Human oocytes image classification method based on deep neural networks

BACKGROUND

The effectiveness of in vitro fertilization depends on the assessment and selection of oocytes and embryos with the highest developmental potential. One of the tasks in the ICSI (intracytoplasmic sperm injection) procedure is the classification of oocytes according to the stages of their meiotic maturity. Oocytes classification traditionally is done manually during their observation under the light microscope. The paper is part of the bigger task, the development of the system for optimal oocyte and embryos selection. In the hereby work, we present the method for the automatic classification of oocytes based on their images, that employs DNN algorithms.

RESULTS

For the purpose of oocyte class determination, two structures based on deep neural networks were applied. DeepLabV3Plus was responsible for the analysis of oocyte images in order to extract specific regions of oocyte images. Then extracted components were transferred to the network, inspired by the SqueezeNet architecture, for the purpose of oocyte type classification. The structure of this network was refined by a genetic algorithm in order to improve generalization abilities as well as reduce the network's FLOPs thus minimizing inference time. As a result, [Formula: see text] at the level of 0.964 was obtained at the level of the validation set and 0.957 at the level of the test set. Generated neural networks as well as code that allows running the processing pipe were made publicly available.

CONCLUSIONS

In this paper, the complete pipeline was proposed that is able to automatically classify human oocytes into three classes MI, MII, and PI based on the oocytes' microscopic image.

Semantic segmentation of human oocyte images using deep neural networks

BACKGROUND

Infertility is a significant problem of humanity. In vitro fertilisation is one of the most effective and frequently applied ART methods. The effectiveness IVF depends on the assessment and selection of gametes and embryo with the highest developmental potential. The subjective nature of morphological assessment of oocytes and embryos is still one of the main reasons for seeking effective and objective methods for assessing quality in automatic manner. The most promising methods to automatic classification of oocytes and embryos are based on image analysis aided by machine learning techniques. The special attention is paid on deep neural networks that can be used as classifiers solving the problem of automatic assessment of the oocytes/embryos.

METHODS

This paper deals with semantic segmentation of human oocyte images using deep neural networks in order to develop new version of the predefined neural networks. Deep semantic oocyte segmentation networks can be seen as medically oriented predefined networks understanding the content of the image. The research presented in the paper is focused on the performance comparison of different types of convolutional neural networks for semantic oocyte segmentation. In the case study, the merits and limitations of the selected deep neural networks are analysed.

RESULTS

71 deep neural models were analysed. The best score was obtained for one of the variants of DeepLab-v3-ResNet-18 model, when the training accuracy (Acc) reached about 85% for training patterns and 79% for validation ones. The weighted intersection over union (wIoU) and global accuracy (gAcc) for test patterns were calculated, as well. The obtained values of these quality measures were 0,897 and 0.93, respectively.

CONCLUSION

The obtained results prove that the proposed approach can be applied to create deep neural models for semantic oocyte segmentation with the high accuracy guaranteeing their usage as the predefined networks in other tasks.

Pro-inflammatory cytokines associated with clinical severity of dry eye disease of patients with depression

PURPOSE

The aim of this study was to assess the correlation of inflammatory cytokines levels in tears with severity of dry eye disease in a cohort of patients with depression.

MATERIAL AND METHODS

Tear fluid samples were collected from 32 patients with depression treated with antidepressants, and 34 healthy subjects. Cytokines were assessed by ELISA. All the subjects completed the Beck Depression Inventory and performed the ophthalmic examination, including dry eye tests.

RESULTS

The tear fluid levels of IL-6, IL-17 and TNF-α in depressive patients were higher than in controls. The clinical severity of dry eye disease correlated significantly with the IL-17 and TNF-α levels.

CONCLUSIONS

Our results suggest a crucial role of inflammatory cytokines, especially IL-17 and TNF-α, in the development of severe dry eye disease in patients with depression. Clarification of the role pro-inflammatory cytokines in the pathogenesis of ocular findings in depressive patients may be useful in establishing immunotherapeutic strategies for this disease.

