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Boutas I, Kontogeorgi A, Koufopoulos N, Dimas DT, Sitara K, Kalantaridou SN, Dimitrakakis C. Breast Cancer and Fertility Preservation in Young Female Patients: A Systematic Review of the Literature. Clin Pract 2023; 13:1413-1426. [PMID: 37987428 PMCID: PMC10660549 DOI: 10.3390/clinpract13060127] [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: 09/05/2023] [Revised: 10/20/2023] [Accepted: 11/08/2023] [Indexed: 11/22/2023] Open
Abstract
INTRODUCTION Breast cancer affects almost 1.5 million women worldwide below the age of 45 years each year. Many of these women will be advised to undergo adjuvant chemotherapy to minimize the risk of death or recurrence of the tumor. For these patients, chemotherapy is a known cause of infertility, as it can damage primordial follicles, which can lead to early menopause or premature ovarian insufficiency. This systematic review aims to synthesize the current evidence of the most suitable treatments for fertility preservation. METHODOLOGY This review was performed following the PRISMA guidelines. The authors conducted an extensive search from the last 15 years. Relevant studies were pursued in PubMed, Embase, and the Cochrane Library up until 31 July 2023. A total of seven eligible studies were identified. RESULTS From the reviewed literature, ovarian suppression with gonadotropin-releasing hormone agonists showed promising results in preserving fertility for breast cancer patients undergoing chemotherapy. Additionally, oocyte and embryo cryopreservation demonstrated successful outcomes, with embryo cryopreservation being the most effective option. Notably, the slow-freezing and vitrification methods were both effective in preserving embryos, with vitrification showing superior results in clinical-assisted reproductive technologies. Ovarian tissue cryopreservation emerged as a viable option for prepubertal girls and those unable to undergo conventional ovarian stimulation. The potential of in vitro maturation (IVM) as an alternative method presents a promising avenue for future fertility preservation research. DISCUSSION The most suitable treatments for fertility preservation in young patients is the temporary suppression with luteinizing hormone-releasing analogs, while the patient undergoes chemotherapy and cryopreservation. For cryopreservation, the physicians might deem it necessary to either cryopreserve ovarian tissue taken from the patient before any treatment or cryopreserve embryos/oocytes. Cryopreservation of oocytes and/or embryos is the most effective solution for fertility preservation in women of reproductive age, who have a sufficient ovarian reserve and are diagnosed with breast cancer, regardless of the histological type of the tumor. Because approximately 50% of young breast cancer patients are interested in becoming pregnant right after completion of therapy, the evolution and development of fertility preservation techniques promise to be very exciting.
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Affiliation(s)
- Ioannis Boutas
- Breast Unit, Rea Maternity Hospital, P. Faliro, 17564 Athens, Greece
| | - Adamantia Kontogeorgi
- Third Department of Obstetrics and Gynecology, Attikon University Hospital, National and Kapodistrian University of Athens, Rimini 1, 12462 Chaidari, Greece; (A.K.); (S.N.K.)
| | - Nektarios Koufopoulos
- Second Pathology Department, Attikon University Hospital, National and Kapodistrian University of Athens, Rimini 1, 12462 Chaidari, Greece;
| | - Dionysios T. Dimas
- Breast Unit, Athens Medical Center, Psychiko Clinic, 11525 Athens, Greece;
| | - Kyparissia Sitara
- Department of Internal Medicine, “Elpis” General Hospital, 11522 Athens, Greece;
| | - Sophia N. Kalantaridou
- Third Department of Obstetrics and Gynecology, Attikon University Hospital, National and Kapodistrian University of Athens, Rimini 1, 12462 Chaidari, Greece; (A.K.); (S.N.K.)
| | - Constantine Dimitrakakis
- First Department of Obstetrics and Gynecology, Alexandra University Hospital, National and Kapodistrian University of Athens, Lourou 4-2, 11528 Athens, Greece;
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Zhang X, Lian F, Liu D. Comparison of IVF/ICSI outcomes in advanced reproductive age patients with polycystic ovary syndrome and advanced reproductive age normal controls: a retrospective cohort study. BMC Pregnancy Childbirth 2023; 23:440. [PMID: 37316805 DOI: 10.1186/s12884-023-05732-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 05/24/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND At present, there are few studies on whether there is reproductive advantage in advanced polycystic ovary syndrome (PCOS) patients, and the existing research results are also controversial. Some research results show that the reproductive window of advanced reproductive age patients with polycystic ovary syndrome is longer than that of the normal control group, and the clinical pregnancy rate and cumulative live birth rate of in vitro fertilization / intracytoplasmic sperm injection(IVF/ICSI)are higher. However, some studies have contradicted the results, and believed that the clinical pregnancy rate and cumulative live birth rate in IVF/ICSI in advanced PCOS patients and normal control groups were roughly similar. This retrospective study aimed to compare IVF/ICSI outcomes in advanced reproductive age patients with PCOS and in advanced reproductive age patients with tubal factor infertility alone. METHODS A retrospective analysis was performed on advanced reproductive age (age ≥ 35 years) patients who received their first IVF/ICSI cycle between January 1, 2018 and December 31, 2020. This study was divided into two groups, one group was PCOS group, the other group was control group, namely tubal factor infertility group, a total of 312 patients and 462 cycles were enrolled. Compare the differences in outcomes such as cumulative live birth rate and clinical pregnancy rate between the two groups. RESULTS In fresh embryo transfer cycles(ET), there was no statistically significant difference in live birth rate [19/62 (30.6%) vs. 34/117 (29.1%), P = 0.825] and clinical pregnancy rate [24/62 (38.7%) vs. 43/117 (36.8%), P = 0.797] between the PCOS and control groups.In the frozen embryo transfer (FET) cycle, the difference in cumulative live birth rate [63/217 (29.0%) vs. 14/66 (21.2%), P = 0.211] and clinical pregnancy rate [74/217 (34.1%) vs. 18/66 (27.3%), P = 0.300] were not statistically significant between the two groups. CONCLUSIONS The IVF/ICSI outcomes of advanced reproductive age patients with PCOS are similar to those of advanced reproductive age patients with tubal factor infertility alone, and the clinical pregnancy rate and live birth rate are roughly the same. Age is an important factor that affects clinical pregnancy rate. It is recommended that patients with PCOS complicated by infertility seek medical treatment as soon as possible to obtain better pregnancy outcomes.
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Affiliation(s)
- Xing Zhang
- Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Fang Lian
- Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China.
| | - Danqi Liu
- Shandong University of Traditional Chinese Medicine, Jinan, China
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Chen H, Sun ZL, Chen MX, Yang Y, Teng XM, Wang Y, Wu YY. Predicting the probability of a live birth after a freeze-all based in vitro fertilization-embryo transfer (IVF-ET) treatment strategy. Transl Pediatr 2022; 11:797-812. [PMID: 35800265 PMCID: PMC9253936 DOI: 10.21037/tp-21-589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 04/02/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The predictors for live birth rate (LBR) following one episode of in vitro fertilization (IVF) cycle for patients using a "freeze-all" strategy are not entirely clear. METHODS A retrospective cohort study utilizing a prediction model was developed to assess the relationship to the LBR. Women undergoing IVF with a freeze-all strategy were screened. Univariate models were first fitted for female age at oocytes retrieval/frozen-thawed embryo transfer (FET), body mass index (BMI), duration and etiology of infertility, previous IVF failures, total dose and duration of gonadotrophin, ovarian sensitivity index (OSI), number of oocytes collected, method of fertilization, number of embryos created, number and stage of embryos frozen, type and number of FET cycles, endometrial thickness (EMT)/pattern, hormone level on transplantation day, storage duration, number of embryos thawed and damaged thawed embryos, number and stage of embryos transferred and number of different quality embryos transferred. Variables with P<0.05 in the univariate model were selected for further analysis of the final multivariate discrete-time logistic regression model. RESULTS A total of 7,602 women undergoing one ovarian stimulation resulted in 9,964 FETs, of whom 3,066 (40.33%) had a live-birth after their first FET and 3,929 (51.68%) after total FETs. The EMT and woman's age at oocyte retrieval were the most important predictors. In the first FET, the LBR of women with an EMT ≤8 mm [27.40%; 95% confidence interval (CI): (21.60-33.81%)] was significantly lower than that of women with EMT between 9 and 11 mm [36.51%; 95% CI: (34.25-38.81%)] and thicker than 12 mm [44.23%; 95% CI: (42.22-46.25%)] (P<0.05). The optimistic and conservative cumulative LBRs of women younger than 31 years [87.5%; 95% CI: (86.32-88.61%) and 63.04%; 95% CI: (61.36-64.69%)] were significantly decreased in women aged 31-35, 36-40 and >40 (P<0.001). CONCLUSIONS Our study provides an effective prediction model for a woman's chance of having a baby after a "freeze-all" policy. The use of EMT and female age as tools to identify LBR are shown to be justified, and repeated FETs cannot reverse the age-dependent decline in fertility.
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Affiliation(s)
- Hong Chen
- Department of Assisted Reproduction, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Zi-Li Sun
- Department of Assisted Reproduction, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Miao-Xin Chen
- Department of Assisted Reproduction, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yang Yang
- Department of Assisted Reproduction, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiao-Ming Teng
- Department of Assisted Reproduction, Shanghai First Maternity and Infant Hospital, Tongji 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
| | - Yuan-Yuan Wu
- Department of Assisted Reproduction, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
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Zhu Y, Fu Y, Tang M, Yan H, Zhang F, Hu X, Feng G, Sun Y, Xing L. Risk of Higher Blood Pressure in 3 to 6 Years Old Singleton Born From OHSS Patients Undergone With Fresh IVF/ICSI. Front Endocrinol (Lausanne) 2022; 13:817555. [PMID: 35865308 PMCID: PMC9294153 DOI: 10.3389/fendo.2022.817555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 05/30/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND A large registry-based study found the increasing disorders of cardiovascular and metabolism in IVF children but underlying mechanism is still unknown. Few studies have investigated any association between OHSS and cardiovascular or metabolic function in subsequent children. OBJECTIVE To evaluate the effect of ovarian hyperstimulation syndrome (OHSS) on blood pressure of singletons after in vitro fertilization (IVF) with or without intracytoplasmic sperm injection (ICSI). STUDY DESIGN The singlet-center corhort study included 1780 singletons born with IVF/ICSI and 83 spontaneously conceived children from 2003 to 2014. Follow-up has lasted more than 10 years, and is still ongoing. This study analyzed data from follow-up surveys at 3 to 6 years of age. PARTICIPANTS SETTING AND METHODS We recruited 83 children (Group E) spontaneously conceived (SC) as control group and 1780 children born with IVF/ICSI including 126 children born to OHSS-fresh embryo transfer (ET) women (Group A), 1069 children born to non OHSS-ET women (Group B), 98 children conceived by women who developed into moderate or severe OHSS after oocyte retrieval and selected the frozen-thawed embryo transfer (FET) (Group C), 487 children conceived with non OHSS-FET (Group D). We evaluated cardiometabolic function, assessed BP in mmHg, heart rate, anthropometrics, and metabolic index including glucose, serum lipid (triglyceride, total cholesterol, low density lipoprotein, high density lipoprotein), thyroid function, of those children. The BP and heart rate were measured twice on the same day. We applied several multiple regression analyses to investigate the effect of OHSS in the early pregnancy. MAIN FINDINGS By the single factor analysis, the SBP and DBP in the SC group (SBP: 99.84 ± 8.9; DBP: 55.27 ± 8.8) were significantly lower than OHSS-ET group's, while the blood pressure was similar between the SC group and other three ART groups. Children had higher BP in the OHSS-ET group (SBP: 101.93 ± 8.17; DBP: 58.75 ± 8.48) than in the non OHSS-ET (SBP: 99.49 ± 8.91; DBP: 56.55 ± 8.02) or OHSS-FET group (SBP: 99.38 ± 8.17; DBP: 55.72 ± 7.94). After using multiple regression analysis to adjust current, early life, parental and ART characteristics, the differences in the SBP and DBP (B (95% confidence interval)) between OHSS-ET and non OHSS-ET remained significant (SBP: 3.193 (0.549 to 2.301); DBP: 3.440 (0.611 to 2.333)). And the BP showed no significant difference complementarily when compared non OHSS-FET group with non OHSS-ET group. In addition, the anthropometrics, fast glucose, serum lipid, and thyroid index did not differ among the ART groups. PRINCIPAL CONCLUSIONS OHSS might play an independent key role on offspring's BP even cardiovascular function. Electing frozen-thawed embryo transfer for high risk of OHSS population may reduce the risk of the high BP trend. WIDER IMPLICATIONS OF THE FINDINGS It is a large sample study to investigate the effect of OHSS on offspring's health. These findings provide a clinic evidence of the impact of early environment (embryo even oocyte stage) on the offspring's cardiovascular health. Our study emphasis the importance of the accuracy of IVF clinic strategy and preventing the OHSS after fresh embryo transfer.
