IVF雙胞胎若其中一胎死腹中，存活胎兒較易早產及體重較輕

Hum Reprod. 2017 Nov 1;32(11):2298-2304. doi: 10.1093/humrep/dex277.

Vanishing twin syndrome among ART singletons and pregnancy outcomes.

Magnus MC1,2,3, Ghaderi S1, Morken NH4,5, Magnus P6,7, Bente Romundstad L8,9, Skjærven R4,10, Wilcox AJ11, Eldevik Håberg S6.

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Abstract

STUDY QUESTION:

Among babies born by ART, do singleton survivors of a vanishing twin have lower birth weight than other singletons?

SUMMARY ANSWER:

Vanishing twin syndrome (VTS) was associated with lower birth weight among ART singletons; a sibship analysis indicated that the association was not confounded by maternal characteristics that remain stable between deliveries.

WHAT IS KNOWN ALREADY:

Previous studies indicate that ART singletons with VTS have increased risk of adverse pregnancy outcomes, compared with other ART singletons. The potential contribution of unmeasured maternal background characteristics has been unclear.

STUDY DESIGN, SIZE AND DURATION:

This was a Norwegian population-based registry study, including 17 368 mothers with 20 410 ART singleton deliveries between January 1984 and December 2013.

PARTICIPANTS/MATERIALS, SETTING, METHODS:

The study population included 17 291 ART singletons without VTS, 638 ART singletons with VTS and 2418 ART singletons with uncertain vanishing twin status. We estimated differences in birth weight and gestational age comparing ART singletons with VTS first to all ART singletons without VTS, and subsequently to their ART siblings without VTS, using random- and fixed-effects linear regression, respectively. The corresponding comparisons for the associations with preterm birth and small for gestational age (SGA) were conducted using random-and fixed-effects logistic regression. The sibling analysis of preterm birth included 587 discordant siblings, while the sibling analysis of SGA included 674 discordant siblings.

MAIN RESULTS AND THE ROLE OF CHANCE:

ART singletons with VTS had lower birth weight when compared to all ART singletons without VTS, with an adjusted mean difference (95% CI) of -116 g (-165, -67). When we compared ART singletons with VTS to their ART singletons sibling without VTS, the adjusted mean difference was -112 g (-209, -15). ART singletons with VTS also had increased risk of being born SGA, with an adjusted odds ratio (OR) (95% CI) of 1.48 (1.07, 2.03) compared to all ART singletons without VTS, and 2.79 (1.12, 6.91) in the sibship analyses. ART singletons with VTS were also more likely to be born preterm, although this difference did not reach statistical significance.

排卵針劑量並不明顯影響囊胚期胚胎之染色體異常率
年齡明顯影響囊胚期胚胎之染色體異常率

Hum Reprod. 2017 Nov 1;32(11):2209-2217. doi: 10.1093/humrep/dex299.

High gonadotropin dosage does not affect euploidy and pregnancy rates in IVF PGS cycles with single embryo transfer.

Barash OO1, Hinckley MD1, Rosenbluth EM1, Ivani KA1, Weckstein LN1.

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1

Reproductive Science Center of the San Francisco Bay Area, 100 Park Place, Suite 200, San Ramon, CA 94583, USA.

Abstract

STUDY QUESTION:

Does high gonadotropin dosage affect euploidy and pregnancy rates in PGS cycles with single embryo transfer?

SUMMARY ANSWER:

High gonadotropin dosage does NOT affect euploidy and pregnancy rates in PGS cycles with single embryo transfer.

WHAT IS KNOWN ALREADY:

PGS has been proven to be the most effective and reliable method for embryo selection in IVF cycles. Euploidy and blastulation rates decrease significantly with advancing maternal age. In order to recruit an adequate number of follicles, the average dosage of gonadotropins administered during controlled ovarian stimulation in IVF cycles often increases significantly with advancing maternal age.

STUDY DESIGN, SIZE, AND DURATION:

A retrospective study of SNP (Single Nucleotide Polymorphism) PGS outcome data from blastocysts biopsied on day 5 or day 6 was conducted to identify differences in euploidy and clinical pregnancy rates. Seven hundred and ninety four cycles of IVF treatment with PGS between January 2013 and January 2017 followed by 651 frozen embryo transfers were included in the study (506 patients, maternal age (y.o.) - 37.2 ± 4.31).

