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Xie P, Aluko A, Cheung S, Goldschlag D, Davis O, Rosenwaks Z, Palermo GD. Assisted gamete treatment to pinpoint acquired meiotic maturity and overcome oocyte activation deficiency contributed by both gametes. F S Rep 2023; 4:72-76. [PMID: 36959954 PMCID: PMC10028469 DOI: 10.1016/j.xfre.2022.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 12/20/2022] [Accepted: 12/21/2022] [Indexed: 12/31/2022] Open
Abstract
Objective To treat couples with total fertilization failure (TFF) based on a combined oocyte- and sperm-related oocyte activation deficiency by optimizing oocyte response to chemical activation with calcium ionophore. Design Case report. Setting Tertiary Hospital. Patients Two couples with a history of TFF after intracytoplasmic sperm injection intracytoplasmic sperm injection (ICSI). Interventions To overcome oocyte-related oocyte activation deficiency (OAD), extended in vivo/in vitro oocyte maturation was performed to enhance ooplasmic maturity; to address sperm-related OAD, assisted gamete treatment (AGT) was performed to trigger oocyte activation. Main outcome measures Treatment cycle outcomes for the 2 couples undergoing ICSI with extended oocyte maturation (EOM) and AGT. Results We identified 2 couples with TFF after ICSI because of a combined factor of OAD confirmed by phospholipase C zeta expression and genomic assessment. Initial AGT treatment alone failed to enhance fertilization, suggesting superimposed oocyte dysmaturity prohibiting oocytes from responding to chemical stimuli. To address this complex form of OAD, in couple 1, 27 oocytes out of 34 retrieved presented normal metaphase II spindles after EOM; ICSI with AGT yielded a fertilization rate of 63.0% (17/27). All 17 zygotes were cryopreserved initially. Two embryos were thawed and transferred, yielding a monochorionic diamniotic twin pregnancy. Couple 2 underwent 3 ICSI cycles with EOM and AGT; 91.4% (32/35) of oocytes displayed normal metaphase II spindle and achieved an overall fertilization rate of 43.8% (14/32). A total of 12 blastocysts were cryopreserved. A single 46XY blastocyst was thawed and transferred, resulting in a singleton pregnancy. Conclusions Our study has demonstrated the usefulness of EOM by targeting spindle presence to enhance chemical responses to AGT.
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Affiliation(s)
| | | | | | | | | | | | - Gianpiero D. Palermo
- Reprint requests: Gianpiero D. Palermo, M.D., Ph.D., The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, 1305 York Avenue, Y720, New York, New York 10021.
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Joshi A, Aluko A, Styer AK, Young BC, Johnson KM, Hacker MR, Modest AM. PCOS and the risk of pre-eclampsia. Reprod Biomed Online 2022; 45:961-969. [PMID: 35953416 PMCID: PMC9637709 DOI: 10.1016/j.rbmo.2022.05.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/20/2022] [Accepted: 05/30/2022] [Indexed: 11/19/2022]
Abstract
RESEARCH QUESTION What is the association between polycystic ovary syndrome (PCOS) and pre-eclampsia? Data suggest that patients with PCOS are at increased risk of developing pre-eclampsia; however, several studies have not found an independent association between the two. DESIGN A retrospective case-control study of singleton deliveries at a tertiary care hospital from 2011 to 2015. Patients with pre-eclampsia (cases) were matched to the next delivery without pre-eclampsia (controls) on gestational age week. Medical history data, a diagnosis or clinical features of PCOS and obstetric data, including pre-eclampsia, were abstracted from the medical record. Groups were compared with the chi-squared test, and conditional logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals (95% CI). OR were adjusted for maternal age at delivery and race/ethnicity. RESULTS This study included 435 cases and 435 controls. Cases were more likely to be Black compared with controls. Age, comorbidities, features of PCOS and use of IVF were similar between groups. Patients with pre-eclampsia were not more likely to have PCOS (8.3%) than those without pre-eclampsia (6.2%, adjusted OR 1.40, 95% CI 0.81-2.30). Sensitivity analyses for body mass index and parity suggested an increased pre-eclampsia risk for patients with PCOS and these additional factors, however no group showed a statistically significant association between PCOS and pre-eclampsia. CONCLUSIONS In this study, a history of PCOS was not associated with the risk of pre-eclampsia. Further investigation is necessary to determine whether there are subgroups of PCOS patients who are at increased risk of pre-eclampsia.
