接近成熟再施打GnRHantagonist & hCG10000iu 破卵
2016年5月28日
單獨低劑量HCG(200 iu/d) 不需另加FSH 即可用於COH
接近成熟再施打GnRHantagonist & hCG10000iu 破卵
To investigate the feasibility of utilizing low-dose hCG alone to complete follicle maturity in a natural cycle, without the need for antecedent exogenous FSH stimulation.
Case series.
Academic fertility program.
Normally ovulatory women with infertility thought to be predominantly due to male factor.
Modified natural IVF cycles were conducted as follows: natural ovulatory cycles were monitored with serial ultrasound examinations and serum E2 determinations. When the lead follicle reached preovulatory status according to cycle day, ultrasound, and E2 levels, 0.25 mg of the GnRH antagonist ganirelix acetate was administered along with 200 IU of hCG. These medications were repeated daily for 2 to 3 days with further serial monitoring. A trigger dose of 10,000 IU of hCG was followed by follicle aspiration, IVF, and ET in a standard manner.
Follicle maturity, live births, documentation of the feasibility of this new approach.
In all cases, E2 levels rose and the dominant follicle continued to increase in size in response to low-dose hCG after GnRH antagonist administration. Follicle aspiration yielded one or more mature oocytes. In vitro fertilization and ET resulted in live births.
Low-dose hCG can be used to complete follicle maturity in a natural cycle without the need for antecedent exogenous FSH stimulation. This finding may have strong clinical utility in modified natural cycle IVF.
接近成熟再施打GnRHantagonist & hCG10000iu 破卵
輸卵管水腫使用子宮鏡近端輸卵管阻塞術可能會下降胚胎著床率(compared to 傳統腹腔鏡輸卵管切斷術)
Does hysteroscopic proximal tubal occlusion by intratubal devices as a treatment for hydrosalpinges result in comparable ongoing pregnancy rates following IVF/ICSI when compared with laparoscopic salpingectomy?
Hysteroscopic proximal tubal occlusion by intratubal devices is inferior to laparoscopic salpingectomy in the treatment of hydrosalpinges in women undergoing IVF/ICSI with respect to ongoing pregnancy rates.
It is known that women with hydrosalpinges undergoing IVF have poorer pregnancy outcomes compared with women with other forms of tubal infertility. In these women, both laparoscopic salpingectomy and laparoscopic proximal tubal ligation are known to improve IVF outcomes. At present, it is unclear whether a less-invasive hysteroscopic treatment with intratubal devices leads to similar ongoing pregnancy rates following IVF when compared with laparoscopic salpingectomy.
A two-centre, randomized, controlled, non-inferiority trial. Between October 2009 and December 2014 a total of 85 women were included in this study; of whom, 42 were randomized to hysteroscopic proximal occlusion by intratubal device placement and 43 were randomized to laparoscopic salpingectomy. Randomization was based on a computer-generated randomization list. The study was unblinded. The primary outcome was ongoing pregnancy rate, defined as a fetal heartbeat on ultrasound beyond 10-week gestation following one IVF/ICSI treatment (fresh and frozen-thawed embryo transfers).
We studied women aged 18-41 years, with uni- or bilateral ultrasound visible hydrosalpinges who were scheduled for an IVF/ICSI treatment.
The ongoing pregnancy rates per patient according to the intention-to-treat principle were 11/42 (26.2%) after hysteroscopic proximal occlusion by intratubal devices (intervention group) versus 24/43 (55.8%) after laparoscopic salpingectomy (control group) (P = 0.008) [absolute difference: 26.1%; 95% confidence interval (CI): 0.5-51.7, relative risk (RR): 0.56; 95% CI: 0.31-1.03, P = 0.01]. In the per protocol analysis, the ongoing pregnancy rate per patient following hysteroscopic proximal occlusion by intratubal devices was 9/27 (33.3%) compared with 19/32 (59.4%) following laparoscopic salpingectomy (P = 0.067) (absolute difference: 29.6%; 95% CI: 7.1 to 49.1, RR: 0.47; 95% CI: 0.27-0.83, P = 0.062).
