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Abstract
In this guideline, recurrent miscarriage has been defined as three or more first trimester miscarriages. However, clinicians are encouraged to use their clinical discretion to recommend extensive evaluation after two first trimester miscarriages, if there is a suspicion that the miscarriages are of pathological and not of sporadic nature. Women with recurrent miscarriage should be offered testing for acquired thrombophilia, particularly for lupus anticoagulant and anticardiolipin antibodies, prior to pregnancy. [Grade C] Women with second trimester miscarriage may be offered testing for Factor V Leiden, prothrombin gene mutation and protein S deficiency, ideally within a research context. [Grade C] Inherited thrombophilias have a weak association with recurrent miscarriage. Routine testing for protein C, antithrombin deficiency and methylenetetrahydrofolate reductase mutation is not recommended. [Grade C] Cytogenetic analysis should be offered on pregnancy tissue of the third and subsequent miscarriage(s) and in any second trimester miscarriage. [Grade D] Parental peripheral blood karyotyping should be offered for couples in whom testing of pregnancy tissue reports an unbalanced structural chromosomal abnormality [Grade D] or there is unsuccessful or no pregnancy tissue available for testing. [GPP] Women with recurrent miscarriage should be offered assessment for congenital uterine anomalies, ideally with 3D ultrasound. [Grade B] Women with recurrent miscarriage should be offered thyroid function tests and assessment for thyroid peroxidase (TPO) antibodies. [Grade C] Women with recurrent miscarriage should not be routinely offered immunological screening (such as HLA, cytokine and natural killer cell tests), infection screening or sperm DNA testing outside a research context. [Grade C] Women with recurrent miscarriage should be advised to maintain a BMI between 19 and 25 kg/m2 , smoking cessation, limit alcohol consumption and limit caffeine to less than 200 mg/day. [Grade D] For women diagnosed with antiphospholipid syndrome, aspirin and heparin should be offered from a positive test until at least 34 weeks of gestation, following discussion of potential benefits versus risks. [Grade B] Aspirin and/or heparin should not be given to women with unexplained recurrent miscarriage. [Grade B] There are currently insufficient data to support the routine use of PGT-A for couples with unexplained recurrent miscarriage, while the treatment may carry a significant cost and potential risk. [Grade C] Resection of a uterine septum should be considered for women with recurrent first or second trimester miscarriage, ideally within an appropriate audit or research context. [Grade C] Thyroxine supplementation is not routinely recommended for euthyroid women with TPO who have a history of miscarriage. [Grade A] Progestogen supplementation should be considered in women with recurrent miscarriage who present with bleeding in early pregnancy (for example 400 mg micronised vaginal progesterone twice daily at the time of bleeding until 16 weeks of gestation). [Grade B] Women with unexplained recurrent miscarriage should be offered supportive care, ideally in the setting of a dedicated recurrent miscarriage clinic. [Grade C].
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Yang H, Chen X, Liu Y, Luo J, Huang R, Zhao Y, Li TC, Huang X. Does non-cavity distorting intramural fibroid affect endometrium around the time of embryo implantation? HUM FERTIL 2023; 26:712-719. [PMID: 37815345 DOI: 10.1080/14647273.2023.2264498] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 06/17/2023] [Indexed: 10/11/2023]
Abstract
The effect of the intramural fibroids not distorting the cavity remains controversial on implantation and pregnancy. The aim of this study was to examine the impact of non-cavity distorting intramural fibroids on endometrium. Fifty-six women with non-cavity distorting intramural fibroid were recruited in this study. Paired endometrial specimens, one from beneath the fibroid (ipsilateral endometrium) and the other from the opposite side of uterine cavity, away from the fibroid (contralateral endometrium) were obtained 7-9 days after the luteinizing hormone surge in a natural cycle. Histological dating, Mucin1 and Glycodelin expression and uterine natural killer (uNK) cell density were compared between the paired samples. The median (IQR) H-score of Mucin1 staining in the ipsilateral luminal epithelium was 210% (142-230%), which was significantly (p < 0.05) higher than that of the contralateral luminal endometrium (157%, IQR 114-176%). There was no significant difference in Mucin1 expression in the glandular epithelium. There was no significant difference in Glycodelin expression in luminal and glandular epithelium, uNK cells density or histological dating results between the paired endometrial samples. In conclusion, it is uncertain whether the altered expression of Mucin1 in luminal epithelium alone may have impact on implantation when other markers are not changed.
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Affiliation(s)
- Haiyan Yang
- Hysteroscopic Center, Fu-Xing Hospital, Capital Medical University, Beijing, China
| | - Xiaoyan Chen
- Assisted Reproductive Center, Department of Obstetrics and Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Yingyu Liu
- Assisted Reproductive Center, Department of Obstetrics and Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Jing Luo
- Department of Pathology, Fu-Xing Hospital, Capital Medical University, Beijing, China
| | - Rui Huang
- Hysteroscopic Center, Fu-Xing Hospital, Capital Medical University, Beijing, China
| | - Yiwei Zhao
- Assisted Reproductive Center, Department of Obstetrics and Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Tin-Chiu Li
- Hysteroscopic Center, Fu-Xing Hospital, Capital Medical University, Beijing, China
- Assisted Reproductive Center, Department of Obstetrics and Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Xiaowu Huang
- Hysteroscopic Center, Fu-Xing Hospital, Capital Medical University, Beijing, China
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Shi X, Guo J, Saravelos S, Huang X, Xia E, Feng L, Li TC. The use of intrauterine balloon therapy in reproductive medicine and surgery: a guidance for practice. HUM FERTIL 2023; 26:742-756. [PMID: 37778373 DOI: 10.1080/14647273.2023.2255745] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 05/15/2023] [Indexed: 10/03/2023]
Abstract
The use of balloon therapy in obstetric practice especially in postpartum haemorrhage (PPH) is well established and has recently been reviewed. However, little attention has been drawn regarding the use of intrauterine balloon (IUB) in gynaecological practice. This study focuses on the various usage of IUB in gynaecological practice. An electronic literature search through Medline, EMBASE and Clinicaltrial.gov from inception to August 2022 was conducted. The study focuses on the three following areas: (1) Indications: prevention and removal of intrauterine adhesions, management of ectopic pregnancy, facilitation of endoscopic surgery and other clinical usages; (2) Practical aspects of balloon therapy including ultrasound guidance, choice of balloon, inflation volume, duration of balloon therapy; and (3) Potential complications including pain, infection, uterine rupture and how they can be avoided. IUB therapy is a simple, inexpensive and effective method that can be applied in various gynaecological conditions ranging from IUA to intrauterine haemorrhage. Complications are rare, but in most cases can be avoided with correct use.
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Affiliation(s)
- Xiaoyu Shi
- Department of Obstetrics and Gynecology, Beijing Tiantan Hospital, The Fifth Clinical Medical College, Capital Medical University, Beijing, P. R. China
| | - Jun Guo
- Department of Obstetrics and Gynecology, Beijing Tongren Hospital, The Fourth Clinical Medical College, Capital Medical University, Beijing, P. R. China
| | - Sotirios Saravelos
- Department of Obstetrics and Gynaecology, IVF Unit, Hammersmith Hospital, Imperial College London, London, UK
| | - Xiaowu Huang
- Department of Hysteroscopic Centre, Fuxing Hospital, Capital Medical University, Beijing, P. R. China
| | - Enlan Xia
- Department of Hysteroscopic Centre, Fuxing Hospital, Capital Medical University, Beijing, P. R. China
| | - Limin Feng
- Department of Obstetrics and Gynecology, Beijing Tiantan Hospital, The Fifth Clinical Medical College, Capital Medical University, Beijing, P. R. China
| | - Tin-Chiu Li
- Department of Hysteroscopic Centre, Fuxing Hospital, Capital Medical University, Beijing, P. R. China
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Guo J, Shi X, Yu F, Cao JH, Xia E, Zhai J, Mol BWJ, Li TC. Adjuvants to prevent reformation of adhesions following adhesiolysis for Asherman syndrome: a systematic review and meta-analysis. HUM FERTIL 2023; 26:797-814. [PMID: 37778374 DOI: 10.1080/14647273.2023.2254492] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 05/15/2023] [Indexed: 10/03/2023]
Abstract
Two international guidelines published on the management of Asherman syndrome (AS) have made recommendations on various adjuvant methods to prevent intrauterine reformation. Nevertheless, the effectiveness of these methods when used in primary or secondary prevention settings is different. Our aim is to assess the effectiveness of various adjuvant methods for the secondary prevention of intrauterine adhesions (IUAs). Articles were considered eligible if they included subjects with AS before surgery and compared a chosen method with either a control or a comparison group (using another method). The primary outcome was the IUA reformation rate at follow-up hysteroscopy. A total of 29 studies [15 randomised controlled trials (RCTs) and 14 cohort studies] were included. Adhesion reformation with various methods to prevented IUA reformation when compared with controls were: second-look hysteroscopy: [risk ratio (RR): 0.21, 95% confidence interval (CI): 0.05-0.90 (p = 0.02)]; intrauterine contraceptive device: RR: 0.64, 95% CI: 0.36-1.12 (p = 0.12); continuous intrauterine balloon: RR: 0.18, 95% CI: 0.05-0.68 (p = 0.01); intermittent intrauterine balloon: RR: 0.50, 95% CI: 0.31-0.80 (p = 0.004); anti-adhesion gel: RR: 0.80, 95% CI: 0.58-1.10 (p = 0.17); amnion graft: RR: 0.63, 95% CI: 0.44-0.91 (p = 0.01).
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Affiliation(s)
- Jun Guo
- Department of Obstetrics and Gynaecology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Xiaoyu Shi
- Department of Obstetrics and Gynaecology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Fei Yu
- Department of Obstetrics and Gynaecology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jing Hong Cao
- Department of Obstetrics and Gynaecology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Enlan Xia
- Hysteroscopic Centre, Fuxing Hospital, Capital Medical University, Beijing, China
| | - Jianjun Zhai
- Department of Obstetrics and Gynaecology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Ben W J Mol
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia
- Aberdeen Centre for Women's Health Research, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, United Kingdom
| | - Tin-Chiu Li
- Hysteroscopic Centre, Fuxing Hospital, Capital Medical University, Beijing, China
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Afnan M, Chung J, Li R, Li TC. Human Fertility publishes China issue. HUM FERTIL 2023; 26:699-701. [PMID: 38105471 DOI: 10.1080/14647273.2023.2283263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Affiliation(s)
| | - Jacqueline Chung
- Assisted Reproductive Technology Unit, Department of Obstetrics & Gynaecology, The Chinese University of Hong Kong, Hong Kong
| | - Raymond Li
- Obstetrics and Gynaecology, Queen Mary Hospital, Hong Kong, China
| | - Tin-Chiu Li
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, Hysteroscopy centre, Fuxing Hospital, Beijing, China
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Hsu CX, Li TC. Impact of the COVID-19 Pandemic on Radiotherapy Interruptions and Patient Outcomes. Clin Oncol (R Coll Radiol) 2023; 35:e566-e567. [PMID: 37308328 PMCID: PMC10241648 DOI: 10.1016/j.clon.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 06/02/2023] [Indexed: 06/14/2023]
Affiliation(s)
- C X Hsu
- Division of Radiation Oncology, Department of Radiology, Far Eastern Memorial Hospital, New Taipei City, Taiwan; School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| | - T C Li
- Division of Medical Imaging, Department of Radiology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
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Wang CC, Lin ZX, Li TC, Wu XK. Chinese versus western medicine for threatened miscarriage: abridged secondary publication. Hong Kong Med J 2023; 29 Suppl 3:8. [PMID: 37357583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2023] Open
Affiliation(s)
- C C Wang
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Z X Lin
- School of Chinese Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - T C Li
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - X K Wu
- Department of Obstetrics and Gynecology, Heilongjiang University of Chinese Medicine, Harbin, China
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Chau OSY, Law TSM, Ng K, Li TC, Chung JPW. Five-year retrospective review of ultrasoundguided manual vacuum aspiration for first-trimester miscarriage. Hong Kong Med J 2023. [PMID: 37226490 DOI: 10.12809/hkmj2210127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
INTRODUCTION Manual vacuum aspiration is increasingly accepted as an alternative to medical or surgical evacuation of the uterus after first-trimester miscarriage. This study aimed to assess the efficacy of ultrasound-guided manual vacuum aspiration (USG-MVA) in the management of first-trimester miscarriage. METHODS This retrospective analysis included adult women with first-trimester miscarriage who underwent USG-MVA in Hong Kong between July 2015 and February 2021. The primary outcome was the efficacy of USG-MVA in terms of complete evacuation of the uterus, without the need for further medical or surgical intervention. Secondary outcomes included tolerance of the entire procedure, the success rate of karyotyping using chorionic villi, and procedural safety (ie, any clinically significant complications). RESULTS In total, 331 patients were scheduled to undergo USG-MVA for first-trimester miscarriage or incomplete miscarriage. The procedure was completed in 314 patients and well-tolerated in all of those patients. The complete evacuation rate was 94.6% (297/314), which is similar to the rate (98.1%) achieved by conventional surgical evacuation in a previous randomised controlled trial in our unit. There were no major complications. Samples from 95.2% of patients were suitable for karyotyping, which is considerably higher than the rate of suitable samples (82.9%) obtained via conventional surgical evacuation in our previous randomised controlled trial. CONCLUSION Ultrasound-guided manual vacuum aspiration is a safe and effective method to manage first-trimester miscarriage. Although it currently is not extensively used in Hong Kong, its broader clinical application could avoid general anaesthesia and shorten hospital stay.
