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Laqqan MM, Yassin MM. Investigation of the Predictive Factors of Diminished Ovarian Reserve in Women Aged Less Than 40 Years and Undergoing ICSI Cycle. Reprod Sci 2023; 30:873-882. [PMID: 36002711 DOI: 10.1007/s43032-022-01055-1] [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: 04/14/2022] [Accepted: 07/30/2022] [Indexed: 11/30/2022]
Abstract
Diminished ovarian reserve (DOR) is one of the primary causes of poor ICSI outcomes. Therefore, this study was performed to speculate which of the following parameters: AMH, AFC, and women's age can be used as a predictor factor of the DOR in women aged < 40 years. This prospective study enrolled 500 women suffering from idiopathic infertility problems and who underwent GnRH antagonist multiple-dose stimulation protocol. The women were divided into two groups: normal fertility (FSH ≤ 10 mIU/mL, n = 300) and DOR (FSH > 10 mIU/mL, n = 200). At the time of the study, the average of women age was 29.3 ± 5.7 years. A significant reduction was found in AMH level, AFC, number of mature, immature oocytes, fertilized oocytes, embryos transferred, and β-hCG level in the DOR group compared to the normal fertility group (P < 0.001). Conversely, a significant increase was shown in the age of the DOR group compared to the normal fertility group (30.8 ± 5.8 vs. 28.2 ± 5.4, respectively; P < 0.001). A significant negative association was found between the AFC, the number of mature oocytes, fertilized oocytes, embryos transferred, and the basal level of FSH in the DOR group (P < 0.01). The receiver operating characteristics (ROC) demonstrated that AMH level and AFC had the highest accuracy, followed by age in the prediction of DOR (P < 0.001) with a cut-off value of ≤ 1.2 ng/mL, ≤ 4.5, and > 29.5 years, respectively. This study exhibited that the levels of AMH and AFC are the best biomarkers, followed by age for the prediction of DOR in women < 40 years old. Furthermore, AMH is the only independent factor that is significantly related to DOR in women.
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Affiliation(s)
- Mohammed M Laqqan
- Faculty of Health Sciences, Department of Medical Laboratory Sciences, Islamic University, P.O. Box 108, Gaza, Palestine.
| | - Maged M Yassin
- Faculty of Medicine, Department of Human Physiology, Islamic University, P.O. Box 108, Gaza, Palestine
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Bosselut H, Paulmyer-Lacroix O, Gnisci A, Bretelle F, Perrin J, Courbiere B. [Prognostic factors of live-birth after in vitro fertilization for unexplained infertility: A cohort study]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2021; 49:601-607. [PMID: 33434750 DOI: 10.1016/j.gofs.2021.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES For 15 to 30% of infertile couples, no etiology can be found, leading to the diagnosis of "unexplained infertility". The aim of our study was to identify prognostic factors for live birth following in vitro fertilization (IVF) for these couples. METHODS A retrospective, monocentric study on a cohort of couples undergoing IVF for unexplained infertility with the woman aged≤40 years old. Primary analysis compared couples with a live birth following IVF versus childless couples following IVF. RESULTS Between January 2014 and December 2018, 104 couples were included, 196 transvaginal oocyte pickup were performed, followed by 234 embryo transfers (fresh or cryopreserved) which resulted in 43 deliveries. The cumulative live birth rate was 40.4% per couple. Before IVF attempts, no clinical or paraclinical prognostic factors between the two groups was observed. However, multivariate analysis showed several biological factors of good prognosis in course of treatment, such as a higher number of mature oocytes and better quality embryos in "live birth" group. CONCLUSIONS For a couple, the chances of having a child following IVF unexplained infertility are 40.4%. However, no clinical characteristic enabled us to identify favourable or unfavourable prognosis factors before starting ART. The prognostic factors identified during IVF cycle are interesting to advise or not to pursue IVF.
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Affiliation(s)
- H Bosselut
- Pôle femmes-parents-enfants, centre clinico-biologique d'AMP-CECOS, AP-HM La Conception, 147, boulevard Baille, 13005 Marseille, France.
| | - O Paulmyer-Lacroix
- Pôle femmes-parents-enfants, centre clinico-biologique d'AMP-CECOS, AP-HM La Conception, 147, boulevard Baille, 13005 Marseille, France; Aix Marseille université, département d'histologie et embryologie, Marseille, France
| | - A Gnisci
- Pôle femmes-parents-enfants, centre clinico-biologique d'AMP-CECOS, AP-HM La Conception, 147, boulevard Baille, 13005 Marseille, France
| | - F Bretelle
- Pôle femmes-parents-enfants, centre clinico-biologique d'AMP-CECOS, AP-HM La Conception, 147, boulevard Baille, 13005 Marseille, France; Aix Marseille université, unité de recherche sur les maladies infectieuses tropicales et émergentes, UM 63, CNRS 7278, IRD 198, Inserm 1095, Marseille, France
| | - J Perrin
- Pôle femmes-parents-enfants, centre clinico-biologique d'AMP-CECOS, AP-HM La Conception, 147, boulevard Baille, 13005 Marseille, France; Aix Marseille université, CNRS, IRD, Avignon université, IMBE, Marseille, France
| | - B Courbiere
- Pôle femmes-parents-enfants, centre clinico-biologique d'AMP-CECOS, AP-HM La Conception, 147, boulevard Baille, 13005 Marseille, France; Aix Marseille université, CNRS, IRD, Avignon université, IMBE, Marseille, France
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Wu J, Zhang J, Kuang Y, Chen Q, Wang Y. The effect of Day 3 cell number on pregnancy outcomes in vitrified-thawed single blastocyst transfer cycles. Hum Reprod 2021; 35:2478-2487. [PMID: 32944763 DOI: 10.1093/humrep/deaa209] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 07/18/2020] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION Does cell number on Day 3 have an impact on pregnancy outcomes in vitrified-thawed single blastocyst transfer cycles? SUMMARY ANSWER A low Day 3 cell number (≤5 cells) was independently associated with decreased live birth rate (LBR) during single blastocyst transfer cycles in young women. WHAT IS KNOWN ALREADY Day 3 cell number is an effective predictor of IVF success rates when transferring cleavage stage embryos. However, the association between Day 3 blastomere number and pregnancy outcomes after blastocyst transfer is still unknown. STUDY DESIGN, SIZE, DURATION A retrospective cohort study of 3543 patients who underwent frozen-thawed single blastocyst transfers from January 2013 to June 2018 at a tertiary-care academic medical center. PARTICIPANTS/MATERIALS, SETTING, METHODS Patients were grouped into six groups according to the Day 3 cell number: ≤4 cells, 5 cells, 6 cells, 7 cells, 8 cells and >8 cells. The primary outcome measure was LBR. A logistic regression analysis was performed to explore the independent association between Day 3 blastomere number and LBR after adjustment for some potential confounders. MAIN RESULTS AND THE ROLE OF CHANCE In women <35 years old, the LBR varied significantly according to Day 3 cell number, with the rate of 31.2%, 34.4%, 41.9%, 45.1%, 48.1% and 48.2% for the ≤4-cell, 5-cell, 6-cell, 7-cell, 8-cell and >8-cell groups, respectively (P < 0.001). This significant difference was also observed in the high- and low-quality blastocyst subgroups of young women. However, for women ≥35 years old, the rate of live birth was similar between groups. Furthermore, after accounting for confounding factors, the LBR was significantly decreased in the ≤4-cell (adjusted odds ratio (aOR): 0.62, 95% CI: 0.48-0.80, P < 0.001) and 5-cell (aOR: 0.73, 95% CI: 0.57-0.92, P = 0.009) groups as compared to the 8-cell group. Likewise, the blastocysts arising from ≤4-cell (aOR: 0.73, 95% CI: 0.57-0.93, P = 0.010) or 5-cell (aOR: 0.77, 95% CI: 0.61-0.97, P = 0.024) embryos were associated with lower clinical pregnancy rate than those from 8-cell embryos. No significant differences were observed in biochemical pregnancy rate and miscarriage rate. LIMITATIONS, REASONS FOR CAUTION A limitation of the current study was its retrospective design. Future prospective studies are needed to confirm our findings. WIDER IMPLICATIONS OF THE FINDINGS Our observations suggested that a low Day 3 cell number was related to decreased LBR after blastocyst transfer in young women, which provided vital information for clinicians in selecting blastocyst during IVF treatment. STUDY FUNDING/COMPETING INTEREST(S) This study was supported by the National Natural Science Foundation of China (NSFC) (31770989 to Y.W.; 81671520 to Q.C.) and the Shanghai Ninth People's Hospital Foundation of China (JYLJ030 to Y.W.). The authors have no conflicts of interest to declare. TRIAL REGISTRATION NUMBER N/A.
