2018年5月20日

使用GnRHantagonist 2指標
領先濾泡達14mm
E2 數值:  300-1100 pg/ml之間


 2018 Apr;109(4):633-637. doi: 10.1016/j.fertnstert.2017.12.021. Epub 2018 Mar 28.

Cycle day, estrogen level, and lead follicle size: analysis of 27,790 in vitro fertilization cycles to determine optimal start criteria for gonadotropin-releasing hormone antagonist.

Abstract

OBJECTIVE:

To determine the optimal criteria at which to start GnRH antagonists during controlled ovarian hyperstimulation (COH) for in vitro fertilization (IVF).

DESIGN:

Retrospective clinical cohort.

SETTING:

IVF clinics.

PATIENT(S):

Women undergoing fresh autologous IVF using GnRH antagonist for ovulation suppression during COH.

INTERVENTION(S):

Measurement of lead follicle size, E2 level, and cycle day of stimulation on day of antagonist initiation.

MAIN OUTCOME MEASURE(S):

Clinical pregnancy rate (PR).

RESULT(S):

The highest clinical PR was achieved when the antagonist was started when a lead follicle reached 14-15.9 mm in size (mean clinical PR 21.3; 95% confidence interval [CI] 19.3, 23.6) on cycle day 6 (mean clinical PR 22.2; 95% CI 17, 28.4), or when the E2 level was between 500 and 599 pg/mL (mean clinical PR 25.4; 95% CI 19.5, 32.4). Starting antagonists when the E2 level was <300 or >1,100 pg/mL reduced the odds of clinical pregnancy by 40% (odds ratio 0.60, 95% CI 0.5, 0.7).

CONCLUSION(S):

Cycle day, E2 level, and follicle size at time of antagonist start are all independent predictors of a clinical pregnancy after IVF. Initiating antagonists when the E2 level is extremely low (<300 pg/mL) or extremely high (>1,100 pg/mL) significantly reduces the odds of pregnancy.

2018年5月19日

超過2cm子宮肌瘤對胚胎著床率有不良影響
 2018 Mar 28. pii: S0015-0282(18)30007-4. doi: 10.1016/j.fertnstert.2018.01.007. [Epub ahead of print]

Effect of type 3 intramural fibroids on in vitro fertilization-intracytoplasmic sperm injection outcomes: a retrospective cohort study.

Yan L1Yu Q1Zhang YN1Guo Z1Li Z1Niu J1Ma J2.

Abstract

OBJECTIVE:

To evaluate the influence of type 3 intramural fibroids on in vitro fertilization-intracytoplasmic sperm injection (IVF-ICSI) outcomes.

DESIGN:

Retrospective cohort study.

SETTING:

University-based reproductive medicine center.

PATIENT(S):

All women undergoing IVF-ICSI from January 1, 2009, to December 31, 2016, in our unit.

INTERVENTION(S):

Each woman was matched with three separate control subjects of the same age (±1 year), number of cycles, type of infertility (primary or secondary), type of protocol used for controlled ovarian hyperstimulation (COH), and no uterine fibroids identified by transvaginal ultrasound.

MAIN OUTCOME MEASURE(S):

Implantation, clinical pregnancy, clinical miscarriage, and live birth rates.

RESULT(S):

We included 151 patients with type 3 intramural fibroids and 453 matched control subjects who underwent IVF-ICSI. The rate of "other protocol" used in COH was significantly higher in women with type 3 fibroids than in the control subjects (P<.001). The experimental group had a significantly lower implantation rate. Type 3 fibroids also resulted in a lower frequency of live births and clinical pregnancy. There was no significant difference between the groups in the rate of clinical miscarriage. Compared with the corresponding control subjects, patients with type 3 fibroids with a single fibroid diameter (SD) or total reported fibroid diameter (TD) >2.0 cm also had significantly lower rates of live birth, clinical pregnancy, and implantation. Type 3 fibroids with SD or TD ≤2.0 cm had no significant difference in IVF-ICSI outcomes compared with corresponding control subjects.

CONCLUSION(S):

Our results suggest that type 3 fibroids exert a negative impact on the rates of implantation, clinical pregnancy, and live birth in patients undergoing IVF-ICSI, but do not significantly increase the clinical miscarriage rate. The deleterious impact of type 3 fibroids was remarkable in women with type 3 fibroids with TD or SD >2.0 cm.
弓形子宮對於胚胎植入後之著床率無明顯不良影響


 2018 Apr;109(4):638-643. doi: 10.1016/j.fertnstert.2017.12.001. Epub 2018 Mar 30.

Arcuate uterus: is there an impact on in vitro fertilization outcomes after euploid embryo transfer?