Hum Reprod. 2016 May 21. pii: dew050. [Epub ahead of print]
Hysteroscopic proximal tubal occlusion versus laparoscopic salpingectomy as a treatment for hydrosalpinges prior to IVF or ICSI: an RCT.
Abstract
STUDY QUESTION:
SUMMARY ANSWER:
WHAT IS KNOWN ALREADY:
STUDY DESIGN, SIZE, DURATION:
PARTICIPANTS/MATERIALS, SETTING, METHODS:
MAIN RESULTS AND THE ROLE OF CHANCE:
精液中AMH濃度與精蟲品質(數量&濃度&活動力)呈正相關
血液AMH濃度與精蟲品質無關
Is anti-Müllerian hormone (AMH) in seminal plasma and serum associated with sperm count and sperm motility?
AMH in seminal plasma is positively associated with sperm concentration, total sperm count, and progressive sperm motility, while no association was found between serum AMH levels and semen characteristics.
AMH is secreted by the Sertoli cells and is detectable in both serum and seminal plasma in adult men. It has been suggested as a marker of spermatogenesis, however, its function in the adult male is largely unknown.
Participants were recruited in between 2008 and 2013, from the general population (n = 94) and from couples with female factor infertility in a fertility clinic (n = 32). AMH data were available for 126 participants.
Mean age of the participants was 36 years, and BMI was between 19 and 39 kg/m2. Semen quality was evaluated by semen analysis according to the World Health Organization, and AMH levels were measured in seminal plasma. Blood samples were analyzed for AMH, total testosterone, FSH, LH, and inhibin B. AMH analysis was performed using the improved Beckman Coulter method.
The central 95% intervals of AMH concentrations were 2-2812 pmol/l in seminal plasma and 15-134 pmol/l in serum. Total AMH (pmol/ejaculate) in seminal plasma was positively associated with sperm concentration (B = 0.177, P< 0.001) and total sperm count (B = 0.212, P< 0.001) when adjusted for age, BMI, time of abstinence, and positively associated with progressive sperm motility (B = 6.762, P = 0.001) when adjusted for age, BMI, time of abstinence, and site of sample collection. No association was found between serum AMH and semen characteristics. Serum levels of inhibin B were positively correlated with total AMH in seminal plasma (B = 18.52, P< 0.001) and concentration of AMH in serum (B = 0.507, P< 0.001).
血液AMH濃度與精蟲品質無關
Hum Reprod. 2016 May 24. pii: dew121. [Epub ahead of print]
Anti-Müllerian hormone in seminal plasma and serum: association with sperm count and sperm motility.
Abstract
STUDY QUESTION:
SUMMARY ANSWER:
WHAT IS KNOWN ALREADY:
STUDY DESIGN, SIZE, DURATION:
PARTICIPANTS/MATERIALS, SETTING, METHODS:
MAIN RESULTS AND THE ROLE OF CHANCE:
PGD (TE+aCGH)----錯誤率約1%
Preimplantation genetic screening (PGS) and diagnosis (PGD) with euploid embryo transfer is associated with improved implantation and live birth rates as compared to routine in vitro fertilization. However, misdiagnosis of the embryo is a potential risk. The purpose of this study was to investigate the clinical discrepant diagnosis rate associated with transfer of trophectoderm-biopsied blastocysts deemed to be euploid via array comparative genomic hybridization (aCGH).
This is a retrospective cohort study including cycles utilizing PGS or PGD with trophectoderm biopsy, aCGH, and euploid embryo transfer at a large university-based fertility center with known birth outcomes from November 2010 through July 2014 (n = 520).
There were 520 embryo transfers of 579 euploid embryos as designated by aCGH. Five discrepant diagnoses were identified. Error rate per embryo transfer cycle was 1.0 %, 0.9 % per embryo transferred, and 1.5 % per pregnancy with a sac. The live birth (LB) error rate was 0.7 % (both sex chromosome errors), and the spontaneous abortion (SAB) error rate was 17.6 % (3/17 products of conception tested, but could range from 3/42 to 7/42). No single gene disorders were mistakenly selected for in any known cases. CONCLUSIONS: Although aCGH has been shown to be a highly sensitive method of comprehensive chromosome screening, several possible sources of error still exist. While the overall error rate is low, these findings have implications for counseling couples that are contemplating PGS and PGD with aCGH.