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Kato K, Ochi M, Nakamura Y, Kamiya H, Utsunomiya T, Yano K, Michikura Y, Hara T, Kyono K, Takeuchi K, Nakayama T, Iwamasa J, Mio Y, Kuramoto T, Nagata Y, Jo T, Asada Y, Ohishi H, Osada H, Yoshida H. A multi-centre, retrospective case series of oocyte cryopreservation in unmarried women diagnosed with haematological malignancies. Hum Reprod Open 2021; 2021:hoaa064. [PMID: 33501384 PMCID: PMC7810816 DOI: 10.1093/hropen/hoaa064] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 10/23/2020] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION Is oocyte cryopreservation an applicable option for fertility preservation in unmarried patients with haematological malignancies? SUMMARY ANSWER Oocyte cryopreservation via the vitrification method is accessible and may be considered an option for fertility preservation in unmarried patients with haematological malignancies. WHAT IS KNOWN ALREADY Haematological malignancies are most commonly observed amongst adolescent and young adult women. Although the survival rate and life expectancy of those with haematological malignancies have improved, chemotherapy and radiotherapy may impair their reproductive potential. Oocyte cryopreservation is thus an ideal option to preserve their fertility. STUDY DESIGN SIZE DURATION This study retrospectively evaluated 193 unmarried patients (age: 26.2 ± 0.4 years) with haematological malignancies, who consulted for oocyte cryopreservation across 20 different fertility centres in Japan between February 2007 and January 2015. The primary outcome measures were the oocyte retrievals and oocyte cryopreservation outcomes. The secondary outcome measures were the outcomes following oocyte warming for IVF. PARTICIPANTS/MATERIALS SETTING METHODS The patients had commenced ovarian stimulation cycles via antagonist, agonist, natural and minimal methods for oocyte retrievals, defined according to the treatment strategy of each respective fertility centre. A vitrification method using the Cryotop safety kit was used for oocyte cryopreservation. ICSIs were used for insemination of warmed oocytes. The endometrial preparation method for embryo transfer was hormonal replacement therapy, except in the case of a patient who underwent a spontaneous ovulatory cycle. MAIN RESULTS AND THE ROLE OF CHANCE Among 193 patients, acute myeloid leukaemia (n = 45, 23.3%) was most common, followed by acute lymphoid leukaemia (n = 38, 19.7%) and Hodgkin's lymphoma (n = 30, 15.5%). In total, 162 patients (83.9%) underwent oocyte retrieval, and oocytes were successfully cryopreserved for 155 patients (80.3%). The mean number of oocyte retrieval cycles and cryopreserved oocytes were 1.7 ± 0.2 and 6.3 ± 0.4, respectively. As of December 2019, 14 patients (9.2%) had requested oocyte warming for IVF. The survival rate of oocytes after vitrification-warming was 85.2% (75/88). The rates of fertilisation and embryo development were 80.0% (60/75) and 46.7% (28/60), respectively. Ten patients (71.4%) had successful embryo transfers, and seven live births (50.0%) were achieved. LIMITATIONS REASONS FOR CAUTION This study was limited by its retrospective nature. Additionally, there remains an insufficient number of cases regarding the warming of vitrified oocytes to reliably conclude whether oocyte cryopreservation is effective for patients with haematological malignancies. Further long-term follow-up study is required. WIDER IMPLICATIONS OF THE FINDINGS Oocyte retrieval and oocyte cryopreservation were accessible for patients with haematological malignancies; however, the number of oocyte retrievals may have been limited due to the initiation of cancer treatments. Acceptable embryonic and pregnancy outcomes could be achieved following oocyte warming; therefore, our results suggest that oocyte cryopreservation can be considered an option for fertility preservation in patients with haematological malignancies. STUDY FUNDING/COMPETING INTERESTS This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors. The authors declare no conflict of interest. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- K Kato
- Kato Ladies Clinic, Tokyo 160-0023, Japan
- Japan Association of Private Assisted Reproductive Technology Clinics and Laboratories (Japan A-PART), Tokyo 160-0023, Japan
| | - M Ochi
- Japan Association of Private Assisted Reproductive Technology Clinics and Laboratories (Japan A-PART), Tokyo 160-0023, Japan
- Ochi Yume Clinic Nagoya, Nagoya, Aichi 460-0002, Japan
| | - Y Nakamura
- Japan Association of Private Assisted Reproductive Technology Clinics and Laboratories (Japan A-PART), Tokyo 160-0023, Japan
- Nakamura Ladies Clinic, Suita, Osaka 564-0051, Japan
| | - H Kamiya
- Japan Association of Private Assisted Reproductive Technology Clinics and Laboratories (Japan A-PART), Tokyo 160-0023, Japan
- Kamiya Ladies Clinic, Sapporo, Hokkaido 060-0003, Japan
| | - T Utsunomiya
- Japan Association of Private Assisted Reproductive Technology Clinics and Laboratories (Japan A-PART), Tokyo 160-0023, Japan
- St. Luke Clinic, Oita, 870-0823 Japan
| | - K Yano
- Japan Association of Private Assisted Reproductive Technology Clinics and Laboratories (Japan A-PART), Tokyo 160-0023, Japan
- Yano Maternity Clinic, Matsuyama, Ehime 790-0872, Japan
| | - Y Michikura
- Japan Association of Private Assisted Reproductive Technology Clinics and Laboratories (Japan A-PART), Tokyo 160-0023, Japan
- Kanazawa Tamago Clinic, Kanazawa, Ishikawa 920-0016, Japan
| | - T Hara
- Japan Association of Private Assisted Reproductive Technology Clinics and Laboratories (Japan A-PART), Tokyo 160-0023, Japan
- Hiroshima Prefectural Hospital, Hiroshima 734-8530, Japan
| | - K Kyono
- Japan Association of Private Assisted Reproductive Technology Clinics and Laboratories (Japan A-PART), Tokyo 160-0023, Japan
- Kyono ART Clinic Sendai, Sendai, Miyagi 980-0014, Japan
| | - K Takeuchi
- Japan Association of Private Assisted Reproductive Technology Clinics and Laboratories (Japan A-PART), Tokyo 160-0023, Japan
- Takeuchi Ladies Clinic, Aira, Kagoshima 899-5421, Japan
| | - T Nakayama
- Japan Association of Private Assisted Reproductive Technology Clinics and Laboratories (Japan A-PART), Tokyo 160-0023, Japan
- Adachi Hospital, Chuo-ku, Kyoto 604-0837, Japan
| | - J Iwamasa
- Japan Association of Private Assisted Reproductive Technology Clinics and Laboratories (Japan A-PART), Tokyo 160-0023, Japan
- Sofia Ladies Clinic Suidocho, Chuo-ku, Kumamoto 860-0844, Japan
| | - Y Mio
- Japan Association of Private Assisted Reproductive Technology Clinics and Laboratories (Japan A-PART), Tokyo 160-0023, Japan
- Mio Fertility Clinic, Yonago, Totttori 683-0008, Japan
| | - T Kuramoto
- Japan Association of Private Assisted Reproductive Technology Clinics and Laboratories (Japan A-PART), Tokyo 160-0023, Japan
- Kuramoto Women’s Clinic, Hakata-ku, Fukuoka 812-0013, Japan
| | - Y Nagata
- Japan Association of Private Assisted Reproductive Technology Clinics and Laboratories (Japan A-PART), Tokyo 160-0023, Japan
- IVF Nagata Clinic, Chuo-ku, Fukuoka 810-0001, Japan
| | - T Jo
- Japan Association of Private Assisted Reproductive Technology Clinics and Laboratories (Japan A-PART), Tokyo 160-0023, Japan
- Jo Clinic, Nishinomiya, Hyogo 860-0844, Japan
| | - Y Asada
- Japan Association of Private Assisted Reproductive Technology Clinics and Laboratories (Japan A-PART), Tokyo 160-0023, Japan
- Asada Ladies Clinic, Nagoya, Aichi 450-0002, Japan
| | - H Ohishi
- Japan Association of Private Assisted Reproductive Technology Clinics and Laboratories (Japan A-PART), Tokyo 160-0023, Japan
- Hamanomachi Hospital, Fukuoka 810-0072, Japan
| | - H Osada
- Kato Ladies Clinic, Tokyo 160-0023, Japan
- Japan Association of Private Assisted Reproductive Technology Clinics and Laboratories (Japan A-PART), Tokyo 160-0023, Japan
- Natural ART Clinic Nihombashi, Chuo-ku, Tokyo 103-6008, Japan
| | - H Yoshida
- Kato Ladies Clinic, Tokyo 160-0023, Japan
- Japan Association of Private Assisted Reproductive Technology Clinics and Laboratories (Japan A-PART), Tokyo 160-0023, Japan
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Liang R, An J, Zheng Y, Li J, Wang Y, Jia Y, Zhang J, Lu Q. predicting and improving the probability of live birth for women undergoing frozen-thawed embryo transfer: a data-driven estimation and simulation model. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2021; 198:105780. [PMID: 33049450 DOI: 10.1016/j.cmpb.2020.105780] [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: 05/01/2020] [Accepted: 09/28/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND AND OBJECTIVE Frozen-thawed embryo transfer (FET) is now widely used for the treatment of infertility. For many couples and clinicians, concerns over the probability and how to increase the chance of a successful birth are very common. Currently, there is not a single model to predict the live birth outcomes for FET. To estimate the probability of live birth (PLB) in FET and to provide advice on potential treatment options by a data-driven predictive (DDP) model. METHODS 2,189 FET cycles from Jan 2012 to Dec 2015 were recruited in a single center. 815 cycles of FET outcomes were live births and 1,374 cycles of FET outcomes failed. To verify the consistency of the DDP model, we carried out 10-fold cross-validation, and the mean and standard deviation of the accuracy were measured. Moreover, the performance of this model was evaluated by the mean and standard deviation of receiver operating characteristic curve and area under the curve (AUC). RESULTS Nine dominant factors, including age, BMI, HOMA-IR, basal follicle stimulating hormone, basal luteinizing hormone, basal estradiol, endometrial thickness, the number of embryo transfers and the total number of embryos, were automatically extracted from 28 candidate factors. The accuracy of our prediction model is 76.9%±1.6%, and the AUC is 0.83. Then, the PLB is estimated by the random forest algorithm. On this basis, the DDP model can comprehensively traverse and dynamically visualize the impact of several factors on live birth outcomes. Finally, optimal suggestions for the treatment of patients before FET are attempted to be made by the genetic algorithm. CONCLUSION The DDP model can not only provide satisfactory performance for predicting live birth outcomes in FET but also offer a visual estimation and simulation tool for clinicians to make treatment plans.
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Affiliation(s)
- Rong Liang
- Center of Reproductive Medicine, Peking University People's Hospital, Beijing 100044, P.R. China
| | - Jian An
- Academy for Advanced Interdisciplinary Studies, Peking University, Beijing 100871, P.R. China
| | - Yijia Zheng
- Academy for Advanced Interdisciplinary Studies, Peking University, Beijing 100871, P.R. China
| | - Jiaqi Li
- Center of Reproductive Medicine, Peking University People's Hospital, Beijing 100044, P.R. China
| | - Yao Wang
- Academy for Advanced Interdisciplinary Studies, Peking University, Beijing 100871, P.R. China
| | - Yingying Jia
- Center of Reproductive Medicine, Peking University People's Hospital, Beijing 100044, P.R. China
| | - Jue Zhang
- Academy for Advanced Interdisciplinary Studies, Peking University, Beijing 100871, P.R. China; College of Engineering, Peking University, Beijing 100871, P.R. China.
| | - Qun Lu
- Center of Reproductive Medicine, Peking University People's Hospital, Beijing 100044, P.R. China
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Khodavandpour Z, Zavareh S, Farrokh P, Nasiri M. Assessment of DNA Repair Gene Expressions in Vitrified Mouse Preantral Follicles. CELL JOURNAL 2020; 22:81-88. [PMID: 32779437 PMCID: PMC7481908 DOI: 10.22074/cellj.2020.6865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 08/19/2019] [Indexed: 12/03/2022]
Abstract
Objective Vitrification of the ovarian tissue is one of the techniques recommended for preserving the fertility of women
who are dealing with infertility. Despite its benefits, our information about the molecular aspects of ovarian follicles
vitrification is somehow ambiguous. Therefore, the aim of this study was to evaluate the expression pattern of DNA
repair genes in vitrified preantral follicles.