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Affiliation(s)
- O S Y Chau
- Department of Obstetrics and Gynaecology, Prince of Wales Hospital, Hong Kong SAR, China
| | - T S M Law
- Department of Obstetrics and Gynaecology, Prince of Wales Hospital, Hong Kong SAR, China
| | - K Ng
- Department of Obstetrics and Gynaecology, Prince of Wales Hospital, Hong Kong SAR, China
| | - T C Li
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - J P W Chung
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong SAR, China
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Shi X, Ren MQ, Wang LT, Chan CPS, Chan DYL, Quan S, Li TC. Blood metal/metalloid concentration of male subjects undergoing IVF/ICSI treatment outcomes: A prospective cohort study. J Trace Elem Med Biol 2023; 78:127196. [PMID: 37209528 DOI: 10.1016/j.jtemb.2023.127196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 04/26/2023] [Accepted: 05/05/2023] [Indexed: 05/22/2023]
Abstract
BACKGROUND Previous epidemiology studies reported that heavy metal/metalloid exposure is associated with the impairment of semen quality. However, it is still not clear whether the in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) treatment outcome will be affected after the heavy metal/metalloid exposure of the male partners. METHODS A prospective cohort study with a 2-year followed-up was conducted in a tertiary IVF center. A total of 111 couples undergoing IVF/ICSI treatment were initially recruited from November 2015 to November 2016. Male blood concentrations of heavy metal/metalloid including Ca, Cr, Mn, Fe, Ni, Cu, Zn, As, Se, Mo, Cd, Hg, and Pb were measured by inductively coupled plasma mass spectrometry, and the lab and pregnancy outcome data were followed up. The associations between male blood heavy metal/metalloid concentration and the clinical outcomes were analyzed by Poisson regression analysis. RESULTS Our results showed that none of the heavy metal/metalloid of male partners we investigated are significantly associated with the oocyte fertilization and good embryo (P ≥ 0.05); however, antral follicle count (AFC) was a protective factor for the oocyte fertilization (RR: 1.07, 95 % CI: 1.04-1.10). The blood Fe concentration of the male partner was positively associated (P < 0.05) with pregnancy in the first fresh cycle (RR:170.93, 95 % CI: 4.13-7082.04), cumulative pregnancy (RR: 23.61, 95 % CI: 3.25-171.64) and cumulative live birth (RR: 36.42, 95 % CI: 1.21-1092.54). In the first frozen embryo cycles, pregnancy was significantly associated (P < 0.05) with the blood Mn (RR: 0.01, 95 % CI:0.00-0.11) and Se concentration (RR: 0.01, 95 % CI:8.25 E-5-0.47) and female age (RR: 0.86, 95 % CI:0.75-0.99); live birth was significantly associated (P < 0.05) with the blood Mn concentration (RR: 0.00, 95 % CI: 1.14E-7-0.51). CONCLUSIONS Our results suggested that the higher male blood Fe concentration was positively associated with pregnancy in the fresh embryo transfer cycle, cumulative pregnancy, and cumulative live birth, whereas the higher male blood Mn and Se concentration were associated with lower chance of pregnancy and live birth in the frozen embryo transfer cycle. However, the underline mechanism of this finding still needs further investigation.
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Affiliation(s)
- Xiao Shi
- Center for Reproductive Medicine, Department of Obstetrics and Gynaecology, NanFang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Mei Qi Ren
- Center for Reproductive Medicine, Department of Obstetrics and Gynaecology, NanFang Hospital, Southern Medical University, Guangzhou, Guangdong, China; The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
| | - Lian Tong Wang
- Center for Reproductive Medicine, Department of Obstetrics and Gynaecology, NanFang Hospital, Southern Medical University, Guangzhou, Guangdong, China; The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
| | - Carol Pui Shan Chan
- Assisted Reproductive Technology Unit, Department of Obstetrics and Gynaecology, Faculty of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - David Yiu Leung Chan
- Assisted Reproductive Technology Unit, Department of Obstetrics and Gynaecology, Faculty of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Song Quan
- Center for Reproductive Medicine, Department of Obstetrics and Gynaecology, NanFang Hospital, Southern Medical University, Guangzhou, Guangdong, China.
| | - Tin-Chiu Li
- Assisted Reproductive Technology Unit, Department of Obstetrics and Gynaecology, Faculty of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
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Zhao Y, Man GCW, Zhang R, Wong CK, Chen X, Chung JPW, Wang CC, Laird S, Zhang T, Li TC. A prospective study comparing the inflammation-related cytokine and chemokine profile from the day of blastocyst transfer to 7 weeks of gestation between pregnancies that did or did not result in a miscarriage. J Reprod Immunol 2022; 154:103755. [PMID: 36272272 DOI: 10.1016/j.jri.2022.103755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 09/24/2022] [Accepted: 10/09/2022] [Indexed: 11/27/2022]
Abstract
The dynamics of maternal immunomodulation is essential in early pregnancy. In our previous study, successful implantation is characterized by a transient increase of pro-inflammatory cytokines followed by a switch to an anti-inflammatory state in peripheral blood around 3-6 days after embryo transfer (ET). In this study, we aimed to extend the time points to compare the cytokine and chemokine profiles between women who did or did not subsequently miscarry. We utilized precisely timed serum samples on the day of ET and 3, 6, 9, 16, 23 and 30 days after ET in women undergoing single blastocyst transfer. Our analysis revealed a significant alteration in cytokine profile after day ET+ 9 between the two groups. Regarding pro-inflammatory cytokine profile, there was a significant increase in IL-17 on days ET+ 16, + 23, and + 30 (50.60 ± 9.97 vs 37.09 ± 3.25, 53.20 ± 8.13 vs 36.51 ± 3.34, 57.06 ± 8.83 vs 33.04 ± 3.11 pg/mL), TNF-α on days ET+ 23 and + 30 (73.90 ± 12.42 vs 50.73 ± 3.55, 74.16 ± 12.46 vs 46.59 ± 3.21 pg/mL), IFN-γ on day ET+ 30 (69.52 ± 13.19 vs 42.28 ± 7.76 pg/mL) in women who miscarried compared to women who had a live birth. In contrast, the concentrations of anti-inflammatory cytokines IL-10 on days ET+ 23 and + 30 (26.23 ± 2.11 vs 38.30 ± 4.64, 23.77 ± 2.06 vs 39.16 ± 4.99 pg/mL) and TGF-β1 on day ET+ 30 (20.30 ± 1.25 vs 23.81 ± 0.88 ng/mL) were significantly decreased in women who miscarried compared to women who had a live birth. While for the chemokine profile, there was no significant alteration observed between the two groups across all the time points. These findings suggest that a sustained anti-inflammatory milieu is concomitant with the maintenance of early pregnancy, while the remarkable pro-inflammatory shift as early as day ET+ 16 in women who subsequently miscarried was observed before the diagnosis of miscarriage.
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Affiliation(s)
- Yiwei Zhao
- Department of Obstetrics and Gynecology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, China; Assisted Reproductive Technology Unit, Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, the Hong Kong Special Administrative Region of China
| | - Gene Chi Wai Man
- Assisted Reproductive Technology Unit, Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, the Hong Kong Special Administrative Region of China
| | - Ruizhe Zhang
- Assisted Reproductive Technology Unit, Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, the Hong Kong Special Administrative Region of China
| | - Chun-Kwok Wong
- Department of Chemical Pathology, The Chinese University of Hong Kong, the Hong Kong Special Administrative Region of China
| | - Xiaoyan Chen
- Assisted Reproductive Technology Unit, Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, the Hong Kong Special Administrative Region of China; Department of Obstetrics and Gynaecology, Shenzhen Baoan Women's and Children's Hospital, Shenzhen University, Shenzhen, China
| | - Jacqueline Pui-Wah Chung
- Assisted Reproductive Technology Unit, Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, the Hong Kong Special Administrative Region of China
| | - Chi-Chiu Wang
- Assisted Reproductive Technology Unit, Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, the Hong Kong Special Administrative Region of China; Reproduction and Development Laboratory, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, the Hong Kong Special Administrative Region of China; School of Biomedical Sciences, The Chinese University of Hong Kong, the Hong Kong Special Administrative Region of China; Chinese University of Hong Kong -Sichuan University Joint Laboratory in Reproductive Medicine, The Chinese University of Hong Kong, the Hong Kong Special Administrative Region of China
| | - Susan Laird
- Department of Biosciences and Chemistry, Sheffield Hallam University, UK
| | - Tao Zhang
- Assisted Reproductive Technology Unit, Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, the Hong Kong Special Administrative Region of China.
| | - Tin-Chiu Li
- Assisted Reproductive Technology Unit, Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, the Hong Kong Special Administrative Region of China; Chinese University of Hong Kong -Sichuan University Joint Laboratory in Reproductive Medicine, The Chinese University of Hong Kong, the Hong Kong Special Administrative Region of China.
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Chung PW, Li TC. Electrocoagulation versus gelantine-thrombin matrix sealant for haemostasis after laparoscopic surgery of ovarian endometriomas: a randomised control trial (abridged secondary publication). Hong Kong Med J 2022; 28 Suppl 3:43-44. [PMID: 35701232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023] Open
Affiliation(s)
- P W Chung
- The Department of Obstetrics and Gynaecology, Prince of Wales Hospital
| | - T C Li
- The Department of Obstetrics and Gynaecology, Prince of Wales Hospital
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Guo Y, Shi X, Song D, Liu Y, Huang X, Xiao Y, Yang L, Xia E, Li TC. The efficacy of auto-cross-linked hyaluronic acid gel in addition to estradiol and intrauterine balloon in the prevention of adhesion reformation after hysteroscopic adhesiolysis. Reprod Biomed Online 2022; 45:501-507. [DOI: 10.1016/j.rbmo.2022.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 04/25/2022] [Accepted: 04/26/2022] [Indexed: 10/18/2022]
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Lee WT, Ng KW, Liao J, Luk ACS, Suen HC, Chan THT, Cheung MY, Chu D, Zhao M, Chan YL, Li TC, Lee TL. P–547 Single-cell RNA sequencing identifies molecular regulations associated with poor maturation performance on rescue in vitro matured oocytes. Hum Reprod 2021. [DOI: 10.1093/humrep/deab130.546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Study question
What is the transcriptome signature associated with rescuein vitro matured (rIVM) oocytes?
Summary answer
GATA–1/CREB1/WNT signaling axis was repressed in rIVM oocytes of poor quality.
What is known already
rIVM aims to produce mature oocytes (MII) for in vitro fertilization (IVF) through IVM of immature oocytes collected from stimulated ovaries. It is less popular due to limited success rate in infertility treatment. Genetic aberrations, cellular stress, and the absence of cumulus cell support in oocytes could account for the failure of rIVM.
Study design, size, duration
We applied single-cell RNA sequencing (scRNA-seq) to capture the transcriptomes of human in vivo (IVO) oocytes (n = 10) from 7 donors and rIVM oocytes (n = 10) from 10 donors, followed by studying the maternal age effect and ovarian responses on rIVM oocyte transcriptomes.
Participants/materials, setting, methods
Human oocytes were collected from donors aged 28–41 years with a body mass index of < 30. RNA extraction, cDNA generation, library construction and sequencing were performed in one preparation. scRNA-seq data were then processed and analyzed. Selected genes in therIVM vs. IVO comparison were validated by quantitative real-time PCR.
Main results and the role of chance
The transcriptome profiles of rIVM/IVO showed distinctive differences. A total of 1559 differentially expressed genes (DEGs, genes with at least two-fold change and adjusted p < 0.05) were found to be enriched in metabolic processes, biosynthesis, and oxidative phosphorylation. Among these DEGs, we identified a repression of WNT/β-catenin signaling in rIVM when compared with IVO oocytes. We found that estradiol level exhibited a significant age-independent correlation with the IVO mature oocyte ratio (MII ratio). rIVM oocytes with higher MII ratio showed over-represented cellular processes such as anti-apoptosis. To further identify targets that contribute to the poor outcomes of rIVM, we compared oocytes collected from young donors with high MII ratio versus donors of advanced maternal age and revealed CREB1was an important regulator in rIVM. Our study identified GATA–1/CREB1/WNT signaling was repressed in both rIVM condition and rIVM oocytes of low-quality.
Limitations, reasons for caution
In the rIVM oocytes of high- and low-quality comparison, the number of samples was limited after data filtering with stringent selection criteria. For the oocyte stage identification, we were unable to predict the presence of oocyte spindle so polar body extrusion was the only indicator.
Wider implications of the findings: This study showed that GATA–1/CREB1/WNT signaling and antioxidant actions were repressed in rIVM condition and was further downregulated in rIVM oocytes of low-quality, providing us the foundation of subsequent follow-up research on human subjects.
Trial registration number
Not applicable
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Affiliation(s)
- W T Lee
- The Chinese University of Hong Kong, School of Biomedical Sciences, Hong Kong, Hong Kong
| | - K W Ng
- The Chinese University of Hong Kong, School of Biomedical Sciences, Hong Kong, Hong Kong
| | - J Liao
- The Chinese University of Hong Kong, School of Biomedical Sciences, Hong Kong, Hong Kong
| | - A C S Luk
- The Chinese University of Hong Kong, School of Biomedical Sciences, Hong Kong, Hong Kong
| | - H C Suen
- The Chinese University of Hong Kong, School of Biomedical Sciences, Hong Kong, Hong Kong
| | - T H T Chan
- The Chinese University of Hong Kong, School of Biomedical Sciences, Hong Kong, Hong Kong
| | - M Y Cheung
- The Chinese University of Hong Kong, School of Biomedical Sciences, Hong Kong, Hong Kong
| | - D Chu
- The Chinese University of Hong Kong, School of Biomedical Sciences, Hong Kong, Hong Kong
| | - M Zhao
- The Chinese University of Hong Kong, Department of Obstetrics and Gynaecology, Hong Kong, Hong Kong
| | - Y L Chan
- The Chinese University of Hong Kong, Department of Obstetrics and Gynaecology, Hong Kong, Hong Kong
| | - T C Li
- The Chinese University of Hong Kong, Department of Obstetrics and Gynaecology, Hong Kong, Hong Kong
| | - T L Lee
- The Chinese University of Hong Kong, School of Biomedical Sciences, Hong Kong, Hong Kong
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14
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Chung JPW, Law T, Sahota D, Mak J, Li TC. P-745 The efficacy of Buscopan® in reducing pain during ultrasound-guided manual vacuum aspiration (USG-MVA): A double-blind randomised placebo-controlled trial. Hum Reprod 2021. [DOI: 10.1093/humrep/deab128.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Study question
Does Buscopan® reduce abdominal pain experienced by women undergoing ultrasound-guided manual vacuum aspiration (USG-MVA)?
