雙側子宮內膜異位瘤束後AMH下降 (2.5->0.9) 
單側子宮內膜異位瘤束後AMH下降 (3.3->1.5) 

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.

Author information

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.

適量補充Cu  Zn有助於防止流產

Int J Fertil Steril. 2019 Jul;13(2):97-101. doi: 10.22074/ijfs.2019.5586. Epub 2019 Apr 27.

Correlation of Copper and Zinc in Spontaneous Abortion.

Thaker R1, Oza H2, Shaikh I1, Kumar S3.

Author information

Abstract

BACKGROUND:

Humans require minute amounts of trace metals to maintain body's normal growth and physiological functions; such elements may also play a vital role in pregnancy and pregnancy outcome. The present study was conducted to assess the role of two trace metals, zinc (Zn) and copper (Cu) in women with history of spontaneous abortion (SAb cases) in comparison to women without such history (controls).

MATERIALS AND METHODS:

In this retrospective study, a total of 277 subjects were enrolled from the Obstetrics and Gynecology Department, Civil Hospital, Ahmedabad, India. Personal demographic information, medical history, reproductive history especially details of number of SAb, duration of last SAb, number of children, etc. were recorded using predesigned and pre-tested proforma. Serum Zn and Cu levels were measured by an atomic absorption spectrophotometer.

RESULTS:

The data indicated that the serum level of Cu (P<0.01) and Zn was lower in SAb cases as compared to controls. Correlation between the number of SAbs and trace metals levels showed a significant negative correlation between Cu and Cu/Zn and the number of SAbs. Cu/Zn was higher in controls and women having at least one child as compared cases and women without child, respectively. Pregnant women had higher levels of trace elements as compared to non-pregnant women at the time of enrollment.

CONCLUSION:

The data revealed that trace metals such as Zn and Cu have a positive role in pregnancy outcome and optimum levels of Zn and Cu might be able to decline the chances of SAb occurrence in addition to other factors. The ratio of Cu/Zn has a positive role in reproductive outcomes.

letrozole 可提高PCO病人冷凍胚胎植入懷孕率

Fertil Steril. 2019 May 21. pii: S0015-0282(19)30389-9. doi: 10.1016/j.fertnstert.2019.04.014. [Epub ahead of print]

Letrozole use during frozen embryo transfer cycles in women with polycystic ovary syndrome.

Zhang J1, Liu H1, Wang Y1, Mao X1, Chen Q1, Fan Y1, Xiao Y1, Kuang Y2.

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Abstract

OBJECTIVE:

To investigate whether live birth rate (LBR) following frozen-thawed embryo transfer in letrozole-stimulated cycles (L-FET) differs from LBR after artificial-cycle frozen-thawed embryos transfers (AC-FET) in women with polycystic ovary syndrome (PCOS).

DESIGN:

Retrospective cohort study.

SETTING:

Tertiary-care academic medical center.

PATIENT(S):

A total of 2,664 patients with PCOS who fulfilled the inclusion criteria were enrolled in the period from 2011 to 2016.

INTERVENTIONS(S):

Letrozole use versus hormone replacement therapies during FET.

MAIN OUTCOME MEASURE(S):

LBR per embryo transfer was the primary outcome. The secondary end points included ongoing and clinical pregnancy rate, cancellation rate, endometrial thickness, and pregnancy loss rate. Multivariable logistic regression analysis was performed to adjust for potential confounders.

RESULT(S):

In our crude analysis, LBR per embryo transfer was similar between groups (54.4% in the L-FET vs. 50.7% for the AC-FET). The crude odds of pregnancy loss was significantly lower in L-FET compared with AC-FET (9.1% vs. 17%). Nonetheless, after adjusting for possible confounding factors, LBR was significantly higher in L-FET compared with AC-FET. Moreover, the rates of pregnancy loss remained consistently lower in the L-FET group than in the AC-FET group.

