凍卵vs新鮮卵
凍卵受孕後分裂速度略慢1 hour
凍卵受孕後囊胚植入後著床率降5%

Fertil Steril. 2017 Sep;108(3):491-497.e3. doi: 10.1016/j.fertnstert.2017.06.024.

Effect of oocyte vitrification on embryo quality: time-lapse analysis and morphokinetic evaluation.

Cobo A1, Coello A2, Remohí J2, Serrano J2, de Los Santos JM2, Meseguer M2.

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Abstract

OBJECTIVE:

To analyze whether oocyte vitrification may affect subsequent embryo development from a morphokinetic standpoint by means of time-lapse imaging.

DESIGN:

Observational cohort study.

SETTING:

University-affiliated private IVF center.

PATIENT(S):

Ovum donation cycles conducted with the use of vitrified (n = 631 cycles; n = 3,794 embryos) or fresh oocytes (n = 1,359 cycles; n = 9,935 embryos) over 2 years.

INTERVENTIONS(S):

None.

MAIN OUTCOME MEASURE(S):

Embryo development was analyzed in a time-lapse imaging incubator. The studied variables included time to 2 cells (t2), 3 cells (t3), 4 cells (t4), 5 cells (t5), morula (tM), and cavitated, early, and hatching blastocyst (tB, tEB, tHB) as well as 2nd cell cycle duration (cc2 = t3 - t2). All of the embryos were classified according to the hierarchic tree model currently used for embryo selection. The analyzed variables were compared with the use of analysis of variance or chi-square and included 95% confidence intervals (CIs).

RESULT(S):

The embryos that originated from vitrified oocytes showed a delay of ∼1 hour from the first division to 2 cells (t2) to the time of blastulation (tB). The embryos that originated from vitrified oocytes showed a delay of ∼1 hour from the 1st division to 2 cells (t2) to the time of blastulation (tB) (P<.05). The proportions of embryos allocated to categories A-E in the hierarchical tree were similar between groups. No differences in implantation rates between the fresh (51.3% [95% CI 47.1%-55.7%]) and vitrified (46.4% [95% CI 38.4%-54.4%]) groups were found.

CONCLUSION(S):

The embryo quality of vitrified oocytes was not impaired: cc2, quality according to our hierarchic morphokinetic model, and implantation rates were similar between fresh and vitrified oocytes. However, morphokinetic differences were observed from t2 to tB. Our main study limitation was the retrospective nature of the analysis, although a large database was studied.

胚胎植入管尖端距離子宮頂最佳距離為1.5-2cm

The PRs in women with embryo flash located <15 mm and >15 mm from the fundus were 47% and 60%, respectively

Fertil Steril. 2018 Jan 3. pii: S0015-0282(17)32028-9. doi: 10.1016/j.fertnstert.2017.10.032. [Epub ahead of print]

Effect of air bubbles localization and migration after embryo transfer on assisted reproductive technology outcome.

Fıçıcıoğlu C1, Özcan P2, Koçer MG1, Yeşiladalı M1, Alagöz O3, Özkara G3, Tayyar AT4, Altunok Ç5.

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Abstract

OBJECTIVE:

To evaluate the effect of embryo flash position and movement of the air bubbles at 1 and 60 minutes after ET on clinical pregnancy rates (PRs).

DESIGN:

Prospective clinical trial.

SETTING:

University fertility clinic.

PATIENT(S):

A total of 230 fresh ultrasound-guided ETs performed by a single physician (C.F.) at the IVF center of Yeditepe University Hospital between September 2016 and February 2017 were included.

INTERVENTION(S):

Transabdominal ultrasonographic guidance at ET.

MAIN OUTCOME MEASURE(S):

Clinical PRs.