Summary answer
The addition of 20mg Buscopan® intravenous injection was not associated with a statistical reduction in pain score but leads to a higher patient satisfaction score.
What is known already
Ultrasound-guided Manual Vacuum aspiration is a feasible and effective out-patient treatment option for treating early pregnancy loss. However, it is associated with a moderate amount of pain due to uterine contraction.
Study design, size, duration
This randomised, double-blinded, placebo-controlled trial was conducted in a university-affiliated tertiary hospital. The study assessed whether 1 ml of 20mg Buscopan® intravenous injection 5 minutes before the USG-MVA will reduce the abdominal pain experienced by the women immediately and 2 hours after the procedure. Participants were randomised between June 2018 to January 2020 using a computer-generated number series in a 1:1 ratio.
Participants/materials, setting, methods
Women aged 18 years or older with first-trimester miscarriage undergoing the USG-MVA procedure were eligible. In total, 122 participants out of 128 eligible were included. Of whom, 111 underwent the USG-MVA procedure, 60 randomised to the Buscopan® group, and 62 to the placebo group.
Main results and the role of chance
The median abdominal pain scores in the Buscopan® group were 16.0% and 21.2% lower than the placebo group immediately post-procedure and 2 hours after the procedure in the Buscopan® group. Repeated measures ANOVA indicated that the both vaginal and abdominal pain scores improved significantly with the time (Vaginal F(1,108)= 180.1,p<0.0001;
Abdominal
F(1,108)=83.41,p<0.001) but not with group. No difference was noted in the complications and side effects profile. The physiological stress measured by Log10 sAA levels reduced significantly with time (F(2.8,286.1)= 6.3, p < 0.001) but not with group (F = 0.1, p = 0.96). Women randomised to Buscopan® had a significantly higher (p = 0.032) mean VAS satisfaction scores compared to those receiving placebo (79.0±17.3 vs 73.4±24.1).
Limitations, reasons for caution
This study was a single-centre study, thus one should be cautious in the overall generalisability of the results.
Wider implications of the findings
Few studies have evaluated the use of anti-spasmodic agents to minimise uterine contraction pain in women undergoing outpatient uterine evacuation. We consider Buscopan® a useful adjunct in the pain control of USG-MVA to specifically reduce uterine cramps. Further larger studies are required to evaluate its efficacy
Trial registration number
ChiCTR1800014590
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Affiliation(s)
- J P W Chung
- The Chinese University of Hong Kong, Department of Obstetrics and Gynaecology, Hong Kong, Hong Kong
| | - T Law
- The Chinese University of Hong Kong, Department of Obstetrics and Gynaecology, Hong Kong, Hong Kong
| | - D Sahota
- The Chinese University of Hong Kong, Department of Obstetrics and Gynaecology, Hong Kong, Hong Kong
| | - J Mak
- The Chinese University of Hong Kong, Department of Obstetrics and Gynaecology, Hong Kong, Hong Kong
| | - T C Li
- The Chinese University of Hong Kong, Department of Obstetrics and Gynaecology, Hong Kong, Hong Kong
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15
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Chung JPW, Law T, Sahota D, Mak J, Li TC. P–745 The efficacy of Buscopan® in reducing pain during ultrasound-guided manual vacuum aspiration (USG-MVA): A double-blind randomised placebo-controlled trial. Hum Reprod 2021. [DOI: 10.1093/humrep/deab130.744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Study question
Does Buscopan® reduce abdominal pain experienced by women undergoing ultrasound-guided manual vacuum aspiration (USG-MVA)?
Summary answer
The addition of 20mg Buscopan® intravenous injection was not associated with a statistical reduction in pain score but leads to a higher patient satisfaction score.
What is known already
Ultrasound-guided Manual Vacuum aspiration is a feasible and effective out-patient treatment option for treating early pregnancy loss. However, it is associated with a moderate amount of pain due to uterine contraction.
Study design, size, duration
This randomised, double-blinded, placebo-controlled trial was conducted in a university-affiliated tertiary hospital. The study assessed whether 1 ml of 20mg Buscopan® intravenous injection 5 minutes before the USG-MVA will reduce the abdominal pain experienced by the women immediately and 2 hours after the procedure. Participants were randomised between June 2018 to January 2020 using a computer-generated number series in a 1:1 ratio.
Participants/materials, setting, methods
Women aged 18 years or older with first-trimester miscarriage undergoing the USG-MVA procedure were eligible. In total, 122 participants out of 128 eligible were included. Of whom, 111 underwent the USG-MVA procedure, 60 randomised to the Buscopan® group, and 62 to the placebo group.
Main results and the role of chance
The median abdominal pain scores in the Buscopan® group were 16.0% and 21.2% lower than the placebo group immediately post-procedure and 2 hours after the procedure in the Buscopan® group. Repeated measures ANOVA indicated that the both vaginal and abdominal pain scores improved significantly with the time (Vaginal F(1,108)=180.1,p<0.0001; Abdominal: F(1,108)=83.41,p<0.001) but not with group. No difference was noted in the complications and side effects profile. The physiological stress measured by Log10 sAA levels reduced significantly with time (F(2.8,286.1)= 6.3, p < 0.001) but not with group (F = 0.1, p = 0.96). Women randomised to Buscopan® had a significantly higher (p = 0.032) mean VAS satisfaction scores compared to those receiving placebo (79.0±17.3 vs 73.4±24.1).
Limitations, reasons for caution
This study was a single-centre study, thus one should be cautious in the overall generalisability of the results.
Wider implications of the findings: Few studies have evaluated the use of anti-spasmodic agents to minimise uterine contraction pain in women undergoing outpatient uterine evacuation. We consider Buscopan® a useful adjunct in the pain control of USG-MVA to specifically reduce uterine cramps. Further larger studies are required to evaluate its efficacy.
Trial registration number
ChiCTR1800014590
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Affiliation(s)
- J P W Chung
- The Chinese University of Hong Kong, Department of Obstetrics and Gynaecology, Hong Kong, Hong Kong
| | - T Law
- The Chinese University of Hong Kong, Department of Obstetrics and Gynaecology, Hong Kong, Hong Kong
| | - D Sahota
- The Chinese University of Hong Kong, Department of Obstetrics and Gynaecology, Hong Kong, Hong Kong
| | - J Mak
- The Chinese University of Hong Kong, Department of Obstetrics and Gynaecology, Hong Kong, Hong Kong
| | - T C Li
- The Chinese University of Hong Kong, Department of Obstetrics and Gynaecology, Hong Kong, Hong Kong
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16
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Abstract
Abstract
Study question
To investigate the different metabolomic profiling in serum between pregnant and non-pregnant women during early implantation period.
Summary answer
Metabolomics of progesterone-related hormones enhances from ET day3 for pregnancy women compared with non-pregnancy women.
What is known already
Metabolomics is based on high-throughput analytical methods to identify and quantify metabolites. Compared to other omics study, metabolomics is the closest one to the phenotype, allowing the observation of dynamic changes in phenotype at specific timepoints. So far there is no published work about the metabolomics profile in human early implantation period. Study design, size, duration: Study design: comparative study. Size: 14 pregnancy women and 14 non-pregnancy women. duration: time-course.
Participants/materials, setting, methods
Participants: pregnancy women and unpregnancy women after embryo transfer (ET). Setting: university-based study. Methods: Peripheral blood were collected at ET day0, 3, 6 and 9. metabolomic profiling in serum by platforms of capillary electrophoresis-mass spectrometry (CE-MS) and liquid chromatography–mass spectrometry (LC-MS).
Main results and the role of chance
There were no statistical difference of the age, BMI, basal FSH level, endometrium thickness on the day of embryo transfer, distribution of primary and secondary fertility, embryo transfer cycle as well as the infertile types between the two groups. After deleting those with over 50% missing data, we finally have 310 metabolites into statistical analysis. Among the 310 metabolite, lipid metabolites account the largest percentage, nearly half of all metabolites. The second biggest class of metabolites in our data was organic acids. Combined results in repeated measurement ANOVA (RM-ANOVA) and ANOVA-simultaneous component analysis (ASCA) as well as multivariate empirical Bayes time-series analysis (MEBA), we finally found that progesterone-related hormones were the most important metabolites for the whole time-series data. Those significant metabolites showed a significant down regulation from ET day0 to ET day3 and up regulation from ET day3 to ET day9.
Limitations, reasons for caution
we have limited sample size for this study and further validation is necessary for confirmation.
Wider implications of the findings: The phenomenon of upregulation of progesterone-related hormones from day3 in pregnancy group might be related to the embryo-originated hcg. Because the embryo has entered into endometrium at day3 and produced cytokines, hcg and other interaction with endometrium.
Trial registration number
NA
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Affiliation(s)
- Y Zhang
- Chinese University of Hong Kong, Department of Obstetrics and Gynecology, Hong Kong, China
| | - Y W Zhao
- Chinese University of Hong Kong, Department of Obstetrics and Gynecology, Hong Kong, China
| | - C C Wang
- Chinese University of Hong Kong, Department of Obstetrics and Gynecology, Hong Kong, China
| | - T C Li
- Chinese University of Hong Kong, Department of Obstetrics and Gynecology, Hong Kong, China
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17
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Zhang T, Zhao Y, Wing CC, Chen X, Wang CC, Li TC. P–408 Inadequate increase in Tim–3 on peripheral NK cells after blastocyst transfer is associated with early miscarriage. Hum Reprod 2021. [DOI: 10.1093/humrep/deab130.407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Study question
Whether the changing peripheral levels of Tim–3/Galectin–9 (Gal–9) and PD–1/PL–1 over 4 weeks after ET in ongoing pregnancies is different from pregnancies destined to miscarry.
Summary answer
A significant and sustained increase of Tim–3 in pNK cells was observed in pregnancies which were ongoing but not in pregnancies which later miscarried.
What is known already
The importance of maternal immune adaptation and tolerance to the implanting embryo, an allograft, has been extensively investigated for decades. Immune checkpoint molecules, like T-cell immunoglobulin mucin–3 (Tim–3) and programed cell death–1 (PD–1), are co-stimulatory receptors negatively regulating immune responses. During pregnancy, Tim–3 and PD–1 are expressed by several immune cells in the decidua and participate in the maternal-fetal immune interactions to mediate maternal immune tolerance through binding to their ligands Gal–9 and progressed death-ligand 1 (PD-L1) produced by trophoblast and immune cells. In addition to the implantation site, Tim–3 and PD–1 expressions in peripheral lymphocytes are modified during pregnancy.
Study design, size, duration
A prospective observational study includes 81 women who achieved ongoing pregnancy and 17 women who suffered from miscarriage after single day–5 blastocyst transfer. All the subjects were recruited from November 2018 to January 2020 in a university teaching hospital.
Participants/materials, setting, methods
Women undergoing single blastocyst transfer after in-vitro-fertilization (IVF) or intracytoplasmic sperm injection (ICSI) treatment were recruited on the day of ET following informed, written consent. They had serial blood samples taken on the day of ET, and 4, 5, 6 and 7 weeks of gestation for measurement of (1) membranous Tim–3 and PD–1 expression on various peripheral lymphocytes by flow cytometry; and (2) serum concentrations of ligands Gal–9 and PD-L1 by ELISA.
Main results and the role of chance
The comparisons between two groups showed there was no significant difference between the 2 groups in baseline levels among all the parameters measured. In women who achieved ongoing pregnancy, a significant and sustained increase of Tim–3 in either peripheral NK (pNK) subsets was observed at 4-week, 5-week, 6-week and 7-week gestations compared to the baseline (Tim–3+CD56dimNK 39.14±1.51%, 41.14±1.62%, 41.34±1.94%, and 41.69±2.12% vs. 30.27±1.49%; Tim–3+CD56brihgtNK cells, 24.54±1.71%, 25.43±1.54%, 27.26±1.88% and 24.70±1.64% vs. 19.08±1.13%), and the concentration of serum PD-L1 was significantly increased at 6-week and 7-week gestations (48.33±17.78 pg/ml, 52.53±20.60 pg/ml) when compared to the day of blastocyst transfer (41.40±16.01 pg/ml). The expressions of Tim–3 in T, NKT cells and PD–1 in NK, T, NKT cells were not significantly changed across the 5 time points. In women who conceived but later miscarried, all the parameters examined from 4–7 weeks of gestation were not significantly different when compared with the baseline measurement. The only measurement which showed a significant difference between the 2 groups and across all time points after ET was the proportion of Tim–3+CD56dimNK cells which was significantly higher in women who achieved ongoing pregnancies compared with women who destined to miscarry from 4 to 7 weeks of gestation.
Limitations, reasons for caution
It is uncertain if the observation would be different between miscarriage associated with aneuploid embryo or euploid embryo as we had not been able to obtain karyotyping result in most of the miscarriage cases.
Wider implications of the findings: Our preliminary observation suggests that the proportion of Tim–3+pNK cells as early as 4-week gestation could be a potential immuno-bio-marker to predict if a pregnancy is likely to progress normally or result in a miscarriage. Clearly, the finding in this study needs to be confirmed in a larger cohort study
Trial registration number
not applicable.
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Affiliation(s)
- T Zhang
- the Chinese University of Hong Kong, Obstetrics and Gynecology, Hong Kong, China
| | - Y Zhao
- the Chinese University of Hong Kong, Obstetrics and Gynecology, Hong Kong, China
| | - C C Wing
- the Chinese University of Hong Kong, Obstetrics and Gynecology, Hong Kong, China
| | - X Chen
- the Chinese University of Hong Kong, Obstetrics and Gynecology, Hong Kong, China
| | - C C Wang
- the Chinese University of Hong Kong, Obstetrics and Gynecology, Hong Kong, China
| | - T C Li
- the Chinese University of Hong Kong, Obstetrics and Gynecology, Hong Kong, China
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18
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Zhao Y, Zhang T, Guo X, Wang CC, Li TC. P–417 A comparison of baseline and sequential changes of extended cytokine profile during implantation window between women who did and did not conceive after embryo transfer. Hum Reprod 2021. [DOI: 10.1093/humrep/deab130.416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Study question
To compare the changing peripheral levels of inflammation-related cytokine profile during a 9-day period after blastocyst transfer between women who did and did not conceive.