CONCLUSION(S):

In patients with PCOS undergoing FET, letrozole use for endometrial preparation was associated with higher LBR compared with artificial cycles, albeit after statistical adjustment for confounding factors. Future prospective randomized studies are needed to verify our findings.

Gavi: 世界第一部全自動胚胎玻璃化冷凍儀器

https://vimeo.com/113990868

J Gynecol Obstet Hum Reprod. 2019 May 8. pii: S2468-7847(19)30109-6. doi: 10.1016/j.jogoh.2019.05.012. [Epub ahead of print]

The first report of pregnancies following blastocyst automated vitrification in Europe.

Dal Canto M1, Moutier C2, Brambillasca F3, Guglielmo MC4, Bartolacci A5, Fadini R6, Renzini MM7, Buratini J8.

Author information

Abstract

Embryo cryopreservation is a valuable technique in assisted reproductive technology (ART) that increases cumulative pregnancy rates and allows postponement of embryo transfer in patients with undesirable uterine or clinical conditions. Although vitrification has been considered the most efficient method to freeze oocytes and embryos, it is time-consuming and highly operator-dependent. Gavi® is the first semi-automated machine for vitrification capable of controlling crucial variables such as temperature, volume, concentration and exposure time during the vitrification process. We report the first two pregnancies obtained with blastocysts cryopreserved with the Gavi® semi-automated vitrification system in Europe. These outcomes suggest that the utilization of semi-automated vitrification may contribute to improve the outcomes and laboratory logistics of fertility clinics.

Day5囊胚著床率高於Day6囊胚著床率 (47%  vs 28%)

Cell Mol Biol (Noisy-le-grand). 2019 Apr 30;65(4):1-5.

Delayed development influences the outcome of different grades of D5 and D6 blastocysts during freeze-thaw cycle.

Zhang H1, Arhin SK1, Zhao J1, Hou X1, Chen Y1, Huang Z1.

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Abstract

To analyze the effects of blastocysts on the 5th day (D5) and 6th day (D6) of frozen-thawed blastocyst transplantation on pregnancy outcome and provide evidence for further improvement of the strategy. This study included transfers from the Reproductive Medicine Center of the Second Affiliated Hospital of Wenzhou Medical University during freeze-thaw cycles from January 2016 to December 2017. They were divided into D5 group (1616 cases) and D6 group (619 cases) according to blastocyst formation and development. Each group was further divided into 5 groups according to the quality of the blastocyst and the number of transplants, making a total of 10 groups. Following the frozen transplantation cycle, the transplanting rate was significantly higher for D5 (41.73%) than for D6 (23.98%) (P &lt; 0.05); the ongoing pregnancy rate (47,40%) was also significantly higher than that of D6 (28.43%) (P &lt; 0.05).In the frozen-thawed blastocyst resuscitation transplantation, compared to D6 blastocysts, D5 blastocysts were more conducive to blastocyst implantation and could be used to achieve better clinical pregnancy outcome. In blastocyst selection, a single D5 excellent blastocyst transplant is preferred. Only at the 6th day of non-excellent D6, 2 blastocysts are recommended for transplantation.

子宮外孕輸卵管切除手術對於卵巢排卵反應沒有明顯不良影響

J Gynecol Obstet Hum Reprod. 2019 May 17. pii: S2468-7847(19)30061-3. doi: 10.1016/j.jogoh.2019.05.009. [Epub ahead of print]

Impact of salpingectomy for ectopic pregnancy on the ovarian response during IVF stimulation.

Gay C1, Perrin J2, Courbiere B2, Bretelle F3, Agostini A4.

Author information

Abstract

INTRODUCTION:

Ovarian reserve is a major prognosic factor for Medical Assisted Procreation. Tubal surgery, realised close to mesosalpinx and ovarian vascularization, could impare ovarian function. However, salpingectomy is currently used to treat ectopic pregnancies or hydrosalpinx before IVF attempt. Disponible studies on this subject are unclear. The aim of this study is to evaluate the impact of salpingectomy for ectopic pregnancy on the ovarian response during IVF attempt.