Abstract

OBJECTIVE:

To study the impact of the arcuate uterus on euploid blastocyst-stage embryo transfer outcomes after comprehensive chromosomal screening (CCS).

DESIGN:

Controlled retrospective trial.

SETTING:

Tertiary care assisted reproduction technology (ART) center.

PATIENT(S):

Consecutive patients undergoing in vitro fertilization and euploid embryo transfer after CCS during 2014.

INTERVENTION(S):

Ultrasound examinations and office hysteroscopy; array comparative genomic hybridization to perform CCS after a trophectoderm biopsy.

MAIN OUTCOME MEASURE(S):

Implantation and live-birth rates.

RESULT(S):

Patients were divided into two groups based on the presence (group 1) or absence (group 2) of arcuate uterus. Exclusion criteria were donor oocytes, evidence of other endometrial cavitary abnormalities, prior uterine surgery, and arcuate uterus <4 mm. Group 1 included 78 patients with arcuate uterus of mean depth 5.43 ± 1.81 mm (range: 4-9.5 mm) undergoing 83 transfer cycles. Group 2 included 354 controls undergoing 378 transfer cycles. There were no differences between the groups in baseline characteristics or mean number of euploid embryos transferred. Cycle outcomes were similar between the two groups: rates of implantation (63.7% vs. 65.4%), live birth (68.67% vs. 67.81%), biochemical pregnancy (8.4% vs. 7.65%), and spontaneous abortion (4.8% vs. 4.27%).

CONCLUSION(S):

Arcuate uterus has no impact on ART outcomes after euploid embryo transfer subsequent to CCS, so arcuate uterus should be considered an incidental finding without an indication for surgical resection.
反覆性卵巢排卵藥刺激是造成黃體素提早上升之主因


 2016 Nov;31(11):2554-2560. Epub 2016 Sep 12.

Impact of gonadotropin type on progesterone elevation during ovarian stimulation in GnRH antagonist cycles.

Abstract

STUDY QUESTION:

Does hormonal stimulation with corifollitropin alpha (CFA) only, mimicking a step down protocol, result in lower incidence of progesterone elevation on the day of hCGtrigger as compared to sustained stimulation with recombinant FSH (rFSH)?

SUMMARY ANSWER:

The current findings support the concept that sustained FSH stimulus contributes to premature progesterone elevation in stimulated IVF cycles.

WHAT IS KNOWN ALREADY:

Serum progesterone rise during the follicular phase of ovarian stimulation for IVF treatment seems to be related to a poorer reproductive outcome. However, the mechanism by which the rise in progesterone is caused is not yet fully understood.

STUDY DESIGN, SIZE, DURATION:

This study was a post hoc analysis of data from two multi-center, randomized, double-blind, double-dummy, active-controlled, non-inferiority trials, ENGAGE and PURSUE, conducted from June 2006 to January 2008 and from July 2010 to October 2012 respectively.

PARTICIPANTS/MATERIALS, SETTING, METHODS:

In the ENGAGE-study, 1506 women, aged 18-36 years, were allocated to either a single injection of 150 mg CFA or daily injections of 200 IU rFSH in the first week of stimulation, using a standard GnRH antagonist protocol. In the PURSUE-study, a total of 1390 women, aged 35-42 years, were allocated to either a single injection of 150 mg of CFA or daily 300 IU of rFSH for the first week, again using a standard GnRH antagonist protocol. In both trials, daily rFSH was continued until three follicles reached >17 mm in size. All women had a body weight of between 50 and 90 kg, regular menstrual cycles and an indication for ovarian stimulation before IVF. The incidence of progesterone elevation on day of hCG-trigger in patients with CFA only or rFSH stimulation, and triggered on Day 8 of stimulation, was analyzed.

MAIN RESULTS AND THE ROLE OF CHANCE:

Of patients with CFA only stimulation, 5.4% (13/239 patients) showed a progesterone elevation above 1.5 ng/ml on day of hCG-trigger, whereas patients with rFSH stimulation had a significant higher incidence of progesterone elevation (18.3%; 62/339 patients) (P < 0.001).
反覆性卵巢排卵針刺激是造成黃體素P4過早上升之主因


 2016 Nov;31(11):2554-2560. Epub 2016 Sep 12.

Impact of gonadotropin type on progesterone elevation during ovarian stimulation in GnRH antagonist cycles.