J Assist Reprod Genet. 2016 Mar 17. [Epub ahead of print]
Discrepant diagnosis rate of array comparative genomic hybridization in thawed euploid blastocysts.
Abstract
PURPOSE:
METHODS:
RESULTS:
mitochondria分布狀況在卵子成熟過程(GV ->M1)有顯著變化
mitochondria分布狀況在卵子成熟過程(M1 ->M2)無顯著變化
mitochondria分布主要在細胞核(GV)周圍
The change of mitochondrial distribution in human oocytes during meiotic maturation was assessed using 223 human oocytes donated from patients undergoing fertility treatment between June 2013 and February 2016.
Live cell images of fluorescence-labelled mitochondria in human oocytes were analysed to investigate dynamic changes in mitochondrial distribution during meiotic maturation using a confocal microscope combined with an incubator in the presence or absence of colchicine and cytochalasin B, inhibitors for tubulin and actin filament, respectively. Subcellular distribution of mitochondria in human oocytes was also assessed at various stages using a transmission electron microscope (TEM).
Live cell imaging analysis revealed that the mitochondria-occupied cytoplasmic area decreased from 83 to 77 % of the total cytoplasmic area around 6 h before germinal vesicle breakdown (GVBD) and that mitochondria accumulated preferentially close to the perinuclear region. Then, the mitochondria-distributed area rapidly increased to 85 % of total cytoplasm at the time of GVBD. On the other hand, there was no significant change in mitochondrial distribution before and after polar body extrusion. Such changes in mitochondrial localization were affected differently by colchicine and cytochalasin B. Most of mitochondria in the cytoplasm formed cluster-like aggregates before GVBD while they distributed homogeneously after GVBD.
Most mitochondria localized predominantly in the non-cortical region of the cytoplasm of GV stage-oocytes, while the mitochondria-occupied area decreased transiently before GVBD and increased rapidly to occupy the entire area of the cytoplasm at GVBD by some cytoskeleton-dependent mechanism.
mitochondria分布狀況在卵子成熟過程(M1 ->M2)無顯著變化
mitochondria分布主要在細胞核(GV)周圍
J Assist Reprod Genet. 2016 Apr 27. [Epub ahead of print]
Dynamic changes in mitochondrial distribution in human oocytes during meiotic maturation.
Takahashi Y1, Hashimoto S2, Yamochi T1, Goto H1, Yamanaka M1, Amo A1, Matsumoto H1, Inoue M1, Ito K1, Nakaoka Y1, Suzuki N3, Morimoto Y1.
Abstract
PURPOSE:
METHODS:
RESULTS:
CONCLUSIONS:
凍胚植入不需大費周張打一堆針(eg. GnRHa, FSH)
少量施打HCG, estrodiol, progesterone即可達類似懷孕率
The aim of the study was to evaluate two methods of endometrial preparation for frozen-thawed single euploid blastocyst transfer: modified natural and artificial cycle with GnRH-agonist pituitary suppression.
In this prospective, controlled randomized trial, a total of 236 patients undergoing infertility treatment were randomized in 1:1 ratio; 118 received a frozen-thawed single euploid blastocyst transfer in a modified natural cycle and 118 in an artificial cycle with GnRH-agonist pituitary suppression. In the artificial protocol, GnRH-agonist combined with estradiol valerate was administered. In the natural protocol, only final oocyte maturation was induced using human chorionic gonadotropin administration. The primary end-points were the clinical pregnancy and implantation rates; the secondary end-points were the cost-benefit in terms of drug cost and the number of visits and the woman psychological distress caused by the treatment.
No significant differences were found in clinical pregnancy, implantation, and miscarriage rates between protocols. The number of clinical and ultrasound controls and the number of laboratory dosages and venous samplings were similar in both study groups. No significant differences were found between the groups in the anxiety and depression values before the start of treatment, on the days of progesterone administration, the blastocyst transfer, and pregnancy test.