RESULT(S):

There was no significant difference in terms of clinical PRs between women with embryo flash located >15 mm and <15 mm from the fundus at 1 or 60 minutes (P=.6 and P=.7, respectively). The PRs in women with embryo flash located <15 mm and >15 mm from the fundus were 47% and 60%, respectively (P=.6). The clinical intrauterine PRs were 69.5%, 38.5%, and 19.1% in fundal, static, and cervical, respectively. The highest PR was in fundal when compared with others (P<.01). The clinical PR appears to be associated with the embryo flash movement/migration and the PR was dramatically reduced when the embryo migrated from its original position toward the cervix at 60 minutes.

CONCLUSION(S):

We concluded that clinical PR appears to be associated with the embryo flash movement/migration at 60 minutes after ET and embryo flash movement toward the fundus is associated with higher clinical PRs. Further well-designed randomized controlled trials are required to optimize ET technique in the future.

長效型降泌乳素藥 carbergolin & quinagolide 可用於防止IVF過程之卵巢過度刺激OHSS

Int J Fertil Steril. 2018 Apr;12(1):1-5. doi: 10.22074/ijfs.2018.5259. Epub 2018 Jan 7.

Comparison of Cabergoline and Quinagolide in Prevention of Severe Ovarian Hyperstimulation Syndrome among Patients Undergoing Intracytoplasmic Sperm Injection.

Taheripanah R1, Vasef M1, Zamaniyan M2,3, Taheripanah A4.

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Abstract

BACKGROUND:

The aim of the current study is to compare quinagolide with cabergoline in prevention of ovarian hyperstimulation syndrome (OHSS) among high risk women undergoing intracytoplasmic sperm injection (ICSI).

MATERIALS AND METHODS:

This randomized clinical trial study was performed from March 2015 to February 2017. One hundred and twenty six women undergoing ICSI who were at high risk of developing OHSS (having over 20 follicles of >12 mm), were randomized into two groups. The first group received cabergoline 0.5 mg and the second group received quinagolide 75 mg every day for 7 days commencing on the day of gonadotropin-releasing hormone (GnRH) agonist administration. Then OHSS symptoms as well as their severity were assessed according to standard definition, 3 and 6 days after GnRH agonist administration. Ascites were determined by trans-vaginal ultrasound. Other secondary points were the number of oocytes and the number of embryos and their quality. Quantitative and qualitative data were analyzed using Student's t test, and Chi-square or fisher's exact test, respectively. A P<0.05 was considered statistically significant.

RESULTS:

The incidence of severe OHSS in the quinagolide-treated group was 3.1% while it was 15.8% in cabergolinetreated subjects (P<0.001). Ascites were less frequent after treatment with Quinagolide as compared to cabergoline (21.9% vs. 61.9%, respectively) (P=0.0001). There was no significant statistical deferences between the two groups in terms of mean age, number of oocytes, metaphase I and metaphase II oocytes, and germinal vesicles. There was a significant difference between cabergoline and quinagolide groups regarding the embryo number (P=0.037) with cabergoline-treated group showing a higher number of embryos. But, the number of good quality embryo in quinagolide- treated individuals was significantly higher than that of the cabergoline-treated group (P=0.001).

CONCLUSION:

Quinagolide seems to be more effective than Cabergoline in prevention of OHSS in high-risk patients undergoing ICSI. 

膽囊癌可能造成HCG上升，誤以為是子宮外孕

J Gynecol Obstet Hum Reprod. 2017 Dec 29. pii: S2468-7847(17)30269-6. doi: 10.1016/j.jogoh.2017.12.005. [Epub ahead of print]

Elevated Human Chorionic Gonadotrophin without pregnancy: a case of gallbladder carcinoma.

Leostic A1, Tran PL2, Fagot H3, Boukerrou M4.

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Abstract

We report a rare case of primary gallbladder adenocarcinoma producing human chorionic gonadotropin (HCG) in a 31-year-old woman. The patient was first misdiagnosed and monitored for an extra-uterine pregnancy. The most frequent cause of elevated serum HCG is pregnancy but elevated HCG can also be a marker of others pathologies like tumors. It is of utmost importance to keep in mind all the possible causes of elevated serum HCG. Once pregnancy has been ruled out, complementary exams should be performed to seek a tumor, especially since tumors producing HCG can be particularly aggressive.