Abstract

STUDY QUESTION:

Does hormonal stimulation with corifollitropin alpha (CFA) only, mimicking a step down protocol, result in lower incidence of progesterone elevation on the day of hCGtrigger as compared to sustained stimulation with recombinant FSH (rFSH)?

SUMMARY ANSWER:

The current findings support the concept that sustained FSH stimulus contributes to premature progesterone elevation in stimulated IVF cycles.

WHAT IS KNOWN ALREADY:

Serum progesterone rise during the follicular phase of ovarian stimulation for IVF treatment seems to be related to a poorer reproductive outcome. However, the mechanism by which the rise in progesterone is caused is not yet fully understood.

STUDY DESIGN, SIZE, DURATION:

This study was a post hoc analysis of data from two multi-center, randomized, double-blind, double-dummy, active-controlled, non-inferiority trials, ENGAGE and PURSUE, conducted from June 2006 to January 2008 and from July 2010 to October 2012 respectively.

PARTICIPANTS/MATERIALS, SETTING, METHODS:

In the ENGAGE-study, 1506 women, aged 18-36 years, were allocated to either a single injection of 150 mg CFA or daily injections of 200 IU rFSH in the first week of stimulation, using a standard GnRH antagonist protocol. In the PURSUE-study, a total of 1390 women, aged 35-42 years, were allocated to either a single injection of 150 mg of CFA or daily 300 IU of rFSH for the first week, again using a standard GnRH antagonist protocol. In both trials, daily rFSH was continued until three follicles reached >17 mm in size. All women had a body weight of between 50 and 90 kg, regular menstrual cycles and an indication for ovarian stimulation before IVF. The incidence of progesterone elevation on day of hCG-trigger in patients with CFA only or rFSH stimulation, and triggered on Day 8 of stimulation, was analyzed.

MAIN RESULTS AND THE ROLE OF CHANCE:

Of patients with CFA only stimulation, 5.4% (13/239 patients) showed a progesterone elevation above 1.5 ng/ml on day of hCG-trigger, whereas patients with rFSH stimulation had a significant higher incidence of progesterone elevation (18.3%; 62/339 patients) (P < 0.001).
補充r-LH對於高齡及卵巢功能不佳之病人有一定助益


 2018 Apr;109(4):644-664. doi: 10.1016/j.fertnstert.2018.01.003.

Recombinant luteinizing hormone supplementation in assisted reproductive technology: a systematic review.

Abstract

OBJECTIVE:

To assess the role of recombinant human LH (r-hLH) supplementation in ovarian stimulation for ART in specific subgroups of patients.

DESIGN:

Systematic review.

SETTING:

Centers for reproductive care.

PATIENT(S):

Six populations were investigated: 1) women with a hyporesponse to recombinant human FSH (r-hFSH) monotherapy; 2) women at an advanced reproductive age; 3) women cotreated with the use of a GnRH antagonist; 4) women with profoundly suppressed LH levels after the administration of GnRH agonists; 5) normoresponder women to prevent ovarian hyperstimulation syndrome; and 6) women with a "poor response" to ovarian stimulation, including those who met the European Society for Human Reproduction and Embryology Bologna criteria.

INTERVENTION(S):

Systematic review.

MAIN OUTCOME MEASURE(S):

Implantation rate, number of oocytes retrieved, live birth rate, ongoing pregnancy rate, fertilization rate, and number of metaphase II oocytes.

RESULT(S):

Recombinant hLH supplementation appears to be beneficial in two subgroups of patients: 1) women with adequate prestimulation ovarian reserve parameters and an unexpected hyporesponse to r-hFSH monotherapy; and 2) women 36-39 years of age. Indeed, there is no evidence that r-hLH is beneficial in young (<35 y) normoresponders cotreated with the use of a GnRH antagonist. The use of r-hLH supplementation in women with suppressed endogenous LH levels caused by GnRH analogues and in poor responders remains controversial, whereas the use of r-hLH supplementation to prevent the development of ovarian hyperstimulation syndrome warrants further investigation.

CONCLUSION(S):

Recombinant hLH can be proposed for hyporesponders and women 36-39 years of age.