PARTICIPANTS/MATERIALS, SETTING, METHODS:

A total of 4034 embryos were analyzed (5.1 ± 3.76 per case) for euploidy status. All embryos were vitrified after biopsy, and selected embryos were subsequently thawed for a hormone replacement frozen embryo transfer cycle. All cycles were analyzed by total gonadotropin dosage (<3000 IU, 3000-5000 IU and >5000 IU), by number of eggs retrieved (1-5, 5-10, 10-15 and >15 eggs) and patient's age (<35, 35-37, 38-40 and ≥41 y.o.). Clinical pregnancy rate was defined by the presence of a fetal heartbeat at 6-7 weeks of gestation.

MAIN RESULTS AND THE ROLE OF CHANCE:

Euploidy rates within the same age group were not statistically different regardless of the total dosage of gonadotropins used or the number of eggs retrieved. In the youngest group of patients (<35 y.o. - 187 IVF cycles) euploidy rates ranged from 62.3% (<3000 IU were used in the IVF cycle) to 67.5% (>5000 IU were used in the IVF cycle) (OR = 0.862, 95% CI 0.687-1.082, P = 0.2) and from 69.5% (1-5 eggs retrieved) to 60.0% (>15 eggs retrieved) (OR = 0.658, 95% CI 0.405-1.071, P = 0.09). Similar data were obtained in the oldest group of patients (≥41 y.o. - 189 IVF cycles): euploidy rates ranged from 30.7 to 26.4% (OR = 0.811, 95% CI 0.452-1.454, P = 0.481) when analyzed by total dosage of gonadotropins used in the IVF cycle and from 40.0 to 30.7% (OR = 0.531, 95% CI 0.204-1.384, P = 0.19), when assessed by the total number of eggs retrieved. Ongoing pregnancy rates were similar, not only within particular age groups, but also between different age groups regardless of the total dosage of gonadotropins used: ranging from to 63.6% (<3000 IU, < 35 y.o.) to 54.8% (>5000 IU, ≥41 y.o) (OR = 0.696, 95% CI 0.310-1.565, P = 0.38).

人工受精後不需要臥床休息15分鐘

Hum Reprod. 2017 Nov 1;32(11):2218-2224. doi: 10.1093/humrep/dex302.

Immobilization or mobilization after IUI: an RCT.

van Rijswijk J1, Caanen MR1, Mijatovic V1, Vergouw CG1, van de Ven PM2, Lambalk CB1, Schats R1.

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Abstract

STUDY QUESTION:

Does 15 min of immobilization after IUI improve pregnancy rates?

SUMMARY ANSWER:

Immobilization for 15 min after IUI does not improve pregnancy rates.

WHAT IS KNOWN ALREADY:

Prior RCTs report a beneficial effect of supine immobilization for 15 min following IUI compared to immediate mobilization, however, these studies can be criticized. Given the importance for the logistics in daily practice and the lack of biological plausibility we planned a replication study prior to potential implementation of this procedure.

STUDY DESIGN, SIZE, DURATION:

A single centre RCT, based in an academic setting in the Netherlands, was performed. Participants were randomly assigned for 15 min of supine immobilization following IUI for a maximum of six cycles compared to the standard procedure of immediate mobilization following IUI. Participants and caregivers were not blinded to group assignment. An independent researcher used computer-generated tables to allocate treatments. Stratification occurred to the indication of IUI (unexplained or mild male subfertility). Revelation of allocation took place just before the insemination by the caregiver. The primary outcome was ongoing pregnancy rate per couple.

PARTICIPANTS/MATERIALS, SETTING, METHODS:

A total of 498 couples diagnosed with unexplained or mild male subfertility and an indication for treatment with IUI were approached and randomized in the study, of which 244 participants were assigned to 15 min of supine immobilization and 254 participants to immediate mobilization.