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Aghajanova L, Kao CN, Cedars M, Tran N. Assessing the impact of semen quality on embryo development in an egg donation model. F S Rep 2021; 2:22-29. [PMID: 34223269 PMCID: PMC8244319 DOI: 10.1016/j.xfre.2020.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 10/22/2020] [Accepted: 10/29/2020] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To investigate if any of the World Health Organization semen parameters and/or male age are associated with embryo development. DESIGN Retrospective chart review between January 2008 and May 2015. SETTING Academic fertility practice. PATIENTS Anonymous egg donors aged ≤30 years. INTERVENTIONS Chart review. MAIN OUTCOME MEASURES Sperm parameters were evaluated on a continuum and were dichotomized to determine if low values (strict morphology < 4%, concentration < 15 × 106, low motility < 40%) or older age (>50 years) are associated with embryo morphology. Repeated linear regression measures to determine the associations and multivariate testing to determine independent effects for each predictor were performed. RESULTS Three hundred eighty-four donors with 574 egg donation cycles were identified, and 205 subjects with 275 cycles were included in the final analysis. The mean donor age was 25.31 ± 2.81 years, with a mean antral follicle count of 28.09 ± 10.5. The mean male age was 43.25 ± 6.65 years. The mean World Health Organization semen parameters at fertilization were 55.8 × 106 ± 44.3 × 106/mL concentration, 44.8% ± 20.2% motility, and 6.9% ± 5.3% strict morphology. Neither male age nor sperm morphology was associated with embryo morphology. A low total motile count was significantly associated with a higher cell number in day-3 embryos and a 1.56-times higher chance of poor day-3 cell symmetry. There was no statistically significant difference in blastocyst formation, clinical pregnancy, or live-birth rates. CONCLUSIONS Although statistically significant, the effect of the low total motile count on day-3 cell number and cell symmetry are likely clinically insignificant. Male age, race, or poor sperm morphology were not associated with a poor cycle outcome or impaired embryo development. The use of intracytoplasmic sperm injection likely alleviates the negative effect of diminished semen quality on treatment outcome.
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Affiliation(s)
- Lusine Aghajanova
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, California
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Stanford School of Medicine, Sunnyvale, California
| | - Chia-Ning Kao
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, California
| | - Marcelle Cedars
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, California
| | - Nam Tran
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, California
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Huang J, Tao Y, Zhang J, Yang X, Wu J, Kuang Y, Wang Y. Poor Embryo Quality Is Associated With A Higher Risk of Low Birthweight in Vitrified-Warmed Single Embryo Transfer Cycles. Front Physiol 2020; 11:415. [PMID: 32499716 PMCID: PMC7243353 DOI: 10.3389/fphys.2020.00415] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 04/06/2020] [Indexed: 12/17/2022] Open
Abstract
Background Previous studies have reported the association between embryo quality and perinatal outcomes in fresh cycles, after cleavage-stage or blastocyst embryo transfer, and found no significant difference. However, in terms of vitrified-warmed embryo transfer cycles, the impact of embryo quality on neonatal and maternal outcomes has not been evaluated. Objectives To explore the association between the quality of a single vitrified-warmed embryo and perinatal outcomes. Methods This retrospective study included 2403 live-born singletons derived from single vitrified-warmed embryo transfer cycles during January 2006 and July 2018. Neonatal and maternal outcomes were compared between singletons resulting from the use of single good quality embryo (GQE) (n = 1854) and single poor quality embryo (PQE) (n = 549) and analyzed in the group of cleavage-stage embryo transfer and the group of blastocyst transfer, respectively. Results A significantly higher risk of low birthweight (LBW, birthweight <2500 g) was observed in the singletons derived from the transfer of single PQE compared with those derived from the transfer of single GQE both in cleavage and blastocyst stages (cleavage-stage, AOR 2.62, 95% CI 1.27-5.37; blastocyst stage, AOR 1.98, 95% CI 1.06-3.70). An increased risk of preterm birth (PTB, gestational age <37 weeks) was also observed in singletons born after transfer of a PQE of cleavage-stage compared with those after a GQE of cleavage-stage (AOR 2.40, 95% CI 1.28-4.49). The transfer of single poor quality blastocyst was associated with a higher risk of placenta previa compared with the transfer of single good quality blastocyst (AOR 2.65, 95% CI 1.26-5.57). Other maternal complications, neonatal malformations, and neonatal complications were similar between compared groups. Conclusion In vitrified-warmed cycles with single embryo transfer, poor embryo quality would result in a significantly higher risk of LBW, regardless of cleavage-stage or blastocyst embryo transfer. Meanwhile, the transfer of poor cleavage-stage embryo was also associated with an increased incidence of PTB.