The findings of this study evidence that in case of frozen-thawed single euploid blastocyst transfer, both protocols are equally effective in terms of clinical outcomes, cost-benefit, and patient compliance. The choice of endometrial preparation protocol should be based on women menstrual and ovulatory characteristics or otherwise on patient need for cycle planning.
少量施打HCG, estrodiol, progesterone即可達類似懷孕率
J Assist Reprod Genet. 2016 May 24. [Epub ahead of print]
The endometrial preparation for frozen-thawed euploid blastocyst transfer: a prospective randomized trial comparing clinical results from natural modified cycle and exogenous hormone stimulation with GnRH agonist.
Abstract
PURPOSE:
METHODS:
RESULTS:
CONCLUSIONS:
IVF COH施打破卵針當天約有5% P4上升>2 ng/mL (5.5% in GnRHa trigger vs. 3.1% in hCG trigger)
P4一旦上升, 不論用HCG或GnRHagonist用於破卵均不利於胚胎著床
To compare the effect of P on live birth rate between hCG and GnRH agonist (GnRH-a) trigger cycles.
Retrospective cohort study.
Large private assisted reproductive technology (ART) practice.
A total of 3,326 fresh autologous ART cycles.
None.
Live birth.
A total of 647 GnRH-a trigger cycles were compared with 2,679 hCG trigger cycles. Live birth was negatively associated with P in both the hCG trigger (odds ratio [OR] 0.62, 95% confidence interval [CI] 0.52-0.76) and the agonist trigger cohorts (OR 0.56, 95% CI 0.45-0.69). Interaction testing evaluating P and trigger medication was not significant, indicating that P had a similar negative effect on live birth rates in both cohorts. Progesterone ≥2 ng/mL occurred more commonly in GnRH-a trigger cycles compared with hCG trigger cycles (5.5% vs. 3.1%) and was negatively associated with live birth in both the hCG trigger (OR 0.28, 95% CI 0.11-0.73) and agonist trigger cohorts (OR 0.35, 95% CI 0.14-0.90). When P ≥2 ng/mL, the live birth rates were poor and similar in the hCG and GnRH-a cohorts (5.9% vs. 14.2%), indicating that P ≥2 ng/mL had a similar negative effect on live birth in both cohorts.
Elevated serum P on the day of hCG was negatively associated with live birth rates in both hCG and GnRH-a trigger cycles.
P4一旦上升, 不論用HCG或GnRHagonist用於破卵均不利於胚胎著床
Fertil Steril. 2016 May 10. pii: S0015-0282(16)61116-0. doi: 10.1016/j.fertnstert.2016.04.024. [Epub ahead of print]
Is the effect of premature elevated progesterone augmented by human chorionic gonadotropin versus gonadotropin-releasing hormone agonist trigger?
Abstract
OBJECTIVE:
DESIGN:
SETTING:
PATIENT(S):
INTERVENTION(S):
MAIN OUTCOME MEASURE(S):
RESULT(S):
CONCLUSION(S):
Published by Elsevier Inc.
2-cell胚胎中，胚葉細胞高達43%具多細胞核
4-cell胚胎中，胚葉細胞降為15%具多細胞核
2-cell胚胎具多細胞核, 具自我修復能力，可發展成正常胚胎
懷孕率類似非多核胚胎(46%)
To study the effect of human embryo multinucleation on the rate of aneuploidy, in vitro developmental morphokinetics, and pregnancy outcome.
Retrospective study.
University-affiliated fertility center.
A total of 296 patients undergoing IVF cycles.
None.
Rate of multinucleation at the 2- and 4-cell stage, time-lapse morphokinetic parameters from zygote to blastocyst stage, ploidy of embryos analyzed by means of trophectoderm biopsy and array comparative genomic hybridization (PGS), and pregnancy outcome.
A total of 1,055 out of 2,441 (43.2%) embryos evaluated with the use of the Embryoscope time-lapse system showed blastomere multinucleation at the 2-cell stage (MN2). The frequency of this abnormality was substantially reduced in 4-cell-embryos (15.0%). Among all clinical factors analyzed, only maternal age had a positive correlation with multinucleation rate. The timing of cleavage divisions from the pronuclear fading to 5-cell embryo was significantly longer (1.0-2.5 h) in MN2 embryos than in non-MN2 control samples. Of the total embryos tested with the use of PGS (n = 607), the rates of multinucleation were similar in euploid versus aneuploid blastocysts (40.8% and 46.7%, respectively). All 24 chromosomes contributed to aneuploidy of MN2 embryos. There were 61 transfers of MN2 embryos that resulted in 45.9% clinical pregnancies and a 31.6% implantation rate.
