Reproductive BioMedicine Online RSS feed: Current Issue. Reproductive BioMedicine Online covers the formation, growth and differentiation of the human embryo. It is intended to bring to public attention new research on biological and clinical research on human reproduction and the human embryo including relevant studies on animals. It is published by a group of scientists and clinicians working in these fields of study. Its audience comprises researchers, clinicians, practitioners, academics and patients. Context The period of human embryonic growth covered is between the formation of the primordial germ cells in the fetus until mid-pregnancy. High quality research on lower animals is included if it helps to clarify the human situation. Studies progressing to birth and later are published if they have a direct bearing on events in the earlier stages of pregnancy.http://www.rbmojournal.com/?rss=yesElsevier Inc.en © 2010 Published by Elsevier Inc. All rights reserved. Reproductive BioMedicine Online1472-6483213September 2010 © 2010 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.rbmojournal.com/article/PIIS1472648310004943/abstract?rss=yesContents10.1016/S1472-6483(10)00494-3Reproductive BioMedicine Online 21, 3 (2010)2010-09-01Reproductive BioMedicine Online2010-09-01213S1472-6483(10)X0011-6iiiiihttp://www.rbmojournal.com/article/PIIS1472648310004384/abstract?rss=yesMartin H Johnson MA PhD FRCOG started his career in reproductive science in 1965 when he encountered Bob Edwards for the first time. Martin had gone to Cambridge University in 1963 to read medicine, and after two years learning basic anatomy, physiology, biochemistry and pharmacology had specialized in advanced physiology. Bob Edwards had arrived in the Physiology Department in 1963 as a Ford Foundation Fellow. He gave a third-year course on Reproduction that fired the imagination and interest of two students in particular, Martin being one and (now Professor) Richard Gardner the other. Together they did a voluntary project in the evenings and at weekends, under Bob’s guidance, involving the vital staining of cortical granules with acridine orange in hamster and mouse eggs. Although the project was not an unqualified success, their appetites for research were stimulated and so, in 1966, instead taking up his clinical place at Charing Cross Hospital Medical School, Martin, together with Richard, became Bob’s first graduate students.Martin Johnson10.1016/j.rbmo.2010.06.029Reproductive BioMedicine Online 21, 3 (2010)2010-08-02Reproductive BioMedicine Online2010-08-02213S1472-6483(10)X0011-6Editorial273273http://www.rbmojournal.com/article/PIIS147264831000444X/abstract?rss=yesAbstract: Chromosome abnormalities are common among human oocytes and are usually lethal to any embryos they produce. It therefore seems logical that a reliable technique for distinguishing between normal and aneuploid embryos would be a useful tool for physicians and embryologists, assisting the choice of which embryo(s) to prioritize for uterine transfer. This concept has led to the development of a variety of methods for the detection of chromosome abnormalities in oocytes and embryos, most often referred to as preimplantation genetic screening (PGS). However, several well-controlled studies have been unable to show an advantage of chromosome screening in terms of pregnancy and birth rates. Some investigators have suggested that damage to embryos, sustained during cleavage-stage biopsy, might explain why PGS has not always provided the anticipated benefits. This paper asks whether there is evidence that a non-invasive, morphological analysis could allow chromosomally normal embryos to be accurately identified and reviews data from the most recent publication concerning IVF outcome following PGS.During an IVF cycle, it is typical for several embryos to be produced. However, not all of these embryos will have the same chance of producing a child. One of the main reasons for the variability in embryo potential is chromosome abnormality. This problem is common in embryos and causes them to fail to implant or miscarry. In order to maximize the success rates of IVF treatment, it is important to make sure that the embryos transferred to the uterus are chromosomally normal. This paper considers two possible methods for the identification of embryos with the correct number of chromosomes: morphological analysis (evaluation of the appearance of the embryo under the microscope) and preimplantation genetic screening (a method based upon testing of cells biopsied