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Affiliation(s)
- Ashwini Joshi
- Harvard Medical School, 25 Shattuck Street, Boston MA 02115, USA; Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston MA 02215, USA
| | - Ashley Aluko
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston MA 02215, USA; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, 25 Shattuck Street, Boston MA 02115, USA
| | - Aaron K Styer
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston MA 02215, USA; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, 25 Shattuck Street, Boston MA 02115, USA; Colorado Center for Reproductive Medicine (CCRM Boston), 330 Boylston Street, Suite 300, Chestnut Hill MA 02459, USA
| | - Brett C Young
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston MA 02215, USA; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, 25 Shattuck Street, Boston MA 02115, USA
| | - Katherine M Johnson
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston MA 02215, USA; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, 25 Shattuck Street, Boston MA 02115, USA
| | - Michele R Hacker
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston MA 02215, USA; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, 25 Shattuck Street, Boston MA 02115, USA
| | - Anna M Modest
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston MA 02215, USA; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, 25 Shattuck Street, Boston MA 02115, USA.
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Aluko A, Vyas N, Grill E, Melnick A, Rosenwaks Z. COUNTING EGGS BEFORE THEY HATCH: UTILIZATION OF OOCYTES AFTER PLANNED OOCYTE CRYOPRESERVATION. Fertil Steril 2022. [DOI: 10.1016/j.fertnstert.2022.09.248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Moronta M, Vyas N, Aluko A, Johal J, Tsai S, Rosenwaks Z, Spandorfer SD. EFFECT OF NON-CAVITY–DISTORTING INTRAMURAL MYOMAS ON PREGNANCY OUTCOMES IN EUPLOID FROZEN EMBRYO TRANSFER CYCLES: A PROSPECTIVE STUDY. Fertil Steril 2022. [DOI: 10.1016/j.fertnstert.2022.08.646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Gelvin BJ, Romanski PA, Bortoletto P, Vyas N, Aluko A, Spandorfer SD. THE ASSOCIATION BETWEEN HPV INFECTION AND LIVE BIRTH OUTCOMES IN THE INFERTILITY POPULATION. Fertil Steril 2022. [DOI: 10.1016/j.fertnstert.2022.08.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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McCarter K, Stewart J, Gordhandas S, Aluko A, Shah N, Schattman G, Rosenwaks Z. The use of fertility preservation services for cancer patients: a single institution experience. F S Rep 2022; 3:349-354. [PMID: 36568923 PMCID: PMC9783135 DOI: 10.1016/j.xfre.2022.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 07/28/2022] [Accepted: 08/03/2022] [Indexed: 12/27/2022] Open
Abstract
Objective To analyze the use of services regarding fertility preservation (FP) in cancer patients at a single institution. Design A retrospective cohort study. Setting Academic medical center. Patients A total of 208 FP referrals. Interventions None. Main Outcome Measures Method of FP; time from referral to FP intervention. Results A total of 553 patients were referred to a reproductive specialist for FP in the setting of a medical diagnosis from 2011 to 2016. Of these, 208 patients satisfied the inclusion criteria and met with a reproductive specialist. Ninety patients underwent FP services. The average age at referral was 30.9 ± 7.9 years. Breast cancer (n=94, 45%) and leukemia/lymphoma (n=62, 30%) were the most prevalent cancer diagnoses. A 68.9% of patients underwent oocyte cryopreservation (n=62), 26.7% underwent embryo cryopreservation (n=24) and 4.4% underwent ovarian tissue preservation (n=4). The time interval from the referral to the FP intervention ranged from 1 to 810 days, with a median of 17 days. Conclusions In the setting of a cancer diagnosis, most patients undergoing FP intervention underwent oocyte cryopreservation, were <35 years old, and underwent FP intervention in <30 days from referral. Whereas FP should ideally be initiated at the time of cancer diagnosis, all patients with a cancer diagnosis should be referred to a reproductive specialist and counseled on options for FP to preserve the optionality for the reproductive future they desire.