The frequency of multinucleation is high in human embryos cultured in vitro and equally affects euploid and aneuploid human embryos. It appears that most MN embryos have the capacity for self-correction during early cleavage divisions and can develop into euploid blastocysts resulting in healthy babies.
4-cell胚胎中，胚葉細胞降為15%具多細胞核
2-cell胚胎具多細胞核, 具自我修復能力，可發展成正常胚胎
懷孕率類似非多核胚胎(46%)
Fertil Steril. 2016 May 17. pii: S0015-0282(16)61138-X. doi: 10.1016/j.fertnstert.2016.04.041. [Epub ahead of print]
The impact of multinucleated blastomeres on embryo developmental competence, morphokinetics, and aneuploidy.
Abstract
OBJECTIVE:
DESIGN:
SETTING:
PATIENT(S):
INTERVENTION(S):
MAIN OUTCOME MEASURE(S):
RESULT(S):
CONCLUSION(S):
2016年5月21日
囊胚期胚胎, ICM會發展成胎兒, TE cell會發展成胎盤
TE cell 之數量與品質比ICM之數量與品質更能預測胚胎著床率
TE cell 之數量與品質A是男性胎兒機率較高(2.5倍)
J Assist Reprod Genet. 2016 Jan;33(1):49-57. doi: 10.1007/s10815-015-0609-9. Epub 2015 Nov 14.
Prolonged in vitro culture is thought to affect pre- and postnatal development of the embryo. This prospective study was set up to determine whether quality/size of inner cell mass (ICM) (from which the fetus ultimately develops) and trophectoderm (TE) (from which the placenta ultimately develops) is reflected in birth and placental weight, healthy live-birth rate, and gender after fresh and frozen single blastocyst transfer.
In 225 patients, qualitative scoring of blastocysts was done according to the criteria expansion, ICM, and TE appearance. In parallel, all three parameters were quantified semi-automatically.
TE quality and cell number were the only parameters that predicted treatment outcome. In detail, pregnancies that continued on to a live birth could be distinguished from those pregnancies that aborted on the basis of TE grade and cell number. Male blastocysts had a 2.53 higher chance of showing TE of quality A compared to female ones. There was no correlation between the appearance of both cell lineages and birth or placental weight, respectively.
The presented correlation of TE with outcome indicates that TE scoring could replace ICM scoring in terms of priority. This would automatically require a rethinking process in terms of blastocyst selection and cryopreservation strategy.
TE cell 之數量與品質比ICM之數量與品質更能預測胚胎著床率
TE cell 之數量與品質A是男性胎兒機率較高(2.5倍)
J Assist Reprod Genet. 2016 Jan;33(1):49-57. doi: 10.1007/s10815-015-0609-9. Epub 2015 Nov 14.
Quantitative and qualitative trophectoderm grading allows for prediction of live birth and gender.
Ebner T1,2, Tritscher K3, Mayer RB4,5,3,6,7, Oppelt P4,5, Duba HC6, Maurer M6, Schappacher-Tilp G7, Petek E3, Shebl O4,5.
Abstract
PURPOSE:
METHODS:
RESULTS:
CONCLUSIONS:
3原核(3PN)異常胚胎可顯微去除多餘原核
去除多餘原核後之胚胎約13.5%形成囊胚
其中染色體正常律約55%
This study aimed to derive heteroparental normal karyotypic human embryonic stem cells (hESCs) from microsurgically corrected tripronuclear (3PN) zygotes.
