Int J Fertil Steril. 2017 Apr-Jun;11(1):28-32. Epub 2016 Nov 11.
2017年5月25日
使用pill & 較早初經可能造成近更年期時AMH較低
Infertility is one of the major social issues. Due to the asymptomatic cervical infection associated with Staphylococcus aureus (S. aureus), the majority of patients remain undiagnosed. The present study intended to assess the frequency of S. aureus isolated from infertile women's endocervix in northwest Iran.
In a descriptive cross sectional study, specimens were randomly collected during vagina examination using a sterile speculum and swabbing. After performance of antibiotic susceptibility testing, polymerase chain reaction (PCR) was used to identify methicillin-resistance S. aureus (MRSA) and toxic shock syndrome toxin-1 (TSST-1).
About 26 (26%) and 9 (9%) women's urogenital tracts were colonized by S. aureus and Candida spp., respectively, of which three (11.5%) patients were infected with fungi and S. aureus, simultaneously. Antibiotic susceptibility results showed high activity of vancomycin and co-trimoxazole on isolates. Regarding PCR results, mecA sequences were detected in 7 (26.9%) strains, whilst the tst gene encoding TSST-1 was not detected in any of clinical strains.
The prevalence of S. aureus was very high in infertile women. Therefore, it demands all patients undergoing infertility treatment to be investigated thoroughly for this type of infection.
不孕症常合併生殖道(子宮頸內)金黃色葡糖球菌之高感染率
Infertility is one of the major social issues. Due to the asymptomatic cervical infection associated with Staphylococcus aureus (S. aureus), the majority of patients remain undiagnosed. The present study intended to assess the frequency of S. aureus isolated from infertile women's endocervix in northwest Iran.
In a descriptive cross sectional study, specimens were randomly collected during vagina examination using a sterile speculum and swabbing. After performance of antibiotic susceptibility testing, polymerase chain reaction (PCR) was used to identify methicillin-resistance S. aureus (MRSA) and toxic shock syndrome toxin-1 (TSST-1).
About 26 (26%) and 9 (9%) women's urogenital tracts were colonized by S. aureus and Candida spp., respectively, of which three (11.5%) patients were infected with fungi and S. aureus, simultaneously. Antibiotic susceptibility results showed high activity of vancomycin and co-trimoxazole on isolates. Regarding PCR results, mecA sequences were detected in 7 (26.9%) strains, whilst the tst gene encoding TSST-1 was not detected in any of clinical strains.
The prevalence of S. aureus was very high in infertile women. Therefore, it demands all patients undergoing infertility treatment to be investigated thoroughly for this type of infection.
Int J Fertil Steril. 2017 Apr-Jun;11(1):28-32. Epub 2016 Nov 11.
The Frequency of Staphylococcus aureus Isolated from Endocervix of Infertile Women in Northwest Iran.
Abstract
BACKGROUND:
MATERIALS AND METHODS:
RESULTS:
CONCLUSION:
AMH<1.6 懷孕率明顯下降
Reduced ovarian reserve predicts poor ovarian response and poor suc- cess rates in infertile women who undergo assisted reproductive technology (ART). Ovarian reserve also decreases with age but the rate of decline varies from one woman to another. This study aims to detect differences in ovarian reserve as measured by basal serum follicle stimulating hormone (FSH) and anti-Müllerian hormone (AMH) between a matched cohort of fertile and infertile regularly menstruating women, 18-45 years of age.
This case-control study involved 64 fertile and 64 subfertile women matched by age at recruitment. Peripheral blood samples were taken from the women recruited from the Gynecological and Outpatient Clinics of Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria. Serum FSH and AMH were quantified using ELISA at the Metabolic Research Laboratory of LAUTECH Teaching Hospital, Ogbomoso, Nigeria.
A significant difference existed in the mean FSH of fertile (6.97 ± 3.34) and infertile (13.34 ± 5.24, P=0.013) women. We observed a significant difference in AMH between fertile (2.71 ± 1.91) and infertile (1.60 ± 2.51, P=0.029) women. There was a negative correlation between FSH and AMH in both fertile (r=-0.311, P=0.01) and infertile (r=-0.374, P=0.002) women.