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Affiliation(s)
- Jiaan Huang
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yu Tao
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jie Zhang
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoyan Yang
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiayi Wu
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yanping Kuang
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yun Wang
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Zhao H, Liu H, Li M, Wu K. Clinical outcomes following frozen-thawed blastocyst transfers with blastocysts derived from different cell numbers on day 3: a retrospective cohort study. J Assist Reprod Genet 2020; 37:641-648. [PMID: 31902101 PMCID: PMC7125268 DOI: 10.1007/s10815-019-01664-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 12/12/2019] [Indexed: 10/25/2022] Open
Abstract
PURPOSE To evaluate clinical outcomes after frozen-thawed blastocyst transfer (TBT) with blastocysts which were derived from different cell numbers on day 3. METHODS The study included 1444 patients undergoing single autologous frozen-thawed blastocyst transfer cycles, which were allocated to five groups according to the cell numbers on day 3 of the transferred blastocysts: ≤ 6-cell (n = 109), 7-cell (n = 169), 8-cell (n = 811), 9-cell (n = 136), and ≥ 10-cell (n = 219). RESULTS The LBR of the ≤ 6-cell group was found to be statistically lower than that of the 8-cell group in single TBT cycles which had been transferred with fair quality blastocysts (defined as 4BB according to Gardner's grading scale) (41.28% vs 55.73%, P = 0.004), while the miscarriage rate was significantly higher for the ≤ 6-cell group compared with the 8-cell group (25.00% vs 13.74%, P = 0.02). No differences were found between the two groups in terms of cPR (P = 0.06). However, for blastocysts categorized as high quality according to Gardner's classification (defined as 4AA/4AB/4BA), cPR, LBR, and early miscarriage rates did not differ between the two groups (P = 0.76, P = 0.44, P = 0.40, respectively). CONCLUSIONS When transferring blastocysts, an evaluation of the cleavage stage should be performed along with blastocyst morphology to shorten the time of conceiving.
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Affiliation(s)
- Haibin Zhao
- Center for Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong University, National Research Center for Assisted Reproductive Technology and Reproductive Genetics, No.157 Jingliu Road, Jinan, 250001, People's Republic of China
- The Key laboratory for Reproductive Endocrinology of Ministry of Education, Jinan, China
- Shandong Provincial Key Laboratory of Reproductive Medicine, NO. 157 Jingliu Road, Jinan, 250001, China
| | - Hui Liu
- Center for Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong University, National Research Center for Assisted Reproductive Technology and Reproductive Genetics, No.157 Jingliu Road, Jinan, 250001, People's Republic of China
- The Key laboratory for Reproductive Endocrinology of Ministry of Education, Jinan, China
- Shandong Provincial Key Laboratory of Reproductive Medicine, NO. 157 Jingliu Road, Jinan, 250001, China
| | - Mei Li
- Center for Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong University, National Research Center for Assisted Reproductive Technology and Reproductive Genetics, No.157 Jingliu Road, Jinan, 250001, People's Republic of China
- The Key laboratory for Reproductive Endocrinology of Ministry of Education, Jinan, China
- Shandong Provincial Key Laboratory of Reproductive Medicine, NO. 157 Jingliu Road, Jinan, 250001, China
| | - Keliang Wu
- Center for Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong University, National Research Center for Assisted Reproductive Technology and Reproductive Genetics, No.157 Jingliu Road, Jinan, 250001, People's Republic of China.
- The Key laboratory for Reproductive Endocrinology of Ministry of Education, Jinan, China.
- Shandong Provincial Key Laboratory of Reproductive Medicine, NO. 157 Jingliu Road, Jinan, 250001, China.
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Yang X, Huang R, Cai M, Liang X. Endometriosis has no negative impact on outcomes of in vitro fertilisation in women with poor ovarian response. BJOG 2018; 123 Suppl 3:76-81. [PMID: 27627604 DOI: 10.1111/1471-0528.14018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2016] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To compare the in vitro fertilisation (IVF) outcomes of poor ovarian responders among women with laparoscopically diagnosed minimal-mild endometriosis (Group A), moderate-severe endometriosis (Group B) and those without endometriosis (Group C). The comparisons were made separately for age groups younger than 35 years and 35 years or older. DESIGN Retrospective study. SETTING A university-affiliated hospital in Guangzhou, China. POPULATION 495 women younger than 35 years old and 543 women aged 35 or older who had poor ovarian response with or without laparoscopically diagnosed endometriosis. METHODS Poor ovarian response (POR) was diagnosed using the Bologna criteria. First cycle parameters were analysed over the same period of time from January 2011 to October 2014. MAIN OUTCOME MEASURES The primary endpoint was the live birth rate per embryo transfer cycle. Secondary outcome measures were clinical pregnancy rate, cycle cancellation rate and miscarriage rate. RESULTS In women aged 35 or older no differences were found among the three subgroups in terms of live birth rate, clinical pregnancy rate, cycle cancellation rate or miscarriage rate; in women aged younger than 35 years, the clinical pregnancy rates were 62.96, 45.45 and 43.27% for Groups A, B and C, respectively (P = 0.028). The live birth rate, cycle cancellation rate and miscarriage rate were not significantly different. Compared with the older group of women, the younger women had a significantly higher live birth rate (P < 0.001). CONCLUSIONS A woman's age is the most important factor governing the live birth rate with IVF. Endometriosis has no consistent impact on IVF outcomes in women with POR. TWEETABLE ABSTRACT Endometriosis has no negative impact on IVF outcomes in women with poor ovarian response.
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Affiliation(s)
- X Yang
- Reproductive Medicine Centre, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - R Huang
- Reproductive Medicine Centre, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - M Cai
- Reproductive Medicine Centre, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - X Liang
- Reproductive Medicine Centre, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China.
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Fan Y, Zhang X, Hao Z, Ding H, Chen Q, Tian L. Effectiveness of mild ovarian stimulation versus GnRH agonist protocol in women undergoing assisted reproductive technology: a meta-analysis. Gynecol Endocrinol 2017; 33:746-756. [PMID: 28508683 DOI: 10.1080/09513590.2017.1320385] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE our meta-analysis was conducted to evaluate the effectiveness of the mild ovulation induction protocol using CC/gonadotropin/GnRH antagonist compared to the conventional GnRH agonist protocol in women undergoing ART. METHOD Six electronic databases were searched from their date of establishment until August 2016. Outcomes in our analysis were calculated in terms of relative risk (RR) and weighted mean differences (WMD) and standard mean differences (SMD) with 95% confidence intervals (CI) using random effect models or fixed effect models. RESULTS Six prospective controlled clinical trials with 1543 women comparing the clinical impacts of the two protocols were included. The synthesized results suggested a significant reduction in the quantity of gonadotropins (SMD: -1.96, 95% CI: -2.28 to 1.64, I2 = 78.5%), the incidence of OHSS (RR: 0.16, 95% CI 0.03-0.86, I2 = 0%) and an increase in the cycle cancelation rate (RR: 1.46, 95% CI 1.05-2.03, I2 = 89.4%). While no evidence of statistically significant differences between the groups existed in the other clinical outcomes. CONCLUSION This study suggested that the probable benefits of the mild protocol, including its less costs and safer process without reducing the overall IVF treatment success rates, seemed to make it a better treatment option. Larger sample prospective trials evaluating live birth, clinical pregnancy, OHSS, multiple pregnancy incidence and so on were desired to establish.