from the embryo). These alternative strategies are discussed with specific reference to the findings of another recent paper published in this journal.Embryo aneuploidy and the role of morphological and genetic screeningDagan Wells10.1016/j.rbmo.2010.06.035Reproductive BioMedicine Online 21, 3 (2010)2010-08-02Reproductive BioMedicine Online2010-08-02213S1472-6483(10)X0011-6Commentaries274277http://www.rbmojournal.com/article/PIIS1472648310004335/abstract?rss=yesAbstract: New emerging evidence from clinical trials demonstrates that acupuncture performed at the time of embryo transfer does not improve the pregnancy or live birth outcome after treatment. This evidence raises questions regarding the futility of conducting further research in this area and the quality of evidence needed before any specific intervention is incorporated into routine clinical practice, particularly when a scientific rationale is lacking.A new study of acupuncture in IVF: pointing in the right directionTarek El-Toukhy, Yacoub Khalaf10.1016/j.rbmo.2010.06.024Reproductive BioMedicine Online 21, 3 (2010)2010-07-23Reproductive BioMedicine Online2010-07-23213S1472-6483(10)X0011-6Commentaries278279http://www.rbmojournal.com/article/PIIS1472648310004633/abstract?rss=yesAbstract: Preimplantation genetic diagnosis (PGD) should not be an option only for the few couples at risk of serious genetic conditions who can afford it. We appear to have lost sight of the original driving force behind the development of PGD, which is that most couples who carry a serious genetic disorder find it more acceptable to choose to conceive with healthy embryos tested in-vitro at preimplantation stages of development within the first week following fertilization, even if that means discarding those diagnosed as affected. It has been shown using cystic fibrosis as an example, that the cost savings to the US healthcare system of providing free IVF-PGD to all carrier couples compared to the lifetime costs of medical treatment for patients affected by this disease, run to dozens of billions of dollars. With the increasing emphasis in medicine on early diagnosis and prevention of disease together with the availability of new molecular genetic diagnostic tools, a national IVF-PGD programme seems to be the next step in modern health care.Preimplantation genetic diagnosis after 20yearsAlan H. Handyside10.1016/j.rbmo.2010.07.007Reproductive BioMedicine Online 21, 3 (2010)2010-08-02Reproductive BioMedicine Online2010-08-02213S1472-6483(10)X0011-6Commentaries280282http://www.rbmojournal.com/article/PIIS1472648310002233/abstract?rss=yesAbstract: Following IVF, single blastocyst transfer has been thought to reduce the risks of high-order multiple pregnancies. This is a report of two cases of monozygotic triplet pregnancies after single blastocyst transfer and a review of the current concepts of the pathogenesis of multiple monozygotic pregnancies as well as the options for managing these high-risk pregnancies. Both cases were reduced to a twin pregnancy by selective cord coagulation at 15–16weeks. Whereas one patient had uneventful pregnancy until labour was induced for growth arrest and cord Doppler abnormalities in one twin, the other developed a severe twin-to-twin transfusion syndrome which required fetoscopic laser surgery at 21weeks. In both cases, healthy twins were delivered by Caesarean section at 34.5 and 34weeks, respectively. As the predictors of their occurrence are not fully understood, patients should be informed of the risks of monozygotic pregnancies after single blastocyst transfer.Monozygotic triplet pregnancies after single blastocyst transfer: two cases and literature reviewLionel Dessolle, Dalila Allaoua, Thomas Fréour, Claudine Le Vaillant, Henri-Jean Philippe, Miguel Jean, Paul Barrière10.1016/j.rbmo.2010.04.011Reproductive BioMedicine Online 21, 3 (2010)2010-07-20Reproductive BioMedicine Online2010-07-20213S1472-6483(10)X0011-6Reviews283289http://www.rbmojournal.com/article/PIIS1472648310002336/abstract?rss=yesAbstract: Post-operative adhesions are a significant complication of all abdominal surgical procedures. The major strategies for adhesion prevention in gynaecological surgery are focused on the optimization of surgical technique and use of anti-adhesive agents, which fall into two main categories: pharmacological agents and barriers. Surgical technique that minimizes peritoneal trauma can reduce, but cannot prevent post-operative adhesion formation. Various local and systemic drugs that can alter the local inflammatory response, inhibit