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Berger M, Patel H, Buyalos R, Hubert G, Wang C, Shamonki M, Quinn M. Estradiol to progesterone ratio is not a predictor of oocyte maturity at time of ovulation trigger. J Assist Reprod Genet 2022; 39:1667-1672. [PMID: 35672539 PMCID: PMC9365892 DOI: 10.1007/s10815-022-02491-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 04/06/2022] [Indexed: 11/29/2022] Open
Abstract
Purpose To evaluate the relationship between progesterone and oocyte maturity rate via estradiol to progesterone ratio (E/P) at the time of ovulatory trigger. Methods This is a retrospective cohort study of first autologous IVF cycles from January to December 2018 from a private practice fertility center. Serum estradiol and progesterone levels were measured on the day of ovulatory trigger. E/P was calculated to control for degree of response. Embryos were cultured to the blastocyst stage for trophectoderm biopsy. Preimplantation genetic testing for aneuploidy (PGT-A) was performed using next-generation sequencing (NGS). Oocyte retrieval rate (oocytes retrieved/follicles ≥ 13 mm), maturity rate (MII/oocytes retrieved), and euploid rate (euploid/total biopsied embryos) were calculated. Clinical pregnancy, ongoing pregnancy (> 10 weeks), and live births following frozen embryo transfer (FET) were examined in relation to E/P. Regression analyses were performed to analyze E/P as a categorical value (defined by quartile) on oocyte maturity. Results Two hundred eleven women underwent controlled ovarian hyperstimulation and had steroid levels at trigger available. Mean E at trigger was 3449 ± 2040 pg/mL while mean P was 1.13 ± 0.58 ng/mL, with mean E/P of 3.36 + 2.04. There were no differences between quartiles of E/P with respect to retrieval, maturity rate, or euploid rate. Two hundred eleven IVF cycles resulted in 138 euploid frozen embryo transfers. There were no differences between quartiles of E/P with respect to clinical pregnancy, ongoing pregnancy, or live birth rate. Conclusion E/P ratio at the time of trigger does not impact oocyte retrieval rate, maturity rate, or euploid rate. Pregnancy and live birth outcomes were also not impacted.
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Zore T, Kroener LL, Wang C, Liu L, Buyalos R, Hubert G, Shamonki M. Transfer of embryos with segmental mosaicism is associated with a significant reduction in live-birth rate. Fertil Steril 2018; 111:69-76. [PMID: 30424882 DOI: 10.1016/j.fertnstert.2018.08.057] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 08/17/2018] [Accepted: 08/29/2018] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To evaluate the impact of segmental mosaicism on pregnancy outcomes from the transfer of embryos previously designated as euploid. DESIGN Retrospective cohort analysis. SETTING Single, private, high-volume fertility center. PATIENT(S) Three hundred and twenty-seven women who underwent 377 frozen single euploid embryo transfers. INTERVENTION(S) Trophectoderm biopsy of embryos cultured to the blastocyst stage, where all transferred embryos were designated euploid by high-density oligonucleotide array comparative genomic hybridization (aCGH); after ascertaining all outcomes, revaluation of aCGH results for evidence of segmental mosaicism (defined as mosaicism on a portion of a chromosome). MAIN OUTCOME MEASURE(S) Live-birth rate and spontaneous abortion rate. RESULT(S) Of the 377 embryos transferred, 357 were euploid with no mosaicism, and 20 embryos had segmental mosaicism. Segmental mosaics had a statistically significantly lower live-birth rate compared with euploid controls (30.0% vs. 53.8%). When controlling for age and day of Trophectoderm biopsy, the odds for live birth after transfer of segmental mosaics were reduced by 66% compared with euploid controls (0.34; 95% confidence interval, 0.13-0.92). The spontaneous abortion rate was statistically significantly higher after transfer of segmental mosaics compared with euploid controls (40.0% vs. 18.2%). CONCLUSION(S) Blastocysts with segmental mosaicism have reduced reproductive potential but retain the ability to result in live birth. These results support reporting segmental mosaicism to optimize selection of a single embryo for transfer that will maximize the chance of life birth.