Duphaston, provera, utrogestan 均可用IVF取卵前之pituitary suppression
均可100%抑制LH surge

Hum Reprod. 2017 Dec 29. doi: 10.1093/humrep/dex367. [Epub ahead of print]

New application of dydrogesterone as a part of a progestin-primed ovarian stimulation protocol for IVF: a randomized controlled trial including 516 first IVF/ICSI cycles.

Yu S1, Long H1, Chang HY1, Liu Y1, Gao H1, Zhu J1, Quan X1, Lyu Q1, Kuang Y1,2, Ai A1.

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Abstract

STUDY QUESTION:

Can dydrogesterone (DYG) be used as an alternative progestin in a progesterone primed ovarian stimulation (PPOS) protocol?

SUMMARY ANSWER:

DYG can be used as an appropriate alternative progestin in a PPOS protocol.

WHAT IS KNOWN ALREADY:

PPOS is a new ovarian stimulation regimen based on a freeze-all strategy that uses progestin as an alternative to a GnRH analog for suppressing a premature LH surge during the follicular phase. Medroxyprogesterone acetate (MPA) has been successfully used as an adjuvant to gonadotrophin in the PPOS protocol. However, the use of MPA may lead to stronger pituitary suppression and thus may require a higher dosage of hMG and a longer duration of ovarian stimulation than that of conventional ovarian stimulation protocol.

STUDY DESIGN SIZE, DURATION:

A prospective RCT including 516 patients was performed between November 2015 and November 2016. Computerized randomization was conducted to assign participants at a 1:1 ratio into two treatment groups: an hMG + DYG group (260 patients) or an hMG + MPA group (256 patients) followed by IVF or ICSI with the freeze-all strategy. One cycle per patient was included. The primary outcome of the trial was the number of oocytes retrieved. The sample size was chosen to detect a difference of two oocytes with a power of 90%.

PARTICIPANTS/MATERIALS, SETTING, METHODS:

Patients under 36 years of age with normal ovarian reserve who were undergoing their first IVF/ICSI procedure due to tubal factor infertility were randomized into two groups based on the oral progestin protocol used: hMG co-treatment with DYG (hMG + DYG) or hMG co-treatment with MPA (hMG + MPA). The different progestin was simultaneously administered at the beginning of menstrual cycle 3 (MC3). Oocyte maturation was co-triggered by administration of a GnRH agonist and hCG. All viable embryos from both protocols were cryopreserved for later transfer. Only the first frozen embryo transfer (FET) cycle was included in our study. The embryological and clinical outcomes were measured.

MAIN RESULTS AND THE ROLE OF CHANCE:

Basic characteristics, such as age, BMI and infertility duration, in both groups were comparable. There was no significant difference in the number (mean ± SD) of oocytes retrieved [10.8 ± 6.3 for the hMG + DYG group versus 11.1 ± 5.8 for the hMG + MPA group, P = 0.33] or the oocyte retrieval rate [74.3 ± 19.6% for the hMG + DYG group versus 75.0 ± 19.5% for the hMG + MPA group, P = 0.69] between the groups. The viable embryo rate per oocyte retrieved did not differ between the two groups [odds ratio (OR): 1.08, 95% CI: 0.97-1.21, P = 0.16]: 37.4% (1052/2815) for the hMG + DYG group versus 35.6% (1009/2837) for the hMG + MPA group. During the whole process of ovarian stimulation, the mean LH level in the hMG + DYG group was always higher than that in the hMG + MPA group (P < 0.001); however, no patient from either group experienced a premature LH surge. In addition, no patients experienced moderate or severe ovarian hyperstimulation syndrome during the ovarian stimulation. No significant difference was found in the clinical pregnancy rate of the first FET cycle between the two groups (OR: 0.82, 95% CI: 0.56-1.21, P = 0.33): 57.6% for the hMG + DYG group (125/217) versus 62.3% for the hMG + MPA group (132/212).