Materials and Methods In this experimental study, the isolated preantral follicles (n=906) from 14-16 days old mice
(n=12) were divided into three groups: fresh, toxic and vitrified which were cultured in vitro for 12 days. Preantral
follicles were vitrified using cryotop followed by exposure to equilibration solution for five minutes and vitrification
solution (VS) for 30 seconds. In the toxic group, preantral follicles were only placed in equilibration and vitrification
media and they were then placed in the warming solutions without exposure to liquid nitrogen. On the second and
sixth days of the culture period, real-time quantitative reverse transcription-polymerase chain reaction (qRT-PCR) was
carried out to evaluate expression of the selected genes involved in DNA repair, including Msh6 (MutS homolog 6),
Mre11 (Meiotic recombination 11), Brca1 (Breast cancer type 1), Rad51 (RAD51 recombinase), Pcna (Proliferating
cell nuclear antigen) and Atm (ATM serine/threonine kinase). In addition, developmental parameters including growth,
survival rate, antrum cavity formation and ovulation were analyzed.
Results The relative mRNA expression of Msh6, Mre11, Brca1, Rad51, Pcna and Atm on the second and sixth days
of the culture period in vitrified group was significantly higher than those of the control and toxic groups, but there was
no significant difference between the toxic and control groups. In addition, developmental parameters of follicles were
similar in both toxic and control groups, while both were significantly higher than that of vitrified group.
Conclusion Vitrification changes the expression pattern of DNA repair genes of the mouse preantral follicles.
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Affiliation(s)
- Zahra Khodavandpour
- Department of Biology, Damghan Branch, Islamic Azad University, Damghan, Iran
| | - Saeed Zavareh
- School of Biology, Damghan University, Damghan, Iran. Electronic Address: .,Institute of Biological Sciences, Damghan University, Damghan, Iran
| | - Parisa Farrokh
- School of Biology, Damghan University, Damghan, Iran.,Institute of Biological Sciences, Damghan University, Damghan, Iran
| | - Meysam Nasiri
- School of Biology, Damghan University, Damghan, Iran.,Institute of Biological Sciences, Damghan University, Damghan, Iran
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Wang C, Shu J, Lin R, Chen H, Gan X, Deng X, Liang G, Wu Z, Wei T, Zhou H. Choosing the optimal blastocyst by morphology score versus developmental rate in frozen-thawed embryo transfer cycles. HUM FERTIL 2020; 25:1-10. [PMID: 32538687 DOI: 10.1080/14647273.2020.1778199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 02/10/2020] [Indexed: 12/13/2022]
Abstract
The aim of this study was to provide guidance for better management in the selection of blastocyst to warm in frozen-thawed embryo transfer (FET) cycles. A retrospective cohort follow-up study was conducted that included single autologous frozen blastocyst transfer cycles performed in our Reproductive Medicine Unit from January 2009 to December 2016. The live birth rate (LBR), clinical pregnancy rate (cPR) were increased as blastocyst morphology scores increased, but the miscarriage rate decreased in all groups. In the high-score groups, there were no differences in LBR between D5 and D6, while in the low-score groups, LBR was significantly higher in D5 compared to the D6. With respect to neonatal outcome, there were no differences in all the groups. After binary logistic regression analysis, it was seen that patients' age, thawed cycles, pre-frozen morphology score and developmental rate were independently associated with LBR. These results suggest that for high-scoring blastocyst, the pre-frozen morphological score should be given priority while for low-scoring blastocysts, the developmental rate should be given priority when thawing in FET cycles.
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Affiliation(s)
- Caizhu Wang
- Reproductive Medicine Center, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Jinhui Shu
- Reproductive Medicine Center, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Rouyun Lin
- Reproductive Medicine Center, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Huanhua Chen
- Reproductive Medicine Center, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Xianyou Gan
- Reproductive Medicine Center, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Xihe Deng
- Reproductive Medicine Center, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Gui Liang
- Reproductive Medicine Center, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Zhulian Wu
- Reproductive Medicine Center, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Tinglv Wei
- Reproductive Medicine Center, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Hong Zhou
- Reproductive Medicine Center, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
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Abstract
Background: The 'freeze-all' practice refers to the cryopreservation of all mature oocytes or viable embryos after ovarian stimulation. The development of the vitrification technique has been crucial to make this approach a reality, since it increases the post-thaw survival rates and permits comparable implantation rates with fresh embryos. Nonetheless, as implantation probabilities are comparable to fresh embryo transfer in normo-responder patients, the freeze- all strategy has demonstrated no benefits overall.Method: Narrative review in which we give an overview of this approach, discuss recent advances in the field, as well as for whom, when and how it is recommended to emply the freeze-all technique.Results: However, there is some clinical evidence that shows its feasibility. Thus, it has been demonstrated that elevation of progesterone at the end of ovarian stimulation decreases the implantation rates after the transfer of day 6 blastocysts in fresh and some uterine pathologies; freeze-all is also the preferred option for patients undergoing pre-implantation genetic testing, since there is an improvement of the results and it allows for inclusion of all blastocysts of the cohort. In high responders, the freeze-all strategy optimizes the response whilst also minimizing the risk of ovarian hyperstimulation syndrome.Conclusion: Due to the different cases that a reproductive expert might encounter, it is essential to highlight benefits and drawbacks of this practice.
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Affiliation(s)
- Paula Celada
- Instituto Valenciano de Infertilidad, Valencia, Spain
| | - Ernesto Bosch
- Instituto Valenciano de Infertilidad, Valencia, Spain
- CONTACT Ernesto Bosch Instituto Valenciano de Infertilidad, Plaza Policia Local n° 3, Valencia, 46015, Spain
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Bosch E, De Vos M, Humaidan P. The Future of Cryopreservation in Assisted Reproductive Technologies. Front Endocrinol (Lausanne) 2020; 11:67. [PMID: 32153506 PMCID: PMC7044122 DOI: 10.3389/fendo.2020.00067] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 01/31/2020] [Indexed: 01/12/2023] Open
Abstract
Societal changes and the increasing desire and opportunity to preserve fertility have increased the demand for effective assisted reproductive technologies (ART) and have increased the range of scenarios in which ART is now used. In recent years, the "freeze-all" strategy of cryopreserving all oocytes or good quality embryos produced in an IVF cycle to transfer later-at a time that is more appropriate for reasons of medical need, efficacy, or desirability-has emerged as an accepted and valuable alternative to fresh embryo transfer. Indeed, improvements in cryopreservation techniques (vitrification) and the development of more efficient ovarian stimulation protocols have facilitated a dramatic increase in the practice of elective frozen embryo transfer (eFET). Alongside these advances, debate continues about whether eFET should be a standard treatment option available to the whole IVF population or if it is important to identify patient subgroups who are most likely to benefit from such an approach. Achieving successful outcomes in ART, whether by fresh or frozen embryo transfer, is influenced by a wide range of factors. As well as the efficiency of IVF and embryo transfer protocols and techniques, factors affecting implantation include maternal aging, sperm quality, the vaginal and endometrial microbiome, and peri-implantation levels of serum progesterone. The safety of eFET, both during ART cycles and on longer-term obstetric and neonatal outcomes, is also an important consideration. In this review, we explore the benefits and risks of freeze-all strategies in different scenarios. We review available evidence on the outcomes achieved with elective cryopreservation strategies and practices and how these compare with more traditional IVF cycles with fresh embryo transfers, both in the general IVF population and in subgroups of special interest. In addition, we consider how to optimize and individualize "freeze-all" procedures to achieve successful reproductive outcomes.
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Affiliation(s)
- Ernesto Bosch
- Instituto Valenciano de Infertilidad, Valencia, Spain
- *Correspondence: Ernesto Bosch
| | - Michel De Vos
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Peter Humaidan
- The Fertility Clinic, Skive Regional Hospital, Skive, Denmark
- Faculty of Health, Aarhus University, Aarhus, Denmark
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11
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Salama M, Anazodo A, Woodruff TK. Preserving fertility in female patients with hematological malignancies: a multidisciplinary oncofertility approach. Ann Oncol 2019; 30:1760-1775. [PMID: 31418765 DOI: 10.1093/annonc/mdz284] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023] Open
Abstract
Oncofertility is a new interdisciplinary field at the intersection of oncology and reproductive medicine that expands fertility options for young cancer patients. The most common forms of hematological malignancies that occur in girls and young women and therefore necessitate oncofertility care are acute lymphocytic leukemia, acute myeloid leukemia, non-Hodgkin's lymphoma, and Hodgkin's lymphoma. Aggressive gonadotoxic anticancer regimens including alkylating chemotherapy and total body irradiation are used often in treating girls and young women with hematological malignancies. The risks of gonadotoxicity and subsequent iatrogenic premature ovarian insufficiency and fertility loss depend mainly on the type and stage of the disease, dose of anticancer therapy as well as the age of the patient at the beginning of treatment. To avoid or at least mitigate the devastating complications of anticancer therapy-induced gonadotoxicity, effective and comprehensive strategies that integrate different options for preserving and restoring fertility ranging from established to experimental strategies should be offered before, during, and after chemotherapy or radiotherapy. A multidisciplinary approach that involves strong coordination and collaboration between hemato-oncologists, gynecologists, reproductive biologists, research scientists, and patient navigators is essential to guarantee high standard of care.
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Affiliation(s)
- M Salama
- Department of Obstetrics and Gynecology, Feinberg School of Medicine-Northwestern University, Chicago, USA
| | - A Anazodo
- Kids Cancer Centre, Sydney Children's Hospital, Sydney, Australia; Nelune Cancer Centre, Prince of Wales Hospital, Sydney, Australia; School of Women's and Children's Health, University of New South Wales, Sydney, Australia
| | - T K Woodruff
- Department of Obstetrics and Gynecology, Feinberg School of Medicine-Northwestern University, Chicago, USA.
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12
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Numerical solution of inward solidification of a dilute ternary solution towards a semi-permeable spherical cell. Math Biosci 2019; 316:108240. [PMID: 31465730 DOI: 10.1016/j.mbs.2019.108240] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 04/09/2019] [Accepted: 08/22/2019] [Indexed: 11/23/2022]
Abstract
Modeling a cell's response to encroaching ice has informed the development of cryopreservation protocols for four decades. It has been well documented that knowledge of the cellular state as a function of media and cooling rate faciliate informed cryopreservation protocol design and explain mechanisms of damage. However, previous efforts have neglected the interaction between solutes and the encroaching ice front and their effects on the cell state. To address this, here we examine the cryobiologically relevant setting of a spherically-symmetric model of a biological cell separated by a ternary fluid mixture from an encroaching solid-liquid interface. The cell and liquid regions contain cell membrane impermeable intracellular and extracellular salts, respectively, a cell membrane permeable solute commonly used in cryopreservation protocols known as a cryoprotective agent (CPA), and water as a membrane permeable solvent. As cooling and solidification proceed the extracellular chemical environment evolves and leads to mass transport across the cell membrane. Consequently, both the solidification front and the cell membrane are free boundaries whose dynamics are coupled through transport processes in the solid, liquid and cell regions. We describe a numerical procedure to solve this coupled free-boundary problem based on a domain transformation and method of lines approach. We also investigate how the thermal and chemical states inside the cell are influenced by different cooling protocols at the external boundary. Finally, we observe that the previously unaccounted-for partial solute rejection at the advancing solid-liquid interface increases the CPA and salt concentrations in the extracellular liquid as a function of the interface speed and segregation coefficients, suggesting that previous model predictions of the cell state during cryopreservation were inaccurate.