The difference in ovarian reserve observed in this study suggests that reduced ovarian reserve in regularly menstruating women may be associated with early ovarian ageing or subfertility.
Int J Fertil Steril. 2017 Apr-Jun;11(1):33-39. Epub 2016 Nov 11.
Follicle Stimulating Hormone and Anti-Müllerian Hormone among Fertile and Infertile Women in Ile-Ife, Nigeria: Is there A Difference?
Abstract
BACKGROUND:
MATERIALS AND METHODS:
RESULTS:
CONCLUSION:
PGS單一切片TE cell 無法代表ICM之染色體狀況
假陽性反應之PGS會捨棄相當數量日後正常之胚胎
囊胚期胚胎著床後仍具自我修復功能
本篇強烈質疑PGS對提升IVF懷孕率之必要性
The hypothesis of preimplantation genetic diagnosis (PGS) was first proposed 20 years ago, suggesting that elimination of aneuploid embryos prior to transfer will improve implantation rates of remaining embryos during in vitro fertilization (IVF), increase pregnancy and live birth rates and reduce miscarriages. The aforementioned improved outcome was based on 5 essential assumptions: (i) Most IVF cycles fail because of aneuploid embryos. (ii) Their elimination prior to embryo transfer will improve IVF outcomes. (iii) A single trophectoderm biopsy (TEB) at blastocyst stage is representative of the whole TE. (iv) TE ploidy reliably represents the inner cell mass (ICM). (v) Ploidy does not change (i.e., self-correct) downstream from blastocyst stage. We aim to offer a review of the aforementioned assumptions and challenge the general hypothesis of PGS. We reviewed 455 publications, which as of January 20, 2017 were listed in PubMed under the search phrase < preimplantation genetic screening (PGS) for aneuploidy>. The literature review was performed by both authors who agreed on the final 55 references. Various reports over the last 18 months have raised significant questions not only about the basic clinical utility of PGS but the biological underpinnings of the hypothesis, the technical ability of a single trophectoderm (TE) biopsy to accurately assess an embryo's ploidy, and suggested that PGS actually negatively affects IVF outcomes while not affecting miscarriage rates. Moreover, due to high rates of false positive diagnoses as a consequence of high mosaicism rates in TE, PGS leads to the discarding of large numbers of normal embryos with potential for normal euploid pregnancies if transferred rather than disposed of. We found all 5 basic assumptions underlying the hypothesis of PGS to be unsupported: (i) The association of embryo aneuploidy with IVF failure has to be reevaluated in view how much more common TE mosaicism is than has until recently been appreciated. (ii) Reliable elimination of presumed aneuploid embryos prior to embryo transfer appears unrealistic. (iii) Mathematical models demonstrate that a single TEB cannot provide reliable information about the whole TE. (iv) TE does not reliably reflect the ICM. (v) Embryos, likely, still have strong innate ability to self-correct downstream from blastocyst stage, with ICM doing so better than TE. The hypothesis of PGS, therefore, no longer appears supportable. With all 5 basic assumptions underlying the hypothesis of PGS demonstrated to have been mistaken, the hypothesis of PGS, itself, appears to be discredited. Clinical use of PGS for the purpose of IVF outcome improvements should, therefore, going forward be restricted to research studies.
假陽性反應之PGS會捨棄相當數量日後正常之胚胎
囊胚期胚胎著床後仍具自我修復功能
本篇強烈質疑PGS對提升IVF懷孕率之必要性
J Ovarian Res. 2017 Mar 27;10(1):21. doi: 10.1186/s13048-017-0318-3.
Is the hypothesis of preimplantation genetic screening (PGS) still supportable? A review.
Abstract
44歲以上高齡之IVF囊胚染色體正常率僅11.8% (22 of 187)
To report laboratory and clinical outcomes in preimplantation genetic diagnosis for aneuploidies (PGD-A) cycles for women 44 to 47 years old.
Multicenter, longitudinal, observational study.
In vitro fertilization (IVF) centers.
One hundred and thirty-seven women aged 44.7 ± 0.7 years (range: 44.0-46.7) undergoing 150 PGD-A cycles during April 2013 to January 2016.
