異常原核胚胎(1PN, 3PN), 若成長到囊胚，仍有69-85%染色體正常
1PN有69%染色體正常
3PN有85%染色體正常

Fertil Steril. 2017 Sep 15. pii: S0015-0282(17)31699-0. doi: 10.1016/j.fertnstert.2017.08.004. [Epub ahead of print]

Abnormally fertilized oocytes can result in healthy live births: improved genetic technologies for preimplantation genetic testing can be used to rescue viable embryos in in vitro fertilization cycles.

Capalbo A1, Treff N2, Cimadomo D3, Tao X2, Ferrero S4, Vaiarelli A4, Colamaria S4, Maggiulli R4, Orlando G4, Scarica C4, Scott R2, Ubaldi FM5, Rienzi L5.

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Abstract

OBJECTIVE:

To test whether abnormally fertilized oocyte (AFO)-derived blastocysts are diploid and can be rescued for clinical use.

DESIGN:

Longitudinal-cohort study from January 2015 to September 2016 involving IVF cycles with preimplantation genetic testing for aneuploidy (PGT-A). Ploidy assessment was incorporated whenever a blastocyst from a monopronuclear (1PN) or tripronuclear zygote (2PN + 1 smaller PN; 2.1 PN) was obtained.

SETTING:

Private IVF clinics and genetics laboratories.

PATIENT(S):

A total of 556 women undergoing 719 PGT-A cycles.

INTERVENTION(S):

Conventional chromosome analysis was performed on trophectoderm biopsies by quantitative polymerase chain reaction. For AFO-derived blastocysts, ploidy assessment was performed on the same biopsy with the use of allele ratios for hetorozygous SNPs analyzed by means of next-generation sequencing (1:1 = diploid; 2:1 = triploid; loss of heterozygosity = haploid). Balanced-diploid 1PN- and 2.1PN-derived blastocysts were transferred in the absence of normally fertilized transferable embryos.

MAIN OUTCOME MEASURE(S):

Ploidy constitution and clinical value of AFO-derived blastocysts in IVF PGT-A cycles.

RESULT(S):

Of the 5,026 metaphase II oocytes injected, 5.2% and 0.7% showed 1PN and 2.1PN, respectively. AFOs showed compromised embryo development (P<.01). Twenty-seven AFO-derived blastocysts were analyzed for ploidy constitution. The 1PN-derived blastocysts were mostly diploid (n = 9/13; 69.2%), a few were haploid (n = 3/13; 23.1%), and one was triploid (n = 1/13; 7.7%). The 2.1PN-derived blastocysts were also mostly diploid (n = 12/14; 85.7%), and the remainder were triploid. Twenty-six PGT-A cycles resulted in one or more AFO-derived blastocysts (n = 26/719; 3.6%). Overall, eight additional balanced-diploid transferable embryos were obtained from AFOs. In three cycles, the only balanced-diploid blastocyst produced was from an AFO (n = 3/719; 0.4%). Three AFO-derived live births were achieved: one from a 1PN zygote and two from 2.1PN zygotes.

CONCLUSION(S):

Enhanced PGT-A technologies incorporating reliable ploidy assessment provide an effective tool to rescue AFO-derived blastocysts for clinical use.

胚胎植入管距離子宮頂之最佳距離 1.5cm 可達最高著床率

J Hum Reprod Sci. 2017 Apr-Jun;10(2):102-107. doi: 10.4103/jhrs.JHRS_54_15.

Correlation of Site of Embryo Transfer with IVF Outcome: Analysis of 743 Cycles from a Single Center.

Singh N1, Lata K1, Malhotra N1, Vanamail P1.

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Abstract

OBJECTIVE:

To investigate the influence of site of embryo transfer (ET) on reproductive outcome.

MATERIALS AND METHODS:

A retrospective analysis of 743 ultrasound-guided ET in fresh in vitro fertilization (IVF) cycles from a single center over a period of 4 years was conducted. The distance between the fundal endometrial surface and the air bubble was measured, and accordingly, patients were divided into four groups (≤10 mm; >10 and ≤15 mm; >15 and 20 mm; >20 and <25 mm).

SETTING:

Tertiary Assisted Reproductive Technology (ART) center.

PATIENTS:

All patients enrolled in the IVF program undergoing ET.

INTERVENTIONS:

Controlled ovarian hyperstimulation (OS), IVF, and ET.

MAIN OUTCOME MEASURES:

Cleavage rate and clinical pregnancy rate.