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Affiliation(s)
- Temeka Zore
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of California, Los Angeles, California.
| | - Lindsay L Kroener
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of California, Los Angeles, California
| | - Chunmin Wang
- Fertility and Surgical Associates of California, Thousand Oaks, California
| | - Lian Liu
- PacGenomics, Agoura Hills, California
| | - Richard Buyalos
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of California, Los Angeles, California; Fertility and Surgical Associates of California, Thousand Oaks, California
| | - Gary Hubert
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of California, Los Angeles, California; Fertility and Surgical Associates of California, Thousand Oaks, California
| | - Mousa Shamonki
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of California, Los Angeles, California; Fertility and Surgical Associates of California, Thousand Oaks, California
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Rim JH, Kim JA, Yoo J. A Novel 1.13 Mb Interstitial Duplication at 19q13.32 Causing Developmental Delay and Microcephaly in a Pediatric Patient: the First Asian Case Reports. Yonsei Med J 2017; 58:1241-1244. [PMID: 29047251 PMCID: PMC5653492 DOI: 10.3349/ymj.2017.58.6.1241] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 11/04/2016] [Accepted: 11/24/2016] [Indexed: 02/07/2023] Open
Abstract
Only 6 patients with partial trisomy of the long arm of chromosome 19 (19q), caused by direct interstitial duplications, have been reported until today. Herein, we report a pediatric patient with a novel 1.13 Mb direct interstitial duplication within 19q13.32, which is the smallest fragment affected so far. A five-year old Korean boy of healthy parents presented with microcephaly, growth retardation, developmental delay, and craniofacial dysmorphism. Even though G-banded chromosome analysis at resolution of 550-band revealed normal karyotype, duplication of 1.13 Mb fragment within 19q13.32 was detected by array comparative genomic hybridization. Comparing with previously reported patients with pure duplication involving 19q as a sole chromosomal abnormality, our case showed the smallest duplication segment with relatively mild degree of clinical features. Our present case might serve as the landmark case among patients with 19q duplication for genotype-phenotype correlation study and further identification of critical region for 19q duplication abnormalities.
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Affiliation(s)
- John Hoon Rim
- Department of Laboratory Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Department of Pharmacology, Yonsei University College of Medicine, Seoul, Korea
- Department of Medicine, Physician-Scientist Program, Yonsei University Graduate School of Medicine, Seoul, Korea
| | - Jeong A Kim
- Department of Pediatrics, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Jongha Yoo
- Department of Laboratory Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Department of Laboratory Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Korea.
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Diagnosis of parental balanced reciprocal translocations by trophectoderm biopsy and comprehensive chromosomal screening. J Assist Reprod Genet 2017; 35:165-169. [PMID: 28900794 DOI: 10.1007/s10815-017-1042-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 09/05/2017] [Indexed: 10/18/2022] Open
Abstract
PURPOSE This study investigates a case series of eight couples who underwent trophectoderm (TE) biopsy and comprehensive chromosomal screening (CCS) for routine aneuploidy screening and were found to have CCS results concerning for previously undetected parental balanced reciprocal translocations. METHODS In each case, controlled ovarian hyperstimulation and in vitro fertilization (IVF) yielded multiple blastocysts that each underwent CCS with high-density oligonucleotide microarray comparative genomic hybridization (aCGH). RESULTS Parental translocations were suspected based on the finding of identical break point mutations in multiple embryos from each couple. Confirmation of these suspected translocations within blastocysts was performed with next-generation sequencing (NGS). Subsequent parental karyotypic evaluation resulted in a diagnosis of parental balanced reciprocal translocation in each case. CONCLUSIONS We demonstrated that high-resolution aCGH and NGS on TE biopsies can accurately detect parental reciprocal translocations when previously unrecognized.
