvement of her symptoms.

INVESTIGATION AND DIAGNOSIS

The following examination showed a low basal blood glucose level as well as pathological levels of insulin and C-peptide. These findings together with the Whipple trias (hypoglycaemia, neurological symptoms and rapid improvement after infusion of glucose) were highly suspicious of an insulinoma. Whereas CT, MRI and DOTATOC-PET were negative, endoscopic ultrasound showed a mass of 13 mm in the tail of the pancreas.

TREATMENT AND COURSE

The tumour was resected from the tail of the pancreas by laparoscopic enucleation. Histological examination revealed an endocrine tumour (insulinoma) of the pancreas. Postoperative blood glucose levels were within the normal range. The patient and her healthy newborn child could be dismissed from hospital on the third day after surgery.

CONCLUSION

Despite its rarity, an insulinoma represents an important differential diagnosis of hypoglycaemia during and right after pregnancy.

Development of an antibody-detection ELISA for Fasciola hepatica and its evaluation against a commercially available test

An ELISA was developed for the detection of Fasciola hepatica antibody in serum of cattle. The assay was applied to sera from 258 naturally infected cattle, 256 non-infected cattle and six calves experimentally infected with F. hepatica. The diagnostic sensitivity and specificity of the ELISA test was 98% (95% confidence intervals, 96-100%) and 96% (95% confidence intervals, 93-98%) respectively at a cut-off value of 15% positivity. The results using sera from the experimentally infected calves showed that antibodies were first detected 2-4 weeks after infection. The ELISA test was also compared to the commercially available Bio-X bovine F. hepatica ELISA kit. A subset of 39 positive sera and 47 negative sera were selected from the samples used to evaluate the in-house test. The results indicated that the agreement between the two tests was almost perfect (k statistic=0.82).

Prevalence of antibodies to Neospora caninum in local and imported cattle breeds in the Kars province of Turkey

This study investigates the seroprevalence of Neospora caninum in cattle in the province of Kars in north-eastern Turkey. A total of 301 serum samples, 228 from local breeds of cows with a history of recent abortion and the remaining 73 collected at random from Simmental cows imported from Germany or their offspring, were tested for anti-Neospora antibodies by ELISA. All the serum samples from local breeds were negative for N. caninum antibodies, apart from one which tested inconclusive. In contrast six of the samples (8.2% with 95%CI: 2-14.5%) from Simmental cows tested positive. There was a significant difference (P<0.001) in the seroprevalence of N. caninum between local and Simmental breeds, even if the inconclusive test was considered positive, and the odds ratio of its occurrence in the Simmental breed was 20.3. In conclusion, it is unlikely that N. caninum contributes to abortion in local cattle breeds and our results also suggest that N. caninum was introduced to the region by the importation of Simmental cattle and that the vertical transmission of the parasite in cattle is important in the region.

Teat onchocercosis in cows with reference to prevalence, species involved and pathology

The present study reports teat onchocercosis in cows in the province of Kars in north eastern Turkey with reference to the prevalence, species involved and pathological findings. In the study, 600 cows of various breeds and ages slaughtered in the local abattoir were examined and 145 (24%) were found to have various lesions on their teats, of which 45 (31%) were infected with three Onchocerca species (Onchocerca gutturosa, O. lienalis and an unidentified Onchocerca spp.), identified according to their morphological characteristics. Gross pathological examination of the teats with lesions revealed scabies and chaps of varying sizes, healed sores and small nodules. Histopathologically, large numbers of microfilariae were commonly observed within the collagenous fibre bundles of the dermis, with only a few microfilariae in the dermis in some cases. The microfilariae were also often found to have accumulated around the perivascular spaces and were frequently associated with infiltration by inflammatory cells, predominantly eosinophil leukocytes and mononuclear cells. In two cases, microfilariae were discovered exclusively in the lumen of the capillaries of the dermal papillaries. In one case, in which microfilarae were not encountered, sections of adult worms surrounded by neutrophil leukocytes were detected free in the teat canal. The presence of extensive teat lesions along with microfilariae of the Onchocerca species as found in this study warrants further assessment of the impact of onchocercosis on dairy farming.

The effects of levamisole poisoning on the haematological and biochemical parameters in dogs

This study was designed to evaluate possible organ and system disorders associated with experimentally induced levamisole poisoning in dogs. For this purpose, twelve clinically healthy dogs of different ages, sexes and breeds were used. They were divided into two equal groups (Group A and Group B) and given levamisole orally at a dose of 25 mg/kg of body weight daily for three days. The dogs in Group B were also injected with atropin sulphate (0.04 mg/kg of body weight) subcutaneously (sc) 1 hour after each administration of levamisole. Routine clinical examinations were made and some haematological, biochemical and blood gas parameters were established at various times after administration of levamisole. The dogs in Group A developed severe neurological signs, gastric haemorrhage, bloody vomiting, colic, anaemia and four dogs died. In Group B these signs were mild and only one dog died. Levamisole poisoning was characterised by a significant reduction in the total number of red blood cells (RBCs), concentration of haemoglobin (Hb) and packed cell volume (PCV), and by anaemia. Peripheral blood pH, actual bicarbonate of plasma (HCO3), actual base excess (BE), partial pressure of oxygen (pO2) and saturated oxygen (O2SAT) increased in both groups of animals and these dogs developed metabolic alkalosis 48 hours after the first administration of levamisole. The results of the study also show that levamisole poisoning in dogs causes a significant increase in the activity of serum alanine aminotransferase (ALT) and of alkaline phosphatase (AP) and in the concentration of urea in both Group A and Group B. In the study, atropin sulphate reduced the severity of the clinical signs and the number of deaths, but it was not alone sufficient to remedy levamisole poisoning in dogs.

Outcome of 67 patients with solid tumors relapsed after high-dose chemotherapy and peripheral blood stem cell transplantation

We retrospectively analyzed the outcome of 67 patients with breast (n=24), ovarian (n=11) or testicular cancer (n=32) treated for relapse after high-dose chemotherapy (HDC) and peripheral blood stem cell (PBSC) transplantation. Treatment, survival and toxicity were analyzed. Patients with breast, ovarian or testicular cancer received a mean of 5.9 (range 1-24), 5.1 (1-13) and 4.6 (1-13) regimens for relapse after HDC. Overall response at the end of the observation period was 20.8% for patients with breast cancer (three complete (CR) and two partial responses (PR)), 45.5% (one CR, four PR) for ovarian and 9.4% (three PR) for testicular cancer patients. The mean overall-survival (OAS) from first relapse was 28 (range 3-44), 17 (2-24) and 10 (1-28) months, respectively. Leukocytopenia grade 3/4 occurred in 27-63% of patients, and thrombocytopenia grade 3/4 was observed in 58-88%, respectively. Nonhematological grade 3/4 toxicities were below 20%. In conclusion, patients with relapse after HDC usually have a poor outcome but long-term survivors are observed. Hematological toxicity is common, while other severe side effects are less frequent.