the coagulation cascade and promote fibrinolysis have been evaluated. Limited data support the administration of post-operative corticosteroids in addition to systemic intra-operative corticosteroids for the prevention of adhesions after gynaecological surgery. None of the remaining pharmacological agents have been found effective for the reduction of post-operative adhesions. Barriers are currently considered the most useful adjuncts, which may reduce adhesion formation. They act by separating the traumatized peritoneal surfaces during the healing period. The separation can be achieved by solid barriers or fluids. There is limited evidence from randomized clinical trials that support the beneficial effect of most of these barrier agents in the prevention of intra-peritoneal adhesions after gynaecological surgery. However, the evidence is not adequate for definite conclusions to be drawn and further research in this field is warranted.Prevention of intra-peritoneal adhesions in gynaecological surgery: theory and evidenceG. Pados, C.A. Venetis, K. Almaloglou, B.C. Tarlatzis10.1016/j.rbmo.2010.04.021Reproductive BioMedicine Online 21, 3 (2010)2010-08-02Reproductive BioMedicine Online2010-08-02213S1472-6483(10)X0011-6Reviews290303http://www.rbmojournal.com/article/PIIS1472648310002269/abstract?rss=yesAbstract: It is well known that the reproductive steroid hormones, particularly progesterone, in addition to its widely recognized effects on endometrial epithelial and stromal cells and spiral arteries, affect the activities of T cells and natural killer cells in the deciduas, thus inducing active immune tolerance against the fetal antigens. The immunomodulatory effects of progesterone on T cells, B cells and natural killer cells have been discussed extensively in the literature. The aim of the present review is to sum up and discuss the results from this and other laboratories of investigations on the effects of progesterone on dendritic cells and adult stem cells, which are some of the other cell populations present at the fetal–maternal interface and possibly are related to the immunoregulation during pregnancy. These cells have been shown to have a number of specific functions but their involvement in the entire process of regulation of the immune response in pregnancy is still under discussion. The present review focuses on facts showing that the progesterone is a kind of ‘regulator of regulators’ in the decidua, thus creating the most favourable conditions for the development of the semi-allogeneic fetus in successful pregnancy.New target cells of the immunomodulatory effects of progesteroneDobroslav Kyurkchiev, Ekaterina Ivanova-Todorova, Stanimir Dobrev Kyurkchiev10.1016/j.rbmo.2010.04.014Reproductive BioMedicine Online 21, 3 (2010)2010-07-20Reproductive BioMedicine Online2010-07-20213S1472-6483(10)X0011-6Reviews304311http://www.rbmojournal.com/article/PIIS1472648310004037/abstract?rss=yesAbstract: Spermatozoa deliver more than the paternal genome into the oocyte; they also carry remnant messenger RNA from spermatogenesis. The RNA profiles of spermatozoa from high-fertility and a low-fertility Holstein bulls were analysed using Affymetrix bovine genechips. A total of 415 transcripts out of approximately 24,000 were differentially detected in spermatozoa collected from both bulls (fold change ⩾2.0; P<0.01). These transcripts were associated with different cellular functions and biological processes. Spermatozoa from high-fertility bulls contained higher concentrations of transcripts for membrane and extracellular space protein locations, while spermatozoa from the low-fertility bulls were deficient of transcripts for transcriptional and translational factors. Quantitative real-time PCR was used on three low-fertility and four high-fertility bulls to validate the microarray data. Two highly represented transcripts in the microarray analysis (protamine 1 and casein beta 2) were validated, as well as a third transcript (thrombospondin receptor CD36 molecule) that showed a lower concentration in low-fertility bulls. This study presents the global analysis of spermatozoa originating from bulls with opposite fertility. These results provide some specific transcripts in spermatozoa that could be associated with bull fertility.Male fertility, ability of the sperm to fertilize the oocyte and support early embryonic development, is one of the most important factors in mammalian reproduction, and it has a significant impact on human health. Fertility evaluation of the male is essential for