Quantitative polymerase chain reaction-based PGD-A on trophectoderm biopsies and cryopreserved euploid single-embryo transfer (SET).
Primary outcome measure: delivery rate per cycle; secondary outcome measures: miscarriage rate, and the rate and reasons for cycle cancelation with subanalyses for female age and number of metaphase 2 oocytes retrieved.
In 102 (68.0%) of 150 cycles blastocyst development was obtained, but only 21 (14.0%) were euploid blastocysts. The overall euploidy rate was 11.8% (22 of 187). Twenty-one SET procedures were performed, resulting in 13 clinical pregnancies, of which 1 miscarried and 12 delivered. The delivery rate was 57.1% per transfer, 8.0% per cycle, and 8.8% per patient. The logistic regression analysis found that only female age (odds ratio 0.78) and number of metaphase 2 oocytes retrieved (odds ratio 1.25) statistically significantly correlated with the likelihood of delivery. The delivery rate per cycle was 10.6% (11 of 104) in patients aged 44.0 to 44.9 years and 2.6% in patients aged 45.0 to 45.9 years (n = 1 of 38). No euploid blastocysts were found for patients older than 45.0 years.
Extensive counseling based on biological and clinical data should be provided to women older than 43 years who are requesting IVF because of their very low odds of success and high risk for embryonic aneuploidies. Nevertheless, the low miscarriage and good delivery rates reported in this study in women with good ovarian reserve aged 44 should encourage the use of PGD-A in this population.
Fertil Steril. 2017 May;107(5):1173-1180. doi: 10.1016/j.fertnstert.2017.03.007. Epub 2017 Apr 19.
Preimplantation genetic diagnosis for aneuploidy testing in women older than 44 years: a multicenter experience.
Ubaldi FM1, Cimadomo D2, Capalbo A3, Vaiarelli A4, Buffo L5, Trabucco E6, Ferrero S7, Albani E8, Rienzi L3, Levi Setti PE8.
Abstract
OBJECTIVE:
DESIGN:
SETTING:
PATIENT(S):
INTERVENTION(S):
MAIN OUTCOMES MEASURE(S):
RESULT(S):
CONCLUSION(S):
2017年5月24日
本篇case report質疑PGS單一切片細胞之準確性
植入8個染色體異常之囊胚, 居然高達5個胎兒日後證實染色體正常
PGS假陽性(染色體異常)比率可能比想像中高
單一位置切片細胞無法代表全體囊胚細胞之染色體狀況
囊胚染色體異常與正常細胞共存之比例可能比想像中高
染色體異常與正常細胞共存下細胞有競合之關係,
物競天擇下, 染色體異常細胞可能會自行淘汰
To preclude transfer of aneuploid embryos, current preimplantation genetic screening (PGS) usually involves one trophectoderm biopsy at blastocyst stage, assumed to represent embryo ploidy. Whether one such biopsy can correctly assess embryo ploidy has recently, however, been questioned.
This descriptive study investigated accuracy of PGS in two ways. Part I: Two infertile couples donated 11 embryos, previously diagnosed as aneuploid and, therefore, destined to be discarded. They were dissected into 37 anonymized specimens, and sent to another national laboratory for repeat analyses to assess (i) inter-laboratory congruity and (ii) intra-embryo congruity of multiple embryo biopsies in a single laboratory. Part II: Reports on human IVF cycle outcomes after transfer of allegedly aneuploid embryos into 8 infertile patients.
Only 2/11 (18.2 %) embryos were identically assessed at two PGS laboratories; 4/11 (36.4 %), on repeat analysis were chromosomally normal, 2 mosaic normal/abnormal, and 5/11 (45.5 %) completely differed in reported aneuploidies. In intra-embryo analyses, 5/10 (50 %) differed between biopsy sites. Eight transfers of previously reported aneuploid embryos resulted in 5 chromosomally normal pregnancies, 4 delivered and 1 ongoing. Three patients did not conceive, though 1 among them experienced a chemical pregnancy.