[Influence of naloxone on uterine contractions in patients with primary dysmenorrhea]

Dysmenorrhea is a common condition among women in childbearing age. An increased uterine contractions, resulting among others from increased vasopressin and oxitocin secretion, is considered as a main cause of the primary dysmenorrhea. The endogenous opioids play the important role in the control of oxytocin and vasopressin release from the pituitary gland. Naloxone is a selective opioid receptor antagonis. So far, there is not much data on naloxone effect on uterine contractions. The aim of study was to determine the influence of naloxone on uterine contractions in patients with primary dysmenorrhea.

MATERIAL AND METHODS

There were 10 female patients with primary dysmenorrhea included into the study. The uterine contractions had been recorded for 30 minutes before and 2 hours after injection of naloxone at the first day of menstruation.

RESULTS

The intrauterine pressure recordings revealed a severe spontaneous uterine contractions, with high frequency and amplitude, at the time of dysmenorrhea. An intravenous administration of naloxone decreased uterine contractile activity and pain intensity.

CONCLUSIONS

Naloxone acting on central nervous system decreases the uterus contractions in the patients suffering from dysmenorrhea. Unexplained mechanisms and multiple factors involved in the pathogenesis of primary dysmenorrhea indicates a need for the further studies on this subject.

[Influence of functional status of ovaries on results of controlled ovarian hyperstimulation]

The controlled ovarian hyperstimulation is an integral part of infertility treatment. Its main objective is to obtain oocytes with a highest developmental potential. The stimulation protocols involving the gonadotropin-releasing hormone analogues and gonadotropins are considered as the most efficient. Despite many years of use, some aspects of controlled ovarian stimulation has not yet been clarified, especially the role of the functional status of ovaries before hormonal stimulation. The aim of study was to assess the influence of the functional status of ovaries on the results of the controlled ovarian hyperstimulation.

MATERIALS AND METHODS

The retrospective study included female patients suffering from infertility The patients were divided into two groups depending on ultrasonographic appearance of ovaries before controlled ovarian hyperstimulation. The patients with small antral follicles < 6 mm in diameter were selected into group I. The patients with five or more antral follicles > or = 8 mm in diameter in each ovary were included into group II. The patients from both groups underwent similar treatment process. The major area of interest was the number, type and quality of oocytes obtained from patients from both groups after ovarian puncture.

RESULTS

A retrospective study was conducted on 635 infertile patients (group I 382, group II 253). Altogether, 4055 oocytes were obtained in the group I and 2555 oocytes in the group II. The mean number of MII oocytes in group I was 9,2 and 8,7 in group II; p < 0.05. There were significantly more MI oocytes in group I than II. The mean numbers of immature oocytes were comparable between groups. The athretic and dysmorphic oocytes were more prevalent in group II.

CONCLUSIONS

The results of the present study indicates that the functional status of ovaries before controlled ovarian hyperstimulation plays pivotal role for the treatment outcome.

[Etiopathogenesis of dysmenorrhea]

Dysmenorrhea is a common and frequently disabling condition among women of childbearing age. Based on results of large epidemiological studies, it is estimated that over a half of the population of young women suffers from dysmenorrhea. In spite of such a high frequency of this condition, its literature. Pain and lower abdominal cramps are among the most common causes for gynecological referral. Dysmenorrhea is sometimes associated with nausea, vomiting, diarrhea, fatigue, fever, headache, back pain, and dizziness. The exact cause of the disorder is not completely understood. However, there are many known factors that play significant roles in the pathogenesis of dysmenorrhea. The most important are: excessive uterine contractility, disturbances in uterine blood supply, synthesis of prostaglandins and anatomical abnormalities of the female reproductive tract. Primary dysmenorrhea refers to painful menstrual bleedings in the absence of any detectable underlying pathology. Secondary dysmenorrhea represents the clinical situation where menstrual pain can be related to an underlying disease, disorder, or structural abnormality either within or outside the uterus. Unexplained mechanisms and multiple factors involved in the pathogenesis of primary dysmenorrhea indicate a vivid need for further studies on this subject.