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Affiliation(s)
- Yuan Fan
- a Reproductive Medical Centre, Peking University People's Hospital , Beijing , China
| | - Xiaowei Zhang
- b Department of Urology , Peking University People's Hospital , Beijing , China , and
| | - Zhidong Hao
- c Department of Obstetrics and Gynecology , Haidian Maternal & Child Health Hospital , Beijing , China
| | - Huanfei Ding
- a Reproductive Medical Centre, Peking University People's Hospital , Beijing , China
| | - Quanyu Chen
- a Reproductive Medical Centre, Peking University People's Hospital , Beijing , China
| | - Li Tian
- a Reproductive Medical Centre, Peking University People's Hospital , Beijing , China
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Tan J, Zou Y, Wu XW, Tian LF, Su Q, He JX, Huang ZH, Zhao Y, Wu LP, Wu QF. Increased SCF in Follicular Fluid and Granulosa Cells Positively Correlates With Oocyte Maturation, Fertilization, and Embryo Quality in Humans. Reprod Sci 2017; 24:1544-1550. [PMID: 28285567 DOI: 10.1177/1933719117697125] [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] [Indexed: 01/25/2023]
Abstract
Stem cell factor (SCF), which is derived from granulosa cells (GCs), plays a key role in the process of follicular development and oocyte maturation. The present study aimed to explore whether the levels of SCF in follicular fluid (FF) and GCs can be used as a potential marker for predicting oocyte developmental potential. Follicular fluid and GC samples from 150 female patients undergoing intracytoplasmic sperm injection were collected in this study. The SCF concentrations in FFs and SCF messenger RNA (mRNA) in GCs were evaluated by using enzyme-linked immunosorbent assay and real-time polymerase chain reaction, respectively. The results showed that the levels of SCF protein and mRNA were significantly associated with oocyte maturation, normal fertilization, cleavage, and embryo quality. Moreover, the levels of SCF protein and mRNA in pregnancy group were also higher than those in the nonpregnancy group. The cutoff value of SCF in FF for predicting high-quality embryo was 1.346, with a sensitivity of 57.8% and a specificity of 72.4%, and the cutoff value of SCF in GCs for predicting high-quality embryo was 6.650, with a sensitivity of 64.4% and a specificity of 78.1%. In conclusion, our results showed a positive and statistically significant relationship between SCF level and oocyte maturation, normal fertilization, cleavage, embryo quality, and clinical pregnancy. Therefore, the levels of SCF in FF and GCs might be considered as a new marker for predicting oocyte developmental potential.
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Affiliation(s)
- Jun Tan
- 1 Reproductive Medicine Center, Jiangxi Provincial Maternal and Child Health Hospital, Nanchang, Jiangxi, People's Republic of China
| | - Yang Zou
- 2 Key Laboratory of Women's Reproductive Health of Jiangxi Province, Jiangxi Provincial Maternal and Child Health Hospital, Nanchang, Jiangxi, People's Republic of China
| | - Xing-Wu Wu
- 1 Reproductive Medicine Center, Jiangxi Provincial Maternal and Child Health Hospital, Nanchang, Jiangxi, People's Republic of China
| | - Li-Feng Tian
- 1 Reproductive Medicine Center, Jiangxi Provincial Maternal and Child Health Hospital, Nanchang, Jiangxi, People's Republic of China
| | - Qiong Su
- 1 Reproductive Medicine Center, Jiangxi Provincial Maternal and Child Health Hospital, Nanchang, Jiangxi, People's Republic of China
| | - Jin-Xia He
- 1 Reproductive Medicine Center, Jiangxi Provincial Maternal and Child Health Hospital, Nanchang, Jiangxi, People's Republic of China
| | - Zhi-Hui Huang
- 1 Reproductive Medicine Center, Jiangxi Provincial Maternal and Child Health Hospital, Nanchang, Jiangxi, People's Republic of China
| | - Yan Zhao
- 1 Reproductive Medicine Center, Jiangxi Provincial Maternal and Child Health Hospital, Nanchang, Jiangxi, People's Republic of China
| | - Li-Ping Wu
- 3 Department of Blood Transfusion, Jiangxi Provincial People's Hospital, Nanchang, Jiangxi, People's Republic of China
| | - Qiong-Fang Wu
- 1 Reproductive Medicine Center, Jiangxi Provincial Maternal and Child Health Hospital, Nanchang, Jiangxi, People's Republic of China
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Cohen J, Chabbert-Buffet N, Darai E. Diminished ovarian reserve, premature ovarian failure, poor ovarian responder--a plea for universal definitions. J Assist Reprod Genet 2015; 32:1709-12. [PMID: 26463876 DOI: 10.1007/s10815-015-0595-y] [Citation(s) in RCA: 151] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Accepted: 10/05/2015] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Diminished ovarian reserve (DOR) is characterized by poor fertility outcomes, and it represents a major challenge in reproductive medicine. Although consensus exists on the concept of DOR, its definition remains blurry. DOR has to be distinguished from premature ovarian failure (POF) and poor ovarian responders (POR), who are clearly defined. METHODS We performed a PubMed search with the terms "diminished ovarian reserve" and "in vitro fertilization (IVF)" to assess the homogeneity of the definition of DOR. RESULTS Out of 121 articles, 14 gave a definition for DOR. Only one definition was used by two different teams (basal follicle-stimulating hormone (FSH) value >10 IU/l) and eight teams used 11 different definitions. Among those, four definitions did not include antral follicular count (AFC) and seven studies did. Two definitions included the results from a previous cycle. CONCLUSIONS The heterogeneity in the definition of DOR used in these studies contributes to confusing results. Hence, there is a need for a clear definition of DOR. It appears that AFC and anti-Müllerian hormone (AMH) serum levels are the most relevant criteria. One option could be the use of the following definition: (i) woman with any of the risk factors for POR and/or (ii) an abnormal ovarian reserve test (i.e., antral follicular count (AFC) <5-7 follicles or AMH <0.5-1.1 ng/ml). This hypothesis requires validation.
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Affiliation(s)
- J Cohen
- Service de Gynécologie-Obstétrique, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, GRC 6-UPMC Centre Expert en Endométriose (C3E), Université Pierre et Marie Curie Paris 6, Paris, France.