Though populations of both study parts are too small to draw statistically adequately powered conclusions on specific degrees of inaccuracy of PGS, here presented results do raise concerns especially about false-positive diagnoses. While inter-laboratory variations may at least partially be explained by different diagnostic platforms utilized, they cannot explain observed intra-embryo variations, suggesting more frequent trophectoderm mosiaicsm than previously reported. Together with recentl published mouse studies of lineages-specific degrees of survival of aneuploid cells in early stage embryos, these results call into question the biological basis of PGS, based on the assumption that a single trophectoderm biopsy can reliably determine embryo ploidy.
植入8個染色體異常之囊胚, 居然高達5個胎兒日後證實染色體正常
PGS假陽性(染色體異常)比率可能比想像中高
單一位置切片細胞無法代表全體囊胚細胞之染色體狀況
囊胚染色體異常與正常細胞共存之比例可能比想像中高
染色體異常與正常細胞共存下細胞有競合之關係,
物競天擇下, 染色體異常細胞可能會自行淘汰
Reprod Biol Endocrinol. 2016 Sep 5;14(1):54. doi: 10.1186/s12958-016-0193-6.
Accuracy of preimplantation genetic screening (PGS) is compromised by degree of mosaicism of human embryos.
Gleicher N1,2,3, Vidali A4,5, Braverman J6, Kushnir VA4,7, Barad DH4,8,9, Hudson C4, Wu YG4, Wang Q4, Zhang L4, Albertini DF4,10; International PGS Consortium Study Group.
Abstract
BACKGROUND:
METHODS:
RESULTS:
CONCLUSIONS:
囊胚期內細胞體ICM呈現較鬆散細胞結合之囊胚, 植入後較易形成同卵雙胞胎
To examine the relationship between the inner cell mass (ICM) grade and its morphological configuration on the occurrence of monochorionic diamniotic (M-D) twinning.
Retrospective embryo cohort study.
Private IVF clinic.
Evaluation of frozen-thawed single blastocyst transfers with hormone replacement treatment in 8,435. This cohort included 71 blastocysts and their ICMs observed by time-lapse photography.
Any changes in configuration of the ICMs observed by time-lapse photography were analyzed retrospectively.
The amount of loosening of blastomeres within the ICM was evaluated by time-lapse observations. The number of cells that were involved in the loosening process was also assessed. Both of these parameters were correlated with the type of monozygotic twinning that eventuated.
The M-D twinning incidence resulting from blastocysts with a high grade ICM (grade A) were transferred was 0.38% (3/796), whereas it was significantly higher, 1.38% (34/2,463), when blastocysts with a poorer (B and C) grade ICM were transferred. Among 71 transferred frozen-thawed blastocysts that were studied with time-lapse photography, there were two dichorionic diamniotic and one M-D twins. Careful observations of the embryo that resulted in the one M-D case, revealed that the ICM acquired a looser appearance due to decompaction of at least eight cells. This type of decompaction was not observed in the ICMs of other transferred blastocysts.
The occurrence of M-D twinning may be avoided by excluding blastocysts that contain decompacting ICMs.
Fertil Steril. 2016 Sep 1;106(3):640-4. doi: 10.1016/j.fertnstert.2016.05.007. Epub 2016 Jun 2.
Grade and looseness of the inner cell mass may lead to the development of monochorionic diamniotic twins.
Abstract
OBJECTIVE:
DESIGN:
SETTING:
PATIENT(S):
INTERVENTION(S):
MAIN OUTCOME MEASURE(S):
RESULT(S):
CONCLUSION(S):
使用類固醇對胚胎著床率無明顯提升作用
To evaluate clinical pregnancy rates in embryo transfer (ET) cycles with and without peri-implantation corticosteroid and oral antibiotic administration.
Retrospective cohort study.
University-affiliated in vitro fertilization (IVF) clinic.
Eight hundred and seventy-six ETs with or without the routine use of methylprednisolone and doxycycline.
Embryo transfer procedures.
Clinical pregnancy rates (CPR).
The CPR with the routine use of methylprednisolone and doxycycline was 56.1% compared with 61.5% after discontinuation of these medications. Ongoing pregnancy rates were 49.5% with medications versus 53.2% without medications. Of the cleavage-stage embryos, 79% underwent assisted hatching; among these, the CPR was 28.7% when treated with corticosteroids and antibiotics compared with 47.4% without medications.