RESULTS:

Clinical pregnancy rate was significantly more in groups 2 and 3 compared to the other groups. Logistic regression analysis showed that one unit increase in embryos transfer will enhance the pregnancy outcome about 3.7 (adjusted odds ratio) times with 95% confidence limits 2.6 to 5.4. Similarly, pregnancy outcome will be 3.1 (95% confidence limits: 1.5-6.4) times higher for distance group >15 and <20 mm compared to less than 10-mm distance group. Ectopic pregnancy rates were similar in all the four groups.

CONCLUSION:

The present study demonstrates that site of ET has significant difference on reproductive outcome.

Letrozole 比傳統排卵藥clomid更能提高多囊性卵巢PCO病患之懷孕率(61% vs 43%)

Hum Reprod. 2017 Aug 1;32(8):1631-1638. doi: 10.1093/humrep/dex227.

Double-blind randomized controlled trial of letrozole versus clomiphene citrate in subfertile women with polycystic ovarian syndrome.

Amer SA1, Smith J2, Mahran A1,3, Fox P4, Fakis A2.

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Abstract

STUDY QUESTION:

Would letrozole as a primary ovulation induction agent generate better pregnancy rates than clomiphene citrate (CC) in subfertile women with anovulatory polycystic ovarian syndrome (PCOS)?

SUMMARY ANSWER:

Participants receiving letrozole as a primary treatment achieved a significantly (P = 0.022) higher clinical pregnancy rate per patient (61.2%) compared to CC (43.0%).

WHAT IS KNOWN ALREADY:

According to a recent Cochrane systematic review (2014), letrozole appears to improve live-birth (LB) and pregnancy rates in anovulatory women with PCOS, compared to CC. However, the review concluded that the quality of evidence was low due to poor reporting of study methods and possible publication bias.

STUDY DESIGN, SIZE, DURATION:

This double-blind randomized controlled trial (RCT) included 159 participants between April 2007 and June 2014. Subjects were randomly allocated to either CC (n = 79) or letrozole (n = 80) in a 1:1 ratio. Both drugs were encapsulated to look identical. Randomization was performed in mixed blocks and stratified by patients' BMI (<30 and 30-35 kg/m2).

PARTICIPANTS/MATERIALS, SETTING, METHODS:

The trial included subfertile women diagnosed with PCOS. Treatment started with one tablet (CC 50 mg, letrozole 2.5 mg) increasing to two in non-responders and continuing until pregnancy or for up to six ovulatory cycles. Non-responders were crossed over to the other treatment after a 6-week break. Cycles were initially monitored with ultrasound follicle tracking then mid-luteal serum progesterone measurement in subsequent cycles.

MAIN RESULTS AND THE ROLE OF CHANCE:

Amongst the 159 participants included in the intention-to-treat analysis, four women conceived before treatment and six were lost-to-follow-up. The remaining 149 participants (74 on CC and 75 on letrozole) completed at least the first treatment. Women receiving letrozole achieved a significantly (P = 0.022; absolute difference [95% confidence interval] 18% [3-33%]) higher pregnancy rate (61.%) than those on CC (43%). The median number of treatment cycles received until pregnancy was significantly (log rank P = 0.038) smaller with letrozole (4[3-5] cycles) compared to CC (6[4-7] cycles). LB rates were not statistically (P = 0.089) different between the two groups, although there was a trend towards higher rates on letrozole (48.8%) compared to CC (35.4%). After the crossover, pregnancy and LB rates on le

胚胎輔助孵化對懷孕率沒有特別助益
對高齡，凍胚也沒有特別助益

Fertil Steril. 2017 Aug 29. pii: S0015-0282(17)30531-9. doi: 10.1016/j.fertnstert.2017.07.011. [Epub ahead of print]

Assisted hatching and live births in first-cycle frozen embryo transfers.

Knudtson JF1, Failor CM2, Gelfond JA3, Goros MW3, Chang TA2, Schenken RS2, Robinson RD2.

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Abstract

OBJECTIVE:

To assess the effect of assisted hatching (AH) on live-birth rates in a retrospective cohort of patients undergoing first-cycle, autologous frozen embryo transfer (FET).

DESIGN:

Longitudinal cohort using cycles reported to the Society for Assisted Reproductive Technology Clinic Outcomes Reporting System between 2004 and 2013.

SETTING:

Not applicable.

PATIENT(S):

Women who underwent first-cycle, autologous FET with (n = 70,738) and without (n = 80,795) AH reported from 2004 to 2013.