understanding the causes of poor quality semen and its specific effects on fertility. This study demonstrates that in addition to providing half of the genomic material, spermatozoa also contribute transcripts to the oocyte. The spectrum of mRNA molecules found in spermatozoa of high and low fertility bulls suggests potential roles for a number of these spermatozoa transcripts in fertilization and early embryonic development in mammals.Transcriptome analysis of bull spermatozoa: implications for male fertilityJ.M. Feugang, N. Rodriguez-Osorio, A. Kaya, H. Wang, G. Page, G.C. Ostermeier, E.K. Topper, E. Memili10.1016/j.rbmo.2010.06.022Reproductive BioMedicine Online 21, 3 (2010)2010-07-20Reproductive BioMedicine Online2010-07-20213S1472-6483(10)X0011-6Male infertility312324http://www.rbmojournal.com/article/PIIS147264831000235X/abstract?rss=yesAbstract: Management of endometrioma before IVF remains controversial. As well as some measurable benefits from surgical treatment, there are also potential risks that should be discussed with the patients to help them make an informed decision. When surgery is compared with expectant management, there appear to be no statistically significant differences in pregnancy rate and ovarian response to exogenous stimulation. The objectives of this European Society of Human Reproduction and Embryology (ESHRE)-sponsored survey were to acquire knowledge of current strategies for the management of endometrioma (>3cm) prior to IVF and to explore adherence to ESHRE guidelines. A validated, peer-reviewed online questionnaire made of 14 questions was sent to 396 members of the ESHRE Special Interest Groups (Reproductive Surgery and Endometriosis/Endometrium), with a response rate of 27%. Surgical management is the most common treatment (82.2%), with drainage and excision of the cyst wall being the preferred surgical approach (78.5%). Monthly depot gonadotrophin-releasing hormone analogues are the preferred choice of medical treatment of endometriomas before IVF, with an average duration of treatment of 3months. The findings demonstrate that surgery remains the commonest treatment offered for women with endometrioma before IVF. This is in line with the recommendations of the ESHRE guidelines.Management of endometrioma prior to IVF: compliance with ESHRE guidelinesTarek A. Gelbaya, Stephan Gordts, Thomas M. D’Hooghe, Marco Gergolet, Luciano G. Nardo10.1016/j.rbmo.2010.04.023Reproductive BioMedicine Online 21, 3 (2010)2010-08-02Reproductive BioMedicine Online2010-08-02213S1472-6483(10)X0011-6Infertility325330http://www.rbmojournal.com/article/PIIS1472648310002348/abstract?rss=yesAbstract: The study was designed to evaluate the isolated effect of high serum oestradiol concentration on human chorionic gonadotrophin (HCG) day in IVF cycles on endometrial receptivity and placentation. A retrospective cohort included all women attending the IVF unit in 2006 and 2007, with the best prognosis to achieve pregnancy: age (<38years), less than three IVF cycles, transfer of two highest grade embryos and no evidence of factors known to impair implantation or that are associated with increased risk of pregnancy complications. The total included 280 patients were categorized into three groups according to their serum oestradiol concentration on HCG day: group 1, oestradiol <5000pmol/l, group 2, oestradiol in the range 5000–10,000pmol/l and group 3, oestradiol in the range of 10,000–15,000pmol/l. No significant differences were found between the groups in implantation, pregnancy and abortion rates. The high oestradiol group was characterized by high rate (20.8%) of pregnancy complications related to abnormal placentation – fetal growth restriction, pregnancy-induced hypertension and abnormal implantation of the placenta. Hence, the decision to perform embryo transfer in high-responder patients should take into consideration both possible risks of ovarian hyperstimulation syndrome and pregnancy complications related to abnormal placentation.High serum oestradiol concentrations in IVF cycles increase the risk of pregnancy complications related to abnormal placentationJacob Farhi, Avi Ben Haroush, Nejmi Andrawus, Haim Pinkas, Onit Sapir, Benjamin Fisch, Jacob Ashkenazi10.1016/j.rbmo.2010.04.022Reproductive BioMedicine Online 21, 3 (2010)2010-08-02Reproductive BioMedicine Online2010-08-02213S1472-6483(10)X0011-6Infertility331337http://www.rbmojournal.com/article/PIIS147264831000218X/abstract?rss=yesAbstract: This report aimed to examine the effects of atosiban on pregnancy outcome after