After sequential culture for 5-6 days, embryos developed from microsurgically corrected 3PN zygotes were analyzed by fluorescence in situ hybridization (FISH) using probes for chromosomes 17, X and Y. Intact 3PN zygotes from clinical in vitro fertilization (IVF) cycles were cultured as the control group. The inner cell mass (ICM) of blastocysts that developed from microsurgically corrected 3PN zygotes was used to derive hESC lines, and the stem cell characteristics of these lines were evaluated. G-banding analysis was adopted to identify the karyotype of the hESC line, and the heteroparental inheritance of the hESC line was analyzed by DNA fingerprinting analysis.
The blastocyst formation rate (13.5 %) of the microsurgically corrected 3PN zygotes was significantly higher (P < 0.05) than that of intact 3PN zygotes (8.7 %). The diploid rate of the blastocysts (55.0 %) was significantly higher (P < 0.05) than that of the arrested cleavage-stage embryos (18.4 %) in microsurgically corrected 3PN zygotes. The triploid rate of the microsurgically corrected 3PN zygotes (5.7 %) was significantly lower (P < 0.01) than that of intact 3PN zygotes (19.4 %). Furthermore, we established one heteroparental normal karyotypic hESC line from the microsurgically corrected tripronuclear zygotes.
Pronuclear removal can effectively remove the surplus chromosome set of 3PN zygotes. A combination of pronuclear removal and blastocyst culture enables the selection of diploidized blastocysts from which heteroparental normal karyotypic hESC lines can be derived.
去除多餘原核後之胚胎約13.5%形成囊胚
其中染色體正常律約55%
J Assist Reprod Genet. 2016 Feb;33(2):255-63. doi: 10.1007/s10815-015-0634-8. Epub 2016 Jan 4.
Pronuclear removal of tripronuclear zygotes can establish heteroparental normal karyotypic human embryonic stem cells.
Abstract
PURPOSE:
METHODS:
RESULTS:
CONCLUSIONS:
卵丘細胞之粒線體DNA狀況(DNA copy number)與卵細胞之品質呈正相關
The median mtDNA content of CCs for good- and poor-quality embryos was 140 and 57, respectively (p < 0.0001).
The aim of this study was to establish a simple tool to predict good-quality embryos in in vitro fertilization (IVF) by using cumulus cells (CCs) or peripheral blood cells (PBCs).
Mitochondrial DNA was extracted from CCs and PBCs in patients undergoing IVF. Using real-time polymerase chain reaction, mtDNA copy number in a single cell was calculated. Embryo quality was assessed when it was transferred or frozen.
CCs were obtained from 60 oocyte cumulus-cell complexes (OCCCs) in 30 women, and PBCs were collected from 18 women. For the 30 women in the study, the median age was 37 years old (range, 24-43), and the mean body mass index was 21.4 (standard error, 2.0). mtDNA content of CCs and PBCs was highly correlated (Pearson's r = 0.900, p < 0.0001). The median mtDNA content of CCs for good- and poor-quality embryos was 140 and 57, respectively (p < 0.0001). The median mtDNA content of PBCs for good- and poor-quality embryos was 36 and 13, respectively (p = 0.604). The logistic regression model indicated that mtDNA content in CCs was the only parameter that predicted good-quality embryos (p = 0.020). The receiver operating characteristic curve for obtaining good-quality embryos by mtDNA copy number in CCs had an area under the curve of 0.823, and using a threshold of 86, positive and negative predictive values were 84.4 and 82.1 %, respectively.
The determination of mtDNA content in CCs can be used to predict good-quality embryos.
The median mtDNA content of CCs for good- and poor-quality embryos was 140 and 57, respectively (p < 0.0001).
J Assist Reprod Genet. 2016 Mar;33(3):367-71. doi: 10.1007/s10815-015-0621-0. Epub 2016 Jan 9.
Mitochondrial DNA copy number in cumulus cells is a strong predictor of obtaining good-quality embryos after IVF.
Abstract
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METHODS:
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新型玻璃化冷凍配方 vs 傳統玻璃化冷凍配方
hydroxypropyl cellulose 取代 傳統SSS
trehalose 取代 傳統sucrose
懷孕率並無明顯提高
This study aimed to determine whether the new formulation of vitrification solutions containing a combination of hydroxypropyl cellulose (HPC) and trehalose does not affect outcomes in comparison with using conventional solutions made of serum substitute supplement (SSS) and sucrose.