[Dry eye disease in patients treated with antidepressants]

PURPOSE

Dry eye disease is defined as a multifactorial disease of tears and ocular surfaces that causes discomfort, visual disturbance, and tear film instability with potential damage to the ocular surface. This study aimed to determine dry eye findings in patients with depression.

MATERIAL AND METHODS

There were 40 patients with depression aged 18-65 years old. A comprehensive ophthalmic examination, including intraocular pressure and dry eye tests, was performed.

RESULTS

Among patients with depression 24 patients (70%) had dry eye syndrome. Compared with patients who did not have dry eye, the patients with dry eye were significantly older than the patients without dry eye (44 years old and 36 years old, respectively). Time in duration of depression in patients with depression and with dry eye lasted over 54 months and time of taking antidepressants was longer than 18 months and was significant, in comparing to the patients without dry eye (36 months and 10 months, respectively).

CONCLUSIONS

Dry eye is frequent disease in patients with depression, especially in older patients, who have longer duration of depression, and taking antidepressant medication for a longer period of time. Using of antidepressant may be cosidered as potential cause of dry eye syndrome.

[Influence of the anti-inflammatory, anti-bacterial and anti-oxidative treatment combined with the dietary supplementation on sperm parameters]

The severe oligospermia and lukocytospermia is diagnosed among 25-40% of the infertile patients despite the absence of any clinical manifestation of the inflammatory process. The white blood cells are the main source of the free oxidative radicals, which can injure the cell membranes and the sperm DNA integrity influencing the reproductive potential of the male gametes. The aim of study was to assess the influence of the anti-inflammatory anti-bacterial and anti-oxidative treatment combined with the dietary supplementation on sperm parameters in the patients with severe oligospermia and lukocytospermia.

MATERIALS AND METHODS

100 patients with a severe oligospermia and leukocytospermia were qualified into the study. The anti-inflammatory anti-bacterial and anti-oxidative treatment combined with dietary supplementation was applied for 90 days. The sperm analysis was performed before and after the treatment.

RESULTS

The mean volume of sperm samples and spermatozoa concentration were comparable before and after treatment. The leukocyte concentration was significantly lower after the therapy. There were significantly more spermatozoa in the fast and slow forward movement, less spermatozoa without movements and comparable concentration in spermatozoa in slow undirected movement after applied treatment.

CONCLUSIONS

The present study demonstrated that the anti-inflammatory, anti-bacterial and anti-oxidative treatment combined with dietary supplementation in the patients with severe oligospermia and lukocytospermia improves the sperm movement parameters and reduces the inflammatory response. Therefore, it might be beneficial to patient suffering from the infertility.

[Thrombosis in the course of ovarian hyperstimulation syndrome]

A 28-year-old woman sought medical advice in the gynecology department because of infertility. Based on the results of the infertility workup, it was decided to apply in vitro fertilization treatment in her case. On the 12th day after embryo transfer, the patient was admitted to hospital because of nausea, vomiting, abdominal distention, and difficulties in breathing. The diagnosis was early pregnancy and the ovarian hyperstimulation syndrome (OHSS). After conservative treatment, the OHSS symptoms disappeared, and she was discharged in a good condition. However, nine days later the patient was readmitted due to a dull pain in her left shoulder, radiating onto the neck and left arm. Ultrasound examination revealed a thrombotic clot at the junction of the left external jugular vein and subclavian vein. Treatment with low-molecular-weight heparin was initiated. After 21 days of medication, the patient's symptoms resolved and, further, her pregnancy continued without complications. Although thromboembolic events are not frequently encountered in the course of OHSS, prophylactic anticoagulant therapy should be considered in all such patients.

Influence of embryo transfer on embryo preimplantation development

OBJECTIVE

To investigate the impact of injection speeds of the transferred load on embryo development.

DESIGN

A laboratory model for in vitro simulation of ET was developed to investigate the impact of varying injection speeds of the transferred load on embryo development.

SETTING

Academic research institutes of reproduction biotechnology and private centers of reproductive medicine.

ANIMAL(S)

Mouse hybrid F(1) females (C57bl/10 J × CBA-H; N = 15) aged 2-3 months.