MATERIAL AND METHODS:

It was a single center comparative study. Included patients were the one receiving oocyte puncture for IVF attempt, with a history of unilateral tubal surgery: salpingectomy for ectopic pregnancy. We conducted a case-control study, comparing the sonographic parameters of the surgery ovary (case) to those of the safe ovary (control) during the first IVF attempt after salpingectomy. The ovarian sonographic response was evaluated according to the follicular antral count on day 3 and the sonographic follicular count on trigger day.

RESULTS:

55 patients were included. There was no significant difference in the number of recruited follicles on the operated side versus control side (p = 0.85 for >14 mm follicles, p = 0,46 for 10 to 14 mm, p = 0,52 for total amount of recruited follicles). There was no significant difference for the follicular antral count neither (p = 0.79).

DISCUSSION:

In our population, there was no significant difference in the sonographic ovarian response to IVF stimulation between the ovary on the operated side and the control ovary among patients treated by unilateral salpingectomy for ectopic pregnancy.

HCG合併FSH用於破卵, IVF懷孕結果優於傳統ＨＣＧ破卵

Int J Fertil Steril. 2019 Jul;13(2):102-107. doi: 10.22074/ijfs.2019.5701. Epub 2019 Apr 27.

Comparison of Oocyte Maturation Trigger Using Follicle Stimulating Hormone Plus Human Chorionic Gonadotropin versus hCG Alone in Assisted Reproduction Technology Cycles.

Dashti S1, Aflatoonian A2, Tabibnejad N1.

Author information

Abstract

BACKGROUND:

The goal of this study was to investigate oocyte maturation, fertilization and pregnancy rates among infertile women, by concomitant follicle stimulating hormone (FSH) administration at the time of human chorionic gonadotropin (hCG) trigger, compared to hCG trigger alone.

MATERIALS AND METHODS:

In this prospective randomized controlled trial, 109 infertile women between the ages of 20 and 40 years, received gonadotropin-releasing hormone (GnRH) antagonist and fresh embryo transfer. Following the procedure, the subjects were randomly divided into two groups on the oocyte-triggering day. In the experimental group, final oocyte maturation was achieved by 5000 IU hCG plus 450 IU FSH. In the control group, however, oocyte triggering was performed by 5000 IU hCG, only. The primary outcome was clinical pregnancy and the secondary outcomes included oocyte recovery rate, oocyte maturity rate, fertilization proportion rate, fertilization rate, implantation rate and chemical pregnancy rate.

RESULTS:

Fifty-four women were appointed to the group with the FSH bolus injection at the time of hCG trigger and 55 women were assigned to the hCG alone group. Women in the FSH group had a significantly higher metaphase II (MII) oocyte (7.17 ± 3.50 vs. 5.87 ± 3.19), 2 pronuclear embryos (2PNs) (5.44 ± 3.20 vs. 3.74 ± 2.30) and total embryos (4.57 ± 2.82 vs. 3.29 ± 2.13) compared to hCG alone group, respectively. Furthermore, fertilization rate (0.75 ± 0.19 vs. 0.68 ± 0.25), implantation rate (14.2 vs. 8.5%) as well as clinical (27.9 vs. 15.9%) and chemical (32.6 vs. 20.5%) pregnancy rates were higher in the FSH group, but no statistically significant difference was found (P>0.05).

CONCLUSION:

Combination of FSH and hCG for oocyte triggering improves oocyte maturity and fertilization proportion rates without increasing the chance of implantation, chemical and clinical pregnancy rates (Registration number: IRCT2017082724512N5).

AMH比FSH 具有更高之卵巢功能預測率
當AMH & FSH不一致時  應以AMH優先評估根據

Fertil Steril. 2019 May 2. pii: S0015-0282(19)30295-X. doi: 10.1016/j.fertnstert.2019.03.022. [Epub ahead of print]

Low antimüllerian hormone (AMH) is associated with decreased live birth after in vitro fertilization when follicle-stimulating hormone and AMH are discordant.