Ovum donation cycles were retrospectively compared regarding the solution used for vitrification and warming of human oocytes. The analysis included 218 cycles (N = 2532 oocytes) in the study group (HPC + trehalose) and 214 cycles (N = 2353 oocytes) in the control group (SSS + sucrose).
No statistical differences were found in ovarian stimulation parameters and baseline characteristics of donors and recipients. The survival rate was 91.3 % (95 % confidence interval (CI) = 89.8-92.9) in the HPC + trehalose group vs. 92.1 % (95 % CI = 90.4-93.7) in the SSS + sucrose group (NS). The implantation rate (42.8 %, 95 % CI = 37.7-47.9 vs. 41.2 %, 95 % CI = 36.0-46.4), clinical pregnancy rate (CPR) per transfer (60.7 %, 95 % CI = 53.9-67.5 vs. 56.4 %, 95 % CI = 49.3-63.5), and ongoing pregnancy rate (OPR) per transfer (48.5 %, 95 % CI = 41.5-55.5 vs. 46.3 %, 95 % CI = 39.2-53.4) were similar for patients who received either HPC + trehalose-vitrified oocytes or SSS + sucrose-vitrified oocytes. Statistical differences were found when analyzing blastocyst rate both per injected oocyte (30.2 %, 95 % CI = 28.3-32.1 vs. 24.1 %, 95 % CI = 22.3-25.9) and per fertilized oocyte (40.8 %, 95 %CI = 38.5-43.1 vs. 33.2 %, 95 % CI = 30.8-35.5) (P < 0.0001). Delivery rate was comparable between groups (37.2 %, 95 % CI = 30.8-46.6 vs. 36.9 %, 95 % CI = 30.4-43.4; NS).
Our data demonstrate that HPC and trehalose are suitable and safe substitutes for serum and sucrose. Therefore, the new commercial media can be used efficiently in the vitrification of human oocytes avoiding viral and endotoxin contamination risk.
hydroxypropyl cellulose 取代 傳統SSS
trehalose 取代 傳統sucrose
懷孕率並無明顯提高
J Assist Reprod Genet. 2016 Mar;33(3):413-21. doi: 10.1007/s10815-015-0633-9. Epub 2016 Jan 11.
A combination of hydroxypropyl cellulose and trehalose as supplementation for vitrification of human oocytes: a retrospective cohort study.
Abstract
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METHODS:
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IMSI vs ICSI, IMSI並無法明顯提高懷孕率
implantation (12 vs 10 %), clinical pregnancy (23 vs 21 %), or live birth rates (20 vs 19 %).
Assessment of sperm morphology has been reconsidered since 2001 with the development of motile sperm organelle morphology examination (MSOME). This observation technique that combines high magnification microscopy and the Nomarski interference contrast makes it possible to select spermatozoa with as few vacuoles as possible before microinjection into the oocyte (intracytoplasmic morphologically selected sperm injection, IMSI). More than 10 years after the development of IMSI, the indications of the IMSI technique and its ability to increase pregnancy and/or birthrates (compared with conventional ICSI) are still subject to debate. We aimed to better define the interest of IMSI in the third attempt.
We assessed the benefit of IMSI by carrying out a retrospective comparative study between IMSI and conventional ICSI during a third ART attempt. Two hundred sixteen couples with two previous ICSI failures were studied between February 2010 and June 2014.
IMSI did not significantly improve the clinical outcomes compared with ICSI, either for implantation (12 vs 10 %), clinical pregnancy (23 vs 21 %), or live birth rates (20 vs 19 %).
This study provides supplementary arguments for not achieving IMSI procedure in the third attempt after two previous ICSI failures.
implantation (12 vs 10 %), clinical pregnancy (23 vs 21 %), or live birth rates (20 vs 19 %).
J Assist Reprod Genet. 2016 Mar;33(3):349-55. doi: 10.1007/s10815-015-0645-5. Epub 2016 Jan 11.
Intracytoplasmic morphologically selected sperm injection (IMSI) does not improve outcome in patients with two successive IVF-ICSI failures.
Abstract
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METHODS:
RESULTS:
CONCLUSION:
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