2013年7月31日

原核Z-score對預估胚胎懷孕率成效有限

原核PN評估Z-score, 對於胚胎植入後之懷孕率預估成效有限

2PN原核荷仁最好>7
Z1----Fig A----最佳
Z2----Fig B----優
Z3----Fig C,D--中
Z4----Fig E,F--差

http://www.ovarianresearch.com/content/6/1/64


Zygote scoring system of Scott et al. [10]. Z1 includes zygotes with equal number of nucleoli aligned at PN junction (A), Z2 includes zygotes with equal number and size of nucleoli (between 3 and 7) which are equally scattered in the two PN (B), Z3 includes zygotes with either very small/large nucleoli (C and D), and Z4 includes zygotes showing PN separated or different in size and small nucleoli, partially aligned or scattered (E and F).
Nicoli et al. Journal of Ovarian Research 2013 6:64   doi:10.1186/1757-2215-6-64
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Pronuclear morphology evaluation for fresh in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) cycles: a systematic review

Alessia NicoliStefano Palomba*Francesco CapodannoMaria FiniAngela Falbo andGiovanni Battista La Sala

Department of Obstetrics, Gynecology and Pediatrics, A.O. Arcispedale S. Maria Nuova, IRCCS, University of Modena and Reggio Emilia, Viale Risorgimento 80, 42123 Reggio Emilia, Italy
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Journal of Ovarian Research 2013, 6:64  doi:10.1186/1757-2215-6-64

The electronic version of this article is the complete one and can be found online at:http://www.ovarianresearch.com/content/6/1/64

Received:5 June 2013
Accepted:16 August 2013
Published:12 September 2013
© 2013 Nicoli et al.; licensee BioMed Central Ltd. 
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

The current systematic review was aimed to assess the effectiveness of the zygote morphology evaluation in fresh in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) cycles. All available studies reporting on zygote morphology and clinical and/or biological outcomes were analyzed. Forty studies were included in the final analysis. Fourteen different zygote scoring systems were employed. Zygote morphology correlated significantly with embryo quality and cleavage, blastocyst stage, embryonic chromosome status, in a high proportion of the studies which assessed the specific outcome [15/25 (60%), 15/20 (75%), 7/8 (87.5%), 6/6 (100%), respectively]. On the other hand, only a reduced proportion of papers showed a statistically significant relationship between implantation, pregnancy and delivery/live-birth rates and zygote morphology score [12/23 (52.2%), 12/25 (48%), 1/4 (25%), respectively]. In conclusion, our findings demonstrate the lack of conclusive data on the clinical efficacy of the zygote morphology evaluation in fresh IVF/ICSI cycles, even if biological results showing a good relationship with embryo viability suggest a role in cycles in which the transfer/freezing is performed at day 1.
Keywords: 
ARTs; Embryo; ICSI; IVF; Morphology; Zygote

2013年7月30日

新鮮捐贈卵子與冷凍捐贈卵子懷孕率無差異

新鮮捐贈卵子與冷凍捐贈卵子受孕植入懷孕率無明顯差異‧

http://www.ncbi.nlm.nih.gov/pubmed/17889865?dopt=Abstract

取卵數多不明顯下降該週期懷孕率

取卵數少vs.取卵數多
取卵數較多(n>18)並不會明顯下降該週期之懷孕率‧
取卵數多累積懷孕率較高 (32 vs 58%)‧
長效排卵針corifollitropin alfa效果與短效排卵針daily rFSH懷孕率類似(32 vs 31%)

http://humrep.oxfordjournals.org/content/28/2/442.abstract


2013年7月23日

打破卵針當天P4/E2>1懷孕率較低

打破卵針當天P4/E2 比例[P (ng/mL) 1,000/E2 (pg/mL).]-------可預測IVF懷孕率

P4/E2>1代表過早黃體化,通常懷孕率較低


http://www.ncbi.nlm.nih.gov/pubmed/18603501


2013年7月20日

cAMP細胞內訊號傳遞與卵細胞發育有關

卵泡發育過程中,卵細胞會分泌inhibin, E2,抑制腦下垂體分泌FSH, LH

FSH會刺激卵細胞之adenylyl cyclase, 引發cAMP製造及細胞內訊號傳遞,及進一步卵顆粒細胞及卵細胞之發育
adenylyl cyclase and the production of cAMP
http://www.biolreprod.org/content/65/3/655.full

2013年7月19日

PCO病人P4大於1.2與IVF結果可能無明顯相關

過早黃體化----P4>1 or 2, 機率約23%,

PCO病人於施打HCG當天測P4>1.2 or P4<1.2,
卵泡越多,P4可能較高,
P4>1.2與IVF結果無明顯相關

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3401251/



2013年7月18日

過早黃體化(premature luteinization)


過早黃體化(premature luteinization)---打破卵針當天P4>1.5 ng/ml(1-2 ng/ml),

可考慮胚胎冷凍保存,或保守植入(少量優質胚胎植入)