MAIN RESULTS AND THE ROLE OF CHANCE:

Participant characteristics were comparable between the groups, and 236 participants were analysed in the immobilization group, versus 245 in the mobilization group. The ongoing pregnancy rate per couple was not found to be superior in the immobilization group (one-sided P-value = 0.97) with 76/236 ongoing pregnancies (32.2%) being accomplished in the immobilization and 98/245 ongoing pregnancies (40.0%) in the immediate mobilization group (relative risk 0.81; 95% CI [0.63, 1.02], risk difference: -7.8%, 95% CI [-16.4%, 0.8%]). No difference was found in miscarriage rate, multiple gestation rate, live birth rate and time to pregnancy between the groups.

凍胚植入時, 若P4過低(<9 ng/ml)可能導致懷孕率明顯下降

Hum Reprod. 2017 Oct 13:1-6. doi: 10.1093/humrep/dex316. [Epub ahead of print]

Low serum progesterone on the day of embryo transfer is associated with a diminished ongoing pregnancy rate in oocyte donation cycles after artificial endometrial preparation: a prospective study.

Labarta E1, Mariani G1, Holtmann N2,3, Celada P1, Remohí J1, Bosch E1.

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Abstract

STUDY QUESTION:

Is there a relationship between serum progesterone (P) and endometrial volume on the day of embryo transfer (ET) with ongoing pregnancy rate (OPR) in artificial endometrium preparation cycles?

SUMMARY ANSWER:

Patients with serum P < 9.2 ng/ml on the day of ET had a significantly lower OPR but endometrial volume was not related with OPR.

WHAT IS KNOWN ALREADY:

A window of optimal serum P levels during the embryo implantation period has been described in artificial endometrium preparation cycles. A very low endometrial volume is related to poor reproductive outcome.

STUDY DESIGN, SIZE, DURATION:

Prospective cohort study with 244 patients who underwent ET in an oocyte donation cycle after an artificial endometrial preparation cycle with estradiol valerate and vaginal micronized progesterone (400 mg/12 h). The study period went from 22 February 2016 to 25 October 2016 (8 months). Sample size was calculated to detect a 20% difference in OPR (35-55%) between two groups according to serum P levels in a two-sided test (80% statistical power, 95% confidence interval (CI)).

PARTICIPANTS/MATERIALS, SETTING, METHODS:

Patients undergoing their first/second oocyte donation cycle, aged <50, BMI < 30 kg/m2, triple layer endometrium >6.5 mm and 1-2 good quality transferred blastocysts. A private infertility centre. Serum P determination and 3D ultrasound of uterine cavity were performed on the day of ET. Endometrial volume measurements were taken using a virtual organ computer-aided analysis (VOCAL™) system. The primary endpoint was OPR beyond pregnancy week 12.

MAIN RESULTS AND ROLE OF CHANCE:

About 211 of the 244 recruited patients fulfilled all the inclusion/exclusion criteria. Mean serum P on the day of embryo transfer was 12.7 ± 5.4 ng/ml (Centiles 25, 9.2; 50, 11.8; 75,15.8). OPRs according to serum P quartiles were: Q1: 32.7%; Q2: 49.1%; Q3: 58.5%; Q4: 50.9%. The OPR of Q1 was significantly lower than Q2-Q4: 32.7% versus 52.8%; P = 0.016; RR (95% CI): 0.62 (0.41-0.94). The mean endometrial volume was 3.4 ± 1.9 ml. Serum P on the day of ET did not correlate with endometrial volume. A logistic regression analysis, adjusted for all the potential confounders, showed that OPR significantly lowered between women with serum P < 9.2 ng/ml versus ≥9.2 ng/ml (OR: 0.297; 95%CI: 0.113-0.779); P = 0.013. The ROC curve showed a significant predictive value of serum P levels on the day of ET for OPR, with an AUC (95%CI) = 0.59 (0.51-0.67).

LIMITATIONS, REASONS FOR CAUTION:

Only the women with normal uterine cavity, appropriate endometrial thickness and good quality blastocysts transfer were included. Extrapolation to an unselected population or to other routes and/or doses of administering P needs to be validated. The role of endometrial volume could not be fully defined as very few patients presented a very low volume.