Ligon S1, Lustik M2, Levy G1, Pier B3.

Author information

Abstract

OBJECTIVE:

To evaluate which factor, AMH or FSH, was superior in predicting live birth after assisted reproductive technologies (ART) when the tests are discordant, using data from the Society for Assisted Reproductive Technology Clinical Outcomes Reporting System database.

DESIGN:

Retrospective cohort.

SETTING:

Clinic-based data.

PATIENT(S):

The study population included 44,696 fresh embryo transfer cycles using autologous oocytes.

INTERVENTION(S):

None.

MAIN OUTCOME MEASURE(S):

Live birth (≥22 wk gestation and ≥300 g birth weight).

RESULT(S):

Live birth rate per started cycle was lower in patients with low AMH and normal FSH than in patients with normal AMH and elevated FSH (26% vs. 39%). A multivariate analysis was performed on patients with normal FSH and low AMH, and the following factors were independently associated with live birth: AMH, age >40 years, body mass index >30 kg/m2, race African-American or Asian, IVF clinic region West, uterine factor infertility diagnosis, agonist suppression, and FSH dosage. IVF cycle cancellation rate was higher in patients with low AMH and normal FSH (30%).

CONCLUSION(S):

AMH is a superior predictor of live birth in patients undergoing IVF when FSH and AMH values are discordant. Lower AMH is independently associated with lower live birth and higher IVF cycle cancellation rates than elevated FSH in patients with discordant values.

Published by Elsevier Inc.

PGS可能提高妊娠高血壓之機率 (10.5% versus 4.1%)

Fertil Steril. 2019 May 15. pii: S0015-0282(19)30316-4. doi: 10.1016/j.fertnstert.2019.03.033. [Epub ahead of print]

Maternal and neonatal outcomes associated with trophectoderm biopsy.

Zhang WY1, von Versen-Höynck F2, Kapphahn KI3, Fleischmann RR4, Zhao Q4, Baker VL5.

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Abstract

OBJECTIVE:

To assess whether pregnancies achieved with trophectoderm biopsy for preimplantation genetic testing (PGT) have different risks of adverse obstetric and neonatal outcomes compared with pregnancies achieved with IVF without biopsy.

DESIGN:

Observational cohort.

SETTING:

University-affiliated fertility center.

PATIENT(S):

Pregnancies achieved via IVF with PGT (n = 177) and IVF without PGT (n = 180) that resulted in a live birth.

INTERVENTION(S):

None.

MAIN OUTCOME MEASURE(S):

Maternal outcomes including preeclampsia and placenta previa and neonatal outcomes including birth weight and birth defects.

RESULT(S):

There was a statistically significant increase in the risk of preeclampsia among IVF+PGT pregnancies compared with IVF without PGT pregnancies, with an incidence of 10.5% versus 4.1% (adjusted odds ratio [aOR] = 3.02; 95% confidence interval [95% CI], 1.10, 8.29). The incidence of placenta previa was 5.8% in IVF+PGT pregnancies versus 1.4% in IVF without PGT pregnancies (aOR = 4.56; 95% CI, 0.93, 22.44). Similar incidences of gestational diabetes, preterm premature rupture of membranes, and postpartum hemorrhage were observed. IVF+PGT and IVF without PGT neonates did not have a significantly different gestational age at delivery or rate of preterm birth, low birth weight, neonatal intensive care unit admission, neonatal morbidities, or birth defects. All trends, including the significantly increased risk of preeclampsia in IVF+PGT pregnancies, persisted upon stratification of analysis to only singleton live births.

CONCLUSION(S):

To date, this is the largest and most extensively controlled study examining maternal and neonatal outcomes after trophectoderm biopsy. There was a statistically significant three-fold increase in the odds of preeclampsia associated with trophectoderm biopsy. Given the rise in PGT use, further investigation is warranted.