2018年5月18日

睪丸靜脈曲張手術後可提高精蟲數量與濃度  但不影響睪固酮濃度

 2018 Jul;12(2):169-172. doi: 10.22074/ijfs.2018.5058. Epub 2018 Mar 18.

Effects of Varicocelectomy on Serum Testosterone Levels among Infertile Men with Varicocele.

Abstract

BACKGROUND:

The main purpose of this study is to evaluate the effects of varicocelectomy on serum testosterone levels and semen quality in infertile men who suffer from varicocele.

MATERIALS AND METHODS:

This prospective study enrolled 115 subjects with clinical varicocele grades II and III and 240 fertile men as the control group. Total volume of testosterone serum level (ng/dl) and semen quality were compared before and after microscopic varicocelectomy. We normalized testosterone serum levels for age, grade, and testis size basis. SPSS 20 software was used to analyze the data. All results of continuous variables were reported as mean ± SD. Statistical significance was set at a P<0.05.

RESULTS:

The mean ages of individuals who participated in the treatment (32.2 ± 5.23) and control (32.8 ± 5.27) groups were similar. There were similar mean values for adjusted testosterone levels between the varicocele (567 ± 222 ng/ml) and control (583 ± 263 ng/ml) groups. In the varicocele group, the adjusted testosterone levels insignificantly increased to 594 ± 243 ng/ml. Among semen parameters, only mean sperm concentration significantly increased after varicocelectomy.

CONCLUSION:

Despite increases in sperm concentration, adjusted testosterone levels did not significantly improve after varicocelectomy.

2018年5月16日

Piezo ICSI (電動微刺ICSI) 精卵融合, 分裂, 囊胚率略優於傳統ICSI

 2018 Apr 10. doi: 10.1007/s10815-018-1174-9. [Epub ahead of print]

Lower blastocyst quality after conventional vs. Piezo ICSI in the horse reflects delayed sperm component remodeling and oocyte activation.

Abstract

PURPOSE:

The aim of this study was to evaluate the differential effects of conventional and Piezo-driven ICSI on blastocyst development, and on sperm component remodeling and oocyte activation, in an equine model.

METHODS:

In vitro-matured equine oocytes underwent conventional (Conv) or Piezo ICSI, the latter utilizing fluorocarbon ballast. Blastocyst development was compared between treatments to validate the model. Then, oocytes were fixed at 0, 6, or 18 h after injection, and stained for the sperm tail, acrosome, oocyte cortical granules, and chromatin. These parameters were compared between injection techniques and between sham-injected and sperm-injected oocytes among time periods.

RESULTS:

Blastocyst rates were 39 and 40%. The nucleus number was lower, and the nuclear fragmentation rate was higher, in blastocysts produced by Conv. Cortical granule loss started at 0H after both sperm and sham injection. The acrosome was present at 0H in both ICSI treatments, and persisted to 18H in significantly more Conv than Piezo oocytes (72 vs. 21%). Sperm head area was unchanged at 6H in Conv but significantly increased at this time in Piezo; correspondingly, at 6H significantly more Conv than Piezo oocytes remained at MII (80 vs. 9.5%). Sham injection did not induce significant meiotic resumption.

CONCLUSIONS:

These data show that Piezo ICSI is associated with more rapid sperm component remodeling and oocyte meiotic resumption after sperm injection than is conventional ICSI, and with higher embryo quality at the blastocyst stage. This suggests that there is value in exploring the Piezo technique, utilized with a non-toxic fluorocarbon ballast, for use in clinical human ICSI.
一階段胚養液(continual culture medium)囊胚率略優於二階段式培養液(sequential culture medium)
mean blastocyst rate: 38.7% ± 29.7% vs. 34.3% ± 29.4%; p = 0.01

但二者活產率類似   Delivery rate (n = 244/903, 27.0% vs. 129/475, 27.2%, NS

 2018 May 3. doi: 10.1007/s10815-018-1195-4. [Epub ahead of print]

Continuous embryo culture elicits higher blastulation but similar cumulative delivery rates than sequential: a large prospective study.

Abstract

PURPOSE:

To assess whether continuous embryo culture involves better embryological and/or clinical outcomes than sequential.