Summary answer:Successful implantation is associated with transient increase in serum pro-inflammatory cytokine profile followed by a switch to anti-inflammatory cytokine profile prior to confirmation of pregnancy.What is known already: Immunomodulation is thought to be important for the prevention of rejection of the implanting semi-allograft embryo and successful establishment of pregnancy. A successful pregnancy is characterized by a dominance of anti-inflammatory cytokine profile in the peripheral blood in the first and second trimesters of pregnancy. It is achieved by a complex interplay between various immune cells and cytokines at the fetal-maternal interface, among which the key-players are interleukine–10 (IL–10) and transforming growth factor-β1 (TGF-β1). The circulating inflammatory response in the first few days after embryo transfer to the pathophysiology of implantation failure remains unclear. Study design, size, duration: This prospective observational and longitudinal study on 47 women with infertility was performed in an in vitro fertilization unit from December 2018 to August 2019. The amounts of a range of cytokines was measured on serial blood samples obtained during a 9-day period after blastocyst transfer.
Participants/materials, setting, methods
Serial blood samples were obtained on the day of embryo transfer, and 3, 6, and 9 days afterward for measurement of serum interferon gamma (IFN-γ), tumor necrosis factor alpha, interleukin (IL)–2, IL–4, IL–10, IL–12, IL–13, IL–17, IL–18, and IL–22 using cytometric bead arrays; transforming growth factor beta 1 (TGF-β1) was measured using commercial enzyme-linked immunosorbent assay kits.
Main results and the role of chance
The cytokine profile was similar between the women who conceived and those who did not on the day of blastocyst transfer. In women who conceived, IFN-γ and IL–17 (pro-inflammatory cytokines) exhibited a transient and significant increase on day 3 after blastocyst transfer, which decreased to the baseline levels by day 6. Meanwhile, IL–10 (anti-inflammatory cytokine) was increased significantly on days 6 and 9, and TGF-β1 (anti-inflammatory cytokine) was increased significantly on day 9 after blastocyst transfer. In women who did not conceive, there was a more pronounced increase in IFN-γ and IL–17 (pro-inflammatory cytokines) on day 3, which was sustained on days 6 and 9 without a switch to an anti-inflammatory cytokine profile. Among women who conceived after blastocyst embryo transfer, there was a transient and modest increase in serum pro-inflammatory cytokine profile (IFN-γ and IL–17) 3 days after blastocyst transfer, which was followed by a switch to anti-inflammatory cytokine profile (increase IL–10 and TGF-β1) by 6 days after blastocyst transfer and the latter increase was sustained 9 days after blastocyst transfer, when pregnancy was confirmed.
Limitations, reasons for caution
This is an observational study on peripheral blood cytokine levels, so it is not possible to draw conclusions if the implantation failure is due primarily to failure of the embryo to elicit a trigger for the switch or failure of maternal response to a normal trigger released by the embryo.
Wider implications of the findings: The characteristic change in peripheral cytokine profile during successful implantation, well before confirmation of pregnancy, may provide an opportunity to develop serum biomarkers to monitor implantation and to understand the mechanism of its failure, especially in women who experience recurrent implantation failure after IVF.
Trial registration number
Not applicable
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Affiliation(s)
- Y Zhao
- The Chinese University of Hong Kong, Department of Obstetrics and Gynaecology- Faculty of Medicine, Shatin, Hong Kong
| | - T Zhang
- The Chinese University of Hong Kong, Department of Obstetrics and Gynaecology- Faculty of Medicine, Shatin, Hong Kong
| | - X Guo
- The Chinese University of Hong Kong, Department of Obstetrics and Gynaecology- Faculty of Medicine, Shatin, Hong Kong
| | - C C Wang
- The Chinese University of Hong Kong, Department of Obstetrics and Gynaecology- Faculty of Medicine, Shatin, Hong Kong
| | - T C Li
- The Chinese University of Hong Kong, Department of Obstetrics and Gynaecology- Faculty of Medicine, Shatin, Hong Kong
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19
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Lee AWT, Ng JKW, Liao J, Luk AC, Suen AHC, Chan TTH, Cheung MY, Chu HT, Tang NLS, Zhao MP, Lian Q, Chan WY, Chan DYL, Leung TY, Chow KL, Wang W, Wang LH, Chen NCH, Yang WJ, Huang JY, Li TC, Lee TL. Single-cell RNA sequencing identifies molecular targets associated with poor in vitro maturation performance of oocytes collected from ovarian stimulation. Hum Reprod 2021; 36:1907-1921. [PMID: 34052851 DOI: 10.1093/humrep/deab100] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 03/08/2021] [Indexed: 12/14/2022] Open
Abstract
STUDY QUESTION What is the transcriptome signature associated with poor performance of rescue IVM (rIVM) oocytes and how can we rejuvenate them? SUMMARY ANSWER The GATA-1/CREB1/WNT signalling axis was repressed in rIVM oocytes, particularly those of poor quality; restoration of this axis may produce more usable rIVM oocytes. WHAT IS KNOWN ALREADY rIVM aims to produce mature oocytes (MII) for IVF through IVM of immature oocytes collected from stimulated ovaries. It is not popular due to limited success rate in infertility treatment. Genetic aberrations, cellular stress and the absence of cumulus cell support in oocytes could account for the failure of rIVM. STUDY DESIGN, SIZE, DURATION We applied single-cell RNA sequencing (scRNA-seq) to capture the transcriptomes of human in vivo oocytes (IVO) (n = 10) from 7 donors and rIVM oocytes (n = 10) from 10 donors. The effects of maternal age and ovarian responses on rIVM oocyte transcriptomes were also studied. In parallel, we studied the effect of gallic acid on the maturation rate of mouse oocytes cultured in IVM medium with (n = 84) and without (n = 85) gallic acid. PARTICIPANTS/MATERIALS, SETTING, METHODS Human oocytes were collected from donors aged 28-41 years with a body mass index of <30. RNA extraction, cDNA generation, library construction and sequencing were performed in one preparation. scRNA-seq data were then processed and analysed. Selected genes in the rIVM versus IVO comparison were validated by quantitative real-time PCR. For the gallic acid study, we collected immature oocytes from 5-month-old mice and studied the effect of 10-μM gallic acid on their maturation rate. MAIN RESULTS AND THE ROLE OF CHANCE The transcriptome profiles of rIVM/IVO oocytes showed distinctive differences. A total of 1559 differentially expressed genes (DEGs, genes with at least 2-fold change and adjusted P < 0.05) were found to be enriched in metabolic processes, biosynthesis and oxidative phosphorylation. Among these DEGs, we identified a repression of WNT/β-catenin signalling in rIVM when compared with IVO oocytes. We found that oestradiol levels exhibited a significant age-independent correlation with the IVO mature oocyte ratio (MII ratio) for each donor. rIVM oocytes from women with a high MII ratio were found to have over-represented cellular processes such as anti-apoptosis. To further identify targets that contribute to the poor clinical outcomes of rIVM, we compared oocytes collected from young donors with a high MII ratio with oocytes from donors of advanced maternal age and lower MII ratio, and revealed that CREB1 is an important regulator. Thus, our study identified that GATA-1/CREB1/WNT signalling was repressed in both rIVM oocytes versus IVO oocytes and in rIVM oocytes of lower versus higher quality. Consequently we investigated gallic acid, as a potential antioxidant substrate in human rIVM medium, and found that it increased the mouse oocyte maturation rate by 31.1%. LARGE SCALE DATA Raw data from this study can be accessed through GSE158539. LIMITATIONS, REASONS FOR CAUTION In the rIVM oocytes of the high- and low-quality comparison, the number of samples was limited after data filtering with stringent selection criteria. For the oocyte stage identification, we were unable to predict the presence of oocyte spindle, so polar body extrusion was the only indicator. WIDER IMPLICATIONS OF THE FINDINGS This study showed that GATA-1/CREB1/WNT signalling was repressed in rIVM oocytes compared with IVO oocytes and was further downregulated in low-quality rIVM oocytes, providing us the foundation of subsequent follow-up research on human oocytes and raising safety concerns about the clinical use of rescued oocytes. STUDY FUNDING/COMPETING INTEREST(S) This work was supported by the Collaborative Research Fund, Research Grants Council, C4054-16G, and Research Committee Funding (Research Sustainability of Major RGC Funding Schemes), The Chinese University of Hong Kong. The authors have no conflicts of interest to declare.
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Affiliation(s)
- A W T Lee
- Developmental and Regenerative Biology Program, School of Biomedical Sciences, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, PR China
| | - J K W Ng
- Developmental and Regenerative Biology Program, School of Biomedical Sciences, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, PR China
| | - J Liao
- Developmental and Regenerative Biology Program, School of Biomedical Sciences, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, PR China
| | - A C Luk
- Developmental and Regenerative Biology Program, School of Biomedical Sciences, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, PR China
| | - A H C Suen
- Developmental and Regenerative Biology Program, School of Biomedical Sciences, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, PR China
| | - T T H Chan
- Developmental and Regenerative Biology Program, School of Biomedical Sciences, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, PR China
| | - M Y Cheung
- Developmental and Regenerative Biology Program, School of Biomedical Sciences, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, PR China
| | - H T Chu
- Developmental and Regenerative Biology Program, School of Biomedical Sciences, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, PR China
| | - N L S Tang
- Department of Chemical Pathology, and Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, PR China
| | - M P Zhao
- Assisted Reproductive Technology Unit, Department of Obstetrics and Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, PR China
| | - Q Lian
- Department of Medicine, The University of Hong Kong, Hong Kong SAR, PR China
| | - W Y Chan
- Developmental and Regenerative Biology Program, School of Biomedical Sciences, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, PR China
| | - D Y L Chan
- Assisted Reproductive Technology Unit, Department of Obstetrics and Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, PR China
| | - T Y Leung
- Department of Medicine, The University of Hong Kong, Hong Kong SAR, PR China
| | - K L Chow
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, N.T., Hong Kong SAR, PR China.,Division of Life Science, Hong Kong University of Science and Technology, Shatin, N.T., Hong Kong SAR, PR China
| | - W Wang
- Department of Obstetrics and Gynecology, IVF Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - L H Wang
- Institute of Molecular and Cellular Biology & Department of Medical Sciences, National Tsing Hua University, Hsinchu, Taiwan
| | - N C H Chen
- Department of Infertility and Reproductive Medicine, Taiwan IVF Group Center, Hsinchu City, Taiwan
| | - W J Yang
- Department of Infertility and Reproductive Medicine, Taiwan IVF Group Center, Hsinchu City, Taiwan
| | - J Y Huang
- Department of Infertility and Reproductive Medicine, Taiwan IVF Group Center, Hsinchu City, Taiwan
| | - T C Li
- Assisted Reproductive Technology Unit, Department of Obstetrics and Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, PR China
| | - T L Lee
- Developmental and Regenerative Biology Program, School of Biomedical Sciences, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, PR China
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Han X, Ma Y, Lu X, Li W, Xia E, Li TC, Zhang H, Huang X. Transplantation of Human Adipose Stem Cells Using Acellular Human Amniotic Membrane Improves Angiogenesis in Injured Endometrial Tissue in a Rat Intrauterine Adhesion Model. Cell Transplant 2021; 29:963689720952055. [PMID: 32838542 PMCID: PMC7784510 DOI: 10.1177/0963689720952055] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Endometrial injury resulting in intrauterine adhesion is associated with extensive damage to the regenerative basal layer of the endometrium and represents a major therapeutic challenge. Human adipose stem cells (hASCs) hold promise for future clinical use in the individualized therapy of injured endometrial tissue. Here, we observed that the use of the acellular human amniotic membrane (AHAM) significantly increased the expression of angiogenic factors, including angiogenin (ANG) and vascular endothelial growth factor (VEGF), in hASCs in vitro. The three-dimensional engineered hASC-AHAM grafts significantly increased the endometrial receptivity, as increased endometrial thickness, greater numbers of endometrial glands, and higher protein levels of leukemia inhibitory factor were observed in injured endometrial tissue that was treated with these grafts compared to those detected in injured endometrial tissue that was treated with AHAM alone. In addition, the hASC-AHAM grafts significantly increased the vascular density in the injured endometrial tissue in rats, when transplanted into an injured uterine cavity. Using the EGFP+-hASC-AHAM grafts for transplantation, we confirmed that the hASCs maintained higher protein levels of ANG and VEGF in the injured uterine cavity in vivo. The results of this study suggest that the ability of the engineered hASC-AHAM grafts to repair injured endometrial tissue may be associated with their ability to promote angiogenesis through the upregulated expression of angiogenic factors in hASCs. These findings may support individualized stem cell–based therapy for endometrial disease using bioartificial grafts.