WIDER IMPLICATIONS OF THE FINDINGS:

The present study suggests a minimum threshold of serum P values on the day of ET that needs to be reached in artificial endometrial preparation cycles to optimize outcome. No upper threshold could be defined.

 胚胎染色體異常主要發生於受孕後之有絲分裂過程(D1-3)

Hum Reprod. 2017 Nov 8:1-12. doi: 10.1093/humrep/dex324. [Epub ahead of print]

The incidence and origin of segmental aneuploidy in human oocytes and preimplantation embryos.

Babariya D1,2, Fragouli E1,2, Alfarawati S1,2, Spath K1,2, Wells D1,2.

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Abstract

STUDY QUESTION:

What is the incidence, origin and clinical significance of segmental aneuploidy in human oocytes and preimplantation embryos?

SUMMARY ANSWER:

Segmental aneuploidy occurs at a considerable frequency in preimplantation embryos with a majority being mitotic in origin.

WHAT IS KNOWN ALREADY:

In recent years, accurate techniques for the detection of aneuploidy in single cells have been developed. Research using such methods has confirmed that aneuploidy is a common feature of human oocytes and preimplantation embryos. However, thus far research has mainly focused on loss or gain of whole chromosomes. We utilized sensitive molecular methods to study another important form of cytogenetic abnormality at the earliest stages of human development, namely segmental aneuploidy.

STUDY DESIGN, SIZE, DURATION:

Chromosomal copy number data was obtained from oocytes and embryos of 635 IVF patients, who requested chromosome screening for various reasons, most commonly for advanced maternal age or previously unsuccessful IVF treatments. A total of 3541 samples comprising of 452 human oocytes, 1762 cleavage stage and 1327 blastocyst stage embryos were investigated in the present study.

PARTICIPANTS/MATERIALS, SETTING, METHODS:

Whole genome amplification (Sureplex, Illumina) was performed on cells biopsied from oocytes and embryos of IVF patients who requested chromosome screening. The samples were subsequently processed and analyzed for their chromosome complement using microarray comparative genomic hybridization (aCGH), (Illumina, Cambridge, UK).

MAIN RESULTS AND THE ROLE OF CHANCE:

Segmental abnormalities, involving loss or gain of chromosomal fragments in excess of 15 Mb, were found to occur at a high frequency. The incidence of such abnormalities was 10.4% in oocytes, but this increased dramatically during the first 3 days of embryonic development (24.3%), before starting to decline as embryos reached the final (blastocyst) stage of preimplantation development (15.6%). While some segmental errors were clearly of meiotic origin, most appear to arise during the first few mitoses following fertilization. The reduction in frequency at the blastocyst stage suggests that many cells/embryos affected by segmental abnormalities are eliminated (e.g. via arrest of the affected embryos or apoptosis of abnormal cells). Interestingly, sites of chromosome breakage associated with segmental aneuploidy were not entirely random but tended to occur within distinct chromosomal regions. Some of the identified hotspots correspond to known fragile sites while others may be considered novel and may be specific to gametogenesis and/or embryogenesis.

45歲IVF活產率僅3%

J Assist Reprod Genet. 2017 Nov 16. doi: 10.1007/s10815-017-1088-y. [Epub ahead of print]

One thousand seventy-eight autologous IVF cycles in women 45 years and older: the largest single-center cohort to date.

Gunnala V1, Irani M2, Melnick A2, Rosenwaks Z2, Spandorfer S2.

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Abstract

PURPOSE:

The purpose of this study was to determine IVF outcomes in women 45 years and older using autologous oocytes.

METHODS:

This is a retrospective cohort study reviewing all IVF cycles in women ≥ 45 years old from January 1995 to June 2015 that were conducted at one academic medical center. One thousand seventy-eight fresh, autologous IVF cycles met inclusion criteria. PGD/S, natural IVF, and donor egg cycles were excluded. Outcomes were analyzed for the different age groups (age 45, n = 773; age 46, n = 221; age 47, n = 57; age 48, n = 22; age 49, n = 5). Primary outcome measures included IVF cycle characteristics, total pregnancy loss, clinical pregnancy, and live birth rates, and were stratified according to patient age.