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2854984/

2013年7月17日

2013年7月12日

卵巢過度刺激之病患可使用腦下垂體抑制劑控制嚴重度

卵巢過度刺激OHSS之病患可使用腦下垂體抑制劑GnRHantagonist控制其嚴重度

研究顯示胚胎植入ET後使用腦下垂體抑制劑,仍可維持不錯懷孕率,
並下降卵巢過度刺激嚴重度

http://humrep.oxfordjournals.org/content/28/7/1929.abstract


2013年7月9日

因卵巢過度刺激下降破卵針劑量可能干擾懷孕結果


因卵巢過度刺激(OHSS)而下降破卵針劑量(6000-->4000iu),可能干擾懷孕結果
卵子受孕率FR: 80 vs 71%
臨床懷孕率PR: 65 vs 35%

http://www.ncbi.nlm.nih.gov/pubmed/21824709

2013年7月6日

母血胎兒DNA唐氏症篩檢仍無法完全準確取代羊水檢驗


母血胎兒DNA唐氏症篩檢仍無法完全準確取代羊水檢驗

但可望取代傳統母血唐氏症篩檢

Noninvasive detection of fetal trisomy 21: systematic review and report of quality and outcomes of diagnostic accuracy studies performed between 1997 and 2012

  1. S.G.M. Frints1,2,*
+Author Affiliations
  1. 1Department of Clinical Genetics, Reproductive Genetics, Maastricht University Medical Center+PO Box 5800, 6202 AZ Maastricht, The Netherlands
  2. 2GROW School for Oncology and Developmental Biology, Maastricht University Medical Center+PO Box 616, 6200 MD Maastricht, The Netherlands
  3. 3Department of Epidemiology, Faculty of Health Medicine and Life Sciences, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands
  4. 4Department of Obstetrics & Gynaecology, Prenatal Diagnosis, Screening and Therapy, Maastricht University Medical Center+PO Box 5800, 6202 AZ Maastricht, The Netherlands
  5. 5South-East Netherlands NIPT Consortium, Maastricht University Medical Center+, PO Box 5800, 6202 AZ Maastricht, The Netherlands
  1. *Correspondence address. Tel: +31-4-33-87-78-55; Fax: +31-4-33-87-58-00; E-mail: s.frints@mumc.nl
  • Received October 26, 2012.
  • Revision received December 20, 2012.
  • Accepted January 3, 2013.

Abstract

BACKGROUND Research on noninvasive prenatal testing (NIPT) of fetal trisomy 21 is developing fast. Commercial tests have become available. To provide an up-to-date overview of NIPT of trisomy 21, an evaluation of the methodological quality and outcomes of diagnostic accuracy studies was made.
METHODS We undertook a systematic review of the literature published between 1997 and 2012 after searching PubMed, using MeSH terms ‘RNA’, ‘DNA’ and ‘Down Syndrome’ in combination with ‘cell-free fetal (cff) RNA’, ‘cffDNA’, ‘trisomy 21’ and ‘noninvasive prenatal diagnosis’ and searching reference lists of reported literature. From 79 abstracts, 16 studies were included as they evaluated the diagnostic accuracy of a molecular technique for NIPT of trisomy 21, and the test sensitivity and specificity were reported. Meta-analysis could not be performed due to the use of six different molecular techniques and different cutoff points. Diagnostic parameters were derived or calculated, and possible bias and applicability were evaluated utilizing the revised tool for Quality Assessment of Diagnostic Accuracy (QUADAS-2).
RESULTS Seven of the included studies were recently published in large cohort studies that examined massively parallel sequencing (MPS), with or without pre-selection of chromosomes, and reported sensitivities between 98.58% [95% confidence interval (CI) 95.9–99.5%] and 100% (95% CI 96–100%) and specificities between 97.95% (95% CI 94.1–99.3%) and 100% (95% CI 99.1–100%). None of these seven large studies had an overall low risk of bias and low concerns regarding applicability. MPS with or without pre-selection of chromosomes exhibits an excellent negative predictive value (100%) in conditions with disease odds from 1:1500 to 1:200. However, positive predictive values were lower, even in high-risk pregnancies (19.7–100%). The other nine cohort studies were too small to give precise estimates (number of trisomy 21 cases: ≤25) and were not included in the discussion.
CONCLUSIONS NIPT of trisomy 21 by MPS with or without pre-selection of chromosomes is promising and likely to replace the prenatal serum screening test that is currently combined with nuchal translucency measurement in the first trimester of pregnancy. Before NIPT can be introduced as a screening test in a social insurance health-care system, more evidence is needed from large prospective diagnostic accuracy studies in first trimester pregnancies. Moreover, we believe further assessment, of whether NIPT can be provided in a cost-effective, timely and equitable manner for every pregnant woman, is required.

Key words

2013年7月1日

精蟲telomere長度與精蟲數量有關

精蟲染色體telomere長度與精蟲數量有關,與病患年齡有關,
telomere越長,精蟲數量越多
telomere越短,精蟲數量越少,越易不孕

http://www.ncbi.nlm.nih.gov/pubmed/23633370