PGS若TE cell出現segmental aneuploids, ICM僅42％出現aneuploids
PGS若TE cell出現whole chromosome aneuploids, ICM98％出現aneuploids

Hum Reprod. 2019 Jan 1;34(1):181-192. doi: 10.1093/humrep/dey327.

Assessment of aneuploidy concordance between clinical trophectoderm biopsy and blastocyst.

Victor AR1,2, Griffin DK2, Brake AJ1, Tyndall JC1, Murphy AE1, Lepkowsky LT1, Lal A1, Zouves CG1,3, Barnes FL1,3, McCoy RC4, Viotti M1,3.

Author information

Abstract

STUDY QUESTION:

Is a clinical trophectoderm (TE) biopsy a suitable predictor of chromosomal aneuploidy in blastocysts?

SUMMARY ANSWER:

In the analyzed group of blastocysts, a clinical TE biopsy was an excellent representative of blastocyst karyotype in cases of whole chromosome aneuploidy, but in cases of only segmental (sub-chromosomal) aneuploidy, a TE biopsy was a poor representative of blastocyst karyotype.

WHAT IS KNOWN ALREADY:

Due to the phenomenon of chromosomal mosaicism, concern has been expressed about the possibility of discarding blastocysts classified as aneuploid by preimplantation genetic testing for aneuploidy (PGT-A) that in fact contain a euploid inner cell mass (ICM). Previously published studies investigating karyotype concordance between TE and ICM have examined small sample sizes and/or have utilized chromosomal analysis technologies superseded by Next Generation Sequencing (NGS). It is also known that blastocysts classified as mosaic by PGT-A can result in healthy births. TE re-biopsy of embryos classified as aneuploid can potentially uncover new instances of mosaicism, but the frequency of such blastocysts is currently unknown.

STUDY DESIGN, SIZE, DURATION:

For this study, 45 patients donated 100 blastocysts classified as uniform aneuploids (non-mosaic) using PGT-A by NGS (n = 93 whole chromosome aneuploids, n = 7 segmental aneuploids). In addition to the original clinical TE biopsy used for PGT-A, each blastocyst was subjected to an ICM biopsy as well as a second TE biopsy. All biopsies were processed for chromosomal analysis by NGS, and karyotypes were compared to the original TE biopsy.

PARTICIPANTS/MATERIALS, SETTING, METHODS:

The setting for this study was a single IVF center with an in-house PGT-A program and associated research laboratory.

MAIN RESULTS AND THE ROLE OF CHANCE:

When one or more whole chromosomes were aneuploid in the clinical TE biopsy, the corresponding ICM was aneuploid in 90 out of 93 blastocysts (96.8%). When the clinical TE biopsy contained only segmental (sub-chromosomal) aneuploidies, the ICM was aneuploid in three out of seven cases (42.9%). Blastocysts showing aneuploidy concordance between clinical TE biopsy and ICM were also aneuploid in a second TE biopsy in 86 out of 88 cases (97.7%). In blastocysts displaying clinical TE-ICM discordance, a second TE biopsy was aneuploid in only two out of six cases (33.3%).

囊胚染色體正常率僅3-4成
年輕病患的卵子僅有16%會形成染色體正常之胚胎
超高齡>41歲病患的卵子僅有4%會形成染色體正常之胚胎

Fertil Steril. 2019 May 15. pii: S0015-0282(19)30323-1. doi: 10.1016/j.fertnstert.2019.03.040. [Epub ahead of print]

Euploidy rates between cycles triggered with gonadotropin-releasing hormone agonist and human chorionic gonadotropin.

Thorne J1, Loza A1, Kaye L1, Nulsen J1, Benadiva C1, Grow D1, Engmann L2.

Author information

Abstract

OBJECTIVE:

To evaluate differences in euploidy rates between IVF cycles triggered with either GnRH agonist (GnRHa) or hCG.

DESIGN:

Retrospective cohort study.