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Affiliation(s)
- Xiao Han
- Hysteroscopic Center, Fuxing Hospital, Capital Medical University, Beijing, China
| | - Yuejiao Ma
- Department of Cell Biology, Municipal Laboratory for Liver Protection and Regulation of Regeneration, 12517Capital Medical University, Beijing, China
| | - Xin Lu
- Department of Cell Biology, Municipal Laboratory for Liver Protection and Regulation of Regeneration, 12517Capital Medical University, Beijing, China
| | - Weihong Li
- Department of Cell Biology, Municipal Laboratory for Liver Protection and Regulation of Regeneration, 12517Capital Medical University, Beijing, China
| | - Enlan Xia
- Hysteroscopic Center, Fuxing Hospital, Capital Medical University, Beijing, China
| | - Tin-Chiu Li
- Hysteroscopic Center, Fuxing Hospital, Capital Medical University, Beijing, China.,Assisted Conception Unit, Department of Obstetrics and Gynecology, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Haiyan Zhang
- Department of Cell Biology, Municipal Laboratory for Liver Protection and Regulation of Regeneration, 12517Capital Medical University, Beijing, China
| | - Xiaowu Huang
- Hysteroscopic Center, Fuxing Hospital, Capital Medical University, Beijing, China
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21
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Shi X, Chan CPS, Man GKY, Chan DYL, Wong MH, Li TC. Associations between blood metal/ metalloid concentration and human semen quality and sperm function: A cross-sectional study in Hong Kong. J Trace Elem Med Biol 2021; 65:126735. [PMID: 33647736 DOI: 10.1016/j.jtemb.2021.126735] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 02/09/2021] [Accepted: 02/19/2021] [Indexed: 01/18/2023]
Abstract
BACKGROUND The association between metal/metalloid exposure on human sperm quality is still inconclusive. There is a lack of data on the effect of metal/metalloid on sperm function. METHODS The aim of this study was to clarify the association between blood metal/metalloid concentration and traditional and functional sperm parameters, the blood concentration of Pb, Hg, Cd, As, Ni, Mo, Zn, Cu, Se, Fe, Mg, Cr and Ca of 288 men in Hong Kong were assessed by inductively coupled plasma-mass spectrometry, and sperm parameters including sperm concentration, motility, morphology, vitality, total sperm count, total motile sperm count, sperm DNA fragmentation and sperm acrosome reaction were measured. Demographic and lifestyle questionnaires were also provided for all participants. Multivariable linear regression analysis was performed to test the association between blood metal/ metalloid concentration and semen parameters after adjusting for relevant confounding variables. RESULTS The results showed that moderate to high level of blood Pb concentration (>27.19 μg/L) appeared to be negatively associated with sperm morphology (P < 0.05); high level of blood Cd concentration (>1.44 μg/L) was negatively associated with sperm acrosome reaction (P < 0.05); Mo was positively associated with semen volume (P < 0.05), however, high level of blood Mo concentration (>13.52 μg/L) was negatively associated with sperm vitality (P < 0.05); high level of blood Zn concentration (>6.20 mg/L) was positively associated with sperm vitality (P < 0.05); moderate level of blood Fe concentration (526.89-566.63 mg/L) was positively associated with sperm acrosome reaction (P < 0.05); moderate level of blood Ca concentration (55.92-66.10 mg/L) was positively associated with semen volume (P < 0.05); however, lower level of blood Ca concentration (45.90-55.92 mg/L) was negatively associated with sperm morphology (P < 0.05). CONCLUSIONS Our results suggested that the sperm function could be affected by blood Cd and Fe concentration and traditional sperm parameters could be affected by blood concentration of Mo, Zn, Pb and Ca.
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Affiliation(s)
- Xiao Shi
- Assisted Conception Unit, Department of Obstetrics and Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, People's Republic of China; Center for Reproductive Medicine, Department of Obstetrics and Gynaecology, Nanfang Hospital, Southern Medical University, People's Republic of China
| | - Carol Pui Shan Chan
- Assisted Conception Unit, Department of Obstetrics and Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Grace Ka Yan Man
- Consortium on Health, Environment, Education and Research (CHEER), Department of Science and Environmental Studies, The Education University of Hong Kong, Hong Kong, People's Republic of China
| | - David Yiu Leung Chan
- Assisted Conception Unit, Department of Obstetrics and Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Ming Hung Wong
- Consortium on Health, Environment, Education and Research (CHEER), Department of Science and Environmental Studies, The Education University of Hong Kong, Hong Kong, People's Republic of China; School of Environmental Science and Engineering, Southern University of Science and Technology, Shenzhen, People's Republic of China.
| | - Tin-Chiu Li
- Assisted Conception Unit, Department of Obstetrics and Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, People's Republic of China.
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22
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Alonso Pacheco L, Ata B, Bettocchi S, Campo R, Carugno J, Checa MA, de Angelis C, Di Spiezio Sardo A, Donnez J, Farrugia M, Ferro J, Franchini M, Garzon S, Gianaroli L, Gergolet M, Gubbini G, Gordts S, Grimbizis G, Haimovich S, Laganà AS, Li TC, Mencaglia L, Rienzi L, Saravelos S, Soares SR, Tanos V, Ubeda A, Ubaldi FM, Van Herendael B, Vereczkey A, Vitagliano A, Vitale SG, Zullo F. Septate uterus and reproductive outcomes: let's get serious about this. Hum Reprod 2021; 35:2627-2629. [PMID: 32968815 DOI: 10.1093/humrep/deaa230] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Bariş Ata
- Endoscopy Unit, Centro Gutenberg, Málaga, Spain
| | | | - Rudi Campo
- Department of Obstetrics and Gynecology, Koç University School of Medicine, Istanbul, Turkey
| | - Jose Carugno
- Inter-Departmental Project Unit of "Minimal-Invasive Gynecological Surgery", Integrated Department of Medicine (D.I.M.), University "Aldo Moro", Policlinico of Bari, Italy
| | - Miguel Angel Checa
- Inter-Departmental Project Unit of "Minimal-Invasive Gynecological Surgery", Integrated Department of Medicine (D.I.M.), University "Aldo Moro", Policlinico of Bari, Italy
| | | | | | - Jacques Donnez
- Université Catholique de Louvain, Brussels, Belgium.,Société de Recherche pour l'Infertilité (SRI), Brussels, Belgium
| | | | - Jaime Ferro
- Instituto Valenciano Infertilidad (IVI) Valencia, Valencia, Spain
| | - Mario Franchini
- Demetra Infertility Center and Villa Cherubini Clinic, Firenze, Italy
| | - Simone Garzon
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | | | | | | | - Stephan Gordts
- Inter-Departmental Project Unit of "Minimal-Invasive Gynecological Surgery", Integrated Department of Medicine (D.I.M.), University "Aldo Moro", Policlinico of Bari, Italy
| | - Grigoris Grimbizis
- Head 1st Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Sergio Haimovich
- Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, The Rappaport Faculty of Medicine, Technion, Israel
| | - Antonio Simone Laganà
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - T C Li
- Department of Obstetrics & Gynaecology, Chinese University of Hong Kong
| | - Luca Mencaglia
- Unit of Phisiopatology of Reproduction USL South Est, Tuscany, Italy
| | - Laura Rienzi
- GENERA, Centre for Reproductive Medicine, Clinica Valle Giulia, Rome, Italy
| | | | | | - Vasilis Tanos
- Aretaeio Hospital and St Georges Medical School, Nicosia University, Nicosia, Cyprus
| | - Alicia Ubeda
- Department of Obstetrics and Gynecology, Institut Universitari Dexeus, Barcelona, Spain
| | - Filippo M Ubaldi
- GENERA, Centre for Reproductive Medicine, Clinica Valle Giulia, Rome, Italy
| | - Bruno Van Herendael
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy.,Stuivenberg General Hospital, Ziekenhuis Netwerk Antwerpen (ZNA), Antwerp, Belgium
| | | | - Amerigo Vitagliano
- Unit of Gynaecology and Obstetrics, Department of Women and Children's Health, University of Padua, Padua, Italy
| | - Salvatore Giovanni Vitale
- Obstetrics and Gynecology Unit, Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | - Fulvio Zullo
- Department of Neuroscience, Reproductive Science and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
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23
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Wang Y, Tian Y, Liu L, Li TC, Tong X, Zhu H, Zhang S. The number of previous failed embryo transfer cycles is an independent factor affecting implantation rate in women undergoing IVF/ICSI treatment: A retrospective cohort study. Medicine (Baltimore) 2021; 100:e25034. [PMID: 33655977 PMCID: PMC7939155 DOI: 10.1097/md.0000000000025034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 02/05/2021] [Indexed: 01/04/2023] Open
Abstract
The implantation rate (IR) in assisted reproductive technologies such as in vitro fertilization (IVF) and intracytoplasmic sperm injection is affected by many different factors such as age, quality of embryo, and stage of embryo development. This study aimed to investigate to what extent the number of previous failed embryo transfer cycles is an independent factor affecting IR.This was a single-center, retrospective cohort study of a consecutive series of 6376 day-3 embryo transfer (ET) cycles following IVF between January 2012 and August 2018. None of the subjects underwent endometrial scratch/injury prior to the treatment cycle, or received intravenous immunoglobulin, steroid, dehydroepiandrosterone, intralipid or heparin during the treatment with the aim of improving implantation rates.Multiple regression analysis showed that the 3 most important independent factors affecting the IR, in decreasing of importance: age, frozen or fresh embryo transfer and the number of previous ET cycles. Having controlled for 2 of the more important confounding variables including maternal age and the type of embryo, the IR in women who had 0, 1, 2, and 3 or more previous failed ET cycles were 45.8%, 35.9%, 31.2%, 21.0%, respectively (P < .001).Repeated implantation failure is a significant independent factor affecting the IR. The number of previous failed ET cycles should be considered in counselling women regarding the prognosis of a further IVF-ET treatment cycle.
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Affiliation(s)
- Yangyang Wang
- Assisted Reproduction Unit, Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine; Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province
- Center of Reproductive Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, P. R. China
| | - Yichao Tian
- Assisted Reproduction Unit, Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine; Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province
- Center of Reproductive Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, P. R. China
| | - Liu Liu
- Assisted Reproduction Unit, Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine; Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province
- Center of Reproductive Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, P. R. China
| | - Tin-Chiu Li
- Department of Obstetrics and Gynecology, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Xiaomei Tong
- Assisted Reproduction Unit, Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine; Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province
- Center of Reproductive Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, P. R. China
| | - Haiyan Zhu
- Assisted Reproduction Unit, Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine; Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province
- Center of Reproductive Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, P. R. China
| | - Songying Zhang
- Assisted Reproduction Unit, Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine; Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province
- Center of Reproductive Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, P. R. China
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24
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Song D, He Y, Wang Y, Liu Z, Xia E, Huang X, Xiao Y, Li TC. Impact of antibiotic therapy on the rate of negative test results for chronic endometritis: a prospective randomized control trial. Fertil Steril 2021; 115:1549-1556. [PMID: 33549312 DOI: 10.1016/j.fertnstert.2020.12.019] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 12/14/2020] [Accepted: 12/15/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To compare the rates of negative test results for chronic endometritis (CE) between subjects who did and did not receive antibiotic treatment. DESIGN Prospective, single-blind randomized controlled trial. SETTING Tertiary hysteroscopic center in a university teaching hospital. PATIENT(S) A total of 132 women with CE confirmed with immunohistochemical study with CD138 epitope. INTERVENTION(S) Women randomized to antibiotic therapy received oral levofloxacin 500 mg and tinidazole 1,000 mg daily for 14 days. Women randomized to the control group did not receive any treatment. A repeated endometrial biopsy was performed 4 to 8 weeks after the initial biopsy to determine whether CE was still present. MAIN OUTCOME MEASURE(S) The rate of negative test results for CE (from positive to negative). RESULT(S) The CE rate of negative test results in the treatment group (89.3%) after one course of antibiotic treatment was significantly higher than that in the control group (12.7%). Among subjects who attempted pregnancy, there was no significant difference in ongoing pregnancy rates and miscarriage rates between the treatment arm (43.2%, 5.4%) and the control arm (25.7%, 14.3%). Among subjects randomized, there was also no significant difference in ongoing pregnancy rates and miscarriage rates between the treatment arm (27.1%, 3.4%) and the control arm (16.4%, 9.1%). CONCLUSION A course of broad-spectrum oral antibiotic therapy for 14 days is effective in the treatment of CE in >89.8% of cases. However, it is not yet clear whether treatment improved pregnancy outcomes. CLINICAL TRIAL IDENTIFICATION NUMBER NCT02648698.
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Affiliation(s)
- Dongmei Song
- Department of Hysteroscopic Centre, Fuxing Hospital, the Eighth Clinical Medical College, Capital Medical University, Beijing, People's Republic of China
| | - Yanfei He
- Reproductive Health Department, Dezhou Decheng Maternal and Child Health Hospital, Shandong, People's Republic of China
| | - Yixuan Wang
- University of Science and Technology, Beijing, People's Republic of China
| | - Ziyu Liu
- Department of Gynecology, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, People's Republic of China
| | - Enlan Xia
- Department of Hysteroscopic Centre, Fuxing Hospital, the Eighth Clinical Medical College, Capital Medical University, Beijing, People's Republic of China
| | - Xiaowu Huang
- Department of Hysteroscopic Centre, Fuxing Hospital, the Eighth Clinical Medical College, Capital Medical University, Beijing, People's Republic of China
| | - Yu Xiao
- Department of Hysteroscopic Centre, Fuxing Hospital, the Eighth Clinical Medical College, Capital Medical University, Beijing, People's Republic of China
| | - Tin-Chiu Li
- Department of Hysteroscopic Centre, Fuxing Hospital, the Eighth Clinical Medical College, Capital Medical University, Beijing, People's Republic of China; Assisted Conception Unit, Department of Obstetrics and Gynaecology, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, People's Republic of China.
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25
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Li TC, Saravelos S, Kong WS. Three-dimensional versus two-dimensional ultrasound-guided embryo transfer: a randomised control study (abridged secondary publication). Hong Kong Med J 2020; 26 Suppl 6:26-29. [PMID: 33229600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023] Open
Affiliation(s)
- T C Li
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong
| | - S Saravelos
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong
| | - W S Kong
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong
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26
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Wiweko B, Ho TM, Li R, Li TC, Tzeng CR, Kovacs G, Tanaka A, Lee JR, Pai H, Khan HL. SARS-CoV-2 and Assisted Reproductive Technology Practice: An Asia Pacific Initiative on Reproduction (ASPIRE) Position Paper. FandR 2020. [DOI: 10.1142/s2661318220500188] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Background: Asia Pacific Initiative on Reproduction (ASPIRE) aims to improve knowledge and awareness of Assisted Reproductive Technology (ART) and infertility-related services, with the aim of improving the quality of patient care. Methods: A survey was developed and responded by a group of 10 ASPIRE board members to gather in-depth information about current practices, recommendations, and perceptions about SARS-CoV-2 and ART. The collected data were summarized and individual responses pooled among questions requiring voting. The overall rates were computed by response category. The group discussed the summary evidence, until a consensus was reached concerning a series of recommendation on how to make decisions concerning ART service provision during the current (and any future) pandemic. A two-tier recommendation was developed based on agreement rate and implementation priority. Tier 1 comprises recommendations in which the rate of “absolutely agree” responses were [Formula: see text]60%, whereas tier 2 refers to recommendations in which the rate of “absolutely agree” plus “agree” was >60%, but the rate of “absolutely agree” was [Formula: see text]50%. Results: The survey was responded by all participants between July 24 and July 30, 2020. Nine tier 1 and five tier 2 recommendations are provided concerning prevention, testing, personal protective equipment, informed consent, and quality management. The former indicates the situations in which most individuals should receive the intervention/procedure, whereas the latter relates to those that may be suitable for individual clinics and patients. Conclusions: This document provides the ASPIRE viewpoint on better managing infertile patients seeking ART during the COVID-19 pandemic. This expert opinion guide aims to help both competent authorities and healthcare providers to deliver quality and safe ART.
