精蟲濃度低於4千萬/cc  活動力低於50%   卵子容易IVF受孕失敗

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J Assist Reprod Genet. 2018 Nov 10. doi: 10.1007/s10815-018-1336-9. [Epub ahead of print]

Semen parameters on the day of oocyte retrieval predict low fertilization during conventional insemination IVF cycles.

Harris AL1,2, Vanegas JC3,4, Hariton E5,6, Bortoletto P5,6, Palmor M7, Humphries LA7, Tanrikut C8,9, Chavarro JE3,4,10, Styer AK5,6.

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Abstract

PURPOSE:

Poor fertilization during conventional IVF is difficult to predict in the absence of abnormal semen parameters; large-scale studies are lacking. The purpose of this study is to evaluate factors associated with low fertilization rates in conventional insemination IVF cycles.

METHODS:

A retrospective cohort study evaluating demographic, reproductive evaluation, and IVF cycle characteristics to identify predictors of low fertilization (defined as 2PN/MII ≤ 30% per cycle). Participants were included if they were undergoing their first IVF cycle utilizing fresh autologous oocytes and conventional insemination with male partner's sperm (with normal pretreatment semen analysis). They were randomly divided into a training set and a validation set; validation modeling with logistic regression and binary distribution was utilized to identify covariates associated with low fertilization.

RESULTS:

Postprocessing sperm concentration of less than 40 million/ml and postprocessing sperm motility < 50% on the day of retrieval were the strongest predictors of low fertilization in the training dataset. Next, in the validation set, cycles with either low postprocessing concentration (≤ 40 million/ml) or low postprocessing progressive motility (≤ 50%) were 2.9-times (95% CI 1.4, 6.2) more likely to have low fertilization than cycles without either risk factor. Furthermore, cycles with low postprocessing concentration and progressive motility were 13.4 times (95% CI 4.01, 45.06) more likely to have low fertilization than cycles without either risk factor.

CONCLUSIONS:

Postprocessing concentration and progressive motility on the day of oocyte retrieval are predictive of low fertilization in conventional IVF cycles with normal pretreatment diagnostic semen analysis parameters.

胚胎分裂遲滯&非對稱--->胚胎染色體異常&著床失敗&流產機率高

J Assist Reprod Genet. 2018 Nov 12. doi: 10.1007/s10815-018-1361-8. [Epub ahead of print]

Time-lapse imaging reveals delayed development of embryos carrying unbalanced chromosomal translocations.

Amir H1, Barbash-Hazan S1, Kalma Y1, Frumkin T1, Malcov M1, Samara N1, Hasson J1, Reches A1, Azem F1, Ben-Yosef D2,3.

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Abstract

PURPOSE:

The purpose of the study was to compare the morphokinetic parameters of embryos carrying balanced chromosomal translocations with those carrying unbalanced chromosomal translocations using time-lapse microscopy.

METHODS:

The study group included 270 embryos that underwent biopsies on day 3 for preimplantation genetic diagnosis (PGD) for chromosomal translocations in our unit between 2013 and 2015. All embryos were incubated under time-lapse microscopy and evaluated for timing of developmental events up to day 5. The timing of these events was compared between balanced and unbalanced embryos, potentially viable and nonviable variants, and maternal versus paternal inheritance of the translocation.

RESULTS:

The PGD analysis found that 209 (77%) of the 270 biopsied embryos carried an unbalanced translocation. Embryos carrying unbalanced translocations, which are expected to lead to implantation failure or miscarriage, cleaved less synchronously and were delayed in time of cleavage to the 4-cell stage (t4) and in time of start of blastulation (tSB) compared with balanced embryos (P < 0.05). Furthermore, embryos carrying nonviable translocations demonstrated a significant delay at the time of pronuclei fading (tPNf) compared with those carrying potentially viable translocations (P < 0.05). Embryos whose unbalanced translocations were of maternal origin were significantly delayed in most of the morphokinetic parameters (including tPNf, t2, t3, t4, t6, t7, t8, cc2, s2, and tSB) compared with embryos carrying balanced translocations (P < 0.05).