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Alecsandru D, Pacheco A, Guerrero-Mayo A, Fabris A, Aparicio P, Barrio A, Pellicer A, Garcia-Velasco JA. Ovarian stimulation does not influence the uterine immune environment in healthy infertile women. Reprod Biomed Online 2019; 40:113-123. [PMID: 31761720 DOI: 10.1016/j.rbmo.2019.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 07/15/2019] [Accepted: 08/14/2019] [Indexed: 10/26/2022]
Abstract
RESEARCH QUESTION There is some controversy regarding the impact of ovarian stimulation on immune cells in women undergoing IVF. The study's aim was to determine whether ovarian stimulation affected immune uterine cells in healthy women undergoing IVF. DESIGN This prospective cohort study included 28 patients undergoing IVF and 47 healthy oocyte donors. Endometrial biopsies were taken in a natural cycle and after ovarian stimulation. All participants had a normal karyotype, pelvic ultrasound and cervical cytology results and thyroid-stimulating hormone concentration, as well as normal glucose and insulin concentrations and inherited and acquired thrombophilia test results. Screening tests including human papillomavirus were normal. Immune cells were analysed using three techniques: fluorescence-activated cell sorting, immunohistochemistry and gene expression. A human leukocyte antigen (HLA)-C tetramer was used as an 'artificial embryo'. The expression of genes including those for tumour necrosis factor (TNF)-α and interleukin-10 (IL-10) was analysed. RESULTS A comparison was made of the percentage and gene expression of CD56brightCD16- uterine natural killer (uNK), CD56dimCD16+ natural killer cells, CD56-CD16+ natural killer cells and TregCD25+CD4+FoxP3+ cells, uNK binding to the HLA-C tetramer, and TNF-α and IL-10 expression. No between- or within-group differences were observed in natural versus ovarian stimulation cycles. CONCLUSIONS Ovarian stimulation does not affect the uterine immune cell population or HLA-C binding in healthy women undergoing ovarian stimulation. Further studies are underway to find out if different responses might be seen in women with previous autoimmune disorders.
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Affiliation(s)
- D Alecsandru
- Department of Immunology, IVI RMA, Madrid, Spain; Rey Juan Carlos University, Madrid, Spain; Health Research Institute La Fe, Valencia, Spain.
| | - A Pacheco
- Health Research Institute La Fe, Valencia, Spain; Department of Andrology, IVI RMA, Madrid, Spain; Alfonso X 'El Sabio' University, Madrid, Spain
| | | | - A Fabris
- Department of Reproductive Endocrinology and Infertility, IVI RMA, Madrid, Spain
| | - P Aparicio
- Department of Immunology, IVI RMA, Madrid, Spain
| | - A Barrio
- Department of Reproductive Endocrinology and Infertility, IVI RMA, Madrid, Spain
| | - A Pellicer
- Health Research Institute La Fe, Valencia, Spain; Universidad de Valencia, IVI Learning Center; Department of Reproductive Endocrinology and Infertility, IVI RMA, Roma, Italy
| | - Juan A Garcia-Velasco
- Rey Juan Carlos University, Madrid, Spain; Health Research Institute La Fe, Valencia, Spain; Universidad de Valencia, IVI Learning Center; Department of Reproductive Endocrinology and Infertility, IVI RMA, Madrid, Spain
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14
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Reljič M, Porović A. Maternal serum levels of angiogenic markers and markers of placentation in pregnancies conceived with fresh and vitrified-warmed blastocyst transfer. J Assist Reprod Genet 2019; 36:1489-1495. [PMID: 31104293 DOI: 10.1007/s10815-019-01484-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 05/09/2019] [Indexed: 12/11/2022] Open
Abstract
PURPOSE The aim of the study was to compare the levels of angiogenic markers and markers of placentation between pregnancies conceived with fresh (ET) and vitrified-warmed blastocyst transfer (FET). METHODS Women with singleton pregnancies resulting from fresh ET or FET during the period between 2013 and 2017 were included in this prospective observational study. Fresh ET was performed in a stimulated and FET in natural cycle. At 6-7 weeks of gestation, after ultrasound confirmation of a single gestational sac with a viable embryo, serum levels of free β-hCG, pregnancy-associated plasma protein A (PAPP-A), placental growth factor (PIGF) and fms-like tyrosine kinase (sFlt-1) were measured. Data on the patients' characteristics, pregnancy complications and outcomes were collected from a questionnaire and National Perinatal Information System of Slovenia. RESULTS Among 211 pregnancies, 126 were achieved with fresh ET and 85 with FET. There were no significant differences in perinatal outcome, pregnancy complication and PIGF level between the fresh ET and FET group. Women achieving pregnancy with FET had significant higher levels of free β-hCG (40.20 ± 30.62 IU/L vs. 28.74 ± 23.52, p = 0.002), PAPP-A (0.09 ± 0.06 vs. 0.06 ± 0.05 IU/L, p = 0.004) and sFlt-1 (596.19 ± 283.06 vs. 436.53 ± 248.23 pg/L, p < 0.0001) compared to women having conceived with fresh ET. There were no significant differences in the levels of evaluated biomarkers between patients with different pregnancy outcomes and complications. CONCLUSION Levels of angiogenic markers and markers of placentation differ between pregnancies achieved with fresh ET and FET which may reflect altered implantation and early placentation with some forms of assisted reproductive technologies.
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Affiliation(s)
- Milan Reljič
- Department of Reproductive Medicine and Gynaecologic Endocrinology, Division of Gynaecology and Perinatology, University Medical Centre Maribor, Ljubljanska 5, 2000, Maribor, Slovenia.
| | - Admir Porović
- Department of Gynaecology and Perinatology, Academic HELIOS Hospital Köthen, University Martin-Luther Halle-Wittenberg, Hallesche Str. 29, 06366, Köthen (Anhalt), Germany
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15
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Zhu J, Zhu Q, Wang Y, Wang B, Lyu Q, Kuang Y. Comparative study on risk for birth defects among infants after in vitro fertilization and intracytoplasmic sperm injection. Syst Biol Reprod Med 2018; 65:54-60. [PMID: 30526119 DOI: 10.1080/19396368.2018.1554012] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Jing Zhu
- Department of Assisted Reproduction, Shanghai Ninth People’s Hospital affiliated with JiaoTong University School of Medicine, Shanghai, China
| | - Qianqian Zhu
- Department of Assisted Reproduction, Shanghai Ninth People’s Hospital affiliated with JiaoTong University School of Medicine, Shanghai, China
| | - Yun Wang
- Department of Assisted Reproduction, Shanghai Ninth People’s Hospital affiliated with JiaoTong University School of Medicine, Shanghai, China
| | - Bian Wang
- Department of Assisted Reproduction, Shanghai Ninth People’s Hospital affiliated with JiaoTong University School of Medicine, Shanghai, China
| | - Qifeng Lyu
- Department of Assisted Reproduction, Shanghai Ninth People’s Hospital affiliated with JiaoTong University School of Medicine, Shanghai, China
| | - Yanping Kuang
- Department of Assisted Reproduction, Shanghai Ninth People’s Hospital affiliated with JiaoTong University School of Medicine, Shanghai, China
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16
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Inna N, Sanmee U, Saeng-Anan U, Piromlertamorn W, Vutyavanich T. Rapid freezing versus Cryotop vitrification of mouse two-cell embryos. Clin Exp Reprod Med 2018; 45:110-115. [PMID: 30202740 PMCID: PMC6125146 DOI: 10.5653/cerm.2018.45.3.110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 06/19/2018] [Accepted: 07/31/2018] [Indexed: 11/30/2022] Open
Abstract
Objective To compare our in-house method of embryo freezing with Cryotop vitrification in terms of immediate survival, subsequent cleavage and blastocyst formation, and cell numbers in blastocysts. Methods Two-cell mouse embryos were randomly allocated into three groups: a non-frozen control group (group 1, n=300), a group that underwent Cryotop vitrification (group 2, n=300), and a group that underwent our in-house freezing method (group 3, n=300). Results There were no significant differences between groups 2 and 3 in the immediate survival rate (96.3% vs. 98.6%, respectively; p=0.085), the further cleavage rate (91.7% vs. 95.0%, respectively; p=0.099), or the blastocyst formation rate (80.7% vs. 78.6%, respectively; p=0.437). The cell numbers in the blastocysts from groups 1, 2, and 3 were comparable (88.99±10.44, 88.29±14.79, and 86.42±15.23, respectively; p=0.228). However, the percentage of good-quality blastocysts in the Cryotop vitrification group was significantly higher than in the group in which our in-house method was performed, but was lower than in the control group (58.0%, 37.0%, and 82.7%, respectively; p<0.001). Conclusion At present, our method is inferior to the commercial Cryotop vitrification system. However, with further improvements, it has the potential to be useful in routine practice, as it is easier to perform than the current vitrification system.
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Affiliation(s)
- Namfon Inna
- Division of Reproductive Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Usanee Sanmee
- Division of Reproductive Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Ubol Saeng-Anan
- Division of Reproductive Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Waraporn Piromlertamorn
- Division of Reproductive Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Teraporn Vutyavanich
- Division of Reproductive Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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17
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Roque M, Valle M, Sampaio M, Geber S. Obstetric outcomes after fresh versus frozen-thawed embryo transfers: A systematic review and meta-analysis. JBRA Assist Reprod 2018; 22:253-260. [PMID: 29782139 PMCID: PMC6106638 DOI: 10.5935/1518-0557.20180049] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Objective To evaluate if there are differences in the risks of obstetric outcomes in
IVF/ICSI singleton pregnancies when compared fresh to frozen-thawed embryo
transfers (FET). Methods This was a systematic review and meta-analysis evaluating the obstetric
outcomes in singleton pregnancies after FET and fresh embryo transfer. The
outcomes included in this study were pregnancy-induced hypertension (PIH),
pre-eclampsia, placenta previa, and placenta accreta. Results The search yielded 654 papers, 6 of which met the inclusion criteria and
reported on obstetric outcomes. When comparing pregnancies that arose from
FET or fresh embryo transfer, there was an increase in the risk of obstetric
complications in pregnancies resulting from FET when compared to those
emerging from fresh embryo transfers in PIH (aOR 1.82; 95% CI 1.24-2.68),
pre-eclampsia (aOR 1.32, 95% CI 1.07, 1.63), and placenta accreta (aOR 3.51,
95% CI 2.04-6.05). There were no significant differences in the risk between
the FET and fresh embryo transfer groups when evaluating placenta previa
(aOR 0.70; 95% CI 0.46-1.08). Conclusion The obstetric outcomes observed in pregnancies arising from ART may differ
among fresh and FET cycles. Thus, when evaluating to perform a fresh embryo
transfer or a freeze-all cycle, these differences found in obstetric
outcomes between fresh and FET should be taken into account. The adverse
obstetric outcomes after FET found in this study emphasize that the
freeze-all policy should not be offered to all the patients, but should be
offered to those with a clear indication of the benefit of this
strategy.
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Affiliation(s)
- Matheus Roque
- ORIGEN - Center for Reproductive Medicine, Rio de Janeiro, Brazil.,Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Marcello Valle
- ORIGEN - Center for Reproductive Medicine, Rio de Janeiro, Brazil
| | - Marcos Sampaio
- ORIGEN - Center for Reproductive Medicine, Belo Horizonte, Brazil
| | - Selmo Geber
- Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,ORIGEN - Center for Reproductive Medicine, Belo Horizonte, Brazil
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Fowler KE, Mandawala AA, Griffin DK, Walling GA, Harvey SC. The production of pig preimplantation embryos in vitro: Current progress and future prospects. Reprod Biol 2018; 18:203-211. [DOI: 10.1016/j.repbio.2018.07.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 06/26/2018] [Accepted: 07/01/2018] [Indexed: 02/07/2023]
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Fisch B, Abir R. Female fertility preservation: past, present and future. Reproduction 2018; 156:F11-F27. [DOI: 10.1530/rep-17-0483] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 03/23/2018] [Indexed: 12/19/2022]
Abstract
Anti-cancer therapy, particularly chemotherapy, damages ovarian follicles and promotes ovarian failure. The only pharmacological means for protecting the ovaries from chemotherapy-induced injury is gonadotrophin-releasing hormone agonist, but its efficiency remains controversial; ovarian transposition is used to shield the ovary from radiation when indicated. Until the late 1990s, the only option for fertility preservation and restoration in women with cancer was embryo cryopreservation. The development of other assisted reproductive technologies such as mature oocyte cryopreservation andin vitromaturation of oocytes has contributed to fertility preservation. Treatment regimens to obtain mature oocytes/embryos have been modified to overcome various limitations of conventional ovarian stimulation protocols. In the last decades, several centres have begun cryopreserving ovarian samples containing primordial follicles from young patients before anti-cancer therapy. The first live birth following implantation of cryopreserved-thawed ovarian tissue was reported in 2004; since then, the number has risen to more than 130. Nowadays, ovarian tissue cryopreservation can be combined within vitromaturation and vitrification of oocytes. The use of cryopreserved oocytes eliminates the risk posed by ovarian implantation of reseeding the cancer. Novel methods for enhancing follicular survival after implantation are presently being studied. In addition, researchers are currently investigating agents for ovarian protection. It is expected that the risk of reimplantation of malignant cells with ovarian grafts will be overcome with the putative development of an artificial ovary and an efficient follicle class- and species-dependentin vitrosystem for culturing primordial follicles.