- Inserm UMRS938, Université Pierre et Marie Curie, Paris, France.
| | - N Chabbert-Buffet
- Service de Gynécologie-Obstétrique, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, GRC 6-UPMC Centre Expert en Endométriose (C3E), Université Pierre et Marie Curie Paris 6, Paris, France
- Inserm UMRS938, Université Pierre et Marie Curie, Paris, France
| | - E Darai
- Service de Gynécologie-Obstétrique, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, GRC 6-UPMC Centre Expert en Endométriose (C3E), Université Pierre et Marie Curie Paris 6, Paris, France
- Inserm UMRS938, Université Pierre et Marie Curie, Paris, France
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Perinatal outcomes of patients who achieved pregnancy with a morphologically poor embryo via assisted reproductive technology. Arch Gynecol Obstet 2015. [PMID: 26202135 DOI: 10.1007/s00404-015-3815-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To learn more about the perinatal outcomes of conception via the use of low-grade embryos, we evaluated the relationship between the status of transferred embryos and the resultant perinatal outcomes. METHODS A total of 340 patients who achieved pregnancy via ART treatment and consequently delivered in our clinic between April 2009 and March 2014 were recruited for this study. Patients were divided into two groups according to a morphological assessment of the transferred embryos, which relegated 79 patients into a poor-embryo group with the remainders (n = 261) placed into a good-embryo group. RESULTS The mean maternal age for the poor-embryo group was 36.0 years, which was similar to the good-embryo group (36.8). In both groups, the percentages of fresh ET cycles were similar. The values for the mean birth weight and birth height of infants in the poor-embryo group were 3055 g and 50.3 cm, respectively, and there were no significant differences with the good-embryo group. The umbilical blood gas analysis in the poor-quality group was similar to that in the good-embryo group. There were no obvious major anomalies among the infants of either group. CONCLUSIONS The perinatal outcomes of the poor-embryo group were comparable to those of the good-embryo group. Based on these results, we can provide qualified assurance for a normal perinatal outcome to patients who had no choice but to undergo embryo transfer with a poor-quality embryo.
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Increased blastomere number in cleavage-stage embryos is associated with higher aneuploidy. Fertil Steril 2014; 103:694-8. [PMID: 25557243 DOI: 10.1016/j.fertnstert.2014.12.090] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2014] [Revised: 11/18/2014] [Accepted: 12/01/2014] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To evaluate the relationship between blastomere number and aneuploidy. DESIGN Historical cohort study. SETTING In vitro fertilization clinic. PATIENT(S) Two hundred fifty-nine patients undergoing in vitro fertilization (IVF) in combination with comprehensive chromosomal screening of embryos. INTERVENTION(S) A total of 1,915 embryos were biopsied on day 3 and underwent comprehensive chromosomal screening with microarray-based comparative genomic hybridization. MAIN OUTCOME MEASURE(S) Relationship between day 3 blastomere number, aneuploidy rate, and progression to the blastocyst stage. RESULT(S) A number of day 3 blastomeres >9 was associated with significantly increased aneuploidy rates. Rapidly developing embryos were significantly more likely to blastulate regardless of their chromosomal status. Number of embryos per patient greater than 13 was independently associated with lower aneuploidy rates after controlling for maternal age. This trend was not significant with the use of a more clinically relevant threshold of greater than six embryos per patient. CONCLUSION(S) Embryos with 6-9 cells at the cleavage stage should be considered for transfer over embryos with >9 cells. Day 3 blastomere number may be used in conjunction with extended culture to improve selection of euploid embryos, especially when supernumerary embryos are available. Further studies are needed to show if these selection criteria improve clinical outcomes.
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Li Y, Li RQ, Ou SB, Zhang NF, Ren L, Wei LN, Zhang QX, Yang DZ. Increased GDF9 and BMP15 mRNA levels in cumulus granulosa cells correlate with oocyte maturation, fertilization, and embryo quality in humans. Reprod Biol Endocrinol 2014; 12:81. [PMID: 25139161 PMCID: PMC4153897 DOI: 10.1186/1477-7827-12-81] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 07/26/2014] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Oocyte secreted factors (OSFs), including growth differentiation factor 9 (GDF9) and bone morphogenetic protein 15 (BMP15), play an important role in the process of follicular development and oocyte maturation. Since OSFs are expressed in oocytes and cumulus granulosa cells, the aim of the present study was to explore whether the expression levels of GDF9 and BMP15 mRNAs in cumulus granulosa cells can be used as molecular markers for predicting oocyte developmental potential. METHODS Cumulus cells of 2426 cumulus-oocyte complexes were collected from 196 female patients who underwent intracytoplasmic sperm injection (ICSI) and were used for mRNA detection on the egg retrieval day. Pearson correlation analysis was used to analyze the correlation between OSF expression and general physiological parameters. Partial correlation analysis was used to analyze the correlation between OSF expression and oocyte developmental potential. Covariance analysis was used to compare OSF expression among different groups. Receiver operating characteristic curves were used to examine the diagnostic value of GDF9 and BMP15 mRNA for predicting pregnancy. RESULTS The expression levels of GDF9 and BMP15 mRNAs were significantly associated with age, body mass index (BMI), oocyte maturation, normal fertilization, and cleavage rate (P < 0.05). The expression levels of GDF9 and BMP15 mRNAs in the group with high-quality embryos were significantly higher than those in the group without high-quality embryos (P < 0.05). The expression levels of GDF9 and BMP15 mRNAs in the pregnancy group were significantly higher than those in the nonpregnancy group (P < 0.05). The cut-off value of GDF9 mRNA for predicting pregnancy was 4.82, with a sensitivity of 82% and a specificity of 64%. The cut-off value of BMP15 mRNA for predicting pregnancy was 2.60, with a sensitivity of 78% and a specificity of 52%. CONCLUSIONS The expression levels of GDF9 and BMP15 mRNAs were closely associated with oocyte maturation, fertilization, embryo quality, and pregnancy outcome; therefore, GDF9 and BMP15 mRNAs in cumulus granulosa cells may be considered as new molecular markers for predicting oocyte developmental potential.