INTERVENTION(S)

In vitro exposure of mouse embryos with either the fast ET (ejection speed, >1 m/s) or slow ET (ejection speed, <0.1 m/s) and consecutive culture for 36 hours.

MAIN OUTCOME MEASURE(S)

Development rate, morphology and apoptotic index of embryos.

RESULT(S)

The development rate was the slowest in embryos exposed to the fast ET. Morphological changes in response to ET were observed only among embryos exposed to the fast ET. The mean apoptotic index was 17.6% in the group exposed to the fast ET, 5.6% in the group exposed to the slow ET, and 2.58% in the control group.

CONCLUSION(S)

A reduction of the ejection speed of the transferred load allows avoidance of a developmental delay and diminishes injury of the embryos. Therefore, it is reasonable to suggest transferring the embryos at the lowest possible ejection speed.

Pressure induced nucleus DNA fragmentation

PURPOSE

The present study was designed to investigate the impact of pressure on nuclear DNA integrity in viable cells of mouse blastocysts.

METHODS

The blastocysts of hybrid F1 females [(C57Bl/10 J × CBA-H);N = 15] aged 2-3 months were exposed into the pressure impulse lasting ~0.021 s and characterized by a positive pressure peak of ~76 mmHg. The nuclear DNA fragmentation index of mouse blastocysts was assessed by TUNEL assay within 60 s after exposure to pressure impulse.

RESULTS

The mean nuclear DNA fragmentation index was significantly higher in the experimental group (83%) than in the control group (19.7%); p < 0.001.

CONCLUSION(S)

A low magnitude pressure impulse can induce nuclear DNA fragmentation in mouse blastocysts. The compression and decompression forces appearing during pressure fluctuations are responsible for the observed DNA shearing.

Influence of embryo transfer on blastocyst viability

OBJECTIVE

To investigate the impact of injection speeds of the transferred load on embryo viability.

DESIGN

Laboratory model for in vitro simulation of embryo transfer (ET).

SETTING

Academic research institutes of reproduction biotechnology and private centers of reproductive medicine.

ANIMAL(S)

Mouse hybrid F1 females, C57bl/10J × CBA-H (N = 15), aged 2 to 3 months.

INTERVENTION(S)

In vitro exposure of mouse blastocysts to either fast ET with an ejection speed of the transferred load of >1 m/s or slow ET with an ejection speed of <0.1 m/s.

MAIN OUTCOME MEASURE(S)

Morphologic changes and apoptotic index of blastocysts.

RESULT(S)

Morphologic changes in response to ET were most prevalent in blastocysts exposed to fast ET. The mean apoptotic index was 52% in the group exposed to fast ET, 25% in the group exposed to slow ET, and 12.8% in control group.

CONCLUSION(S)

Fast ejection of the transferred load can trigger both morphologic changes and apoptosis in mouse blastocysts. A reduction of the ejection speed of the transferred load minimizes injury to the embryos. Therefore, embryos should be transferred at the lowest possible speed.

Macular pigmentary changes as a sequelae of retinal hemorrhages in premature infants with retinopathy of prematurity

PURPOSE

We assess the incidence of macular changes in ROP patients with retinal hemorrhages.

PATIENTS AND METHODS

The premature group consisted of 360 children born 32 weeks gestation and/or with weight below 1,500 g. We used the RetCam-120 Digital Retinal Camera to document retinal changes.

RESULTS

Of the 360 premature infants 241 (67%) had no ROP, and 119 (33%) had ROP. Of the preterm infants with ROP retinal hemorrhages were found in 46 (38%) children. Of the newborns with ROP and with retinal hemorrhages, macular pigmentary changes were found in 3 (6%) patients. Of these 3 patients, the first had pre-threshold ROP, the second threshold ROP and had underwent diode laser photocoagulation, and the third patient had stage 2 ROP. In the patients with pre-threshold and threshold ROP retinal hemorrhages appeared 6 weeks after birth and macular pigmentary changes were found 6 months after birth. In the patient with stage 2 ROP hemorrhages appeared 7-8 weeks after birth and macular pigmentary changes were detected 12 months after birth.