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Mohsenzadeh M, Salehi-Abargouei A, Tabibnejad N, Karimi-Zarchi M, Khalili MA. Impact of vitrification on human oocytes before and after in vitro maturation: A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2018; 227:19-26. [PMID: 29864696 DOI: 10.1016/j.ejogrb.2018.05.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Revised: 05/16/2018] [Accepted: 05/21/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE There are controversies regarding in vitro maturation (IVM) procedure, the time of storing frozen oocytes and maturation stage of vitrified oocytes and its impact on oocytes fertilization capability. The aim of this systematic review and meta-analysis was to evaluate the impact of vitrification on human oocytes during IVM procedure. STUDY DESIGN A systematic review with meta-analysis was undertaken. Main search terms were those related key words. We searched Medline, Embase, Scopus and ISI web of science to detect English-language studies. The final search was performed on 27 January 2018. The original articles which studied laboratory outcomes after vitrification of MII or GV oocytes before or after IVM were included. Exclusion criteria were animal trials and the studies that performed cryopreservation using slow-freeze method. Oocyte maturation, survival, fertilization and cleavage rates were assessed. Bias and quality assessments were applied. RESULTS 2476 articles were screened and after duplicates removing together with application of inclusion and exclusion criteria, 14 studies assessed for eligibility. Finally 5 studies included for analysis. All studies compared laboratory outcomes between oocytes that vitrified at the GV stage and those which firstly matured in vitro, and then vitrified. Meta-analysis showed that vitrification of oocytes at GV stage had a negative impact on maturation rate (RR = 1.28, 95% CI: 0.96-1.70); but not on cleavage rate (RR = 1.07, 95% CI: 0.70-1.64); fertilization rate (RR = 0.99, 95% CI: 0.85-1.14) and survival rate(RR = 1.01, 95% CI: 0.96-1.06). CONCLUSION In general, Based on our results, oocyte vitrification decreases the maturation rate. In addition, survival, fertilization as well as cleavage rates did not significantly differ between the oocytes vitrified before IVM versus oocytes vitrified after IVM.
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Affiliation(s)
- Mehdi Mohsenzadeh
- Research and Clinical Center for Infertility, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran; Gerash Al-Zahra Fertility Center, Gerash University of Medical Sciences, Gerash, Iran
| | - Amin Salehi-Abargouei
- Nutrition and Food Security Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran; Department of Nutrition, Faculty of Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Nasim Tabibnejad
- Research and Clinical Center for Infertility, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mojgan Karimi-Zarchi
- Department of Obstetrics and Gynecology, Shahid Sadoughi Hospital, Faculty of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mohammad Ali Khalili
- Research and Clinical Center for Infertility, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Isachenko V, Todorov P, Seisenbayeva A, Toishibekov Y, Isachenko E, Rahimi G, Mallmann P, Foth D, Merzenich M. Vitrification of human pronuclear oocytes by direct plunging into cooling agent: Non sterile liquid nitrogen vs. sterile liquid air. Cryobiology 2018; 80:84-88. [DOI: 10.1016/j.cryobiol.2017.11.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 11/20/2017] [Accepted: 11/21/2017] [Indexed: 11/24/2022]
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Naredi N, Singh S, Lele P, Nagraj N. Severe ovarian hyperstimulation syndrome: Can we eliminate it through a multipronged approach? Med J Armed Forces India 2018; 74:44-50. [PMID: 29386731 PMCID: PMC5771764 DOI: 10.1016/j.mjafi.2017.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 04/24/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Prevention of severe Ovarian Hyperstimulation Syndrome (OHSS), a potentially fatal complication of controlled ovarian hyperstimulation has been the aim of all fertility experts. Various pharmacologic and non-pharmacologic interventions have been instituted but the results have been conflicting. These preventive strategies were administered in isolation or as a combination of few aiming to eliminate this iatrogenic sequel. This study aimed to eliminate severe OHSS by multipronged approach incorporating almost all preventive modalities available in patients at high risk for this dreadful complication. METHODS It was a prospective observational study wherein 112 high risk patients planned for IVF were studied. The multipronged approach was in the form administering calcium gluconate infusion, cabergoline, albumin infusion, GnRH antagonist in luteal phase in addition to elective cryopreservation of embryos. The primary outcome measure was incidence of severe OHSS in the study group and the rate of hospitalisation. The secondary outcome measure was the number of days required for complete recovery and resolution of signs and symptoms. RESULTS Out of the 112 high risk patients only one patient (1/112; 0.9%) developed severe OHSS with an overall incidence of 0.095% of severe OHSS in all the cycles. There was no biochemical or haematological derangement in any of the high risk patients. CONCLUSION Although this is the first study evaluating the multipronged approach in preventing the dreaded complication of severe OHSS, it does add to the knowledge that targeting the various pathophysiological pathways at different time frames will bring about prevention of OHSS but further randomised studies may reveal superiority of one intervention over the other.
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Affiliation(s)
- Nikita Naredi
- Classified Specialist (Obst & Gynae) & IVF Specialist, Assisted Reproductive Technology Centre, Command Hospital (Southern Command), Pune 411040, India
| | - S.K. Singh
- Classified Specialist (Obst & Gynae), Command Hospital (Southern Command), Pune 411040, India
| | - Prasad Lele
- Senior Advisor (Obst & Gynae) & IVF Specialist, Command Hospital (Eastern Command), Kolkata, India
| | - N. Nagraj
- Classified Specialist (Obst & Gynae) & IVF Specialist, Assisted Reproductive Technology Centre, Army Hospital (R&R), New Delhi 110 010, India
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Salama M, Isachenko V, Isachenko E, Rahimi G, Mallmann P. Advances in fertility preservation of female patients with hematological malignancies. Expert Rev Hematol 2017; 10:951-960. [PMID: 28828900 DOI: 10.1080/17474086.2017.1371009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The most common forms of hematological malignancies that occur in female reproductive years are lymphoma and leukemia. Areas covered: Several aggressive gonadotoxic regimens such as alkylating chemotherapy and total body irradiation are used frequently in treatment of lymphoma and leukemia leading to subsequent iatrogenic premature ovarian failure and fertility loss. In such cases, female fertility preservation options should be offered in advance. Expert commentary: In order to preserve fertility of young women and girls with lymphoma and leukemia, several established, experimental, and debatable options can be offered before starting chemotherapy and radiotherapy. However, each of those female fertility preservation options has both advantages and disadvantages and may not be suitable for all patients. That is why a fertility preservation strategy should be individualized and tailored distinctively for each patient in order to be effective. Artificial human ovary is a novel experimental in vitro technology to produce mature oocytes that could be the safest option to preserve and restore fertility of young women and girls with hematological malignancies especially when other fertility preservation options are not feasible or contraindicated. Further research and studies are needed to improve the results of artificial human ovary and establish it in clinical practice.
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Affiliation(s)
- Mahmoud Salama
- a Department of Gynecology and Obstetrics, Medical Faculty , University of Cologne , Cologne , Germany
| | - Vladimir Isachenko
- a Department of Gynecology and Obstetrics, Medical Faculty , University of Cologne , Cologne , Germany
| | - Evgenia Isachenko
- a Department of Gynecology and Obstetrics, Medical Faculty , University of Cologne , Cologne , Germany
| | - Gohar Rahimi
- a Department of Gynecology and Obstetrics, Medical Faculty , University of Cologne , Cologne , Germany
| | - Peter Mallmann
- a Department of Gynecology and Obstetrics, Medical Faculty , University of Cologne , Cologne , Germany
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Zheng X, Chen Y, Yan J, Wu Y, Zhuang X, Lin S, Zhu J, Lian Y, Qiao J, Liu P. Effect of repeated cryopreservation on human embryo developmental potential. Reprod Biomed Online 2017; 35:627-632. [PMID: 29102427 DOI: 10.1016/j.rbmo.2017.08.016] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 08/05/2017] [Accepted: 08/08/2017] [Indexed: 11/26/2022]
Abstract
Repeated cryopreservation of surplus embryos from frozen-thawed cycles should occasionally be considered. The purpose of this retrospective cohort study was to evaluate the pregnancy and perinatal outcome of repeated cryopreservation by vitrification of human blastocysts derived from slowly frozen-thawed day 3 embryos. In total, 571 vitrified-warmed blastocyst transfer cycles were investigated. The vitrified-warmed blastocysts were derived from slowly frozen-thawed cleavage embryos (twice-cryopreserved group) or fresh embryos (control group) cultured to the blastocyst stage. Age, body mass index, endometrial thickness, blastocyst developmental rate and number of embryos transferred were not significantly different between twice-cryopreserved and control groups. Clinical pregnancy and implantation rates were also similar. Compared with controls, the miscarriage rate was significantly higher in the twice-cryopreserved group (33.93% versus 19.07%, P = 0.017). This resulted in a significantly lower live birth rate in the twice-cryopreserved group than in controls (29.13% versus 39.18, P = 0.038). No differences were observed in mean gestational age, birthweight and sex ratio of newborns between groups. In conclusion, acceptable clinical pregnancy outcomes may be expected from transfer of twice-cryopreserved human embryos. While the neonatal outcome is not affected, the correlation between the risk of higher pregnancy loss and repeated cryopreservation needs further investigation.
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Affiliation(s)
- Xiaoying Zheng
- Centre of Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University, Third Hospital, Beijing 100191, China; Key Laboratory of Assisted Reproduction, Ministry of Education, Beijing 100191, China
| | - Yuan Chen
- Centre of Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University, Third Hospital, Beijing 100191, China; Key Laboratory of Assisted Reproduction, Ministry of Education, Beijing 100191, China
| | - Jie Yan
- Centre of Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University, Third Hospital, Beijing 100191, China; Key Laboratory of Assisted Reproduction, Ministry of Education, Beijing 100191, China
| | - Yuqi Wu
- Centre of Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University, Third Hospital, Beijing 100191, China; Key Laboratory of Assisted Reproduction, Ministry of Education, Beijing 100191, China
| | - Xinjie Zhuang
- Centre of Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University, Third Hospital, Beijing 100191, China; Key Laboratory of Assisted Reproduction, Ministry of Education, Beijing 100191, China
| | - Shengli Lin
- Centre of Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University, Third Hospital, Beijing 100191, China; Key Laboratory of Assisted Reproduction, Ministry of Education, Beijing 100191, China
| | - Jinliang Zhu
- Centre of Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University, Third Hospital, Beijing 100191, China; Key Laboratory of Assisted Reproduction, Ministry of Education, Beijing 100191, China
| | - Ying Lian
- Centre of Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University, Third Hospital, Beijing 100191, China; Key Laboratory of Assisted Reproduction, Ministry of Education, Beijing 100191, China
| | - Jie Qiao
- Centre of Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University, Third Hospital, Beijing 100191, China; Key Laboratory of Assisted Reproduction, Ministry of Education, Beijing 100191, China
| | - Ping Liu
- Centre of Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University, Third Hospital, Beijing 100191, China; Key Laboratory of Assisted Reproduction, Ministry of Education, Beijing 100191, China.
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Khalili MA, Shahedi A, Ashourzadeh S, Nottola SA, Macchiarelli G, Palmerini MG. Vitrification of human immature oocytes before and after in vitro maturation: a review. J Assist Reprod Genet 2017; 34:1413-1426. [PMID: 28822010 DOI: 10.1007/s10815-017-1005-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Accepted: 07/21/2017] [Indexed: 12/27/2022] Open
Abstract
The use of immature oocytes subjected to in vitro maturation (IVM) opens interesting perspectives for fertility preservation where ovarian reserves are damaged by pathologies or therapies, as in PCO/PCOS and cancer patients. Human oocyte cryopreservation may offer some advantages compared to embryo freezing, such as fertility preservation in women at risk of losing fertility due to oncological treatment or chronic disease, egg donation and postponing childbirth. It also eliminates religious and/or other ethical, legal, and moral concerns of embryo freezing. In addition, a successful oocyte cryopreservation program could eliminate the need for donor and recipient menstrual cycle synchronization. Recent advances in vitrification technology have markedly improved the oocyte survival rate after warming, with fertilization and implantation rates comparable with those of fresh oocytes. Healthy live births can be achieved from the combination of IVM and vitrification, even if vitrification of in vivo matured oocytes is still more effective. Recently, attention is given to highlight whether vitrification procedures are more successful when performed before or after IVM, on immature GV-stage oocytes, or on in vitro matured MII-stage oocytes. In this review, we emphasize that, even if there are no differences in survival rates between oocytes vitrified prior to or post-IVM, reduced maturation rates of immature oocytes vitrified prior to IVM can be, at least in part, explained by underlying ultrastructural and biomolecular alterations.