RESULTS:

Mean age of patients in the study cohort was 45.4 ± 0.72. 11.7% of patients did not start due to an elevated FSH or cyst and 28.5% of patients were canceled prior to oocyte retrieval. The overall pregnancy rate per transfer was 18.7% (117/626), of which 82.1% ended in a pregnancy loss. The overall clinical pregnancy and live birth rates per transfer were 9.6 and 3.4%, respectively, which did not differ between age groups. Per cycle start women aged 45 had significantly higher positive pregnancy rates compared to women aged 46 and 47 (14.1 vs. 8.6 vs. 5.9%, p = 0.04). For women 45 years old, the live birth rate was 2.9% per cycle start and was 4.4% per embryo transfer. Of the 21 live births, 20 were in women aged 45 and one live birth was in a 46-year-old woman. There were no live births in any patient with ≤ 4 oocytes retrieved.

CONCLUSION:

Autologous IVF in women aged 45 with acceptable ovarian reserve is not futile; however, it does carry very low prognosis. Patients aged 46 and older should be counseled appropriately that a live birth seems highly unlikely.

高齡引發卵丘細胞之粒線體異常

Hum Reprod. 2017 Oct 17:1-9. doi: 10.1093/humrep/dex309. [Epub ahead of print]

Age-related changes in the mitochondria of human mural granulosa cells.

Liu Y1, Han M2,3, Li X4,5, Wang H1, Ma M1, Zhang S1, Guo Y1, Wang S1, Wang Y1, Duan N6, Xu B1, Yin J6, Yao Y1.

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Abstract

STUDY QUESTION:

What changes in the mitochondria of human mural granulosa cells (mGCs) with maternal aging?

SUMMARY ANSWER:

The mitochondrial membrane potential (MMP) and the ability of oxidative phosphorylation (OXPHOS) of mGCs declines with reproductive aging, accompanied with more abnormal mitochondria.

WHAT IS KNOWN ALREADY:

Mitochondria play an important role in the dialogue between the mGCs and oocytes. However, the underlying mechanism of mitochondrial dysfunction in mGCs in aging is still poorly understood.

STUDY DESIGN SIZE, DURATION:

In total, 149 infertile women underwent IVF in the ART Centre of the Chinese PLA General Hospital, China from September 2016 to May 2017. Two age groups were investigated: the young group (<38 years old) and the old group (≥38 years old).

PARTICIPANTS/MATERIALS, SETTING, METHODS:

The mitochondrial ultrastructure of mGCs was observed by transmission electron microscopy, and real-time quantitative polymerase chain reaction was applied to quantify the mitochondrial DNA (mtDNA) copy number, 4977-bp deleted DNA and mRNA expression of mitochondrial ATP synthases ATP5A1 and ATP5I. MMP was detected by flow cytometry and fluorescence microscopy, respectively. Reactive oxygen species (ROS) was tested by flow cytometry. A luminometer was used to measure the ATP levels and western blot to analyse the OXPHOS complex.

MAIN RESULTS AND THE ROLE OF CHANCE:

In the young group, mitochondria were mostly round or oval, with a few intact parallel tubular-vesicular cristae and homogenous matrix density, while elongated mitochondria were mainly observed in the old group, which had numerous cristae and more high-density matrix particles. Abnormal mitochondria were more common in aging women (P = 0.012). mtDNA relative copy number was positively correlated with maternal age (r = 0.294, P = 0.009) and we found no one with 4977-bp deleted mitochondria. JC-1 (dye used as an indicator of MMP) ratio in the old group was significantly lower than the young group (3.01 ± 0.21 vs 3.85 ± 0.27, P = 0.033). Intracellular ROS levels between the groups did not differ significantly (P = 0.191). The intracellular ATP level in the young group was 1.75-fold higher than that of the advanced-age group (7.17 ± 1.16 vs 4.15 ± 0.60, P = 0.025). The protein expression of ATP5A1, as one of five proteins of OXPHOS, decreased with aging (P < 0.001). ATP5A1 mRNA expression was negatively correlated with aging (r = -0.341, P = 0.012).