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Affiliation(s)
- Kelly McCarter
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical College, New York, New York,Reprint requests: Kelly McCarter, M.D., The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical College, 1305 York Avenue 6 Floor New York, New York, United States, 10021).
| | - Joshua Stewart
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical College, New York, New York
| | - Sushmita Gordhandas
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ashley Aluko
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical College, New York, New York
| | - Nirali Shah
- New York University Fertility Center, New York, New York
| | - Glenn Schattman
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical College, New York, New York
| | - Zev Rosenwaks
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical College, New York, New York
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Aluko A, Xie P, Rosenwaks Z, Palermo G. P-798 Utilization of Haploid Androgenetic Blastomeres to Characterize Male Genomic Inheritance and as a Male Gamete Substitute. Hum Reprod 2022. [DOI: 10.1093/humrep/deac107.733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Study question
Can sperm genomes be replicated by generating androgenetic embryos, and can resulting haploid blastomeres be used as a substitute for male gametes with known genotype?
Summary answer
Once utilized as male gametes, haploid androgenetic blastomeres can be used for gamete genotyping and can sustain embryo development to live offspring.
What is known already
Heterozygosity in human spermatozoa may represent a risk to offspring health. This has led to attempts to replicate the gamete genome by generating haploid embryonic stem cells (haESCs) that can be used to typify heterozygosity or as gamete substitutes. Although haESC lines are unstable with a tendency to self-diploidize, utilizing haploid androgenetic cells in the early embryonic stages, such as the blastomere stage, can provide multiple copies of genetically functional pseudo-gametes.
Study design, size, duration
Haploid androgenetic embryos were generated using spermatozoa from B6 heterozygous mice (B6-EGFP x B6D2F1) and cultured until the 8-cell stage. Individual haploid blastomeres with green fluorescent protein (GFP) expression were fused with activated recipient oocytes. Resulting conceptuses were cultured in a time-lapse system to monitor each stage of preimplantation development. Blastocysts with GFP expression were transferred to pseudo-pregnant surrogates. Pregnancy and offspring reproductive health were evaluated. Piezo-actuated ICSI was performed on unmanipulated oocytes as control.
Participants/materials, setting, methods
To generate haploid androgenetic embryos, metaphase II oocytes of B6D2F1 mice were treated with cytochalasin B, enucleated under Oosight®, and inseminated by piezo-actuated ICSI. Haploid androgenetic embryos were cultured to the 8-cell stage. Androgenetic blastomeres with GFP expression were coated with inactivated Sendai-virus and grafted to an activated recipient oocyte from another cohort. Cleavage parameters of reconstructed zygotes were compared to controls. Blastocysts were transferred into the uterine cavity of a 2.5-day post-coitus CD-1 surrogate.