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Affiliation(s)
- Mohammad Ali Khalili
- Research and Clinical Center for Infertility, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.,Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Abbas Shahedi
- Department of Biology and Anatomical Sciences, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Sareh Ashourzadeh
- Research and Clinical Center for Infertility, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.,Afzalipour Clinical Center for Infertility, Kerman University of Medical Sciences, Kerman, Iran
| | - Stefania Annarita Nottola
- Department of Anatomy, Histology, Forensic Medicine and Orthopaedics, University of Rome La Sapienza, Rome, Italy
| | - Guido Macchiarelli
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Maria Grazia Palmerini
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy.
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Adeviye Erşahin A, Acet M, Erşahin SS, Dokuzeylül Güngör N. Frozen embryo transfer prevents the detrimental effect of high estrogen on endometrium receptivity. J Turk Ger Gynecol Assoc 2017; 18:38-42. [PMID: 28506949 PMCID: PMC5450209 DOI: 10.4274/jtgga.2016.0186] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To investigate whether serum levels of estradiol affect reproductive outcomes of normoresponder women undergoing fresh embryo transfer (ET) versus frozen-thawed ET (FET). MATERIAL AND METHODS Two hundred fifty-five normoresponder women underwent fresh ET in their first or second in vitro fertilization cycle. Ninety-two women with negative pregnacy test results underwent FET. Clinical and ongoing pregnancy rates, implantation, and live birth rates of women undergoing fresh ET versus FET were compared. RESULTS One hundred forty-seven (57.65%) out of the 255 normoresponder women receiving FET had positive beta-human chorionic gonadotrophin (hCG) results. The remaining 108 women had negative beta-hCG results. The clinical pregnancy rates of the fresh ET group were found as 55.69% (n=142). Ninety-two of the 108 women with failed pregnancies underwent FET; 72.83% had positive beta-hCG results (n=67), and 70.65% had clinical pregnancy (n=65). Both biochemical and clinical pregnancy rates of women undergoing FET increased significantly (p<0.012 and p<0.013, respectively). Ongoing pregnancy (60.87% vs. 52.94%) and live birth rates (59.87% vs. 48.63%) were similar in both fresh and FET groups. Serum E2 levels of women who failed to conceive were significantly higher than those women did conceive. Serum progesterone levels of women who conceived versus those that did not were similar. CONCLUSION The detrimental effect of high serum estradiol levels on endometrial receptivity could be prevented by FET.
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Affiliation(s)
- Aynur Adeviye Erşahin
- Department of Obstetrics and Gynecology, Bahçesehir University Faculty of Medicine, İstanbul, Turkey
| | - Mustafa Acet
- Department of Obstetrics and Gynecology, Medipol University Faculty of Medicine, İstanbul, Turkey
| | - Suat Süphan Erşahin
- Department of Obstetrics and Gynecology, Kemerburgaz University Faculty of Medicine, İstanbul, Turkey
| | - Nur Dokuzeylül Güngör
- Department of Obstetrics and Gynecology, Medicalpark Göztepe Hospital, İstanbul, Turkey
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27
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Reduced competence of immature and mature oocytes vitrified by Cryotop method: assessment by in vitro fertilization and parthenogenetic activation in a bovine model. ZYGOTE 2017; 25:222-230. [DOI: 10.1017/s0967199416000381] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
SummaryThis study aimed to evaluate the embryo development competence, the nuclear maturation and the viability of germinal vesicle (GV) and metaphase II (MII) oocytes vitrified by the Cryotop method. Cumulus–oocyte complexes were derived from bovine ovaries and three experiments were conducted. In Experiment 1, GV oocytes were vitrified and underwent in vitro maturation (IVM) or not and their nuclear maturation was assessed by orcein staining. In Experiment 2, GV oocytes and MII oocytes were vitrified or not and the viability was assessed by calcein/ethidium homodimer-1 staining. In Experiment 3, MII oocytes matured before or after vitrification were submitted to in vitro fertilization (IVF) and parthenogenetic activation (PA) in order to evaluate embryo development. No difference was found for the nuclear maturation rate in the GV group (50%) and the GV control group (67%; P = 0.23) and for viability rate (56%; 77%; P = 0.055, respectively). However, in the MII group (27%) viability was significantly lower than that of the MII control group (84%; P < 0.0001). The cleavage rate by IVF and PA was similar in the GV group and the MII group. In contrast, vitrified MII oocytes showed no capacity for blastocyst development after IVF or PA and vitrified GV oocytes were able to develop to blastocysts only after PA, but not after IVF. In conclusion, oocyte vitrification by the Cryotop method reduced the capacity for embryo development. Vitrification of GV oocytes, however, did not influence the capacity of meiotic nuclear maturation and they exhibited higher viability following vitrification at the MII stage.
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28
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Roque M, Valle M, Guimarães F, Sampaio M, Geber S. Freeze-all cycle for all normal responders? J Assist Reprod Genet 2016; 34:179-185. [PMID: 27817036 DOI: 10.1007/s10815-016-0834-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 10/23/2016] [Indexed: 12/25/2022] Open
Abstract
PURPOSE The purpose of this study is to evaluate the freeze-all strategy in subgroups of normal responders, to assess whether this strategy is beneficial regardless of ovarian response, and to evaluate the possibility of implementing an individualized embryo transfer (iET) based on ovarian response. METHODS This was an observational, cohort study performed in a private IVF center. A total of 938 IVF cycles were included in this study. The patients were submitted to controlled ovarian stimulation (COS) with a gonadotropin-releasing hormone (GnRH) antagonist protocol and a cleavage-stage day 3 embryo transfer. We performed a comparison of outcomes between the fresh embryo transfer (n = 523) and the freeze-all cycles (n = 415). The analysis was performed in two subgroups of patients based on the number of retrieved oocytes: Group 1 (4-9 oocytes) and Group 2 (10-15 oocytes). RESULT(S) In Group 1 (4-9 retrieved oocytes), the implantation rates (IR) were 17.9 and 20.5% (P = 0.259) in the fresh and freeze-all group, respectively; the ongoing pregnancy rates (OPR) were 31 and 33% (P = 0.577) in the fresh and freeze-all group, respectively. In Group 2 (10-15 oocytes), the IR were 22.1 and 30.1% (P = 0.028) and the OPR were 34 and 47% (P = 0.021) in the fresh and freeze-all groups, respectively. CONCLUSION(S) Although the freeze-all policy may be related to better in vitro fertilization (IVF) outcomes in normal responders, these potential advantages decrease with worsening ovarian response. Patients with poorer ovarian response do not benefit from the freeze-all strategy.
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Affiliation(s)
- Matheus Roque
- ORIGEN-Center for Reproductive Medicine, Avenida Rodolfo de Amoedo, 140-Barra da Tijuca, Rio de Janeiro, Brazil. .,Universidade Federal de Minas Gerais, Avenida Alfredo Balena, 190, Belo Horizonte, Brazil.
| | - Marcello Valle
- ORIGEN-Center for Reproductive Medicine, Avenida Rodolfo de Amoedo, 140-Barra da Tijuca, Rio de Janeiro, Brazil
| | - Fernando Guimarães
- ORIGEN-Center for Reproductive Medicine, Avenida Rodolfo de Amoedo, 140-Barra da Tijuca, Rio de Janeiro, Brazil
| | - Marcos Sampaio
- ORIGEN-Center for Reproductive Medicine, Av do Contorno, 7747-Lourdes, Belo Horizonte, Brazil
| | - Selmo Geber
- Universidade Federal de Minas Gerais, Avenida Alfredo Balena, 190, Belo Horizonte, Brazil.,ORIGEN-Center for Reproductive Medicine, Av do Contorno, 7747-Lourdes, Belo Horizonte, Brazil
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29
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Mandawala A, Harvey S, Roy T, Fowler K. Cryopreservation of animal oocytes and embryos: Current progress and future prospects. Theriogenology 2016; 86:1637-44. [DOI: 10.1016/j.theriogenology.2016.07.018] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 07/14/2016] [Accepted: 07/16/2016] [Indexed: 10/21/2022]
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30
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Nohales-Córcoles M, Sevillano-Almerich G, Di Emidio G, Tatone C, Cobo AC, Dumollard R, De Los Santos Molina MJ. Impact of vitrification on the mitochondrial activity and redox homeostasis of human oocyte. Hum Reprod 2016; 31:1850-8. [PMID: 27251202 DOI: 10.1093/humrep/dew130] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 05/12/2016] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION Do the extreme conditions of vitrification affect mitochondrial health and reactive oxygen species (ROS) levels of human oocytes? SUMMARY ANSWER Vitrification of discarded human oocytes shifts the intracellular redox potential towards oxidation but does not alter the mitochondrial potential or intracellular ROS levels. WHAT IS KNOWN ALREADY Recent studies have reflected increased ROS levels in warmed young oocytes and have highlighted the temporal dynamic loss of mitochondrial potential that could, therefore, lead to a decrease in ATP production, impairing embryo development. Mitochondrial function can also be evaluated in vivo by the FAD/NAD(P)H autofluorescence ratio, which reflects the respiratory chain activity and is considered as a marker of the intracellular redox state. STUDY DESIGN, SIZE, DURATION A total of 629 discarded Metaphase II (MII) oocytes collected from June 2013 to April 2014 were included in this control (fresh oocytes, n= 270) versus treatment (vitrified oocytes, n= 359) study. PARTICIPANTS/MATERIALS, SETTING, METHODS Discarded MII oocytes were donated to research by young (<27 years old) and reproductively aged (>36 years old) women who underwent ovarian stimulation for IVF at a university-affiliated private fertility clinic. Redox state was assessed by measuring the FAD/NAD(P)H autofluorescence ratio, while ROS and mitochondrial activity were reported by in vivo labelling with carboxy-H2DCFDA and JC-1, respectively. MAIN RESULTS AND THE ROLE OF CHANCE Young and aged oocytes showed high and similar survival rates (81.8 versus 83.1%, not significant). Confocal microscopy revealed that the FAD/NAD(P)H ratio was significantly higher in vitrified oocytes than in fresh oocytes, suggesting a significant shift towards the oxidized state in oocytes after vitrification, regardless of the maternal age. Mitochondrial distribution was not affected by vitrification. Furthermore, it was not possible to resolve any difference in mitochondrial potential using JC-1 potentiometric dye or in reactive oxygen species (ROS) production (assessed with H2-DCFDA staining) between fresh and vitrified oocytes. Therefore, measurement of intracellular redox potential by autofluorescence imaging may be a more sensitive method to assess oxidative stress or mitochondrial demise in human oocytes because it showed a higher resolving power than JC-1 staining and displayed less variability than H2-DCFDA staining. LIMITATIONS, REASONS FOR CAUTION Owing to sample availability, MII discarded oocytes (in vitro matured oocytes and unfertilized oocytes 20 h after ICSI) were included in the study. These discarded oocytes do not necessarily reflect the physiological condition of the MII human oocyte. WIDER IMPLICATIONS OF THE FINDINGS Although vitrified oocytes yield comparable clinical outcomes compared with fresh oocytes, lower cleavage and blastocyst rates can be observed during in vitro culture. Data here obtained suggest that the redox state of human oocytes could be affected by vitrification. Therefore, the importance of adding protective antioxidant molecules to the vitrification solution and to the post-warming culture medium to improve embryo cleavage deserves some research. STUDY FUNDING/COMPETING INTERESTS This research project was supported by the Valencian Government (Val+i+D program, M.N.-C.), INCLIVA Foundation for health research (G.S.-A.) and by the University of L'Aquila and Regione Abruzzo ('Reti per l'Alta Formazione' - P.O.F.S.E. Abruzzo 2007-2013 G.D.E.). No conflicts of interest were declared.