女性荷爾蒙&男性荷爾蒙，配合FSH，有助於卵子之成長發育

Hum Reprod. 2017 Oct 25:1-9. doi: 10.1093/humrep/dex322. [Epub ahead of print]

Direct actions of androgen, estrogen and anti-Müllerian hormone on primate secondary follicle development in the absence of FSH in vitro.

Baba T1,2, Ting AY1, Tkachenko O1, Xu J1,3, Stouffer RL1,3.

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Abstract

STUDY QUESTION:

What are effects of androgen, estrogen and anti-Müllerian hormone (AMH), independent of FSH action, on the development and function of primate follicles from the preantral to small antral stage in vitro?

SUMMARY ANSWER:

Androgen and estrogen, but not AMH, promote follicle survival and growth in vitro, in the absence of FSH. However, their growth-promoting effects are limited to the preantral to early antral stage.

WHAT IS KNOWN ALREADY:

FSH supports primate preantral follicle development in vitro. Androgen and estrogen augment follicle survival and growth in the presence of FSH during culture.

STUDY DESIGN SIZE, DURATION:

Nonhuman primate model; randomized, control versus treatment groups. Rhesus macaque (n = 6) secondary follicles (n = 24 per animal per treatment group) were cultured for 5 weeks.

PARTICIPANTS/MATERIALS, SETTING, METHODS:

Follicles were encapsulated in 0.25% (w/v) alginate and cultured individually in modified alpha minimum essential media with (i) FSH (1 ng/ml; control), (ii) no FSH, (iii) no FSH + estradiol (E2; 100 pg/ml)/dihydrotestosterone (DHT; 50 ng/ml) and (iv) no FSH + AMH (50 ng/ml). In a second experiment, follicles were cultured with (i) FSH (1 ng/ml), (ii) no FSH, (iii) no FSH + E2 (1 ng/ml), (iv) no FSH + DHT (50 ng/ml) and (v) no FSH + E2/DHT. Follicle survival, antrum formation and growth pattern were evaluated. Progesterone (P4), E2 and AMH concentrations in culture media were measured.

MAIN RESULTS AND THE ROLE OF CHANCE:

In the first experiment, FSH deprivation significantly decreased (P < 0.05) follicle survival rates in the no FSH group (16 ± 5%), compared to CTRL (66 ± 9%). E2/DHT (49 ± 5%), but not AMH (27 ± 8%), restored follicle survival rate to the CTRL level. Similarly, antrum formation rates were higher (P < 0.05) in CTRL (56 ± 6%) and E2/DHT groups (54 ± 14%), compared to no FSH (0 ± 0%) and AMH (11 ± 11%) groups. However, follicle growth rate after antrum formation and follicle diameter at week 5 was reduced (P < 0.05) in the E2/DHT group (405 ± 25 μm), compared to CTRL (522 ± 29 μm). Indeed, the proportion of fast-grow follicles at week 5 was higher in CTRL (29% ± 5), compared to E2/DHT group (10 ± 3%). No fast-grow follicles were observed in no FSH and AMH groups. AMH levels at week 3 remained similar in all groups. However, media concentrations of P4 and E2 at week 5 were lower (P < 0.05, undetectable) in no FSH, E2/DHT and AMH groups, compared to CTRL (P4 = 93 ± 10 ng/ml; E2 = 4 ± 1 ng/ml). In the second experiment, FSH depletion diminished follicle survival rate (66 ± 8% in control versus 45 ± 9% in no FSH, P = 0.034). E2 plus DHT (31.5 ± 11%) or DHT alone (69 ± 9%) restored follicle survival rate to the control (FSH) level as expected. Also, E2 plus DHT or DHT alone improved antrum formation rate. However, in the absence of FSH, E2 plus DHT or DHT alone did not support growth, in terms of follicle diameter, or steroid (P4 or E2) production after the antral stage.

melatonin (退黑激素) 可改善卵子有絲分裂狀況

Hum Reprod. 2017 Nov 3:1-12. doi: 10.1093/humrep/dex331. [Epub ahead of print]

The protective role of melatonin in porcine oocyte meiotic failure caused by the exposure to benzo(a)pyrene.

Miao Y1, Zhou C1, Bai Q2, Cui Z1, ShiYang X1, Lu Y1, Zhang M1, Dai X1, Xiong B1.