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Kaing A, Kroener LL, Tassin R, Li M, Liu L, Buyalos R, Hubert G, Shamonki M. Earlier day of blastocyst development is predictive of embryonic euploidy across all ages: essential data for physician decision-making and counseling patients. J Assist Reprod Genet 2017; 35:119-125. [PMID: 28894983 DOI: 10.1007/s10815-017-1038-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Accepted: 09/03/2017] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The purpose of this study is to evaluate whether day of blastocyst development is associated with embryo chromosomal status as determined by high-density oligonucleotide microarray comparative genomic hybridization (aCGH). METHODS This is a retrospective cohort analysis, including women who underwent in vitro fertilization (IVF) with trophectoderm biopsy at a single private fertility center from January 2014 to December 2014. Repeat cycles were excluded. Cycles were assessed for percentage of blastocysts biopsied on days 5, 6, or 7 and rate of euploid embryos per cycle. Cycles were stratified by Society for Assisted Reproductive Technology (SART) age groups (< 35, 35-37, 38-40, 41-42, > 42) and by donor status. RESULTS A total of 388 IVF cycles and 2132 biopsied blastocysts were evaluated. The percentages of blastocysts biopsied on days 5, 6, and 7 were 62.5, 35.8, and 1.7%, respectively. Blastocyst euploid rates on days 5, 6, and 7 were 49.5, 36.5, and 32.9%, respectively. Earlier blastocyst development was associated with a significantly increased euploid rate (p < 0.0001). Younger maternal age (p < 0.0001) and higher number of blastocysts biopsied per patient (p = 0.0063) were both independently associated with greater percentage of euploidy. CONCLUSIONS Earlier blastocyst development is independently associated with a higher likelihood of embryonic euploidy in both autologous and donor embryos. In non-biopsied embryos, these data support selection of day 5 blastocysts for transfer over later-developing embryos. These results can assist with patient counseling regarding expectations and outcomes. To our knowledge, this is the first study to examine embryonic euploidy as stratified by both day of blastocyst development and SART age group.
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Affiliation(s)
- Amy Kaing
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of California, Los Angeles, 10833 LeConte Ave, Los Angeles, CA, 90095, USA
| | - Lindsay L Kroener
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of California, Los Angeles, 10833 LeConte Ave, Los Angeles, CA, 90095, USA
| | - Robyn Tassin
- Fertility and Surgical Associates of California, 325 Rolling Oaks Dr. Suite 110, Thousand Oaks, CA, 91361, USA
| | - Man Li
- Fertility and Surgical Associates of California, 325 Rolling Oaks Dr. Suite 110, Thousand Oaks, CA, 91361, USA
| | - Lian Liu
- PacGenomics, 28222 Agoura Rd. Suite 200/201, Agoura Hills, CA, 91301, USA
| | - Richard Buyalos
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of California, Los Angeles, 10833 LeConte Ave, Los Angeles, CA, 90095, USA
- Fertility and Surgical Associates of California, 325 Rolling Oaks Dr. Suite 110, Thousand Oaks, CA, 91361, USA
| | - Gary Hubert
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of California, Los Angeles, 10833 LeConte Ave, Los Angeles, CA, 90095, USA
- Fertility and Surgical Associates of California, 325 Rolling Oaks Dr. Suite 110, Thousand Oaks, CA, 91361, USA
| | - Mousa Shamonki
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of California, Los Angeles, 10833 LeConte Ave, Los Angeles, CA, 90095, USA.
- Fertility and Surgical Associates of California, 325 Rolling Oaks Dr. Suite 110, Thousand Oaks, CA, 91361, USA.
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Jackson CC, Lefèvre-Utile A, Guimier A, Malan V, Bruneau J, Gessain A, Cassar O, Amiel J, Cobat A, Rattina V, Abel L, Casanova JL, Blanche S. Kaposi sarcoma, oral malformations, mitral dysplasia, and scoliosis associated with 7q34-q36.3 heterozygous terminal deletion. Am J Med Genet A 2017; 173:1858-1865. [PMID: 28488400 DOI: 10.1002/ajmg.a.38275] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 04/04/2017] [Indexed: 12/13/2022]
Abstract
Chromosome 7 germline macrodeletions have been implicated in human congenital malformations and developmental delays. We herein report a novel heterozygous macrodeletion of 7q34-q36.3 in a 16-year-old girl originally from West Indies. Similar to previously reported cases of germline chromosome 7q terminal deletions, our patient has dental malposition, and developmental (growth and intellectual) delay. Novel phenotypic features include endemic Kaposi sarcoma (KS), furrowed tongue, thoracolumbar scoliosis, and mild mitral valve dysplasia. The occurrence of human herpes virus 8-driven KS, in a child otherwise normally resistant to other infectious agents and without any other tumoral lesion, points to a very selective immunodeficiency. While defects in organogenesis have been described with such macrodeletions, this is the first report of immunodeficiency and cancer predisposition.