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Affiliation(s)
- Budi Wiweko
- Department Obstetric Gynecology Faculty of Medicine Universitas Indonesia — Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Tuong M. Ho
- IVFMD, My Duc Hospital, Ho Chi Minh City, Vietnam
| | - Rong Li
- Department of OB & GYN, Reproductive Medical Center, Peking University Third Hospital, Beijing, China
| | - Tin-Chiu Li
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong
| | | | | | | | - Jung Ryeol Lee
- Department Obstetric Gynecology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Korea
| | - Hrishikesh Pai
- Medical Director, Lilavati Hospital IVF and Bloom IVF Group India
| | - Haroon Latif Khan
- Lahore Institute of Fertility and Endocrinology, Hameed Latif Hospital, Lahore, Pakistan
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27
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Zhao Y, Chen X, Zhang T, Chan LKY, Liu Y, Chung JPW, Kwong J, Li TC. The use of multiplex staining to measure the density and clustering of four endometrial immune cells around the implantation period in women with recurrent miscarriage: comparison with fertile controls. J Mol Histol 2020; 51:593-603. [PMID: 32857228 DOI: 10.1007/s10735-020-09908-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 08/20/2020] [Indexed: 11/24/2022]
Abstract
Serval studies showed an increased uterine natural killer cell density in women with recurrent miscarriage. However, no study has previously investigated the density and clustering of major immune cells simultaneously in precisely timed endometrial specimen section of this group of women. This study aimed to investigate the profile of endometrial immune cells populations and clustering level simultaneously in women with recurrent miscarriage and compare the results to fertile controls. A total of 30 women with unexplained recurrent miscarriage and 30 fertile controls were included in this study. Endometrial biopsy was performed precisely 7 days after LH surge. The cells density was expressed as percentage of positive immune cell/total stromal cells and the clustering of different endometrial cells was measured by R language toolbox 'spatstat'. Multiplex immunohistochemical method was employed to stain a panel of human endometrium samples simultaneously with antibodies against CD3 for T cells, CD20 for B cells, CD68 for macrophages and CD56 for uterine natural killer cells. The median CD3+, CD68+ and CD56+ cell density in the miscarriage group were significantly higher than those of the fertile controls. In addition, the clustering between CD56+ uterine natural killer cells and CD68+ macrophages in the miscarriage group was significantly increased compared with fertile controls. In conclusion, the significant change in numbers of three out of four endometrial immune cell density and a significant increase in clustering between CD68+ and CD56+ cells suggest that several immune cells and their interactions may be important in the function of the endometrium; abnormal interactions may predispose to recurrent miscarriage.
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Affiliation(s)
- Yiwei Zhao
- Department of Obstetrics and Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Xiaoyan Chen
- Department of Obstetrics and Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong.,Department of Obstetrics and Gynaecology, Shenzhen Baoan Women's and Children's Hospital, Shenzhen University, Shenzhen, China
| | - Tao Zhang
- Department of Obstetrics and Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Loucia K Y Chan
- Department of Obstetrics and Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Yingyu Liu
- Department of Obstetrics and Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Jacqueline Pui-Wah Chung
- Department of Obstetrics and Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Joseph Kwong
- Department of Obstetrics and Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong.
| | - Tin-Chiu Li
- Department of Obstetrics and Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong.
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28
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Huang X, Li TC, Xia E. Hysteroscopic adhesiolysis using the “ploughing technique”. Ann Transl Med 2020; 8:811. [PMID: 32793656 PMCID: PMC7396240 DOI: 10.21037/atm.2020.03.226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Xiaowu Huang
- Hysteroscopy Center, Fuxing Hospital, Capital Medical University, Beijing, China
| | - Tin-Chiu Li
- Hysteroscopy Center, Fuxing Hospital, Capital Medical University, Beijing, China
- Assisted Conception Unit, Department of Obstetrics & Gynaecology, Chinese University of Hong Kong, Hong Kong, China
| | - Enlan Xia
- Hysteroscopy Center, Fuxing Hospital, Capital Medical University, Beijing, China
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29
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Saravelos SH, Balfoussia DT, Kong GWS, Chung JPW, Mak JSM, Chung CHS, Cheung LP, Li TC. Embryo migration following ART documented by 2D/3D ultrasound. Facts Views Vis Obgyn 2020; 12:143-148. [PMID: 32832929 PMCID: PMC7431202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Embryos have traditionally been thought to implant at the exact site they are transferred during assisted reproductive technology (ART). The introduction of 2D/3D ultrasound has allowed for mapping of the transfer site using air bubbles as a surrogate marker of embryo location. This study's aim was to compare the location of embryo transfer (ET) on ultrasound to that of embryo implantation. We present four cases of ectopic pregnancy at four sites: tubal, cervical, interstitial and ovarian. We compare the site of implantation on 2D/3D ultrasound at six weeks of pregnancy to that of transfer as assessed on 2D/3D ultrasound. In all four cases, the embryo flash was visualised in the centre of the uterine cavity on ultrasound at ET. At six weeks of pregnancy, the uterine cavity was empty and an ectopic pregnancy was identified. The tubal and ovarian ectopics were managed surgically whilst the cervical and interstitial pregnancies were treated with systemic methotrexate. These cases demonstrate embryo implantation distal to the ultrasound-confirmed site of transfer. These cases provide visually compelling evidence of embryo migration following ET and lend support to the theory that ectopic pregnancy may occur as a result of embryo migration, rather than poor ET technique.
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Affiliation(s)
- SH Saravelos
- Assisted Reproductive Technology Unit, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong;,Wolfson Fertility Centre, Hammersmith Hospital, Imperial College Healthcare NHS Trust, W12 0HS, London, UK
| | - DT Balfoussia
- Wolfson Fertility Centre, Hammersmith Hospital, Imperial College Healthcare NHS Trust, W12 0HS, London, UK;,Department of Obstetrics and Gynaecology, Hillingdon Hospital, UB8 3NN, London, UK
| | - GWS Kong
- Assisted Reproductive Technology Unit, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - JPW Chung
- Assisted Reproductive Technology Unit, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - JSM Mak
- Assisted Reproductive Technology Unit, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - CHS Chung
- Assisted Reproductive Technology Unit, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - LP Cheung
- Assisted Reproductive Technology Unit, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - TC Li
- Assisted Reproductive Technology Unit, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
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Yang X, Liu Y, Li TC, Xia E, Xiao Y, Zhou F, Song D, Zhou Q. Durations of intrauterine balloon therapy and adhesion reformation after hysteroscopic adhesiolysis: a randomized controlled trial. Reprod Biomed Online 2020; 40:539-546. [DOI: 10.1016/j.rbmo.2019.11.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 11/13/2019] [Accepted: 11/30/2019] [Indexed: 01/05/2023]
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Xia E, Huang X, Li TC. Pregnancy outcome after intrauterine adhesiolysis. Ann Transl Med 2020; 8:154. [PMID: 32309303 PMCID: PMC7154401 DOI: 10.21037/atm.2020.01.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Enlan Xia
- Hysteroscopy Center, Fuxing Hospital, Capital Medical University, Beijing 100038, China
| | - Xiaowu Huang
- Hysteroscopy Center, Fuxing Hospital, Capital Medical University, Beijing 100038, China
| | - Tin-Chiu Li
- Hysteroscopy Center, Fuxing Hospital, Capital Medical University, Beijing 100038, China
- Assisted Conception Unit, Department of Obstetrics & Gynaecology, Chinese University of Hong Kong, Hong Kong, China
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Mak JSM, Lao TT, Leung MBW, Chung CHS, Chung JPW, Cheung LP, Li TC. Ovarian HBV replication following ovulation induction in female hepatitis B carriers undergoing IVF treatment: A prospective observational study. J Viral Hepat 2020; 27:110-117. [PMID: 31519044 DOI: 10.1111/jvh.13210] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 08/14/2019] [Accepted: 08/15/2019] [Indexed: 01/15/2023]
Abstract
Hepatitis B virus (HBV) can be found in ovarian tissues. This study compared HBV DNA levels in follicular fluid collected during oocyte retrieval with paired serum samples in HBV carriers after ovarian stimulation during IVF treatment for infertility. Sixty-four HBV carrier women referred to the Assisted Reproductive Units of two Hong Kong hospitals were recruited. At oocyte retrieval, the follicular fluid aspirated from the first follicle was collected for study. In 22 women, the first follicular fluid sample from both ovaries was similarly collected and studied. These women were also tested for liver function test and HBeAg. In 28 (43.8%) women, HBV DNA was detected in follicular fluid and the level correlated with serum levels (Spearman's correlation P < .001). There was concordant detection of HBV DNA in both ovaries, and the levels were significantly correlated (Spearman's correlation P = .029). In 40% of women with FF HBV DNA, the follicular fluid:serum ratio was >1.0, suggesting stimulation of HBV replication. These women also had significantly different liver function test results. Increased HBV replication exists in 40% of women with HBV DNA detected in follicular undergoing ovarian stimulation during IVF treatment.
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Affiliation(s)
- Jennifer Sze Man Mak
- Assisted Reproduction Technology Unit, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Terence T Lao
- Assisted Reproduction Technology Unit, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Maran Bo Wah Leung
- Assisted Reproduction Technology Unit, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Cathy Hoi Sze Chung
- Assisted Reproduction Technology Unit, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Jacqueline Pui Wah Chung
- Assisted Reproduction Technology Unit, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Lai Ping Cheung
- Assisted Reproduction Technology Unit, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Tin-Chiu Li
- Assisted Reproduction Technology Unit, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
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Akhtar MA, Saravelos SH, Li TC, Jayaprakasan K. Reproductive Implications and Management of Congenital Uterine Anomalies: Scientific Impact Paper No. 62 November 2019. BJOG 2019; 127:e1-e13. [PMID: 31749334 DOI: 10.1111/1471-0528.15968] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Congenital uterine anomalies (CUAs) are malformations of the womb that develop during fetal life. When a baby girl is in her mother's womb, her womb develops as two separate halves from two tubular structures called 'müllerian ducts', which fuse together before she is born. Abnormalities that occur during the baby's development can be variable from complete absence of a womb through to more subtle anomalies, which are classified into specific categories. While conventional ultrasound is good in screening for CUAs, 3D ultrasound is used to confirm a diagnosis. If a complex womb abnormality is suspected, MRI scanning may also be used, with a combination of laparoscopy in which a camera is inserted into the cavity of the abdomen, and hysteroscopy, when the camera is placed in the womb cavity. As there can be a link between CUAs and abnormalities of the kidney and bladder, scans of these organs are also usually requested. Although CUAs are present at birth, adult women typically do not have any symptoms, although some may experience painful periods. Most cases of CUA do not cause a woman to have difficulty in becoming pregnant and the outcome of pregnancy is good. However, these womb anomalies are often discovered during investigations for infertility or miscarriage. Moreover, depending upon the type and severity of CUA, there may be increased risk of first and second trimester miscarriages, preterm birth, poor growth of the baby in the mother's womb (fetal growth restriction), pre-eclampsia and difficult positioning of the baby for birth (fetal malpresentation). Surgical treatment is only recommended to a woman who has had recurrent miscarriages and has a septate uterus, i.e., the womb cavity is divided by a partition. In this case, surgery may improve her chances for a successful pregnancy, although the risks of surgery, especially scarring of the womb should be considered. However, further evidence from randomised controlled trials are required to provide conclusive evidence-based recommendations for surgical treatment for septate uterus. Surgical treatment for other types of CUAs is not usually recommended as the risks outweigh potential benefits, and evidence for any benefits is lacking. Women with CUAs may be at an increased risk of preterm birth even after surgical treatment for a septate uterus. These women, if suspected to be at an increased risk of preterm birth based on the severity of CUA, should be followed up using an appropriate protocol for preterm birth as outlined in UK Preterm Birth Clinical Network Guidance.1 >.
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Yu H, Li B, Li T, Zhang S, Lin X. Combination of noninvasive methods in diagnosis of infertile women with minimal or mild endometriosis, a retrospective study in China. Medicine (Baltimore) 2019; 98:e16695. [PMID: 31374059 PMCID: PMC6709301 DOI: 10.1097/md.0000000000016695] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 06/11/2019] [Accepted: 07/10/2019] [Indexed: 11/29/2022] Open
Abstract
This study means to investigate a combination of noninvasive methods in diagnosis of minimal or mild endometriosis expecting to narrow down the range of laparoscopic exploration for female infertility.It is a retrospective case control study of totally 447 patients suspected unexplained infertility before surgery were eligible from May 2012 to February 2017. Of these, 299 patients were laparoscopy-proved minimal or mild endometriosis group, the remaining 148 patients served as control group (normal pelvis). Preoperative age, duration of infertility, type of infertility, body mass index, baseline follicle-stimulating hormone, anti-Müllerian hormone, serum CA125, clinical symptoms, findings on vagino-recto-abdominal examinations and pregnancy prognosis had been recorded. Every variable and their combinations were evaluated.Any single factor had limited diagnostic value. The cut-off value for CA125 was 19.25 IU/L. Parallel testing had a higher sensitivity at 81.3%. Serial tests of vagino-recto-abdominal examination combined with dysmenorrhea or positive CA125 got reasonable sensitivity (51.4% and 49%), remarkable high specificities (95.7% and100%) and Positive Predictive Value (96.4% and 100%). Multivariate logistic regression identified the following factors in decreasing order of importance: (1) vagino-recto-abdominal examinations, (2) CA125, (3) dysmenorrhea, their ORs being 16.148, 3.796, and 2.809, respectively. The spontaneous pregnancy rate (50.8%) in minimal or mild endometriosis was higher than control (35.6%, P = .043).A combination of noninvasive diagnostic methods had certain preoperative diagnostic value of minimal or mild endometriosis, which might benefit some patients from avoiding laparoscopic surgery.