METHODS:

Prospective study at a private IVF center. All consecutive IVF cycles (September 2013-2015) fulfilling the inclusion criteria underwent embryo culture in either Continuous-Single-Culture-Media (CSCM, n = 972) or sequential media (Quinn's Advantage, n = 514), respectively. ICSI, blastocyst culture in either standard (MINC) or undisturbed (Embryoscope) incubation, transfer (until September 2016), and pregnancy follow-up (until September 2017) were performed. When aneuploidy testing was required, trophectoderm biopsy and qPCR were performed. Sub-analyses and logistic regression corrected for confounders were performed. The primary outcomes were overall blastocyst rate per oocyte and mean blastocyst rate per cycle. The sample size was defined to reach 95 and 80% statistical power for the former and the latter outcome, respectively. Secondary outcomes were euploidy (if assessed), cumulative delivery rates, gestational age, and birthweight.

RESULTS:

Continuous embryo culture resulted into a higher overall blastocyst rate per inseminated oocyte than sequential (n = 2211/5841, 37.9% vs. 1073/3216, 33.4%; p < 0.01), confirmed also from a cycle-based analysis (mean blastocyst rate: 38.7% ± 29.7% vs. 34.3% ± 29.4%; p = 0.01). The continuous media (OR = 1.23), the undisturbed incubation system (OR = 1.22), the maternal age (OR = 0.92), and the sperm factor (OR = 0.85) were outlined as positive predictors of blastulation. However, the cumulative delivery rates per ended cycle (i.e., delivery achieved or no blastocyst produced or left; > 90%) were comparable in the two groups (n = 244/903, 27.0% vs. 129/475, 27.2%). The neonatal outcomes were similar.

CONCLUSIONS:

Continuous culture involves better embryological but similar clinical outcomes than sequential. This large prospective study supports the absence of clinical disparity among the two approaches.

2018年5月15日

大陸上海2萬例IVF統計
全冷凍胚胎懷孕率高達50%
其中31歲懷孕率高達60%
40歲懷孕率達4%

 2018 May 1;33(5):924-929. doi: 10.1093/humrep/dey044.

Live birth rates in the first complete IVF cycle among 20 687 women using a freeze-all strategy.

Zhu Q1Chen Q1Wang L1Lu X1Lyu Q1Wang Y1Kuang Y1.

Abstract

STUDY QUESTION:

What is the chance of having a child following one complete IVF cycle for patients using a freeze-all strategy?

SUMMARY ANSWER:

The chance of having a child after the first complete IVF cycle was 50.74% with the freeze-all strategy.

WHAT IS KNOWN ALREADY:

Several studies have reported on live birth rates (LBRs) based on only the fresh embryo transfer cycle or fresh and frozen-thawed embryo transfer cycles. However, the LBR using a freeze-all strategy in IVF is unknown.

STUDY DESIGN SIZE AND DURATION:

This retrospective cohort study included 20 687 women who started their first IVF cycles using a freeze-all strategy during the period from 1 January 2007, through 31 March 2016, in China.

PARTICIPANTS /MATERIALS, SETTING, METHODS:

Data on 20 687 women undergoing their first complete cycles using a freeze-all strategy from 2007 to 2016 were analyzed to estimate LBRs. The LBR in a complete cycle was defined as the chance of a live birth from an ovarian stimulation cycle including all subsequent frozen embryo transfers from this stimulation. The relationship between LBR and number of oocyte was explored.

MAIN RESULTS AND THE ROLE OF CHANCE:

The LBR for the first complete cycle was 50.74% for patients using a freeze-all strategy. By age group, the LBR declined from 63.81% for women under 31 years old to 4.71% for women over 40 years old after the first complete cycle. The LBRs improved as the number of oocytes retrieved increased up to 25 in the freeze-all strategy.
睪丸切片TESE後頭1-2年  常合併男性賀爾蒙下降
1-2年後男性賀爾蒙才逐漸回復手術前水準

 2018 May 3. doi: 10.1093/humupd/dmy015. [Epub ahead of print]

The risk of TESE-induced hypogonadism: a systematic review and meta-analysis.

Abstract

BACKGROUND:

Testicular sperm extraction (TESE) is a surgical procedure to retrieve spermatozoa from the testes of men with azoospermia to help them achieve biological parenthood. Although effective, the surgical procedure is not without complications and haematoma, devascularization, inflammation and a decrease in testosterone levels have been described as such. The prevalence and duration of hypogonadism and associated symptoms after TESE have not been studied systematically.

OBJECTIVE AND RATIONALE:

In this systematic review we addressed the following research questions: Are serum testosterone levels decreased after TESE and, if so, do these levels recover over time? What is the prevalence of symptoms and signs related to hypogonadism after TESE and are they related to testosterone levels?