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Affiliation(s)
- Carolyn C Jackson
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, New York.,Department of Pediatrics, The Memorial Sloan Kettering Cancer Center, New York, New York.,Division of Pediatric Hematology/Oncology, Weill Cornell Medical Center, New York, New York
| | - Alain Lefèvre-Utile
- Pediatric Immunology-Hematology-Rheumatology Unit, Necker-Enfants Malades Hospital, Paris, France
| | - Anne Guimier
- Department of Genetics, Necker-Enfants Malades Hospital, AP-HP, Paris, France
| | - Valérie Malan
- Department of Genetics, Necker-Enfants Malades Hospital, AP-HP, Paris, France
| | - Julie Bruneau
- Unit of Pathology, Necker-Enfants Malades Hospital, Paris, France
| | - Antoine Gessain
- Unit of Epidemiology and Physiopathology of Oncogenic Viruses, Pasteur Institute, Paris, France
| | - Olivier Cassar
- Unit of Epidemiology and Physiopathology of Oncogenic Viruses, Pasteur Institute, Paris, France
| | - Jeanne Amiel
- Department of Genetics, Necker-Enfants Malades Hospital, AP-HP, Paris, France
| | - Aurélie Cobat
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Necker-Enfants Malades Hospital, INSERM, Paris, France.,Paris Descartes University, Imagine Institute, Paris, France
| | - Vimel Rattina
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Necker-Enfants Malades Hospital, INSERM, Paris, France.,Paris Descartes University, Imagine Institute, Paris, France
| | - Laurent Abel
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, New York.,Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Necker-Enfants Malades Hospital, INSERM, Paris, France.,Paris Descartes University, Imagine Institute, Paris, France
| | - Jean-Laurent Casanova
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, New York.,Pediatric Immunology-Hematology-Rheumatology Unit, Necker-Enfants Malades Hospital, Paris, France.,Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Necker-Enfants Malades Hospital, INSERM, Paris, France.,Paris Descartes University, Imagine Institute, Paris, France.,Howard Hughes Medical Institute, New York, New York
| | - Stéphane Blanche
- Pediatric Immunology-Hematology-Rheumatology Unit, Necker-Enfants Malades Hospital, Paris, France
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Shamonki MI, Jin H, Haimowitz Z, Liu L. Proof of concept: preimplantation genetic screening without embryo biopsy through analysis of cell-free DNA in spent embryo culture media. Fertil Steril 2016; 106:1312-1318. [PMID: 27565258 DOI: 10.1016/j.fertnstert.2016.07.1112] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 07/05/2016] [Accepted: 07/21/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess whether preimplantation genetic screening (PGS) is possible by testing for free embryonic DNA in spent IVF media from embryos undergoing trophectoderm biopsy. DESIGN Prospective cohort analysis. SETTING Academic fertility center. PATIENT(S) Seven patients undergoing IVF and 57 embryos undergoing trophectoderm biopsy for PGS. INTERVENTION(S) On day 3 of development, each embryo was placed in a separate media droplet. All biopsied embryos received a PGS result by array comparative genomic hybridization. Preimplantation genetic screening was performed on amplified DNA extracted from media and results were compared with PGS results for the corresponding biopsy. MAIN OUTCOME MEASURE(S) [1] Presence of DNA in spent IVF culture media. [2] Correlation between genetic screening result from spent media and corresponding biopsy. RESULT(S) Fifty-five samples had detectable DNA ranging from 2-642 ng/μL after a 2-hour amplification. Six samples with the highest DNA levels underwent PGS, rendering one result with a derivative log ratio SD (DLRSD) of <0.85 (a quality control metric of oligonucleotide array comparative genomic hybridization). The fluid sample and trophectoderm results were identical demonstrating (45XY, -13). Three samples were reamplified 1 hour later and tested showing improving DLRSD. One of the three samples with a DLRSD of 0.85 demonstrated (46XY), consistent with the biopsy. Overnight DNA amplification showed DNA in all samples. CONCLUSION(S) We demonstrate two novel findings: the presence of free embryonic DNA in spent media and a result that is consistent with trophectoderm biopsy. Improvements in DNA collection, amplification, and testing may allow for PGS without biopsy in the future.