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Affiliation(s)
- Huaying Yu
- Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University
| | - Baijia Li
- Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University
| | - TinChiu Li
- Department of Obstetrics & Gynecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Honk Kong
| | - Songying Zhang
- Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University
- Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, No. 3 Qingchun East Road, Jianggan District, Hangzhou 310016, China
| | - Xiaona Lin
- Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University
- Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, No. 3 Qingchun East Road, Jianggan District, Hangzhou 310016, China
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Shi X, Saravelos SH, Zhou Q, Huang X, Xia E, Li TC. Prevention of postoperative adhesion reformation by intermittent intrauterine balloon therapy: a randomised controlled trial. BJOG 2019; 126:1259-1266. [PMID: 31207009 DOI: 10.1111/1471-0528.15843] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2019] [Indexed: 01/04/2023]
Affiliation(s)
- X Shi
- Department of Hysteroscopic Centre Fuxing Hospital the Eighth Clinical Medical College Capital Medical University Beijing China
| | - SH Saravelos
- IVF Unit Hammersmith Hospital Imperial College London UK
- Assisted Conception Unit Department of Obstetrics and Gynaecology Prince of Wales Hospital Chinese University of Hong Kong Hong Kong China
| | - Q Zhou
- Department of Hysteroscopic Centre Fuxing Hospital the Eighth Clinical Medical College Capital Medical University Beijing China
| | - X Huang
- Department of Hysteroscopic Centre Fuxing Hospital the Eighth Clinical Medical College Capital Medical University Beijing China
| | - E Xia
- Department of Hysteroscopic Centre Fuxing Hospital the Eighth Clinical Medical College Capital Medical University Beijing China
| | - TC Li
- Department of Hysteroscopic Centre Fuxing Hospital the Eighth Clinical Medical College Capital Medical University Beijing China
- Assisted Conception Unit Department of Obstetrics and Gynaecology Prince of Wales Hospital Chinese University of Hong Kong Hong Kong China
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Huang X, Saravelos SH, Li TC, Huang R, Xu R, Zhou Q, Ma N, Xia E. Cervical cerclage in twin pregnancy. Best Pract Res Clin Obstet Gynaecol 2019; 59:89-97. [PMID: 31331744 DOI: 10.1016/j.bpobgyn.2019.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 06/10/2019] [Accepted: 06/11/2019] [Indexed: 10/26/2022]
Abstract
Cervical cerclage in women with twin pregnancy is not routinely indicated but appears to be beneficial in subjects with a history of preterm birth or very short cervix or dilated cervix. There is a paucity of literature data regarding transabdominal or laparoscopic cervical cerclage (LCC) in twin pregnancy. It is uncertain whether LCC is more effective than transvaginal cerclage. Our own experience of 24 cases of LCC in twin pregnancy showed encouraging results. Further, well-planned studies are required to answer whether, when, and how cervical cerclage should be performed in women with twin pregnancy.
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Affiliation(s)
- Xiaowu Huang
- Hysteroscopic Center, Fuxing Hospital, The Eighth Clinical Medical College, Capital Medical University, Beijing, China
| | - S H Saravelos
- IVF Unit, Hammersmith Hospital, Imperial College, London, UK
| | - Tin-Chiu Li
- Assisted Reproductive Technology Unite, Prince of Wales Hospital, The Chinese University of HongKong, HongKong
| | - Rui Huang
- Hysteroscopic Center, Fuxing Hospital, The Eighth Clinical Medical College, Capital Medical University, Beijing, China
| | - Ruonan Xu
- Hysteroscopic Center, Fuxing Hospital, The Eighth Clinical Medical College, Capital Medical University, Beijing, China
| | - Qiaoyun Zhou
- Hysteroscopic Center, Fuxing Hospital, The Eighth Clinical Medical College, Capital Medical University, Beijing, China
| | - Ning Ma
- Hysteroscopic Center, Fuxing Hospital, The Eighth Clinical Medical College, Capital Medical University, Beijing, China
| | - Enlan Xia
- Hysteroscopic Center, Fuxing Hospital, The Eighth Clinical Medical College, Capital Medical University, Beijing, China.
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Mak JSM, Leung MBW, Chung CHS, Chung JPW, Cheung LP, Lao TT, Li TC. Presence of Hepatitis B virus DNA in follicular fluid in female Hepatitis B carriers and outcome of IVF/ICSI treatment: A prospective observational study. Eur J Obstet Gynecol Reprod Biol 2019; 239:11-15. [PMID: 31158788 DOI: 10.1016/j.ejogrb.2019.05.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 05/20/2019] [Accepted: 05/23/2019] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To determine the relationship between the presence of detectable HBV DNA in the follicular fluid in HBV carriers with IVF/ICSI treatment outcome. STUDY DESIGN A prospective observational study conducted in the Assisted Reproductive Unit, a tertiary referral centre affiliated with the Department of Obstetrics and Gynecology, The Chinese University of Hong Kong; and the Union Reproductive Medicine Centre at Union Hospital, Hong Kong. The primary outcome measure was pregnancy rate. Secondary outcome measures were the prevalence of detectable HBV DNA in the follicular fluid, implantation rate, clinical pregnancy rate, ongoing pregnancy rate and live birth rate. RESULTS HBV DNA was detected in the follicular fluid of 28 (43.8%) of the 64 women, and the mean level in this group in log10 copies/mL (±SD) was 4.36 ± 1.85. Women with detectable follicular fluid HBV DNA were younger, lighter, had longer duration of infertility, higher incidence of detectable serum HBV DNA (OR 4.592, 95% C I 2.333-9.038), and significantly wider range in the number of total fertilized, viable embryos, and blastocyst rate, but no difference in cycle characteristics, stimulation and pregnancy outcomes, although the almost doubled ongoing pregnancy/live birth rate per cycle initiated (60.7% versus 38.9%) failed to reach statistical significance due to the small numbers. CONCLUSION Our results suggested HBV infection did not appear to be detrimental to the outcome of IVF/ICSI treatment.
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Affiliation(s)
- Jennifer S M Mak
- Assisted Reproduction Technology unit, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, People's Republic of China.
| | - Maran B W Leung
- Assisted Reproduction Technology unit, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Cathy H S Chung
- Assisted Reproduction Technology unit, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Jacqueline P W Chung
- Assisted Reproduction Technology unit, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - L P Cheung
- Assisted Reproduction Technology unit, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Terence T Lao
- Assisted Reproduction Technology unit, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - T C Li
- Assisted Reproduction Technology unit, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
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Chung JPW, Law TSM, Chung CHS, Mak JSM, Sahota DS, Li TC. Impact of haemostatic sealant versus electrocoagulation on ovarian reserve after laparoscopic ovarian cystectomy of ovarian endometriomas: a randomised controlled trial. BJOG 2019; 126:1267-1275. [DOI: 10.1111/1471-0528.15807] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2019] [Indexed: 12/23/2022]
Affiliation(s)
- JPW Chung
- Department of Obstetrics and Gynaecology Prince of Wales Hospital The Chinese University of Hong Kong Shatin Hong Kong, SAR
| | - TSM Law
- Department of Obstetrics and Gynaecology Prince of Wales Hospital The Chinese University of Hong Kong Shatin Hong Kong, SAR
| | - CHS Chung
- Department of Obstetrics and Gynaecology Prince of Wales Hospital The Chinese University of Hong Kong Shatin Hong Kong, SAR
| | - JSM Mak
- Department of Obstetrics and Gynaecology Prince of Wales Hospital The Chinese University of Hong Kong Shatin Hong Kong, SAR
| | - DS Sahota
- Department of Obstetrics and Gynaecology Prince of Wales Hospital The Chinese University of Hong Kong Shatin Hong Kong, SAR
| | - TC Li
- Department of Obstetrics and Gynaecology Prince of Wales Hospital The Chinese University of Hong Kong Shatin Hong Kong, SAR
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Zhu W, Yeung Q, Chan D, Chi L, Huang J, Wang Q, Chung J, Li TC. Maternal β-HCG concentrations in early IVF pregnancy: association with the embryo development stage of blastocysts. Reprod Biomed Online 2019; 38:683-690. [DOI: 10.1016/j.rbmo.2018.11.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 11/13/2018] [Accepted: 11/19/2018] [Indexed: 11/29/2022]
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40
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Song D, Li TC, Zhang Y, Feng X, Xia E, Huang X, Xiao Y. Correlation between hysteroscopy findings and chronic endometritis. Fertil Steril 2019; 111:772-779. [DOI: 10.1016/j.fertnstert.2018.12.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 12/10/2018] [Accepted: 12/10/2018] [Indexed: 10/27/2022]
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Abstract
Embryo transfer is the final and rate-limiting step of the assisted reproductive technique. Few advances have occurred in the last few decades with regard to this procedure. Studies conducted thus far have focused on factors and interventions taking place before, during and after this procedure. These factors are highly varied and range from methods to improve the psychological state of the patients to methods aimed at reducing uterine contractility and methods aimed at optimising the precise transfer of the embryo. The key question is which factors and interventions have thus far been proven to increase pregnancy rates and live birth rates. This paper aims to review the evidence relating to embryo transfer techniques in a systematic manner with a view to provide practical recommendations to practitioners involved in the procedure.
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Affiliation(s)
| | - Tin-Chiu Li
- Assisted Reproductive Technology Unit, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
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Jin XY, Zhao LJ, Luo DH, Liu L, Dai YD, Hu XX, Wang YY, Lin X, Hong F, Li TC, Zhang SY. Pinopode score around the time of implantation is predictive of successful implantation following frozen embryo transfer in hormone replacement cycles. Hum Reprod 2018; 32:2394-2403. [PMID: 29040606 DOI: 10.1093/humrep/dex312] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Accepted: 09/27/2017] [Indexed: 01/05/2023] Open
Abstract
STUDY QUESTION Is pinopode measurement of any prognostic value? SUMMARY ANSWER Pinopode expression was significantly associated with the occurrence of pregnancy after frozen embryo transfer. WHAT IS KNOWN ALREADY Pinopodes are expressed in the endometrium during the implantation period. Pinopode measurement has been proposed as a marker of endometrial receptivity. STUDY DESIGN, SIZE, DURATION A prospective cohort study was conducted at the Center of Reproductive Medicine, Sir Run Run Shaw Hospital, between 2014 and 2016, recruiting 172 women with infertility and undergoing frozen embryo transfer following IVF treatment. Among 172 participants, 46 women took part in the first study to quantify the daily changing pattern of pinopodes 3-7 days after the initiation of progesterone therapy in the hormone replacement cycles and the remaining 126 women with infertility participated in a study to examine the relationship between pinopode count and pregnancy outcome following frozen embryo transfer in hormone replacement cycles. PARTICIPANTS/MATERIALS, SETTING, METHODS The mean age of participants was 29 years old. All participants received an artificial hormone replacement protocol capable of supporting successful implantation. Endometrial biopsies from 46 women were obtained 3, 4, 5, 6 and 7 days after the initiation of progesterone therapy (P + 3, n = 6; P + 4, n = 6; P + 5, n = 11; P + 6, n = 13; P + 7, n = 10, respectively). Another 126 endometrial biopsies were obtained precisely 6 days after the initiation of progesterone. Scanning electron microscopy was used to capture the pinopode images, followed by use of the image J program to quantify the count and subtype of the pinopodes. MAIN RESULTS AND THE ROLE OF CHANCE We found that at least 60 microscopic fields were necessary to achieve a reproducible result. An intra-observer variability study showed good agreement between two measurements regarding the developing pinopode (DP) subtype (r = 0.95) and the fully developed pinopode (FDP) subtype (r = 0.86) but not for the regressing (RP) pinopode subtype (r = 0.39). The proportion of DP/total pinopodes (TP) declined rapidly form day P + 4 to a minimum on day P + 6. The percentage of FDP/TP increased rapidly from day P + 4 to reach a peak on day P + 6. On the other hand, the percentage of RP/TP reached a peak on day P + 7. Participants who conceived had a significantly (P = 0.011) higher percentage of FDP/TP on day P + 6 and significantly (P = 0.005) lower percentage of DP/TP on the same day compared with participants who did not become pregnant. Using a scoring system incorporating the percentages of DP and FDP, it was found that the pregnancy rate and the embryo implantation rate of women with a high pinopode score (82.3%; 63.0%) was significantly (P = 0.001; P = 0.046) higher than that of women with a low pinopode score (53.3%; 46.7%), respectively. There remains a possibility that the observations could have arisen due to chance. LIMITATIONS, REASONS FOR CAUTION This study examined pinopode count and subtype in the HRT cycles, and it is uncertain whether the same observations apply to in natural cycles. WIDER IMPLICATIONS OF THE FNDINGS Pinopodes have been questioned as a potential marker of endometrial receptivity for many years. Our results suggested that pinopode measurement may be of value in predicting pregnancy. STUDY FUNDING/COMPETING INTEREST(S) The study was supported by the grants from the general project of medicine and health in Zhejiang Province of China (2015KYA142; 2018KY106), the Key Research and Development Program of Zhejiang Province (2017C03022) and the National Natural Science Foundation of China (81701514).The funders had no role in the study design, data collection and analysis, decision to publish or preparation of the manuscript. We have no competing interests to declare. TRIAL REGISTRATION NUMBER ISRCTN26300668.