Main results and the role of chance
A total of 421 oocytes were enucleated with a survival rate of 98.6%. The ooplasts underwent ICSI; 351 (84.6%) constructs developed a single male pronucleus 4-6h post-ICSI, and 208 (59.3%) constructs cleaved to the 8-cell stage. Parthenogenic activation by calcium ionophore was successful in 96.4% of the recipient oocytes, confirmed by the appearance of a single female pronucleus. A total of 148 haploid androgenotes with GFP expression were grafted onto corresponding activated oocytes; 145 successfully fused. Up to 2 unused sibling haploid blastomeres per embryo were genotyped using whole exome sequencing by a reference laboratory. A total of 481 untreated oocytes were inseminated, yielding 437 control zygotes. The cleavage of reconstructed embryos into the 2-cell (96.4%), 4-cell (94.3%), and 8-cell stage (91.4%) was comparable to that of control conceptuses (97.5%, 93.8%, and 92.7% respectively). Although morula compaction (80.0%) and blastulation (60.7%) were lower than control (89.2% and 80.8%, P <0.001, respectively), morphokinetic parameters were comparable. A total of 45 blastocysts were transferred into 5 recipient mice; 8 blastocysts implanted (17.8%) in 2 surrogates, yielding 5 live offspring (11.1%) weighing 1.51±0.22g. All live offspring expressed GFP and were confirmed fertile once reaching adulthood.
Limitations, reasons for caution
Although copies of gamete substitutes were generated that could be genotyped and used to produce live offspring with the desired phenotype in a mouse model, the system needs to be optimized and proven reproducible in humans, specifically in regard to the role of the sperm centrosome.
Wider implications of the findings
Once our proposed technique is implemented in humans, it may benefit patients to control germline heterozygosity by allowing genotyping of identical copies of the gametes. This technique, when used in conjunction with heritable genomic editing, can obviate the inherently highly condensed sperm genome to provide genome-edited gamete substitutes.
Trial registration number
N/A
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Affiliation(s)
- A Aluko
- Weill Cornell Medicine/New York-Presbytarian, Division of Reproductive Medicine , New York, U.S.A
| | - P Xie
- Weill Cornell Medicine, Division of Reproductive Medicine , New York, U.S.A
| | - Z Rosenwaks
- Weill Cornell Medicine/New York-Presbytarian, Division of Reproductive Medicine , New York, U.S.A
| | - G Palermo
- Weill Cornell Medicine/New York-Presbytarian, Division of Reproductive Medicine , New York, U.S.A
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Romanski PA, Aluko A, Bortoletto P, Elias R, Rosenwaks Z. Age-specific blastocyst conversion rates in embryo cryopreservation cycles. Reprod Biomed Online 2022; 45:432-439. [DOI: 10.1016/j.rbmo.2022.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 04/06/2022] [Accepted: 04/12/2022] [Indexed: 10/18/2022]
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Romanski PA, Aluko A, Bortoletto P, Troiano RN, Pfeifer SM. Aqueous vaginal contrast and scheduled hematocolpos with magnetic resonance imaging to delineate complex müllerian anomalies. Fertil Steril 2021; 117:221-223. [PMID: 34548169 DOI: 10.1016/j.fertnstert.2021.08.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 08/19/2021] [Accepted: 08/25/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To demonstrate the advantage of using aqueous vaginal contrast and scheduled hematocolpos with magnetic resonance imaging (MRI) to improve the delineation of gynecologic anatomy and to recommend that this modality be considered in patients with complex müllerian anomalies. DESIGN Video demonstration of MRI adjuncts to improve visualization of gynecologic anatomy. SETTING Academic Hospital. PATIENT(S) A patient with obstructed hemivagina and ipsilateral renal agenesis (OHVIRA) who presented for definitive surgical management. INTERVENTION(S) OHVIRA is a unilateral obstructed müllerian anomaly that presents typically after menarche with progressively worsening dysmenorrhea caused by progressive distension of the obstructed hemivagina and uterine horn. The definitive treatment