CONCLUSIONS

Although macular hemorrhages almost always resorb without complications, our study allows the assumption that retinal hemorrhages may cause macular pigmentary changes in the macula, and thus may lead to deprivation amblyopia. Our results may suggest that the presence of the macular pigmentary changes may be related to the hemorrhage and not to the specific therapy or to the disease.

[Endometrial carcinoma during the IVF program]

The paper presents a case of abnormal endometrium proliferation detected during routine examinations before the final stage of the in vitro fertilization and embryo transfer program (IVF-ET). Diagnostic excochleation of the uterus histopathologically revealed Ca endometrium.

[Prolonged desensitization pretreatment for in vitro fertilization in women with polycystic ovary]

OBJECTIVE

To analyse the outcome of intracytoplasmic sperm injection (ICSI) in women with severe polycystic ovary disease (PCD), stimulated after prolonged pituitary desensitization in comparison with regular long protocol therapy.

MATERIALS AND METHODS

The results of controlled ovarian hyperstimulation (COH), fertilization rate, early embryo development parameters and clinical pregnancy rates were compared depending on the duration of pituitary desensitization before gonadotropin administration. A total of 60 patients with severe PCOD were desensitized with GnRH agonist up to 30 days before COH. The results were compared with the group of 213 patients with mild PCOD treated with regular long protocol (control).

RESULTS

We observed a slightly higher rate of mature oocytes MII as well as the number of embryos obtained in the control group, however the pregnancy rate in the group with prolonged desensitization was significantly higher (50%) in comparison to the control group (33.8%).

CONCLUSION

The prolonged pituitary desensitization before controlled ovarian hyperstimulation gives better chance for obtaining pregnancy in patients with severe PCOD. It could be recommended facing previous treatment failure.

[Seasonal changes in donor's sperm motility: CASA parameters]

Computer assisted semen analysis was employed to find out whether there are some changes in movement parameters between autumn-winter and spring-summer time. 473 sperm specimens obtained from 12 sperm donors were analyzed. Statistically significant percentage of motile spermatozoa was higher during spring-summer time.

Stimulation of vasopressin release in women with primary dysmenorrhoea and after oral contraceptive treatment--effect on uterine contractility

OBJECTIVE

To study aspects of the aetiology of primary dysmenorrhoea and mechanisms underlying the therapeutic effect in this condition of an oral contraceptive.

INTERVENTION

Intrauterine pressure was recorded before and during infusion of hypertonic saline (5% NaCl, 0.06 ml/kg/min) over 75 min on the first day of bleeding in women with dysmenorrhoea and after 3 weeks of oral contraceptive treatment. Plasma sampling every 15 min of ongoing infusion for the estimation of osmolality, arginine vasopressin, oxytocin and the prostaglandin (PG) F-metabolite, 15-keto-13,14-dihydro-PGF2 alpha.

SUBJECTS

Ten healthy nulliparous women with moderate to severe primary dysmenorrhoea.

MAIN OUTCOME MEASURES

Plasma levels of posterior pituitary hormones and the PGF-metabolite. Total pressure area (TPA) of the recording curve.

RESULTS

In dysmenorrhoea before infusion the plasma concentration of vasopressin was in mean 2.18, oxytocin 5.05 and the PGF-metabolite 321.5 pmol/l, and the TPA 3.8 kPa x 10 min. After oral contraceptive treatment the vasopressin level and the TPA were significantly reduced. At both sessions apart from intensifying the pain, the saline infusion increased vasopressin and oxytocin levels as well as the TPA, whereas the concentration of the PGF-metabolite at both sessions decreased.

CONCLUSION

Confirmation is provided of the elevated secretion of arginine vasopressin and PGF2 alpha, as well as increased uterine activity in primary dysmenorrhoea. The observations are in agreement with the concept that a lowered level of vasopressin and a decreased uterine activity contributes to the beneficial effect of OCs in the condition. Stimulation of the secretion of vasopressin increases the uterine activity and symptoms of primary dysmenorrhoea, but results suggest that this effect does not involve a mechanism of increased PGF-synthesis. The role of oxytocin in dysmenorrhoea can not yet be defined.