SEARCH METHODS:

We searched the databases Pubmed and Embase from 1 January 1993 to 26 June 2017. We combined subject headings with terms in title and/or abstract for participants, intervention and outcomes. We included all studies that reported on TESE, regardless of the specific technique used, that measured testosterone and/or LH, and/or had information on signs or symptoms related to hypogonadism as defined by hypogonadism guidelines. An additional inclusion criterion was that studies described these measurements both before and after TESE. The quality of the included studies was assessed using the Risk Of Bias In Non-randomized Studies-of Interventions tool.

OUTCOMES:

We identified 15 studies reporting on total testosterone levels of which five studies also reported on testicular volume and one study on erectile dysfunction. Men with Klinefelter syndrome and men with non-obstructive azoospermia had the strongest decrease in total testosterone levels 6 months after TESE, with a mean decrease of 4.1 and 2.7 nmol/l, respectively, which recovered again to baseline levels 26 and 18 months after TESE, respectively. At 6 months after TESE, some studies reported serum total testosterone concentrations below a cut-off value of 12 nmol/l, where symptoms and signs related to hypogonadism may appear. Furthermore, an increased prevalence of erectile dysfunction related to decreased total testosterone levels 6 months after TESE was reported. Also, in some men a decrease in testicular volume was reported. However, it is not clear if this is related to low testosterone levels.

WIDER IMPLICATIONS:

The transient, but statistically significant, decrease in total testosterone levels indicates that men are at risk of developing a temporary hypogonadism after TESE, but there is insufficient evidence for whether patients actually experience clinical symptoms in case of decreased serum testosterone levels. To be able to properly counsel TESE patients, more large-scale monitoring on signs and symptoms of hypogonadism, in combination with testosterone measurements, needs to be performed in men undergoing TESE.
2 cell胚葉細胞之間之mRNA差異為17%
在接下來分裂為4-8 cell胚葉細胞之間之mRNA差異下降為1%
其間牽涉多重複雜之交互作用機轉使胚葉細胞之間之mRNA差異大幅下降
 2018 May 9. doi: 10.1093/molehr/gay021. [Epub ahead of print]

RETROSPECTIVE ANALYSIS: REPRODUCIBILITY OF INTERBLASTOMERE DIFFERENCES OF mRNA EXPRESSION IN 2-CELL STAGE MOUSE EMBRYOS IS REMARKABLY POOR DUE TO COMBINATORIAL MECHANISMS OF BLASTOMERE DIVERSIFICATION.

Abstract

STUDY QUESTION:

What is the prevalence, reproducibility and biological significance of transcriptomic differences between sister blastomeres of the mouse 2-cell embryo?

SUMMARY ANSWER:

Sister 2-cell stage blastomeres are distinguishable from each other by mRNA analysis, attesting to the fact that differentiation starts mostly early in the mouse embryo; however, the interblastomere differences are poorly reproducible and invoke the combinatorial effects of known and new mechanisms of blastomere diversification.

WHAT IS KNOWN ALREADY:

Transcriptomic datasets for single blastomeres in mice have been available for years but have never been systematically analysed together, although such an analysis may shed light onto some unclarified topics of early mammalian development. Two unknowns that remain are at which stage embryonic blastomeres start to diversify from each other and what is the molecular origin of that difference. At the earliest postzygotic stage, the 2-cell stage, opinions differ regarding the answer to these questions; one group claims that the first zygotic division yields two equal blastomeres capable of forming a full organism (totipotency) and another group claims evidence for interblastomere differences reminiscent of the prepatterning found in embryos of lower taxa. Regarding the molecular origin of interblastomere differences, there are four prevalent models which invoke 1) oocyte anisotropy, 2) sperm entry point, 3) partition errors of the transcript pool, and 4) asynchronous embryonic genome activation in the two blastomeres.

STUDY DESIGN SIZE, DURATION:

Seven transcriptomic studies published between 2011 and 2017 were eligible for retrospective analysis, since both blastomeres of the mouse 2-cell embryo had been analysed individually regarding the original pair associations and since the datasets were made available in public repositories. Five of these studies, encompassing a total of 43 pairs of sister blastomeres, were selected for further analyses based on high interblastomere correlations of mRNA levels. A double cut-off was used to select mRNAs that had robust interblastomere differences both within and between embryos (hits). The hits of each study were compared and contrasted with the hits of the other studies using Venn diagrams. The hits shared by at least four of five studies were analysed further by bioinformatics.