for this anomaly is resection of the unilateral obstruction. When the obstructed hemivagina is within close proximity to the patent hemivagina, vaginal septum resection should be performed to relieve the obstruction successfully. However, when the obstructed hemivagina and uterine horn are not adjacent to the patent hemivagina, a simple septum resection is not feasible and there is a high rate of restenosis if anastomosis is attempted. In this case, laparoscopic removal of the obstructed uterine horn, fallopian tube, cervix, and vagina should be considered as an alternative approach to resolving the obstruction. A surgical approach can be recommended only once the surgeon has a clear understanding of the patient's pelvic anatomy and the magnitude of the obstruction. In the presented case, a 17-year-old patient with OHVIRA presented for definitive surgical management. While on hormonal suppression, a pelvic MRI was performed that identified a uterus didelphys with a left hemiuterus and cervix communicating with a patent vagina. The right hemiuterus and cervix were measured 2.5 cm from the patent vagina. However, because of hormonal suppression, the vaginal cavity was decompressed, making it very difficult to discern the relationship between the two uteri and vaginas. To better determine whether vaginal septum resection to relieve the obstruction was feasible, norethindrone was discontinued to allow menstrual blood to fill the obstructed hemivagina followed by a subsequent pelvic MRI with aqueous vaginal contrast to fill the patent vagina with contrast gel to improve the visualization of the decompressed vaginal cavities. MAIN OUTCOME MEASURE(S) Advantage of aqueous vaginal contrast and scheduled hematocolpos with MRI to image pelvic anatomy in a patient with a complex müllerian anomaly to guide surgical decision-making. RESULT(S) The addition of vaginal aqueous contrast clearly delineated the course and caliber of the patent vagina and its relationship to the obstructed hemivagina, now filled with blood. The inferior margin was in closer proximity to the patent vagina, but with only a very narrow segment (<1 cm) adjacent to the patent vagina and the obstructed cervix was displaced superiorly, now measuring 3.5 cm above the patent vagina. Surgical management options were discussed with the patient, and given the superior location of the obstructed uterus and cervix with only a narrow border of the vagina in continuity with the patent vagina, the risk of postoperative stenosis after vaginal septum resection was determined to be too high. The decision was made to proceed with a laparoscopic resection of the obstructed right side, and the patient underwent laparoscopic resection of the right hemiuterus, fallopian tube, cervix, and vagina. Intraoperatively, a survey of the pelvis again confirmed that the two vaginas were too far to reconnect safely without a high risk of stenosis. The patient recovered without complications postoperatively and her menses resumed without any pain. CONCLUSION(S) We highlight the use of two techniques to optimize MRI imaging of pelvic anatomy in a patient with a complex müllerian anomaly. First, the use of aqueous vaginal contrast with MRI is advantageous to clearly delineate the course and caliber of the patent vagina in patients with complex gynecologic anatomy. Second, cessation of hormonal suppression to allow menstruation to cause hematocolpos helped delineate the relationship between the obstructed vagina and patent vagina. In the presented case, these MRI adjuncts provided necessary detail that could not be appreciated with standard MRI to confirm that vaginal septum resection to preserve the right uterus would be too high a risk for postoperative stenosis in this patient. Aqueous vaginal contrast and scheduled hematocolpos should be considered as adjuncts to MRI when standard imaging modalities are unable to clearly describe the relationship between pelvic structures in cases of complex müllerian anomalies to help guide treatment recommendations.
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Affiliation(s)
- Phillip A Romanski
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York.