SETTING:

University-affiliated fertility center.

PATIENT(S):

A total of 366 patients performing 539 IVF cycles utilizing preimplantation genetic testing for aneuploidy (PGT-A).

INTERVENTION(S):

Gonadotropin-releasing hormone agonist or hCG trigger of oocyte maturation during IVF cycles.

MAIN OUTCOME MEASURE(S):

Rate of euploid embryos.

RESULT(S):

Patients in the GnRHa trigger arm were younger, with a lower body mass index and higher antimüllerian hormone level, and they had a higher number of oocytes retrieved and embryos biopsied. Euploid rate per embryo biopsied was higher after GnRHa trigger than after hCG trigger (37.8% ± 2.1% vs. 30.3% ± 1.8%), but multivariate regression analysis controlling for potential confounding factors did not show any differences between the two groups. Moreover, the euploid rate per oocyte retrieved was not significantly different overall (GnRHa vs. hCG: 33.9% ± 2.2% vs. 28.0% ± 1.9%). The anticipated decline in the rate of euploid embryos per oocyte retrieved went from 15.8% ± 1.2% for age <35 years to 4.3% ± 0.9% for patients aged ≥41 years. There were no significant differences between the two groups after stratifying by age and controlling for PGT-A testing modality.

CONCLUSION(S):

Both GnRHa and hCG trigger result in comparable euploid rates. Trigger with GnRHa should therefore be considered a valid option for trigger modality in freeze-all PGT-A cycles, in view of its demonstrated effectiveness and known safety enhancement.

Copyright © 2019. Published by Elsevier Inc.

母體B肝帶原較容易不孕, 接受IVF-ET後胚胎著床率較低 

ertil Steril. 2019 May 15. pii: S0015-0282(19)30322-X. doi: 10.1016/j.fertnstert.2019.03.039. [Epub ahead of print]

Maternal chronic hepatitis B virus infection does not affect pregnancy outcomes in infertile patients receiving first in vitro fertilization treatment.

Wang L1, Li L2, Huang C1, Diao L1, Lian R1, Li Y1, Xiao S1, Hu X1, Mo M1, Zeng Y3.

Abstract

OBJECTIVE:

To evaluate whether maternal chronic hepatitis B virus (HBV) infection affects pregnancy outcomes in infertile patients undergoing their first in vitro fertilization (IVF) treatment.

DESIGN:

A retrospective case control study.

SETTING:

Fertility center.

PATIENT(S):

Female patients, comprising 8,550 infertile women including 180 HBsAg+HBeAg+, 714 HBsAg+HBeAg-, and 7,656 HBsAg seronegative controls undergoing their first IVF treatments.

INTERVENTION(S):

Clinical characteristics, pregnancy and neonatal outcomes were analyzed by Kruskal-Wallis test, analysis of variance, or chi-square test. Logistic regression was employed to verify the contribution of maternal HBV to clinical pregnancy, live birth, and miscarriage.

MAIN OUTCOME MEASURE(S):

Primary outcome: live-birth rate; secondary outcomes: implantation, clinical pregnancy, and miscarriage rates.

RESULT(S):

An increased duration of infertility and more secondary infertility and ovulatory disorders were observed in the HBV patients. The implantation rate was statistically significantly lower in the HBsAg+HBeAg- group compared with the controls. However, the clinical pregnancy rate, miscarriage rate, live-birth rate, neonatal outcomes, and pregnancy complications showed no statistically significant differences among the groups. The logistic regression analysis showed that HBV infection status did not affect the clinical pregnancy, miscarriage, or live-birth rates, unlike maternal age, endometrial thickness, and use of high-quality embryos.

CONCLUSION(S):

Hepatitis B virus infection is not an independent contributor to pregnancy outcomes, although it is associated with prolonged infertility duration, a high frequency of secondary infertility and ovulatory disorders, and a reduced implantation rate.