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Affiliation(s)
- Mousa I Shamonki
- Fertility and Surgical Associates of California, Thousand Oaks, California; University of California, Los Angeles, Fertility and Reproductive Health Center, Los Angeles, California.
| | - Helen Jin
- PacGenomics, Agoura Hills, California
| | | | - Lian Liu
- PacGenomics, Agoura Hills, California
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Qi ST, Liang LF, Xian YX, Liu JQ, Wang W. Arrested human embryos are more likely to have abnormal chromosomes than developing embryos from women of advanced maternal age. J Ovarian Res 2014; 7:65. [PMID: 24955133 PMCID: PMC4065243 DOI: 10.1186/1757-2215-7-65] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 06/10/2014] [Indexed: 11/10/2022] Open
Abstract
Background Aneuploidy is one of the major factors that result in low efficiency in human infertility treatment by in vitro fertilization (IVF). The development of DNA microarray technology allows for aneuploidy screening by analyzing all 23 pairs of chromosomes in human embryos. All chromosome screening for aneuploidy is more accurate than partial chromosome screening, as errors can occur in any chromosome. Currently, chromosome screening for aneuploidy is performed in developing embryos, mainly blastocysts. It has not been performed in arrested embryos and/or compared between developing embryos and arrested embryos from the same IVF cycle. Methods The present study was designed to examine all chromosomes in blastocysts and arrested embryos from the same cycle in patients of advanced maternal ages. Embryos were produced by routine IVF procedures. A total of 90 embryos (45 blastocysts and 45 arrested embryos) from 17 patients were biopsied and analyzed by the Agilent DNA array platform. Results It was found that 50% of the embryos developed to blastocyst stage; however, only 15.6% of the embryos (both blastocyst and arrested) were euploid, and most (84.4%) of the embryos had chromosomal abnormalities. Further analysis indicated that 28.9% of blastocysts were euploid and 71.1% were aneuploid. By contrast, only one (2.2%) arrested embryo was euploid while others (97.8%) were aneuploid. The prevalence of multiple chromosomal abnormalities in the aneuploid embryos was also higher in the arrested embryos than in the blastocysts. Conclusions These results indicate that high proportions of human embryos from patients of advanced maternal age are aneuploid, and the arrested embryos are more likely to have abnormal chromosomes than developing embryos.
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Affiliation(s)
- Shu-Tao Qi
- Key Laboratory of Major Obstetrics Diseases of Guangdong Province, The Third Hospital Affiliated to Guangzhou Medical University, Guangdong, China
| | - Li-Feng Liang
- Key Laboratory of Major Obstetrics Diseases of Guangdong Province, The Third Hospital Affiliated to Guangzhou Medical University, Guangdong, China
| | - Ye-Xing Xian
- Key Laboratory of Major Obstetrics Diseases of Guangdong Province, The Third Hospital Affiliated to Guangzhou Medical University, Guangdong, China
| | - Jian-Qiao Liu
- Key Laboratory of Major Obstetrics Diseases of Guangdong Province, The Third Hospital Affiliated to Guangzhou Medical University, Guangdong, China ; Reproductive Medicine Center, the Third Hospital Affiliated to Guangzhou Medical University, Guangdong, China
| | - Weihua Wang
- Key Laboratory of Major Obstetrics Diseases of Guangdong Province, The Third Hospital Affiliated to Guangzhou Medical University, Guangdong, China ; Houston Fertility Institute/Houston Fertility Laboratory, Houston, Texas, USA
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