| | - Ashley Aluko
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
| | - Pietro Bortoletto
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
| | - Robert N Troiano
- Department of Radiology, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
| | - Samantha M Pfeifer
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
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Romanski PA, Aluko A, Bortoletto P, Troiano RN, Pfeifer SM. AQUEOUS VAGINAL CONTRAST AND SCHEDULED HEMATOCOLPOS WITH MAGNETIC RESONANCE IMAGING TO DELINEATE COMPLEX MÜLLERIAN ANOMALIES. Fertil Steril 2021. [DOI: 10.1016/j.fertnstert.2021.07.1172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Aluko A, Vaughan DA, Modest AM, Penzias AS, Hacker MR, Thornton K, Sakkas D. Multiple cryopreservation-warming cycles, coupled with blastocyst biopsy, negatively affect IVF outcomes. Reprod Biomed Online 2021; 42:572-578. [PMID: 33516664 PMCID: PMC10036156 DOI: 10.1016/j.rbmo.2020.11.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 11/13/2020] [Accepted: 11/25/2020] [Indexed: 11/28/2022]
Abstract
RESEARCH QUESTION Do multiple cryopreservation-warming cycles, coupled with blastocyst biopsy, negatively affect IVF outcomes? DESIGN Patients undergoing IVF with homologous single embryo transfer, and who underwent trophectoderm biopsy for preimplantation genetic testing for aneuploidy (PGT-A) between 2013 and 2017, were divided into three groups based on degree of embryonic micromanipulation: once-biopsied, once-cryopreserved (group BC, n = 2603), once-biopsied, twice-cryopreserved (group CBC, n = 95) and twice-biopsied, twice-cryopreserved (group BCBC, n = 15). The primary outcome was live birth; secondary outcomes included positive serum pregnancy test, clinical pregnancy and miscarriage. RESULTS Group CBC had a significantly lower chance of live birth (adjusted RR 0.57, 95% CI 0.41 to 0.79) and clinical pregnancy (adjusted RR 0.67, 95% CI 0.53 to 0.85) compared with group BC. Miscarriage rates were similar between groups BC and CBC (adjusted RR 1.3, 95% CI 0.64 to 2.7). CONCLUSIONS Multiple cryopreservation-warming cycles, coupled with blastocyst biopsy, negatively affect IVF outcomes. Although PGT-A is thought to improve reproductive outcomes on a per transfer basis, caution must be exercised in counselling patients on the possibility of diminishing returns owing to further embryonic micromanipulation after an embryo has been cryopreserved.
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Affiliation(s)
- Ashley Aluko
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston MA, USA; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston MA, USA
| | - Denis A Vaughan
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston MA, USA; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston MA, USA; Boston IVF, Waltham MA, USA.
| | - Anna M Modest
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston MA, USA; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston MA, USA
| | - Alan S Penzias
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston MA, USA; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston MA, USA; Boston IVF, Waltham MA, USA
| | - Michele R Hacker
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston MA, USA; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston MA, USA; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston MA, USA
| | - Kim Thornton
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston MA, USA; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston MA, USA; Boston IVF, Waltham MA, USA
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Modest AM, Johnson KM, Aluko A, Joshi A, Wise LA, Fox MP, Hacker MR, Sakkas D. Elevated serum progesterone during in vitro fertilization treatment and the risk of ischemic placental disease. Pregnancy Hypertens 2021; 24:7-12. [PMID: 33618055 DOI: 10.1016/j.preghy.2021.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 01/22/2021] [Accepted: 02/04/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Elevated progesterone on the day of human chorionic gonadotropin (hCG) administration is associated with decreased live birth rates in IVF cycles. The association with adverse pregnancy outcomes is unknown. OBJECTIVES Assess the association between serum progesterone on the day of hCG administration and the risk of ischemic placental disease [IPD; preeclampsia, placental abruption, and/or small for gestational age (SGA)]. METHODS We conducted a retrospective cohort study of autologous fresh IVF cycles resulting in delivery between 2005 and 2018. All IVF procedures were conducted at a large, university-affiliated infertility center. Patients were divided into tertiles based on their serum progesterone level on the day of hCG administration; the lowest tertile served as the reference group. We identified pregnancies complicated by preeclampsia and placental abruption using ICD-9/10 codes and medical record review. We defined SGA as < 10th percentile using U.S. growth curves. RESULTS The cohort included 166 deliveries in the lowest tertile of progesterone (0.2-0.73 ng/ml), 166 deliveries in the middle (0.64-1.05 ng/ml) and 167 deliveries in the highest tertile (1.05-5.6 ng/ml). Compared with the lowest tertile, the risk of IPD was greater in the middle (RR 1.6; 95% CI 1.1-2.5) tertile after adjustment for age, parity, number of oocytes retrieved, and estradiol. The highest tertile was also not associated with an increased risk of IPD. CONCLUSION In an IVF population, elevated serum progesterone in the range of 0.64-1.05 ng/mL on the day of hCG administration was associated with a small increased risk of IPD.