CONCLUSIONS:

Embryos carrying unbalanced chromosomal translocations mainly of maternal origin undergo delayed development and asynchronous cleavage that may lead to implantation failure or miscarriage.

精蟲生長最加溫度 34 C

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Fertil Steril. 2018 Nov;110(6):1045-1057.e3. doi: 10.1016/j.fertnstert.2018.07.018.

Influence of temperature, serum, and gonadotropin supplementation in short- and long-term organotypic culture of human immature testicular tissue.

Medrano JV1, Vilanova-Pérez T2, Fornés-Ferrer V2, Navarro-Gomezlechon A2, Martínez-Triguero ML3, García S4, Gómez-Chacón J3, Povo I3, Pellicer A5, Andrés MM4, Novella-Maestre E4.

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Abstract

OBJECTIVE:

To study how temperature, serum, and gonadotropin supplementation affect the organotypic culture of human immature testicular tissue (ITT) in vitro.

DESIGN:

Experimental basic science study.

SETTING:

Reproductive biology laboratory.

PATIENT(S):

ITT from 4 boys with cancer that had testicular tissue cryopreserved as part of their fertility preservation treatment.

INTERVENTION(S):

In vitro organotypic culture of ITT, exposed to different temperatures (37°C vs. 34°C), serum (fetal bovine serum [FBS] vs. Knockout Serum Replacement [KOS]), and gonadotropin supplementation (with and without FSH and LH).

MAIN OUTCOME MEASURE(S):

Characterization of the tissue was performed at days 0, 14, and 70 with the use of reverse-transcription quantitative polymerase chain reaction, terminal deoxynucleotide transferase-mediated dUTP nick-end labeling, histologic analysis by means of hematoxylin-eosin staining, and immunohistochemical staining. Hormonal secretion was determined at days 3, 14, 28, and 70 by means of immunofluorescent assay.

RESULT(S):

The 37°C conditions showed an accelerated loss of tubular morphology and higher intratubular apoptosis. KOS supplementation triggered the up-regulation of STAR, SOX9, DAZL, DDX4, PLZF, and UTF1, the percentage of SOX9+/androgen receptor (AR)-positive mature Sertoli cells at day 14, and testosterone secretion. Gonadotropin supplementation increased the numbers of both undifferentiated UTF1+ spermatogonia and premeiotic VASA+/SYCP3+ spermatogonia at day 14, and the number of SOX9+ Sertoli cells at day 70. The low SOX9+/AR+ colocalization, the disorganized pattern of ZO-1, and the progressive decrease of antimüllerian hormone secretion indicated inefficient Sertoli cell maturation in vitro.

CONCLUSION(S):

The 34°C condition in KOS showed the best results for the survival of both spermatogonia and Sertoli cells. FSH/LH supplementation also improved long-term survival of Sertoli cells and the maturation of spermatogonia up to meiotic initiation in short-term culture.

初經早ㄉ病人　　服用避孕藥ㄉ病人　　ＡＭＨ常會提早下降

Fertil Steril. 2017 Apr;107(4):1012-1022.e2. doi: 10.1016/j.fertnstert.2017.02.105.

Demographic, lifestyle, and other factors in relation to antimüllerian hormone levels in mostly late premenopausal women.

Jung S1, Allen N2, Arslan AA3, Baglietto L4, Brinton LA5, Egleston BL6, Falk R5, Fortner RT7, Helzlsouer KJ8, Idahl A9, Kaaks R7, Lundin E10, Merritt M11, Onland-Moret C12, Rinaldi S13, Sánchez MJ14, Sieri S15, Schock H7, Shu XO16, Sluss PM17, Staats PN18, Travis RC19, Tjønneland A20, Trichopoulou A21, Tworoger S22, Visvanathan K23, Krogh V24, Weiderpass E25, Zeleniuch-Jacquotte A26, Zheng W16, Dorgan JF27.