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Affiliation(s)
| | | | - G Di Emidio
- Department of Health, Life and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - C Tatone
- Department of Health, Life and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - A C Cobo
- Instituto Universitario IVI Valencia, Valencia, Spain
| | - R Dumollard
- Centre National de la Recherche (CNRS), Laboratoire de Biologie du Développement de Villefranche-sur-mer, Observatoire Océanographique, Sorbonne Universités, UPMC Univ Paris 06, 06230 Villefranche-sur-mer, France
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31
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Chen H, Zhang L, Deng T, Zou P, Wang Y, Quan F, Zhang Y. Effects of oocyte vitrification on epigenetic status in early bovine embryos. Theriogenology 2016; 86:868-78. [PMID: 27068359 DOI: 10.1016/j.theriogenology.2016.03.008] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 03/03/2016] [Accepted: 03/05/2016] [Indexed: 10/22/2022]
Abstract
Oocyte cryopreservation has a great impact on subsequent embryonic development. Currently, several studies have primarily focused on the consequences of vitrification and the development potential of cellular structures. This study determined whether oocyte vitrification caused epigenetic instabilities of bovine embryos. The effects of oocyte vitrification on DNA methylation, histone modifications, and putative imprinted genes' expression in early embryos derived by intracytoplasmic sperm injection were examined. Results showed that oocyte vitrification did not affect zygote cleavage rates (67.0% vs. 73.8% control, P > 0.05) but reduced the blastocyst rate (9.6% vs. 23.0%, P < 0.05). The levels of DNA methylation and H3K9me3 in oocytes and early cleavage embryos were lower (P < 0.05) than those in control group, but the level of acH3K9 increased (P < 0.05) in the vitrification group during the early cleavage phases. No differences were observed for DNA methylation, H3K9me3, and acH3K9 in the inner cell mass of blastocysts, whereas decreased levels of DNA methylation and acH3K9 (P < 0.05) existed in TE cells after vitrification. The expression of putative-imprinted genes PEG10, XIST, and KCNQ1O1T was upregulated in blastocysts. These epigenetic abnormalities may be partially explained by altered expression of genes associated with epigenetic regulations. DNA methylation and H3K9 modification suggest that oocyte vitrification may excessively relax the chromosomes of oocytes and early cleavage embryos. In conclusion, these epigenetic indexes could be used as damage markers of oocyte vitrification during early embryonic development, which offers a new insight to assess oocyte vitrification.
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Affiliation(s)
- Huanhuan Chen
- Key Laboratory of Animal Biotechnology of the Ministry of Agriculture, College of Veterinary Medicine, Northwest A&F University, Yangling, Shaanxi, China
| | - Lei Zhang
- Key Laboratory of Animal Biotechnology of the Ministry of Agriculture, College of Veterinary Medicine, Northwest A&F University, Yangling, Shaanxi, China
| | - Tengfei Deng
- Key Laboratory of Animal Biotechnology of the Ministry of Agriculture, College of Veterinary Medicine, Northwest A&F University, Yangling, Shaanxi, China
| | - Pengda Zou
- Key Laboratory of Animal Biotechnology of the Ministry of Agriculture, College of Veterinary Medicine, Northwest A&F University, Yangling, Shaanxi, China
| | - Yongsheng Wang
- Key Laboratory of Animal Biotechnology of the Ministry of Agriculture, College of Veterinary Medicine, Northwest A&F University, Yangling, Shaanxi, China
| | - Fusheng Quan
- Key Laboratory of Animal Biotechnology of the Ministry of Agriculture, College of Veterinary Medicine, Northwest A&F University, Yangling, Shaanxi, China.
| | - Yong Zhang
- Key Laboratory of Animal Biotechnology of the Ministry of Agriculture, College of Veterinary Medicine, Northwest A&F University, Yangling, Shaanxi, China.
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32
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Kato K. Vitrification of embryos and oocytes for fertility preservation in cancer patients. Reprod Med Biol 2016; 15:227-233. [PMID: 29259440 DOI: 10.1007/s12522-016-0239-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 02/12/2016] [Indexed: 12/24/2022] Open
Abstract
As survival rates and the life expectancy of those with malignancy have increased, more women in their reproductive years are referred for fertility preservation. Chemotherapy and radiotherapy can severely affect ovarian function, and the effect is irreversible. Therefore, it is optimal to attempt fertility preservation before chemotherapy and radiotherapy are initiated. Oocyte and embryo cryopreservation is the most common option for fertility preservation in women. Several reports have proven that embryo and oocyte cryopreservation can achieve a successful pregnancy. This review discusses the impact of chemotherapy and radiotherapy on ovarian function, and the importance of oocyte and embryo cryopreservation for fertility preservation. In addition, the current status of pregnancy outcomes and potential for cryopreserved oocytes to result in live births in cancer patients was reviewed. This may provide useful information for decision-making in cancer patients regarding oocyte and embryo cryopreservation and fertility preservation.
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Affiliation(s)
- Keiichi Kato
- Kato Ladies' Clinic7-20-3 Nishishinjuku, Shinjuku-ku 160-0023 Tokyo Japan
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33
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Hardarson T, Bungum M, Conaghan J, Meintjes M, Chantilis SJ, Molnar L, Gunnarsson K, Wikland M. Noninferiority, randomized, controlled trial comparing embryo development using media developed for sequential or undisturbed culture in a time-lapse setup. Fertil Steril 2015; 104:1452-9.e1-4. [PMID: 26409153 DOI: 10.1016/j.fertnstert.2015.08.037] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 08/28/2015] [Accepted: 08/28/2015] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To study whether a culture medium that allows undisturbed culture supports human embryo development to the blastocyst stage equivalently to a well-established sequential media. DESIGN Randomized, double-blinded sibling trial. SETTING Independent in vitro fertilization (IVF) clinics. PATIENT(S) One hundred twenty-eight patients, with 1,356 zygotes randomized into two study arms. INTERVENTION(S) Embryos randomly allocated into two study arms to compare embryo development on a time-lapse system using a single-step medium or sequential media. MAIN OUTCOME MEASURE(S) Percentage of good-quality blastocysts on day 5. RESULT(S) Percentage of day 5 good-quality blastocysts was 21.1% (standard deviation [SD] ± 21.6%) and 22.2% (SD ± 22.1%) in the single-step time-lapse medium (G-TL) and the sequential media (G-1/G-2) groups, respectively. The mean difference (-1.2; 95% CI, -6.0; 3.6) between the two media systems for the primary end point was less than the noninferiority margin of -8%. There was a statistically significantly lower number of good-quality embryos on day 3 in the G-TL group [50.7% (SD ± 30.6%) vs. 60.8% (SD ± 30.7%)]. Four out of the 11 measured morphokinetic parameters were statistically significantly different for the two media used. The mean levels of ammonium concentration in the media at the end of the culture period was statistically significantly lower in the G-TL group as compared with the G-2 group. CONCLUSION(S) We have shown that a single-step culture medium supports blastocyst development equivalently to established sequential media. The ammonium concentrations were lower in the single-step media, and the measured morphokinetic parameters were modified somewhat. CLINICAL TRIAL REGISTRATION NUMBER NCT01939626.
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Affiliation(s)
| | - Mona Bungum
- Reproductive Medicine Centre, Skåne University Hospital, Malmö, Sweden
| | - Joe Conaghan
- Pacific Fertility Center, San Francisco, California
| | - Marius Meintjes
- Frisco Institute for Reproductive Medicine, Dallas/Austin, Texas
| | | | | | | | - Matts Wikland
- Fertilitetscentrum, Carlanderska Hospital, Gothenburg, Sweden
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El Hachem H, Atallah D, Grynberg M. Fertility preservation in breast cancer patients. Future Oncol 2015; 10:1767-77. [PMID: 25303056 DOI: 10.2217/fon.14.55] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Breast cancer is the most common malignant tumor in women of reproductive age, and is characterized by a high survival rate owing to improved antineoplastic treatments. Young survivors face the prospect of a diminished fertility as a consequence of the gonadotoxic chemotherapy, and many are seeking ways to preserve their fertility. Embryo and/or oocyte cryopreservation following controlled ovarian stimulation is currently the fertility preservation method of choice, but breast cancer patients may have contraindications to exogenous gonadotropin administration and may not have enough time to undergo ovarian stimulation prior to chemotherapy. Fortunately, many other options are available for these women, such as the letrozole-follicle-stimulating hormone ovarian stimulation protocol, in vitro maturation of oocytes and ovarian tissue cryopreservation. In this review, we discuss the benefits and disadvantages of the different fertility preservation techniques that can be offered to breast cancer patients.
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Affiliation(s)
- Hady El Hachem
- Service de Gynécologie-Obstétrique, Hôpital Hôtel-Dieu de France, Beyrouth, Liban
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Smith V, Osianlis T, Vollenhoven B. Prevention of Ovarian Hyperstimulation Syndrome: A Review. Obstet Gynecol Int 2015; 2015:514159. [PMID: 26074966 PMCID: PMC4446511 DOI: 10.1155/2015/514159] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 04/29/2015] [Indexed: 01/01/2023] Open
Abstract
The following review aims to examine the available evidence to guide best practice in preventing ovarian hyperstimulation syndrome (OHSS). As it stands, there is no single method to completely prevent OHSS. There seems to be a benefit, however, in categorizing women based on their risk of OHSS and individualizing treatments to curtail their chances of developing the syndrome. At present, both Anti-Müllerian Hormone and the antral follicle count seem to be promising in this regard. Both available and upcoming therapies are also reviewed to give a broad perspective to clinicians with regard to management options. At present, we recommend the use of a "step-up" regimen for ovulation induction, adjunct metformin utilization, utilizing a GnRH agonist as an ovulation trigger, and cabergoline usage. A summary of recommendations is also made available for ease of clinical application. In addition, areas for potential research are also identified where relevant.
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Affiliation(s)
- Vinayak Smith
- Alice Springs Hospital, Department of Obstetrics and Gynaecology, Alice Springs, NT 0870, Australia
| | - Tiki Osianlis
- Monash IVF, 252 Clayton Road, Clayton, VIC 3168, Australia
| | - Beverley Vollenhoven
- Monash IVF, 252 Clayton Road, Clayton, VIC 3168, Australia
- Monash Health, Women's and Children's Program, Monash Medical Centre, Clayton Road, Clayton, VIC 3168, Australia
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC 3168, Australia
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Roque M, Valle M, Guimarães F, Sampaio M, Geber S. Freeze-all policy: fresh vs. frozen-thawed embryo transfer. Fertil Steril 2015; 103:1190-3. [DOI: 10.1016/j.fertnstert.2015.01.045] [Citation(s) in RCA: 141] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 01/27/2015] [Accepted: 01/30/2015] [Indexed: 10/23/2022]
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Implantation of fresh and thawed–warmed embryos in single embryo transfer cycles: interpreting the initial beta-HCG. Reprod Biomed Online 2015; 30:319-21. [DOI: 10.1016/j.rbmo.2014.12.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 12/02/2014] [Accepted: 12/03/2014] [Indexed: 11/21/2022]
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Roque M. Freeze-all policy: is it time for that? J Assist Reprod Genet 2015; 32:171-6. [PMID: 25428436 PMCID: PMC4354191 DOI: 10.1007/s10815-014-0391-0] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 11/07/2014] [Indexed: 11/30/2022] Open
Abstract
PURPOSE This publication will evaluate the available evidence in the literature comparing fresh embryo transfer (ET) and elective frozen-thawed embryo transfer (FET) regarding the possible interference of controlled ovarian stimulation (COS) in implantation and endometrial receptivity, IVF safety, and obstetric and perinatal outcomes. METHODS We performed a review in the literature of the available evidence comparing fresh to elective FET (freeze-all policy). RESULTS The improvements made in cryopreservation techniques have led to few or no detrimental effects to the embryo and have resulted in no consequences to the offspring when compared to fresh embryos; this has allowed reproductive practitioners to create the freeze-all policy (when all viable embryos are electively cryopreserved in the fresh cycle and transferred in a posterior cycle). There are increasing concerns about the adverse effects associated with COS over the endometrial and uterine environments, as well as with the safety of COS in pregnancies that have originated from fresh ET during in vitro fertilization (IVF) treatments. COS may contribute to modifications in the endometrium, which might be related to poorer outcomes when fresh ET is performed. It has been suggested that obstetric and perinatal outcomes in pregnancies resulting from fresh ET are poorer when compared with those that occur after FET. In cycles with fresh ET, there is still a risk of ovarian hyperstimulation syndrome (OHSS). CONCLUSION There is growing evidence in the literature suggesting better IVF outcomes, and decreased obstetric and perinatal morbidity when adopting the freeze-all policy instead of fresh ET.