Author information

Abstract

STUDY QUESTION:

Does melatonin restore the benzo(a)pyrene (BaP)-induced meiotic failure in porcine oocytes?

SUMMARY ANSWER:

Melatonin effectively inhibits the increased reactive oxygen species (ROS) level and apoptotic rate in BaP-exposed porcine oocytes to recover the meiotic failure.

WHAT IS KNOWN ALREADY:

BaP, a widespread environmental carcinogen found in particulate matter, 2.5 µm or less (PM2.5), has been shown to have toxicity at the level of the reproductive systems. BaP exposure disrupts the steroid balance, alters the expression of ovarian estrogen receptor and causes premature ovarian failure through the rapid depletion of the primordial follicle pool. In addition, acute exposure to BaP has transient adverse effects on the follicle growth, ovulation and formation of corpora lutea, which results in transient infertility.

STUDY DESIGN, SIZE, DURATION:

Porcine oocytes were randomly assigned to control, BaP-exposed and melatonin-supplemented groups. BaP was dissolved in dimethylsulphoxide and diluted to a final concentration of 50, 100 or 250 μM with maturation medium, respectively. Melatonin was dissolved in the absolute ethanol and diluted with maturation medium to a final concentration of 1 nM, 100 nM, 10 μM and 1 mM, respectively. The in vitro cultured oocytes from each group after treatment were applied to the subsequent analysis.

PARTICIPANTS/MATERIALS, SETTING, METHODS:

Acquisition of oocyte meiotic competence was assessed using immunostaining, fluorescent intensity quantification and/or immunoblotting to analyse the cytoskeleton assembly, mitochondrial integrity, cortical granule dynamics, ovastacin distribution, ROS level and apoptotic rate. Fertilization ability of oocytes was examined by sperm binding assay and IVF.

MAIN RESULTS AND THE ROLE OF CHANCE:

BaP exposure resulted in the oocyte meiotic failure (P = 0.001) via impairing the meiotic apparatus, showing a prominently defective spindle assembly (P = 0.003), actin dynamics (P < 0.001) and mitochondrion integrity (P < 0.001). In addition, BaP exposure caused the abnormal distribution of cortical granules (P < 0.001) and ovastacin (P = 0.003), which were consistent with the observation that fewer sperm bound to the zona pellucida surrounding the unfertilized BaP-exposed eggs (P < 0.001), contributing to the fertilization failure (P < 0.001). Conversely, melatonin supplementation recovered, at least partially, all the meiotic defects caused by BaP exposure through inhibiting the rise in ROS level (P = 0.015) and apoptotic rate (P = 0.001).

clomid+HMG vs Letrozole+HMG用於COH
clomid產生較多卵子

J Hum Reprod Sci. 2017 Jul-Sep;10(3):173-177. doi: 10.4103/jhrs.JHRS_120_16.

A Study of Controlled Ovarian Stimulation with Clomiphene Citrate or Letrozole in Combination with Gonadotropins and IUI in Unexplained Infertility.

Hembram M1, Biswas R2, Jain A3.

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Abstract

AIM:

To compare the effect of clomiphene citrate (CC) + human menopausal gonadotropin (hMG) with letrozole + hMG on size, number of follicles, endometrial thickness, serum levels of oestradiol and progesterone and pregnancy rate.

SETTINGS AND DESIGN:

Non-randomised interventional study.

PATIENTS AND METHODS:

A total number of 60 patients in the age group of 20-35 years with unexplained infertility were divided into two groups, 30 in each. Group A received CC + hMG and group B received letrozole + hMG. In both the groups, ovulation was triggered by hCG followed by intrauterine insemination.

RESULTS:

The number of follicles on day 8 were significantly higher in the CC + hMG group than that in the letrozole + hMG group. Serum oestradiol level was significantly higher in the CC + hMG group on day 10 and on the day of hCG administration. Pregnancy rate in the CC + hMG group was 23.3% and 13.3% in the letrozole + hMG group.

CONCLUSION:

The sequential protocol was cost-effective. CC + hMG could be a preferred ovarian stimulation protocol in couples with unexplained infertility with the added advantage of having no significant complications in properly monitored cycles.