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Affiliation(s)
- Yi Li
- />Reproductive Medicine Research Center, Memorial Hospital of Sun Yat-Sen University, 107 Yan-jiang-xi Road, Guangzhou, 510120 China
| | - Rui-Qi Li
- />Reproductive Medicine Research Center, Memorial Hospital of Sun Yat-Sen University, 107 Yan-jiang-xi Road, Guangzhou, 510120 China
| | - Song-Bang Ou
- />Reproductive Medicine Research Center, Memorial Hospital of Sun Yat-Sen University, 107 Yan-jiang-xi Road, Guangzhou, 510120 China
| | - Ning-Feng Zhang
- />Reproductive Medicine Research Center, Memorial Hospital of Sun Yat-Sen University, 107 Yan-jiang-xi Road, Guangzhou, 510120 China
| | - Ling Ren
- />Ultrasound Diagnostic Center, First Affiliated Hospital of Gannan Medical Collage, 23 Qing-nian Road, Gangzhou, 341000 China
| | - Li-Na Wei
- />Reproductive Medicine Research Center, Sixth Affiliated Hospital of Sun Yat-Sen University, 17 Shou-gou-ling Road, Guangzhou, 510655 China
| | - Qing-Xue Zhang
- />Reproductive Medicine Research Center, Memorial Hospital of Sun Yat-Sen University, 107 Yan-jiang-xi Road, Guangzhou, 510120 China
| | - Dong-Zi Yang
- />Reproductive Medicine Research Center, Memorial Hospital of Sun Yat-Sen University, 107 Yan-jiang-xi Road, Guangzhou, 510120 China
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Chen Y, Kong S, Tang X, Fu Y, Wang B, Zhang S, Wang H. Preimplantation Mouse Embryo Is a Target for Opioid Ligand-Receptor Signaling1. Biol Reprod 2014; 91:4. [DOI: 10.1095/biolreprod.114.118083] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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Revelli A, Chiadò A, Dalmasso P, Stabile V, Evangelista F, Basso G, Benedetto C. "Mild" vs. "long" protocol for controlled ovarian hyperstimulation in patients with expected poor ovarian responsiveness undergoing in vitro fertilization (IVF): a large prospective randomized trial. J Assist Reprod Genet 2014; 31:809-15. [PMID: 24700398 DOI: 10.1007/s10815-014-0227-y] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 03/20/2014] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND This large prospective, randomized study was designed to compare the "mild" protocol with clomiphene citrate, low-dose gonadotropins and a GnRH-antagonist (CC/Gn/GnRH-ant protocol) with the "long" protocol with a GnRH-agonist and high-dose Gn for the controlled ovarian hyperstimulation (COH) of patients with expected poor ovarian responsiveness undergoing IVF. MATERIALS AND METHODS A total of 695 women with clinical, endocrine and ultrasound characteristics suggesting a low ovarian reserve and a poor responsiveness to COH were recruited and randomly assigned to receive the CC/Gn/GnRH-ant "mild" protocol (mild group, n = 355) or the "long" protocol with high-dose Gn (long group, n = 340). RESULTS The "mild" stimulation led to significantly shorter follicular phase, lower consumption of exogenous Gn and lower peak estradiol level than the "long" regimen. With the "long" protocol, significantly less cycles were cancelled due to the lack of ovarian response; further, it obtained significantly more oocytes, more mature oocytes, more embryos, and a thicker endometrium. As for the final IVF outcome, however, the two stimulation regimens obtained comparable implantation rate, clinical pregnancy rate, and ongoing pregnancy rate at 12 weeks. CONCLUSIONS In conclusion, the "mild" CC/Gn/GnRH-ant stimulation protocol is a valid alternative to the long protocol with high Gn dose as it obtains a comparable success rate and requires significantly less medications, with an obvious economical advantage.
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Affiliation(s)
- Alberto Revelli
- Physiopathology of Reproduction and IVF Unit, Department of Surgical Sciences, University of Torino, St. Anna Hospital, via Ventimiglia 3, 10126, Torino, Italy,
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Broer SL, van Disseldorp J, Broeze KA, Dolleman M, Opmeer BC, Bossuyt P, Eijkemans MJ, Mol BWJ, Broekmans FJ, Broer S, van Disseldorp J, Broeze K, Dolleman M, Opmeer B, Anderson R, Ashrafi M, Bancsi L, Caroppo LE, Copperman A, Ebner T, Eldar Geva M, Erdem M, Greenblatt E, Jayaprakasan K, Fenning R, Klinkert E, Kwee J, Lambalk C, La Marca A, McIlveen M, Merce L, Muttukrishna S, Nelson S, Ng H, Popovic-Todorovic B, Smeenk J, Tomás C, Van der Linden P, van Rooij I, Vladimirov I, Bossuyt P, Eijkemans M, Mol B, Frank B. Added value of ovarian reserve testing on patient characteristics in the prediction of ovarian response and ongoing pregnancy: an individual patient data approach. Hum Reprod Update 2013. [DOI: 10.1093/humupd/dms041] [Citation(s) in RCA: 302] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Simone L. Broer
- Department of Reproductive Medicine, University Medical Center Utrecht, Room F05.126, P.O. Box 85500, Utrecht 3508 GA, The Netherlands
- Department of Obstetrics and Gynaecology, Amsterdam Medical Center, Amsterdam, the Netherlands
| | - Jeroen van Disseldorp
- Department of Reproductive Medicine, University Medical Center Utrecht, Room F05.126, P.O. Box 85500, Utrecht 3508 GA, The Netherlands
- Department of Obstetrics and Gynaecology, Amsterdam Medical Center, Amsterdam, the Netherlands
| | - Kimiko A. Broeze
- Department of Reproductive Medicine, University Medical Center Utrecht, Room F05.126, P.O. Box 85500, Utrecht 3508 GA, The Netherlands
- Department of Obstetrics and Gynaecology, Amsterdam Medical Center, Amsterdam, the Netherlands
| | - Madeleine Dolleman
- Department of Reproductive Medicine, University Medical Center Utrecht, Room F05.126, P.O. Box 85500, Utrecht 3508 GA, The Netherlands
- Department of Obstetrics and Gynaecology, Amsterdam Medical Center, Amsterdam, the Netherlands
| | - Brent C. Opmeer
- Department of Reproductive Medicine, University Medical Center Utrecht, Room F05.126, P.O. Box 85500, Utrecht 3508 GA, The Netherlands
- Department of Obstetrics and Gynaecology, Amsterdam Medical Center, Amsterdam, the Netherlands
| | - Patrick Bossuyt
- Department of Reproductive Medicine, University Medical Center Utrecht, Room F05.126, P.O. Box 85500, Utrecht 3508 GA, The Netherlands
- Department of Obstetrics and Gynaecology, Amsterdam Medical Center, Amsterdam, the Netherlands
| | - Marinus J.C. Eijkemans
- Department of Reproductive Medicine, University Medical Center Utrecht, Room F05.126, P.O. Box 85500, Utrecht 3508 GA, The Netherlands
- Department of Obstetrics and Gynaecology, Amsterdam Medical Center, Amsterdam, the Netherlands
| | - Ben-Willem J. Mol
- Department of Reproductive Medicine, University Medical Center Utrecht, Room F05.126, P.O. Box 85500, Utrecht 3508 GA, The Netherlands
- Department of Obstetrics and Gynaecology, Amsterdam Medical Center, Amsterdam, the Netherlands
| | - Frank J.M. Broekmans
- Department of Reproductive Medicine, University Medical Center Utrecht, Room F05.126, P.O. Box 85500, Utrecht 3508 GA, The Netherlands
- Department of Obstetrics and Gynaecology, Amsterdam Medical Center, Amsterdam, the Netherlands
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Lee H, Kim J, Yang H. Steroidogenic acute regulatory protein (StAR) and peripheral-type benzodiazepine receptor (PBR) are decreased in human apoptotic embryos. Anim Cells Syst (Seoul) 2011. [DOI: 10.1080/19768354.2011.604102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Kunt C, Ozaksit G, Keskin Kurt R, Cakir Gungor AN, Kanat-Pektas M, Kilic S, Dede A. Anti-Mullerian hormone is a better marker than inhibin B, follicle stimulating hormone, estradiol or antral follicle count in predicting the outcome of in vitro fertilization. Arch Gynecol Obstet 2011; 283:1415-21. [PMID: 21562964 DOI: 10.1007/s00404-011-1889-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Accepted: 02/24/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The present study aims to compare anti-Mullerian hormone (AMH) with other ovarian reserve markers and to find a cut-off value of AMH for predicting ovarian response towards controlled ovarian hyperstimulation in an in vitro fertilization (IVF) program. MATERIALS AND METHODS A prospective analysis was performed in 180 patients undergoing their first IVF trial, which is being conducted at a department of assisted reproduction in a tertiary medical center. The main outcome measures were determined as age and antral follicle count as well as the serum concentrations of follicle stimulating hormone, luteinizing hormone (LH), estradiol (E2), inhibin B and AMH. The predictive power of the aforementioned measures in specifying ovarian response was determined by means of discriminate analyses. RESULTS As expected, day 3 LH levels were significantly high in the poor responder group. The poor responders had significantly lower antral follicle counts, retrieved oocyte number, and mature oocyte counts as well as day 3 AMH levels (5.8 ± 2.32 vs. 1.8 ± 0.80 ng/ml). There was a positive correlation with antral follicle count, basal AMH, E2 and follicle count on the day of HCG administration and negative correlation with age. The AMH level was addressed as the only significant factor in determination of mature oocyte number. A cut-off point for serum AMH concentration indicating the value of 2.97 ng/ml was found to predict the poor ovarian response with a sensitivity of 100.0% and a specificity of 89.6%. However, the same cut-off point was not as predictive for the non-conception circumstance. CONCLUSION The present study concludes that AMH is a promising biochemical marker for the prediction of ovarian response and that a cut-off point indicating the value of 2.97 ng/ml can be adopted for this prediction.