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Affiliation(s)
- Matheus Roque
- ORIGEN - Center for Reproductive Medicine, Av Rodolfo de Amoedo, 140 - Barra da Tijuca, 22520-350, Rio de Janeiro, Rio de Janeiro, Brazil,
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Martinez M, Rabadan S, Domingo J, Cobo A, Pellicer A, Garcia-Velasco JA. Obstetric outcome after oocyte vitrification and warming for fertility preservation in women with cancer. Reprod Biomed Online 2014; 29:722-8. [DOI: 10.1016/j.rbmo.2014.09.002] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 08/28/2014] [Accepted: 09/03/2014] [Indexed: 11/24/2022]
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Oktay K, Bedoschi G. Oocyte cryopreservation for fertility preservation in postpubertal female children at risk for premature ovarian failure due to accelerated follicle loss in Turner syndrome or cancer treatments. J Pediatr Adolesc Gynecol 2014; 27:342-6. [PMID: 25214440 PMCID: PMC4252563 DOI: 10.1016/j.jpag.2014.01.003] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Revised: 01/10/2014] [Accepted: 01/13/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To preliminarily study the feasibility of oocyte cryopreservation in postpubertal girls aged between 13 and 15 years who were at risk for premature ovarian failure due to the accelerated follicle loss associated with Turner syndrome or cancer treatments. DESIGN Retrospective cohort and review of literature. SETTING Academic fertility preservation unit. PARTICIPANTS Three girls diagnosed with Turner syndrome, 1 girl diagnosed with germ-cell tumor. and 1 girl diagnosed with lymphoblastic leukemia. INTERVENTIONS Assessment of ovarian reserve, ovarian stimulation, oocyte retrieval, in vitro maturation, and mature oocyte cryopreservation. MAIN OUTCOME MEASURE Response to ovarian stimulation, number of mature oocytes cryopreserved and complications, if any. RESULTS Mean anti-müllerian hormone, baseline follical stimulating hormone, estradiol, and antral follicle counts were 1.30 ± 0.39, 6.08 ± 2.63, 41.39 ± 24.68, 8.0 ± 3.2; respectively. In Turner girls the ovarian reserve assessment indicated already diminished ovarian reserve. Ovarian stimulation and oocyte cryopreservation was successfully performed in all female children referred for fertility preservation. A range of 4-11 mature oocytes (mean 8.1 ± 3.4) was cryopreserved without any complications. All girls tolerated the procedure well. CONCLUSIONS Oocyte cryopreservation is a feasible technique in selected female children at risk for premature ovarian failure. Further studies would be beneficial to test the success of oocyte cryopreservation in young girls.
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Affiliation(s)
- K Oktay
- Innovation Institute for Fertility Preservation and IVF, New York, NY; Laboratory of Molecular Reproduction and Fertility Preservation, Obstetrics and Gynecology, New York Medical College, Valhalla, NY.
| | - G Bedoschi
- Innovation Institute for Fertility Preservation and IVF, New York, NY; Laboratory of Molecular Reproduction and Fertility Preservation, Obstetrics and Gynecology, New York Medical College, Valhalla, NY
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Herrero L, Pareja S, Aragonés M, Cobo A, Bronet F, Garcia-Velasco JA. Oocyte versus embryo vitrification for delayed embryo transfer: an observational study. Reprod Biomed Online 2014; 29:567-72. [DOI: 10.1016/j.rbmo.2014.07.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Revised: 07/09/2014] [Accepted: 07/09/2014] [Indexed: 11/28/2022]
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Palmerini MG, Antinori M, Maione M, Cerusico F, Versaci C, Nottola SA, Macchiarelli G, Khalili MA, Antinori S. Ultrastructure of immature and mature human oocytes after cryotop vitrification. J Reprod Dev 2014; 60:411-20. [PMID: 25168087 PMCID: PMC4284314 DOI: 10.1262/jrd.2014-027] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
In vitro maturation of vitrified immature germinal vesicle (GV) oocytes is a promising fertility preservation option. We analyzed the ultrastructure of human GV oocytes after Cryotop vitrification (GVv) and compared it with fresh GV (GVc), fresh mature metaphase II (MIIc) and Cryotop-vitrified mature (MIIv) oocytes. By phase contrast microscopy and light microscopy, the oolemmal and cytoplasmic organization of fresh and vitrified oocytes did not show significant changes. GVv oocytes showed significant ultrastructural alterations of the microvilli in 40% of the samples; small vacuoles and occasional large/isolated vacuoles were abnormally present in the ooplasm periphery of 50% of samples. The ultrastructure of nuclei and mitochondria-vesicle (MV) complexes, as well as the distribution and characteristics of cortical granules (CGs), were comparable with those of GVc oocytes. MIIv oocytes showed an abnormal ultrastructure of microvilli in 30% of the
samples and isolated large vacuoles in 70% of the samples. MV complexes were normal, but mitochondria-smooth endoplasmic reticulum aggregates appeared to be of reduced size. CGs were normally located under the oolemma but presented abnormalities in distribution and matrix electron density. In conclusion, Cryotop vitrification preserved main oocyte characteristics in the GV and MII stages, even if peculiar ultrastructural alterations appeared in both stages. This study also showed that the GV stage appears more suitable for vitrification than the MII stage, as indicated by the good ultrastructural preservation of important structures that are present only in immature oocytes, like the nucleus and migrating CGs.
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Affiliation(s)
- Maria Grazia Palmerini
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
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Konc J, Kanyó K, Kriston R, Somoskői B, Cseh S. Cryopreservation of embryos and oocytes in human assisted reproduction. BIOMED RESEARCH INTERNATIONAL 2014; 2014:307268. [PMID: 24779007 PMCID: PMC3980916 DOI: 10.1155/2014/307268] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Accepted: 02/13/2014] [Indexed: 11/17/2022]
Abstract
Both sperm and embryo cryopreservation have become routine procedures in human assisted reproduction and oocyte cryopreservation is being introduced into clinical practice and is getting more and more widely used. Embryo cryopreservation has decreased the number of fresh embryo transfers and maximized the effectiveness of the IVF cycle. The data shows that women who had transfers of fresh and frozen embryos obtained 8% additional births by using their cryopreserved embryos. Oocyte cryopreservation offers more advantages compared to embryo freezing, such as fertility preservation in women at risk of losing fertility due to oncological treatment or chronic disease, egg donation, and postponing childbirth, and eliminates religious and/or other ethical, legal, and moral concerns of embryo freezing. In this review, the basic principles, methodology, and practical experiences as well as safety and other aspects concerning slow cooling and ultrarapid cooling (vitrification) of human embryos and oocytes are summarized.
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Affiliation(s)
- János Konc
- Infertility and IVF Center of Buda, Szent János Hospital, Budapest 1125, Hungary
| | - Katalin Kanyó
- Infertility and IVF Center of Buda, Szent János Hospital, Budapest 1125, Hungary
| | - Rita Kriston
- Infertility and IVF Center of Buda, Szent János Hospital, Budapest 1125, Hungary
| | - Bence Somoskői
- Faculty of Veterinary Science, Szent István University, Budapest 1078, Hungary
| | - Sándor Cseh
- Faculty of Veterinary Science, Szent István University, Budapest 1078, Hungary
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Ronn R, Holzer HEG. Oncofertility in Canada: cryopreservation and alternative options for future parenthood. CURRENT ONCOLOGY (TORONTO, ONT.) 2014; 21:e137-46. [PMID: 24523611 DOI: 10.3747/co.20.1360] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Cancer can be a devastating diagnosis. In particular, malignancy and its indicated treatments have profoundly negative effects on the fertility of young cancer patients. Oncofertility has emerged as a new interdisciplinary field to address the issue of gonadotoxicity associated with cancer therapies and to facilitate fertility preservation. In Canada, these fertility issues are often inadequately addressed despite the availability of resources. The goal of this four-part series is to facilitate systemic improvements in fertility preservation for adolescent and young adult Canadians with a new diagnosis of cancer. METHODS This article reviews fertility preservation options that use cryopreservation techniques. It also outlines some of the alternative options for future parenthood. RESULTS Cryopreservation of a woman's gametes and gonadal tissue may involve embryo, oocyte, and ovarian tissue cryopreservation with or without ovarian stimulation. Similarly, male gametes and gonadal tissue may be cryopreserved. Techniques and success rates continue to improve. Third-party assistance through gamete donation, gestational carriers, and adoption are also alternative options for parenthood. CONCLUSIONS Cryopreservation techniques are especially feasible options for fertility preservation in the newly diagnosed cancer patient.
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Affiliation(s)
- R Ronn
- Department of Obstetrics and Gynecology, Queen's University, Kingston, ON
| | - H E G Holzer
- McGill University Health Centre, Reproductive Centre, and Department of Obstetrics and Gynecology, McGill University, Montreal, QC
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Effect of mouse oocyte vitrification on mitochondrial membrane potential and distribution. ACTA ACUST UNITED AC 2014; 34:99-102. [DOI: 10.1007/s11596-014-1238-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Revised: 12/05/2013] [Indexed: 10/25/2022]
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Vajta G, Reichart A, Ubaldi F, Rienzi L. From a backup technology to a strategy-outlining approach: the success story of cryopreservation. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/eog.12.80] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Vajta G. Vitrification in human and domestic animal embryology: work in progress. Reprod Fertil Dev 2014; 25:719-27. [PMID: 22951206 DOI: 10.1071/rd12118] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2012] [Accepted: 06/16/2012] [Indexed: 11/23/2022] Open
Abstract
According to the analysis of papers published in major international journals, rapidly increasing application of vitrification is one of the greatest achievements in domestic animal and especially human embryology during the first decade of our century. This review highlights factors supporting or hampering this progress, summarises results achieved with vitrification and outlines future tasks to fully exploit the benefits of this amazing approach that has changed or will change many aspects of laboratory (and also clinical) embryology. Supporting factors include the simplicity, cost efficiency and convincing success of vitrification compared with other approaches in all species and developmental stages in mammalian embryology, while causes that slow down the progress are mostly of human origin: inadequate tools and solutions, superficial teaching, improper application and unjustified concerns resulting in legal restrictions. Elimination of these hindrances seems to be a slower process and more demanding task than meeting the biological challenge. A key element of future progress will be to pass the pioneer age, establish a consensus regarding biosafety requirements, outline the indispensable features of a standard approach and design fully-automated vitrification machines executing all phases of the procedure, including equilibration, cooling, warming and dilution steps.
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Affiliation(s)
- Gábor Vajta
- Institute for Resource Industries and Sustainability, Central Queensland University, Rockhampton, Qld 4702, Australia.
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Abstract
PURPOSE OF REVIEW The development of new reproductive medicine techniques creates opportunities for preserving fertility in transgender persons. Before, losing fertility was accepted as the price to pay for transitioning. RECENT FINDINGS The desire for children is present in many trans persons, as in the general population. Ethical concerns are sometimes raised against the preservation of fertility; however, the only unique aspect of this group is the gender transition of one of the parents. All other elements such as same sex parenthood, use of donor gametes, social stigma, etc., can be found in other groups of parents. Not all reproductive options for all trans persons are equal because not only the gametes are of importance, but also the sex of the (future) partner. In trans women, the best option to preserve gametes is cryopreservation of sperm by preference initiated before starting hormonal therapy. In trans men, donor sperm is most often used, but in theory, there are three options available to preserve fertility: oocyte banking, embryo banking and banking of ovarian tissue. SUMMARY Fertility is possible for both trans men and women, but it requires timely cryopreservation of gametes or stopping cross-sex hormones and possible fertility treatments which are costly and may be unpleasant. Centers should elucidate their policy and inform trans persons on the possibilities and limitations.
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Affiliation(s)
- Guy TʼSjoen
- aDepartment of Endocrinology bCenter for Sexology and Gender problems, Ghent University Hospital, Ghent, Belgium
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Levi Setti PE, Albani E, Morenghi E, Morreale G, Delle Piane L, Scaravelli G, Patrizio P. Comparative analysis of fetal and neonatal outcomes of pregnancies from fresh and cryopreserved/thawed oocytes in the same group of patients. Fertil Steril 2013; 100:396-401. [DOI: 10.1016/j.fertnstert.2013.03.038] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Revised: 03/17/2013] [Accepted: 03/21/2013] [Indexed: 01/29/2023]
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