PARTICIPANTS/MATERIALS, SETTING, METHODS:

PubMed was systematically examined for mRNA expression profiles of single 2-cell stage blastomeres in addition to publicly available microarray datasets (GEO, ArrayExpress). Based on the original normalisations, data from seven studies were screened for pairwise sample correlation at the gene level (Spearman), and the top five datasets with the highest correlation were subjected to hierarchical cluster analysis. Interblastomere differences of gene expression were expressed as a ratio of the higher to the lower mRNA level for each pair of blastomeres. A double cut-off was used to make the call of interblastomere difference, accepting genes with mRNA ratios above 2 when observed in at least 50% of the pairs, and discarding the other genes. The proportion of interblastomere differences common to at least four of the five datasets was calculated. Finally, the corresponding gene, pathway and enrichment analyses were performed utilising PANTHER and GORILLA platforms.

MAIN RESULTS AND THE ROLE OF CHANCE:

An average of 17% of genes within the datasets are differently expressed between sister blastomeres, a proportion which falls to 1% when considering the differences that are common to at least four of the five studies. Housekeeping mRNAs were not included in the 17% and 1% gene lists, suggesting that the interblastomere differences do not occur simply by chance. The 1% of shared interblastomere differences comprise 100 genes, of which 35 are consistent with at least one of the four prevalent models of sister blastomere diversification. Bioinformatics analysis of the remaining 65 genes that are not consistent with the four models suggests that at least one more mechanism is at play, potentially related to the endomembrane system. Although there are many dimensions to the issue of reproducibility (biological, experimental, analytical), we consider that the sister blastomeres are poised to escape high interblastomere correlations of mRNA levels, because at least five sources of diversity superimpose on each other, accounting for at least 25 = 32 different states. As a result, interblastomere mRNA differences of a given 2-cell embryo are necessarily difficult to reproduce in another 2-cell embryo.

2018年5月13日

PCO病患服用Diane 3月後再施行IVF,可下降PCO懷孕後之妊娠高血壓,妊娠糖尿病,早產


 2018 Apr;109(4):720-727. doi: 10.1016/j.fertnstert.2017.12.023. Epub 2018 Mar 7.

Comparing the risk of adverse pregnancy outcomes of Chinese patients with polycystic ovary syndrome with and without antiandrogenic pretreatment.

Li Y1Ruan X2Wang H1Li X1Cai G1Du J1Wang L1Zhao Y1Mueck AO3.

Abstract

OBJECTIVE:

To evaluate the prevalence of adverse pregnancy outcomes in healthy Chinese women and to investigate whether these outcomes could be decreased in patients with polycystic ovary syndrome (PCOS) by ethinylestradiol/cyproterone acetate (EE/CPA) pretreatment.

DESIGN:

Retrospective study.

SETTING:

Medical university.

PATIENT(S):

Six thousand healthy women (group A) were selected from 24,566 pregnant women by randomized sampling. Four hundred forty-eight patients with PCOS without EE/CPA pretreatment were assigned to group B, and 222 patients with PCOS with 3 months of pretreatment to group C. All patients with PCOS had biochemical and/or clinical hyperandrogenism and conceived within 3 monthly ovulation inductions using clomiphene.

INTERVENTION(S):

None.

MAIN OUTCOME MEASURE(S):

Gestational diabetes mellitus (GDM), pregnancy-induced hypertension (PIH), premature delivery (PD), and neonatal birth weight.

RESULT(S):

The prevalence of GDM, PIH, and PD was higher in group B than in groups A and C (A vs. B vs. C: GDM, 21.2% vs. 35.0% vs. 22.5%; PIH, 6.5% vs. 14.1% vs. 7.7%; PD, 5.4% vs. 8.6% vs. 6.8%). No significant difference was found in neonatal birth weight. After adjusting for age, pregestational body mass index, education level, and employment status, PCOS without pretreatment increased the risk of GDM (adjusted odds ratio [aOR] = 1.666; 95% confidence interval [CI], 1.340-2.072), PIH (aOR = 1.487; 95% CI, 1.093-2.023), and PD (aOR = 1.522; 95% CI 1.051-2.205), compared with healthy women. No increased risk was found in group C.

CONCLUSION(S):

In our highly selected study population, patients with PCOS are more likely to develop GDM, PIH, and PD. Pretreatment with EE/CPA was associated with a lower risk of GDM, PIH, and PD.