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Affiliation(s)
- Cigdem Kunt
- Department of Assisted Reproduction Technology, Dr. Zekai Tahir Burak Women Health Research and Education Hospital, Yunus Emre Mah., Dereboyu Sok. No: 71/2 Yenimahalle 06170, Ankara, Turkey
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Revelli A, Casano S, Salvagno F, Delle Piane L. Milder is better? Advantages and disadvantages of "mild" ovarian stimulation for human in vitro fertilization. Reprod Biol Endocrinol 2011; 9:25. [PMID: 21324155 PMCID: PMC3048523 DOI: 10.1186/1477-7827-9-25] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Accepted: 02/16/2011] [Indexed: 11/24/2022] Open
Abstract
In the last decades, several steps have been made aiming at rendering human IVF more successful on one side, more tolerable on the other side. The "mild" ovarian stimulation approach, in which a lower-than-average dose of exogenous gonadotropins is given and gonadotropin treatment is started from day 2 to 7 of the cycle, represents a significant step toward a more patient's friendly IVF. However, a clear view of its virtues and defects is still lacking, because only a few prospective randomized trials comparing "mild" vs. conventional stimulation exist, and they do not consider some important aspects, such as, e.g., thawing cycles. This review gives a complete panorama of the "mild" stimulation philosophy, showing its advantages vs. conventional ovarian stimulation, but also discussing its disadvantages. Both patients with a normal ovarian responsiveness to exogenous gonadotropins and women with a poor ovarian reserve are considered. Overall, we conclude that the level of evidence supporting the use of "mild" stimulation protocols is still rather poor, and further, properly powered prospective studies about "mild" treatment regimens are required.
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Affiliation(s)
- Alberto Revelli
- Reproductive Medicine and IVF Unit, Department of Obstetrical and Gynecological Sciences, University of Torino, via Ventimiglia 3, 10126 Torino, Italy
| | - Simona Casano
- Reproductive Medicine and IVF Unit, Department of Obstetrical and Gynecological Sciences, University of Torino, via Ventimiglia 3, 10126 Torino, Italy
| | - Francesca Salvagno
- Reproductive Medicine and IVF Unit, Department of Obstetrical and Gynecological Sciences, University of Torino, via Ventimiglia 3, 10126 Torino, Italy
| | - Luisa Delle Piane
- Reproductive Medicine and IVF Unit, Department of Obstetrical and Gynecological Sciences, University of Torino, via Ventimiglia 3, 10126 Torino, Italy
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Han Z, Mtango NR, Zhong Z, Vassena R, Latham KE. Early transcription from the maternal genome controlling blastomere integrity in mouse two-cell-stage embryos. Am J Physiol Cell Physiol 2010; 298:C1235-44. [PMID: 20107036 DOI: 10.1152/ajpcell.00393.2009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Blastomere cytofragmentation in mammalian embryos poses a significant problem in applied and clinical embryology. Mouse two-cell-stage embryos display strain-dependent differences in the rate of cytofragmentation, with a high rate observed in C3H/HeJ embryos and a lower rate observed in C57BL/6 embryos. The maternally inherited genome exerts the strongest effect on the process, with lesser effects mediated by the paternally inherited genome and the ooplasm. The effect of the maternal genome is transcription dependent and independent of the mitochondrial strain of origin. To identify molecular mechanisms that underlie cytofragmentation, we evaluated transcriptional activities of embryos possessing maternal pronuclei (mPN) of different origins. The mPN from C57BL/6 and C3H/HeJ strains directed specific transcription at the two-cell stage of mRNAs corresponding to 935 and 864 Affymetrix probe set IDs, respectively. Comparing transcriptomes of two-cell-stage embryos with different mPN revealed 64 transcribed genes with differential expression (1.4-fold or greater). Some of these genes occupy molecular pathways that may regulate cytofragmentation via a combination of effects related to apoptosis and effects on the cytoskeleton. These results implicate specific molecular mechanisms that may regulate cytofragmentation in early mammalian embryos. The most striking effect of mPN strain of origin on gene expression was on adenylate cyclase 2 (Adcy2). Treatment with dibutyryl cAMP (dbcAMP) elicits a high rate and severe form of cytofragmentation, and the effective dbcAMP concentration varies with maternal genotype. An activator of exchange proteins directly activated by cAMP (EPACs, or RAPGEF 3 and 4) 8-pCPT-2'-O-methyl-cAMP, elicits a high level of fragmentation while the PKA-specific activator N6-benzoyl-cAMP does not. Inhibition of A kinase anchor protein activities with st-Ht31 induces fragmentation. Inhibition of phosphatidylinositol 3-kinase signaling also induces fragmentation. These results reveal novel mechanisms by which maternal genotype affects cytofragmentation, including a system of opposing signaling pathways that most likely operate by controlling cytoskeletal function.