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Affiliation(s)
- Anna M Modest
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA, USA.
| | - Katherine M Johnson
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA, USA
| | - Ashley Aluko
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA, USA
| | | | - Lauren A Wise
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Matthew P Fox
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA; Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Michele R Hacker
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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13
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Renati S, Henderson C, Aluko A, Burgin S. Basal cell carcinoma of the vulva: a case report and systematic review of the literature. Int J Dermatol 2018; 58:892-902. [DOI: 10.1111/ijd.14307] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 09/10/2018] [Accepted: 10/24/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Sruthi Renati
- Department of Dermatology University of Michigan Ann Arbor MI USA
| | | | - Ashley Aluko
- Department of Obstetrics and Gynecology Beth Israel Deaconess Medical Center Boston MA USA
| | - Susan Burgin
- Department of Dermatology Beth Israel Deaconess Medical Center Boston MA USA
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14
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Aluko A, Vaughan D, Modest A, Murphy L, Seidler E, Duvall D, Hacker M, Penzias A, Toth T, Sakkas D. Do multiple cryopreservation-warm cycles coupled with blastocyst biopsy impact IVF outcomes? Fertil Steril 2018. [DOI: 10.1016/j.fertnstert.2018.07.265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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15
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Aluko A, Rana J, Burgin S. Teaching & Learning Tips 9: Case-based teaching with patients. Int J Dermatol 2018; 57:858-861. [PMID: 29878314 DOI: 10.1111/ijd.13781] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 08/09/2017] [Accepted: 08/22/2017] [Indexed: 11/30/2022]
Abstract
Challenge: "Case-based teaching" is a buzzword for engaging clinical teaching through cases, but how can it be implemented effectively in practice? We review popular case-based teaching methods (i.e., one-minute preceptor, SNAPPS, and the "Aunt Minnie method") for use during traditional one-on-one clinical preceptorships in the ambulatory dermatological setting.
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Affiliation(s)
- Ashley Aluko
- Department of OBGYN, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - Susan Burgin
- Harvard Medical School, Boston, MA, USA.,Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, MA, USA
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16
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Aluko A, Rana J, Burgin S. Teaching & Learning Tips 8: Preparing to teach in ambulatory settings. Int J Dermatol 2018; 57:715-718. [DOI: 10.1111/ijd.13784] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 08/09/2017] [Accepted: 08/22/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Ashley Aluko
- Department of OBGYN; Beth Israel Deaconess Medical Center; Boston MA USA
| | | | - Susan Burgin
- Harvard Medical School; Boston MA USA
- Department of Dermatology; Beth Israel Deaconess Medical Center; Boston MA USA
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17
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Winston JB, Schulkey CE, Chen IBD, Regmi SD, Efimova M, Erlich JM, Green CA, Aluko A, Jay PY. Complex trait analysis of ventricular septal defects caused by Nkx2-5 mutation. ACTA ACUST UNITED AC 2012; 5:293-300. [PMID: 22534315 DOI: 10.1161/circgenetics.111.961136] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The occurrence of a congenital heart defect has long been thought to have a multifactorial basis, but the evidence is indirect. Complex trait analysis could provide a more nuanced understanding of congenital heart disease. METHODS AND RESULTS We assessed the role of genetic and environmental factors on the incidence of ventricular septal defects (VSDs) caused by a heterozygous Nkx2-5 knockout mutation. We phenotyped >3100 hearts from a second-generation intercross of the inbred mouse strains C57BL/6 and FVB/N. Genetic linkage analysis mapped loci with lod scores of 5 to 7 on chromosomes 6, 8, and 10 that influence the susceptibility to membranous VSDs in Nkx2-5(+/-) animals. The chromosome 6 locus overlaps one for muscular VSD susceptibility. Multiple logistic regression analysis for environmental variables revealed that maternal age is correlated with the risk of membranous and muscular VSD in Nkx2-5(+/-) but not wild-type animals. The maternal age effect is unrelated to aneuploidy or a genetic polymorphism in the affected individuals. The risk of a VSD is not only complex but dynamic. Whereas the effect of genetic modifiers on risk remains constant, the effect of maternal aging increases over time. CONCLUSIONS Enumerable factors contribute to the presentation of a congenital heart defect. The factors that modify rather than cause congenital heart disease substantially affect risk in predisposed individuals. Their characterization in a mouse model offers the potential to narrow the search space in human studies and to develop alternative strategies for prevention.