缺乏Vit D可能導致IVF較易流產

Hum Reprod. 2017 Nov 15:1-16. doi: 10.1093/humrep/dex326. [Epub ahead of print]

Vitamin D and assisted reproductive treatment outcome: a systematic review and meta-analysis.

Chu J1,2, Gallos I1,2, Tobias A1,3, Tan B4,5, Eapen A1,2, Coomarasamy A1,2.

Author information

Abstract

STUDY QUESTION:

Is serum vitamin D associated with live birth rates in women undergoing ART?

SUMMARY ANSWER:

Women undergoing ART who are replete in vitamin D have a higher live birth rate than women who are vitamin D deficient or insufficient.

WHAT IS KNOWN ALREADY:

Vitamin D deficiency has been associated with an increased risk of abnormal pregnancy implantation as well as obstetric complications such as pre-eclampsia and fetal growth restriction. However, the effect of vitamin D on conception and early pregnancy outcomes in couples undergoing ART is poorly understood.

STUDY DESIGN, SIZE, DURATION:

A systematic review and meta-analysis of 11 published cohort studies (including 2700 women) investigating the association between vitamin D and ART outcomes.

PARTICIPANTS/MATERIALS, SETTINGS, METHODS:

Literature searches were conducted to retrieve studies which reported on the association between vitamin D and ART outcomes. Databases searched included MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and CINAHL. Eleven studies matched the inclusion criteria.

MAIN RESULTS AND THE ROLE OF CHANCE:

Live birth was reported in seven of the included studies (including 2026 patients). Live birth was found to be more likely in women replete in vitamin D when compared to women with deficient or insufficient vitamin D status (OR 1.33 [1.08-1.65]). Five studies (including 1700 patients) found that women replete in vitamin D were more likely to achieve a positive pregnancy test than women deficient or insufficient in vitamin D (OR 1.34 ([1.04-1.73]). All 11 of the included studies (including 2700 patients) reported clinical pregnancy as an outcome. Clinical pregnancy was found to be more likely in women replete in vitamin D (OR 1.46 [1.05-2.02]). Six studies (including 1635 patients) reported miscarriage by vitamin D concentrations. There was no association found between miscarriage and vitamin D concentrations (OR 1.12 [0.81-1.54]. The included studies scored well on the Newcastle-Ottawa quality assessment scale.

跑步機運動可改善多囊性卵巢

The effects of moderate treadmill and running wheel exercises on oxidative stress in female rats with steroid-induced polycystic ovaries

Fatemeh Aghaie, Homayoun Khazali , Mehdi Hedayati, Ali Akbarnejad

Abstract:   (1973 Views)

Introduction: Polycystic ovary syndrome (PCOS) is one of the most common endocrinological pathologies in women during their reproductive years with ovulatory dysfunction, abdominal obesity, hyperandrogenism and insulin resistance. The aim of the present research was to evaluate the total antioxidant capacity (TAC), total oxidant status (TOS), free testosterone, ovarian morphology and estrous cyclicity in the estradiol valerate (EV)-induced PCOS rat model and the effect of treadmill and running wheel exercises on these parameters. Methods: Fifty female Wistar rats were randomly selected (220 ± 20 g). They had every 2 to 3 consecutive estrous cycles during 12 to 14 days. The first two groups were divided into control (n=10) and polycystic (n=40) that were induced PCOS by EV injection after 60 days. The polycystic groups were divided into three groups (n=10 in each group) PCOS, experiment group with treadmill exercise (running for 28 m/min at 60 min/day) and experiment group with running wheel exercise (running daily for 4 hours) for 8 weeks. Results: The PCOS rats had significantly higher testosterone, TOS and lower TAC than control. Eight weeks of treadmill and running wheel exercise significantly increased serum levels of TAC (just for treadmill exercise) and decreased level of TOS and T (just for treadmill exercise) in EV-induced PCOS rats compared to PCOS group. Ovarian morphology and estrous cycle was almost normalized in the PCOS exercise (treadmill and running wheel) groups. Conclusion: The present study demonstrate EV-induced PCOS in rats is associated with an increased oxidative stress and this increase can be returned to normal levels by exercise.