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Abstract

OBJECTIVE:

To identify reproductive, lifestyle, hormonal, and other correlates of circulating antimüllerian hormone (AMH) concentrations in mostly late premenopausal women.

DESIGN:

Cross-sectional study.

SETTING:

Not applicable.

PATIENT(S):

A total of 671 premenopausal women not known to have cancer.

INTERVENTION(S):

None.

MAIN OUTCOME MEASURE(S):

Concentrations of AMH were measured in a single laboratory using the picoAMH ELISA. Multivariable-adjusted median (and interquartile range) AMH concentrations were calculated using quantile regression for several potential correlates.

RESULT(S):

Older women had significantly lower AMH concentrations (≥40 [n = 444] vs. <35 years [n = 64], multivariable-adjusted median 0.73 ng/mL vs. 2.52 ng/mL). Concentrations of AMH were also significantly lower among women with earlier age at menarche (<12 [n = 96] vs. ≥14 years [n = 200]: 0.90 ng/mL vs. 1.12 ng/mL) and among current users of oral contraceptives (n = 27) compared with never or former users (n = 468) (0.36 ng/mL vs. 1.15 ng/mL). Race, body mass index, education, height, smoking status, parity, and menstrual cycle phase were not significantly associated with AMH concentrations. There were no significant associations between AMH concentrations and androgen or sex hormone-binding globulin concentrations or with factors related to blood collection (e.g., sample type, time, season, and year of blood collection).

CONCLUSION(S):

Among premenopausal women, lower AMH concentrations are associated with older age, a younger age at menarche, and currently using oral contraceptives, suggesting these factors are related to a lower number or decreased secretory activity of ovarian follicles.

卵巢子宮內膜異位瘤手術後ＡＭＨ 明顯下降50%

Fertil Steril. 2018 Nov;110(6):1173-1180. doi: 10.1016/j.fertnstert.2018.07.019.

Changes in serum antimüllerian hormone levels in patients 6 and 12 months after endometrioma stripping surgery.

Kovačević VM1, Anđelić LM1, Mitrović Jovanović A2.

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Abstract

OBJECTIVE:

To investigate the impact of laparoscopic endometrioma cystectomy on the ovarian reserve and to identify the most important factors that predict the ovarian reserve in patients with endometriomas.

DESIGN:

Prospective study.

SETTINGS:

Endoscopy unit of a general hospital.

PATIENT(S):

Fifty-four patients with unilateral (n = 37) and bilateral endometriomas (n = 17).

INTERVENTIONS(S):

The serum antimüllerian hormone (AMH) concentration was assessed before surgery and at 6 and 12 months after surgery.

MAIN OUTCOME MEASURE(S):

The primary outcome was the damage to the ovarian reserve, as assessed by the serum AMH concentration. Secondary end points were the persistence or recovery of ovarian damage after 1 year.

RESULT(S):

AMH concentrations decreased after the laparoscopic excision of cystic ovarian endometriomas. Before surgery and at 6 and 12 months after surgery, the concentrations were, respectively 3.07, 1.29, and 1.46 ng/mL. In the unilateral group, the median AMH levels were 3.31, 1.43, and 1.72 ng/mL, and in the bilateral group the levels were 2.55, 0.98, and 0.89 ng/mL. The serum AMH concentrations thus decreased by 53.27 ± 38.2% and 49.43 ± 38.3% at 6 and 12 months after cystectomy, respectively.

CONCLUSION(S):

In patients with endometriomas, the decrease in ovarian reserve occurs immediately after the excision of the endometrioma. Significant predictors of AMH values at 6 and 12 months after surgery include the baseline AMH level, patient age, and bilateral endometriomas.