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Affiliation(s)
- X Y Jin
- Department of Obstetrics and Gynecology, Assisted Reproduction Unit, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, 3# Qingchun East Road, Hangzhou 310016, PR China
| | - L J Zhao
- Department of Obstetrics and Gynecology, Assisted Reproduction Unit, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, 3# Qingchun East Road, Hangzhou 310016, PR China
| | - D H Luo
- Department of Obstetrics and Gynecology, Assisted Reproduction Unit, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, 3# Qingchun East Road, Hangzhou 310016, PR China
| | - L Liu
- Department of Obstetrics and Gynecology, Assisted Reproduction Unit, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, 3# Qingchun East Road, Hangzhou 310016, PR China
| | - Y D Dai
- Department of Obstetrics and Gynecology, Assisted Reproduction Unit, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, 3# Qingchun East Road, Hangzhou 310016, PR China
| | - X X Hu
- Department of Obstetrics and Gynecology, Assisted Reproduction Unit, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, 3# Qingchun East Road, Hangzhou 310016, PR China
| | - Y Y Wang
- Department of Obstetrics and Gynecology, Assisted Reproduction Unit, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, 3# Qingchun East Road, Hangzhou 310016, PR China
| | - X Lin
- Department of Obstetrics and Gynecology, Assisted Reproduction Unit, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, 3# Qingchun East Road, Hangzhou 310016, PR China
| | - F Hong
- Department of Obstetrics and Gynecology, Assisted Reproduction Unit, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, 3# Qingchun East Road, Hangzhou 310016, PR China
| | - T C Li
- Department of Obstetrics & Gynecology, Chinese University of Hong Kong, Shatin, Hong Kong, PR China
| | - S Y Zhang
- Department of Obstetrics and Gynecology, Assisted Reproduction Unit, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, 3# Qingchun East Road, Hangzhou 310016, PR China
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Cheung CWC, Saravelos SH, Chan TYA, Sahota DS, Wang CC, Chung PW, Li TC. A prospective observational study on the stress levels at the time of embryo transfer and pregnancy testing following in vitro fertilisation treatment: a comparison between women with different treatment outcomes. BJOG 2018; 126:271-279. [DOI: 10.1111/1471-0528.15434] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2018] [Indexed: 11/28/2022]
Affiliation(s)
- CWC Cheung
- Assisted Reproductive Technology Unit Department of Obstetrics and Gynaecology Faculty of Medicine The Chinese University of Hong Kong Hong Kong China
| | - SH Saravelos
- Assisted Reproductive Technology Unit Department of Obstetrics and Gynaecology Faculty of Medicine The Chinese University of Hong Kong Hong Kong China
| | - TYA Chan
- Department of Psychology The Chinese University of Hong Kong Hong Kong China
| | - DS Sahota
- Assisted Reproductive Technology Unit Department of Obstetrics and Gynaecology Faculty of Medicine The Chinese University of Hong Kong Hong Kong China
| | - CC Wang
- Assisted Reproductive Technology Unit Department of Obstetrics and Gynaecology Faculty of Medicine The Chinese University of Hong Kong Hong Kong China
| | - PW Chung
- Assisted Reproductive Technology Unit Department of Obstetrics and Gynaecology Faculty of Medicine The Chinese University of Hong Kong Hong Kong China
| | - TC Li
- Assisted Reproductive Technology Unit Department of Obstetrics and Gynaecology Faculty of Medicine The Chinese University of Hong Kong Hong Kong China
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Liu J, Li TC, Wang J, Wang W, Hou Z, Liu J. The impact of ovarian stimulation on the outcome of intrauterine insemination treatment: an analysis of 8893 cycles. BJOG 2018; 123 Suppl 3:70-5. [PMID: 27627603 DOI: 10.1111/1471-0528.14020] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the impact of ovarian stimulation on the outcome of intrauterine insemination (IUI). DESIGN Retrospective analysis. SETTING A single university-based centre. POPULATION A total of 5109 couples with 8893 cycles. METHODS The outcome of IUI with different protocols for ovarian stimulation was examined. MAIN OUTCOME MEASURES The live birth rate (LBR), twin pregnancy rate and ovarian hyperstimulation syndrome (OHSS). RESULTS In ovulatory women without ovarian stimulation, the LBR was 7.6%. Stimulation with clomifene citrate (CC), letrozole (LE), human menopausal gonadotrophin (HMG), CC or LE combined with HMG achieved LBRs of 6.1, 5, 7.9, 8 and 12.2%, respectively. LE combined with HMG achieved a significantly improved LBR compared with no stimulation. HMG stimulation was associated with a higher rate of twins (7.4%) than no stimulation (0%, P < 0.01). In ovulatory women, the LBR appeared lower in CC and LE compared with no stimulation (P > 0.05). In anovulatory women, ovarian stimulation with CC, LE, HMG, CC or LE combined with HMG achieved LBRs of 11.3, 5.1, 11.8, 12.6 and 13.6%, respectively. No significant difference was observed. There were no triplet pregnancies or OHSS in stimulated cycles. CONCLUSIONS In ovulatory women, ovarian stimulation with LE combined with HMG achieved a significantly improved live birth rate. HMG stimulation resulted in a high risk for twins. TWEETABLE ABSTRACT In ovulatory women, ovarian stimulation with letrozole and HMG resulted in a significantly improved LBR.
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Affiliation(s)
- Jinyong Liu
- The State Key Laboratory of Reproductive Medicine, Clinical Centre of Reproductive Medicine, First Affiliated Hospital of Nanjing Medical University, Hong Kong, China
| | - Tin-Chiu Li
- Department of Obstetrics and Gynaecology, Chinese University of Hong Kong, Hong Kong, China
| | - Jing Wang
- The State Key Laboratory of Reproductive Medicine, Clinical Centre of Reproductive Medicine, First Affiliated Hospital of Nanjing Medical University, Hong Kong, China
| | - Wei Wang
- The State Key Laboratory of Reproductive Medicine, Clinical Centre of Reproductive Medicine, First Affiliated Hospital of Nanjing Medical University, Hong Kong, China
| | - Zhen Hou
- The State Key Laboratory of Reproductive Medicine, Clinical Centre of Reproductive Medicine, First Affiliated Hospital of Nanjing Medical University, Hong Kong, China
| | - Jiayin Liu
- The State Key Laboratory of Reproductive Medicine, Clinical Centre of Reproductive Medicine, First Affiliated Hospital of Nanjing Medical University, Hong Kong, China.
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Cheung CWC, Yee AWW, Chan PS, Saravelos SH, Chung JPW, Cheung LP, Kong GWS, Li TC. The impact of music therapy on pain and stress reduction during oocyte retrieval – a randomized controlled trial. Reprod Biomed Online 2018; 37:145-152. [DOI: 10.1016/j.rbmo.2018.04.049] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Revised: 04/18/2018] [Accepted: 04/18/2018] [Indexed: 01/18/2023]
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Affiliation(s)
- Xiao Shi
- Department of Obstetrics and Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Carol Pui Shan Chan
- Department of Obstetrics and Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Tarah Waters
- Department of Obstetrics and Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Ling Chi
- Department of Obstetrics and Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - David Yiu Leung Chan
- Department of Obstetrics and Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Tin-Chiu Li
- Department of Obstetrics and Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, SAR, China
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Liu YH, Hesse M, Li TC, Kuznetsova M, Le A. Orientation and Stability of Asymmetric Magnetic Reconnection X Line. J Geophys Res Space Phys 2018; 123:4908-4920. [PMID: 30364510 PMCID: PMC6196328 DOI: 10.1029/2018ja025410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Accepted: 05/18/2018] [Indexed: 06/08/2023]
Abstract
The orientation and stability of the reconnection x line in asymmetric geometry is studied using three-dimensional (3-D) particle-in-cell simulations. We initiate reconnection at the center of a large simulation domain to minimize the boundary effect. The resulting x line has sufficient freedom to develop along an optimal orientation, and it remains laminar. Companion 2-D simulations indicate that this x line orientation maximizes the reconnection rate. The divergence of the nongyrotropic pressure tensor breaks the frozen-in condition, consistent with its 2-D counterpart. We then design 3-D simulations with one dimension being short to fix the x line orientation but long enough to allow the growth of the fastest growing oblique tearing modes. This numerical experiment suggests that reconnection tends to radiate secondary oblique tearing modes if it is externally (globally) forced to proceed along an orientation not favored by the local physics. The development of oblique structure easily leads to turbulence inside small periodic systems.
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Affiliation(s)
- Yi-Hsin Liu
- Department of Physics and Astronomy, Dartmouth College, Hanover, NH, USA
| | - M Hesse
- Department of Physics and Technology, University of Bergen, Bergen, Norway
- Southwest Research Institute, San Antonio, TX, USA
| | - T C Li
- Department of Physics and Astronomy, Dartmouth College, Hanover, NH, USA
| | - M Kuznetsova
- NASA-Goddard Space Flight Center, Greenbelt, MD, USA
| | - A Le
- Los Alamos National Laboratory, Los Alamos, NM, USA
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Gu HB, Zhao EM, Li TC, Shen H, Cong TC, Qin Y, Liu YH, Xiao SF. [The clinical assessment of regional resection in the benign tumor of parotid gland]. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2018; 32:669-672. [PMID: 29771083 DOI: 10.13201/j.issn.1001-1781.2018.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Indexed: 11/12/2022]
Abstract
Objective:To evaluate the clinical assessment of regional resection and superficial lobe total resection in the treatment of benign tumors of the parotid gland. Method:One hundred and nighty-five patients operated in the First Hospital of Peking University from January 1998 to March 2017 with benign tumor of the parotid gland were retrospectively analyzed. There were 189 patients with single side tumor and 6 patients with bilateral sides, 157 cases underwent regional resection and the other 44 cases underwent superficial lobe total resection. All the results and complications were recorded and analyzed between the two groups.Result:There were total 195 patients with 201 cases. All the complications were as follows, 4 cases with recurrence, 44 cases with temporal facial paralysis, 13 cases with permanent facial paralysis, 80 cases with earlobe numbness, 49 cases with facial numbness, 44 cases with skin retraction, 26 cases with operated region effusion, 2 cases with sialosyrinx, 55 cases with Frey syndrome. There were no significant differences between the two groups in the incidences of recurrence, temporal facial paralysis, permanent facial paralysis, earlobe numbness, facial numbness, skin retraction. The incidence of Frey syndrome in the superficial lobe total resection group was significantly higher than the regional resection group(45.5%, 22.3%,P<0.05). The incidence of operated region effusion or sialosyrinx in the regional resection group was significantly higher than the superficial lobe total resection group (16.6%, 4.5%,P<0.05),further analysis showed that the operation method and the location of the tumor were the independent risk factors. Conclusion:Regional resection in the parotid gland tumor was less invasive, the incidences in the most complications were in consistent with superficial lobe total resection, and it was helpful in preventing the occurrence of Frey syndrome. Although regional resection conserved more parotid gland tissue so that the more conserved gland function and it also did not increase the incidence of sialosyrinx, the operated region effusion was significantly increased. If the operated region effusion was not discovered and handled, there would be a risk of sialosyrinx.
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Affiliation(s)
- H B Gu
- Department of Otolaryngology Head and Neck Surgery,the First Hospital of Peking University,Beijing,100034,China
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Liu Y, Chen X, Huang J, Wang CC, Yu MY, Laird S, Li TC. Comparison of the prevalence of chronic endometritis as determined by means of different diagnostic methods in women with and without reproductive failure. Fertil Steril 2018; 109:832-839. [DOI: 10.1016/j.fertnstert.2018.01.022] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 01/17/2018] [Accepted: 01/18/2018] [Indexed: 11/24/2022]
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Liu L, Huang X, Xia E, Zhang X, Li TC, Liu Y. A cohort study comparing 4 mg and 10 mg daily doses of postoperative oestradiol therapy to prevent adhesion reformation after hysteroscopic adhesiolysis. HUM FERTIL 2018; 22:191-197. [PMID: 29504823 DOI: 10.1080/14647273.2018.1444798] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
This is a retrospective cohort study conducted in a national training centre for hysteroscopy between January 2012 and December 2014 to compare the clinical outcome of two doses of oestradiol valerate (4 mg and 10 mg daily) in the prevention of recurrence of adhesions after hysteroscopic adhesiolysis. A total of 176 women who suffered from Asherman syndrome with moderate to severe intrauterine adhesions were included: 91 subjects received a 10 mg daily dose of oestradiol and 85 subjects received a 4 mg daily dose of oestradiol in the postoperative period. Second look hysteroscopy was performed 4-6 weeks after the initial surgery. There was no difference in age and preoperative American Fertility Society (AFS) adhesion score between the two groups. The proportion of women in whom menstruation had returned to normal in the 10 mg group (49/91 = 53.8%) was significantly (p < 0.05) higher than that of subjects in the 4 mg group (35/85 = 41.2%). However, there was no difference in AFS scores at second look hysteroscopy between the two groups or in the conception rate and miscarriage rate between the two groups. The findings do not support the use of high-dose postoperative oestrogen therapy following hysteroscopic adhesiolysis.
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Affiliation(s)
- Linlin Liu
- a Hysteroscopic Centre, Fuxing Hospital, Capital Medical University , Beijing , China
| | - Xiaowu Huang
- a Hysteroscopic Centre, Fuxing Hospital, Capital Medical University , Beijing , China
| | - Enlan Xia
- a Hysteroscopic Centre, Fuxing Hospital, Capital Medical University , Beijing , China
| | - Xiaoyu Zhang
- a Hysteroscopic Centre, Fuxing Hospital, Capital Medical University , Beijing , China
| | - Tin-Chiu Li
- a Hysteroscopic Centre, Fuxing Hospital, Capital Medical University , Beijing , China.,b Department of Obstetrics and Gynecology, Prince of Wales Hospital, Chinese University of Hong Kong , Hong Kong , China
| | - Yuhuan Liu
- a Hysteroscopic Centre, Fuxing Hospital, Capital Medical University , Beijing , China
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