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Affiliation(s)
- Zhiming Han
- The Fels Institute for Cancer Research and Molecular Biology, Temple Univ. School of Medicine, Philadelphia, PA 19140, USA
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Evidence that oocyte quality in younger women with diminished oocyte reserve is superior to those of women of advanced reproductive age. Med Hypotheses 2009; 74:264-7. [PMID: 19846257 DOI: 10.1016/j.mehy.2009.09.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2009] [Accepted: 09/10/2009] [Indexed: 11/21/2022]
Abstract
Evidence is provided supporting the hypothesis that the much improved prognosis for younger women with diminished oocyte reserve compared to women of advanced reproductive age is related to a difference in mechanism for oocyte depletion. For younger women the majority have had destruction of certain portions of their ovarian tissue but the remaining spared ovarian tissue has proportionately the same percentage of normal follicles as their age peers. The hypothesis continues that some factor that is responsible for earlier development of primary to antral follicles persists with the early conceptus and protects it from early programmed cell death. Thus by natural selection most women of advanced reproductive age have oocytes that fertilize normally and produce normal morphologic embryos, but lacking this apoptosis inhibiting factor dies very early between days 6 and 12 from fertilization.
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Motta EL, Smith GD, Serafini PC, Coslovsky M, Hassun P, Rocha AM, Yadid I. Human choriogonadotropin prior to controlled ovarian stimulation and in vitro fertilization improves implantation, and pregnancy rates. J Assist Reprod Genet 2009; 26:305-11. [PMID: 19533324 DOI: 10.1007/s10815-009-9322-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2008] [Accepted: 05/18/2009] [Indexed: 10/20/2022] Open
Abstract
PURPOSE Our purpose was to retrospectively compare controlled ovarian stimulation(COH) in IVF cycles with administration of hCG on the day of menses (D1-hCG) with women not receiving hCG at day 1 of menses (Control). METHODS Data on maternal age, endocrine profile, amount of rFSH required, embryo characteristics, implantation and pregnancy rates were recorded for comparison between D1-hCG (n = 36) and Control (n = 64). RESULTS Dose of rFSH required to accomplish COH was significantly lower in D1-hCG. Following ICSI, more top-quality embryos were available for transfer per patient in the D1-hCG and biochemical pregnancy rates per transfer were significantly higher in the D1-hCG. Significantly higher implantation and on-going pregnancy rates per embryo transfer were observed in D1-hCG (64%) compared to Control (41%). CONCLUSIONS Administration of D1-hCG prior to COH reduces rFSH use and enhances oocyte developmental competence to obtain top quality embryos, and improves implantation and on-going pregnancy rates. At present it is not clear if the benefit is related to producing an embryo that more likely to implant or a more receptive uterus, or merely fortuitous and related to the relatively small power of the study.
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Affiliation(s)
- Eduardo L Motta
- Huntington Center for Reproductive Medicine of Brazil, Ipanema, Rio de Janeiro, 22420-030, Brazil
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Check JH. 30 years of IVF: what does the future hold? WOMENS HEALTH 2008; 4:307-10. [PMID: 19072493 DOI: 10.2217/17455057.4.4.307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Kovacic B, Vlaisavljević V. Influence of atmospheric versus reduced oxygen concentration on development of human blastocysts in vitro: a prospective study on sibling oocytes. Reprod Biomed Online 2008; 17:229-36. [PMID: 18681997 DOI: 10.1016/s1472-6483(10)60199-x] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Numerous studies show the beneficial effect of reduced oxygen on the culture of animal embryos in vitro. However, few similar studies have been carried out in humans, and the conclusions from these were contradictory. Using sibling human oocytes, a prospective study was carried out to analyse the effect of 5 and 20% oxygen on prolonged development of embryos. The outcomes measured were fertilization rate and proportion of morphologically optimal embryos, blastocysts and optimal blastocysts developing on day 5. The results were analysed separately for the group of IVF (n = 988 oocytes) and ICSI (n = 928 oocytes) cycles. It was found that low oxygen did not influence fertilization, but in comparison with 20% oxygen, it resulted in a significantly higher proportion of embryos being optimal on day 3 after IVF (59 versus 43.2%; P < 0.001) as well as after ICSI cycles (51.2 versus 28.5%; P < 0.001). In both methods, the lower oxygen concentration improved the blastulation rate (73.2 versus 63.1%; P < 0.05 and 67.4 versus 54.7%; P < 0.001) and increased the proportion of embryos reaching the stage of expanded blastocyst with normal inner cell mass on day 5 (31.1 versus 14.6%; P < 0.001 and 18.9 versus 11.4%; P < 0.01). The ratio of successful embryo development to optimal blastocyst stage on day 5 of culture, calculated for two oxygen concentrations, was 2.1 for IVF and 1.7 for ICSI, in favour of lower oxygen tension.
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Affiliation(s)
- B Kovacic
- Department of Reproductive Medicine, University Clinical Centre Maribor, Ljubljanska 5, SI-2000 Maribor, Slovenia.
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Derivation and maintenance of human embryonic stem cells from poor-quality in vitro fertilization embryos. Nat Protoc 2008; 3:923-33. [PMID: 18451800 DOI: 10.1038/nprot.2008.60] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Human embryonic stem (hES) cells are self-renewing, pluripotent cells that are valuable research tools and hold promise for use in regenerative medicine. Most hES cell lines are derived from cryopreserved human embryos that were created during in vitro fertilization (IVF) and are in excess of clinical need. Embryos that are discarded during the IVF procedure because of poor morphology and a low likelihood for generating viable pregnancies or surviving the cryopreservation process are also a viable source of hES cells. In this protocol, we describe how to derive novel hES cells from discarded poor-quality embryos and how to maintain the hES cell lines.
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Check JH. Mild ovarian stimulation. J Assist Reprod Genet 2007; 24:621-7. [PMID: 18058016 DOI: 10.1007/s10815-007-9179-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2007] [Accepted: 10/31/2007] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To evaluate the efficacy of using only mild ovarian stimulation protocols for in vitro fertilization. Both groups with decreased and normal ovarian reserve were evaluated. METHODS Three different mild stimulation protocols were evaluated: natural with no exogenous follicle stimulation hormone (FSH) drugs at all, natural with a boost of low dose FSH to complete follicular maturation, and minimal stimulation with low dose (75-150IU) FSH from day 3-5 of the menstrual cycle. Ethinyl estradiol was sometimes used to lower high day 3 serum FSH. RESULTS Good pregnancy and implantation rates were found even in those women with elevated serum FSH that could only generate one follicle. CONCLUSIONS Mild ovarian stimulation seems preferable to high dose FSH regimens in women with elevated day 3 serum FSH based on previous poor reported pregnancy rates with the latter protocols. Comparable pregnancy rates to high dose regimen were seen in women with normal egg reserve at much lower risk and cost.
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Affiliation(s)
- Jerome H Check
- Department of Obstetrics and Gynecology, Cooper Hospital/University Medical Center, The University of Medicine and Dentistry of New Jersey, Camden, NJ, USA.
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