體重過重女性胚胎分裂速度較慢 (胖 vs Ｎ 病人）
T5: 50.84 h vs. 49.24 h 
T8: 57.89 hvs. 55.66 h 

J Assist Reprod Genet. 2019 May 6. doi: 10.1007/s10815-019-01456-3. [Epub ahead of print]

Maternal body mass index affects embryo morphokinetics: a time-lapse study.

Bartolacci A1, Buratini J1,2, Moutier C1, Guglielmo MC1, Novara PV1, Brambillasca F1, Renzini MM1, Dal Canto M3.

Author information

Abstract

PURPOSE:

To assess the effect of body mass index (BMI) on morphokinetic parameters of human embryos evaluated with time-lapse technology during in vitro culture.

METHODS:

A retrospective analysis of ART cycles utilizing time-lapse technology was undertaken to assess the potential impact of maternal BMI on morphokinetic and static morphological parameters of embryo development. The cohort of patients was divided into four groups: 593 embryos from 128 underweight women in group A; 5248 embryos from 1107 normal weight women in group B; 1053 embryos from 226 overweight women in group C; and 286 embryos from 67 obese women in group D.

RESULTS:

After adjusting for maternal age, paternal age, and cause of infertility, time to reach five blastomeres (t5) and time to reach eight blastomeres (t8) were longer in obese women compared with normoweight women [50.84 h (46.31-55.29) vs. 49.24 h (45.69-53.22) and 57.89 h (51.60-65.94) vs. 55.66 h (50.89-62.89), adjusted p < 0.05 and adjusted p < 0.01, respectively]. In addition, t8 was also delayed in overweight compared with normoweight women [56.72 h (51.83-63.92) vs. 55.66 h (50.89-62.89), adjusted p < 0.01]. No significant differences were observed among groups with regard to embryo morphology and pregnancy rate. Miscarriage rate was higher in underweight compared with normoweight women (OR = 2.1; 95% CI 1.12-3.95, adjusted p < 0.05).

CONCLUSION:

Assessment with time-lapse technology but not by classical static morphology evidences that maternal BMI affects embryo development. Maternal obesity and overweight are associated with slower embryo development.

男性不孕精蟲經過grading分離後DNA fragment 增加

J Assist Reprod Genet. 2019 May 14. doi: 10.1007/s10815-019-01476-z. [Epub ahead of print]

DNA fragmentation in concert with the simultaneous assessment of cell viability in a subfertile population: establishing thresholds of normality both before and after density gradient centrifugation.

Punjabi U1,2, Van Mulders H3, Goovaerts I3, Peeters K3, Roelant E4, De Neubourg D3,5.

Author information

Abstract

PURPOSE:

TUNEL assay is the most common, direct test for sperm chromatin integrity assessment. But, lack of standardized protocols makes interlaboratory comparisons impossible. Consequently, clinical thresholds to predict the chance of a clinical pregnancy also vary with the technique adopted. This prospective study was undertaken to assess the incidence of sperm DNA fragmentation in a subfertile population and to establish threshold values of normality as compared to a fertile cohort, both before and after density gradient centrifugation in the total and vital fractions.

METHOD:

Men presenting at a university hospital setup for infertility treatment. DNA damage via TUNEL assay was validated on fresh semen samples, as conventional semen parameters, to reduce variability of results.

RESULTS:

Total DNA fragmentation in the neat semen was significantly higher in the subfertile group, but the vital fraction was not significantly different between the two cohorts. After gradient centrifugation, DNA fragmentation increased significantly in the total fraction of the subfertile group but decreased significantly in the vital fraction. In the fertile cohort, there was a non-significant increase in total fragmentation and in the vital fraction the trend was unclear.

CONCLUSIONS:

Estimating total and vital sperm DNA fragmentation, after density gradient centrifugation, increased both the sensitivity and the specificity, thereby lowering the number of false negatives and false positives encountered. These findings provide opportunities to investigate the significance of the total and the vital fractions after different assisted reproductive technologies.