INTERVENTION(S):

None.

MAIN OUTCOME MEASURE(S):

Live births.

RESULT(S):

Propensity matching was used to account for confounding covariates, and a logistic regression model was constructed to identify the predictors of live-birth rates in relationship to AH. In all first-cycle FETs, there was a slight but statistically significant decrease in the live-birth rate with AH compared with no AH (34.2% vs. 35.4%). In older patients and in the years 2012-2013 AH was associated with decreased live births. Live-birth rates and the number of AH cycles performed before FET vary by the geographic location of clinics.

CONCLUSION(S):

Assisted hatching slightly decreases the live-birth rate in first-cycle, autologous FET. Its use should be carefully considered, especially in patients 38 years old and older. Prospective, clinical studies are needed to improve our knowledge of the impact of AH.

AMH下降, 胚胎植入後流產率上升

Fertil Steril. 2017 Sep;108(3):518-524. doi: 10.1016/j.fertnstert.2017.07.001.

Serum antimüllerian hormone levels are independently related to miscarriage rates after in vitro fertilization-embryo transfer.

Tarasconi B1, Tadros T2, Ayoubi JM2, Belloc S2, de Ziegler D2, Fanchin R3.

Author information

Abstract

OBJECTIVE:

To investigate whether serum antimüllerian hormone (AMH) levels are independently related to miscarriage rates after in vitro fertilization-embryo transfer (IVF-ET).

DESIGN:

Cohort study.

SETTING:

University-affiliated IVF-ET center.

PATIENT(S):

A total of 1,060 patients who attained a clinical pregnancy after IVF-ET.

INTERVENTIONS(S):

Centralized serum AMH measurements were performed within the 12 months before IVF-ET. Binary logistic regression was used to verify whether serum AMH levels were associated with the occurrence of a miscarriage independently from confounding factors, such as age and intensity of ovarian response to controlled ovarian stimulation assessed by the number of oocytes retrieved.

MAIN OUTCOME MEASURE(S):

Miscarriage rates.

RESULT(S):

In patients displaying reduced serum AMH levels, miscarriage rates were significantly increased independently from age and the number of oocytes retrieved.

CONCLUSION(S):

The present data indicate that serum AMH levels are independently associated with the occurrence of a miscarriage after IVF-ET.

子宮腺肌症對於試管胚胎著床有不良影響

Fertil Steril. 2017 Sep;108(3):483-490.e3. doi: 10.1016/j.fertnstert.2017.06.025.

Effects of adenomyosis on in vitro fertilization treatment outcomes: a meta-analysis.

Abstract

OBJECTIVE:

To systematically review and summarize the existing evidence related to the effect of adenomyosis on fertility and on in vitro fertilization (IVF) clinical outcomes, and to explore the effects of surgical or medical treatments.

DESIGN:

Meta-analysis.

SETTING:

Not applicable.

PATIENT(S):

An electronic-based search was performed with the use of the following databases: Pubmed, Embase, Ovid Medline, Cochrane Central Register of Controlled Trials, and Google Scholar, identifying all related articles up to November 2016. We included 11 comparative studies that evaluated the clinical outcomes of IVF treatments in women with (519 patients) and without (1,535 patients) adenomyosis diagnosed with the use of magnetic resonance imaging or transvaginal ultrasound. We also separately evaluated four articles comparing fertility outcomes in two groups of infertile adenomyotic patients untreated and treated surgically or medically with the use of GnRH agonist (GnRHa).

INTERVENTION(S):

None.

MAIN OUTCOME MEASURE(S):

Primary outcome: clinical pregnancy rate after IVF.

SECONDARY OUTCOMES:

rates of implantation, ongoing pregnancy, live birth, miscarriage, and ectopic pregnancy. The summary measures were expressed as odds ratio (OR) and 95% confidence interval (CI).

RESULT(S):

The rates of implantation, clinical pregnancy per cycle, clinical pregnancy per embryo transfer, ongoing pregnancy, and live birth among women with adenomyosis were significantly lower than in those without adenomyosis. The miscarriage rate in women with adenomyosis was higher than in those without adenomyosis. It appears that surgical treatment or treatment withf GnRHa increases the spontaneous pregnancy rate in women with adenomyosis.

CONCLUSION(S):

Adenomyosis has a detrimental effect on IVF clinical outcomes. Pretreatment with the use of long-term GnRHa or long protocol could be beneficial.