No statistically significant difference in overall IVF outcomes was noted after the discontinuation of routine peri-implantation corticosteroids and antibiotics. The use of these medications varies across the country and may be a result of habit rather than evidence-based medicine.
Fertil Steril. 2017 May 10. pii: S0015-0282(17)30307-2. doi: 10.1016/j.fertnstert.2017.04.003. [Epub ahead of print]
Old habits die hard: retrospective analysis of outcomes with use of corticosteroids and antibiotics before embryo transfer.
Abstract
OBJECTIVE:
DESIGN:
SETTING:
PATIENT(S):
INTERVENTION(S):
MAIN OUTCOME MEASURE(S):
RESULT(S):
CONCLUSION(S):
2017年5月23日
Day 1單原核1PN之胚胎染色體正常比率僅17%
形成囊胚之比例<5%
The purpose of this study was to investigate the chromosomal constitution and the developmental potential of intracytoplasmic sperm injection (ICSI) deriving embryos displaying a single pronucleus at the zygote stage.
Eighty-eight embryos from single pronucleus (1PN) two polar bodies (2PB) ICSI zygotes from 64 preimplantational genetic screening (PGS) cycles (October 2012-December 2014), were retrospectively analyzed. Zygotes were cultured in a time-lapse incubator. Embryo biopsy was performed on day 3 and genetic analysis approached by array comparative genomic hybridization.
Chromosomal analysis revealed that 17% (15/88) of embryos derived from 1PN 2PB zygotes were diagnosed as euploid. After blastomere biopsy at day 3, the blastocyst rate at day 5 was 3.4% (3/88). Only 2.3% (2/88) euploid blastocysts were obtained. In two couples and after counseling and patient agreement, the transfer of a euploid blastocyst from a 1PN 2PB ICSI zygote was performed resulting in the birth of a healthy child.
These results open the possibility to consider embryos coming from 1PN 2PB ICSI zygotes for transfer when no other embryos from 2PN 2PB ICSI zygotes are available and if a PGS diagnosis of euploidy is obtained. Confirmation of biparental inheritance is strongly recommended.
形成囊胚之比例<5%
J Assist Reprod Genet. 2017 May 11. doi: 10.1007/s10815-017-0937-z. [Epub ahead of print]
Could monopronucleated ICSI zygotes be considered for transfer? Analysis through time-lapse monitoring and PGS.
Abstract
PURPOSE:
METHODS:
RESULTS:
CONCLUSIONS:
2017年5月20日
封閉型冷凍載具懷孕率還是略低於開放型冷凍載具
Closed vitrification can minimize the risk of microbiological transmission through liquid nitrogen during the cooling, storage, and warming procedures. As cooling rates may reduce when closed vitrification is applied, clinical outcomes should be compared between closed and open vitrification in order to justify the use of closed vitrification. This study was conducted to investigate the differences in survival, implantation, clinical pregnancy, and live birth rates between closed and open vitrification for human blastocyst cryopreservation. This systematic review and meta-analysis included 7 studies that reported survival, implantation, clinical pregnancy, or live birth rates following closed or open vitrification. There were no statistically significant differences in survival rates (risk ratio [RR]: 1.00, 95% confidence interval [CI]: 0.98-1.02), implantation rates (RR: 1.02, 95% CI: 0.93-1.11), clinical pregnancy rates (RR: 0.99, 95% CI: 0.89-1.10), and live birth rates (RR: 0.77, 95% CI: 0.58-1.03) between closed and open vitrification. Although there was no statistical significance, the tendency of lower live birth rates with closed vitrification than with open vitrification could be clearly identified. Therefore, it is not yet possible to conclude that closed vitrification clearly provides an aseptic alternative to open vitrification in human blastocyst cryopreservation.
Cryobiology. 2017 May 15. pii: S0011-2240(17)30067-6. doi: 10.1016/j.cryobiol.2017.05.006. [Epub ahead of print]
Closed versus open vitrification for human blastocyst cryopreservation: A meta-analysis.
Abstract
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