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Affiliation(s)
- Julia B Winston
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
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18
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Adaramoye OA, Aluko A, Oyagbemi AA. Cnidoscolus aconitifolius Leaf Extract Protects against Hepatic Damage Induced by Chronic Ethanol Administration in Wistar Rats. Alcohol Alcohol 2011; 46:451-8. [DOI: 10.1093/alcalc/agr060] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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19
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Adaramoye OA, Aluko A. Methanolic Extract of Cnidoscolus aconitifolius Attenuates Renal Dysfunction Induced by Chronic Ethanol Administration in Wistar Rats. Alcohol Alcohol 2010; 46:4-9. [DOI: 10.1093/alcalc/agq082] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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20
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Winston JB, Erlich JM, Green CA, Aluko A, Kaiser KA, Takematsu M, Barlow RS, Sureka AO, LaPage MJ, Janss LL, Jay PY. Heterogeneity of genetic modifiers ensures normal cardiac development. Circulation 2010; 121:1313-21. [PMID: 20212279 PMCID: PMC2953850 DOI: 10.1161/circulationaha.109.887687] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Mutations of the transcription factor Nkx2-5 cause pleiotropic heart defects with incomplete penetrance. This variability suggests that additional factors can affect or prevent the mutant phenotype. We assess here the role of genetic modifiers and their interactions. METHODS AND RESULTS Heterozygous Nkx2-5 knockout mice in the inbred strain background C57Bl/6 frequently have atrial and ventricular septal defects. The incidences are substantially reduced in the Nkx2-5(+/-) progeny of first-generation (F1) outcrosses to the strains FVB/N or A/J. Defects recur in the second generation (F2) of the F1 X F1 intercross or backcrosses to the parental strains. Analysis of >3000 Nkx2-5(+/-) hearts from 5 F2 crosses demonstrates the profound influence of genetic modifiers on disease presentation. On the basis of their incidences and coincidences, anatomically distinct malformations have shared and unique modifiers. All 3 strains carry susceptibility alleles at different loci for atrial and ventricular septal defects. Relative to the other 2 strains, A/J carries polymorphisms that confer greater susceptibility to atrial septal defect and atrioventricular septal defects and C57Bl/6 to muscular ventricular septal defects. Segregation analyses reveal that > or = 2 loci influence membranous ventricular septal defect susceptibility, whereas > or = loci and at least 1 epistatic interaction affect muscular ventricular and atrial septal defects. CONCLUSIONS Alleles of modifier genes can either buffer perturbations on cardiac development or direct the manifestation of a defect. In a genetically heterogeneous population, the predominant effect of modifier genes is health. (Circulation. 2010;121:1313-1321.)
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MESH Headings
- Animals
- Disease Models, Animal
- Female
- Genetic Predisposition to Disease/genetics
- Heart/embryology
- Heart Defects, Congenital/epidemiology
- Heart Defects, Congenital/genetics
- Heart Septal Defects, Atrial/epidemiology
- Heart Septal Defects, Atrial/genetics
- Heart Septal Defects, Ventricular/epidemiology
- Heart Septal Defects, Ventricular/genetics
- Homeobox Protein Nkx-2.5
- Homeodomain Proteins/genetics
- Incidence
- Male
- Mice
- Mice, Inbred C57BL
- Mice, Inbred Strains
- Mice, Knockout
- Mutation/genetics
- Phenotype
- Risk Factors
- Transcription Factors/genetics
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Affiliation(s)
- Julia B Winston
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO 63110, USA
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