IVF–embryo transfer. A prospective, randomized, placebo-controlled clinical study was performed. A total of 180 women undergoing intracytoplasmic sperm injection who had top-quality embryos were randomly allocated into treatment and control groups. All the patients had infertility due to tubal factor, hormonal-anovulatory disorders, male factor or unexplained reasons. The treatment group received intravenous administration of atosiban before embryo transfer with a total administered dose of 37.5mg. In the control group, the same number of cycles was performed with placebo medication. The clinical pregnancy rate (PR) per cycle and implantation rate (IR) per transfer were 46.7% and 20.4% in the atosiban-treated group, which were significantly higher than in the control group (28.9% and 12.6%, respectively, P=0.01). The miscarriage rates of groups 1 and 2 were 16.7% and 24.4%, respectively (P=0.01). These results have indicated that atosiban increases the IR and PR after IVF–embryo transfer. These results suggest that atosiban treatment before embryo transfer is effective in priming of the uterus for implantation. This is the first study to investigate the possible contributions of atosiban for improving the PR after IVF–embryo transfer.Treatment with oxytocin antagonists before embryo transfer may increase implantation rates after IVFOzlem Moraloglu, Esra Tonguc, Turgut Var, Tugba Zeyrek, Sertac Batıoglu10.1016/j.rbmo.2010.04.009Reproductive BioMedicine Online 21, 3 (2010)2010-07-20Reproductive BioMedicine Online2010-07-20213S1472-6483(10)X0011-6Infertility338343http://www.rbmojournal.com/article/PIIS1472648310002257/abstract?rss=yesAbstract: The gene for growth differentiation factor 9 (GDF9) is expressed in human oocytes and has an important function in regulating early follicle growth and fertility. Polycystic ovary syndrome (PCOS) is one of the common defects that causes ovary dysfunction and is linked to aberrant processes in folliculogenesis. Previous studies have discovered several mutations in the screening of GDF9 in premature ovarian failure but none in PCOS. This current study focused on the mutational analysis of the coding region of GDF9 among 216 Chinese PCOS patients. Of the 10 different variants found in this study, five novel missense mutations in GDF9 were discovered namely c.15C>G, c.118T>G, c.133A>G, c.1025A>T and c.1275C>A. The above-mentioned mutations indicate GDF9 may be potentially associated with PCOS patients. As far as is known, this study is the first to provide evidence for such an association.Identification of novel missense mutations of GDF9 in Chinese women with polycystic ovary syndromeBinbin Wang, Sirui Zhou, Jing Wang, Jingjing Liu, Feng Ni, Jinting Yan, Yuan Mu, Yunxia Cao, Xu Ma10.1016/j.rbmo.2010.04.013Reproductive BioMedicine Online 21, 3 (2010)2010-08-02Reproductive BioMedicine Online2010-08-02213S1472-6483(10)X0011-6Infertility344348http://www.rbmojournal.com/article/PIIS1472648310002245/abstract?rss=yesAbstract: The osteopontin: αvβ3 integrin complex has been proposed as a means of distinguishing receptive from non-receptive endometrium in clinical practice, thus offering new directions for the development of contraceptive approaches targeted to the endometrium as well as a better understanding of occult causes of infertility in women. Histological dating and immunohistochemical study were performed in control and study cycles in seven groups of women including 10 subjects per group and who received clomiphene citrate, ovarian stimulation for IVF, oral contraception, dehydrogesterone for endometrial luteal phase defect, two different regimens of hormone replacement therapy, or no treatment. Ten healthy fertile women served as a general control group. Osteopontin and αvβ3 integrin expression in the human endometrium was closely related to endometrial maturation and this was irrespective of the endometrium being in-phase or out-of-phase and the hormonal treatment (or no treatment) received. In conclusion, immunohistochemical assessment of the endometrium indicates that the use of osteopontin and αvβ3 integrin or the osteopontin: αvβ3 integrin complex as targets for the development of contraceptive approaches or the understanding of the pathogenesis of female infertility offer little benefit compared with simple histological dating.Osteopontin and αvβ3 integrin as markers of endometrial receptivity: the effect of different hormone therapiesGemma Casals, Jaume Ordi, Montserrat Creus, Francisco Fábregues, Francisco Carmona, Roser Casamitjana, Juan Balasch10.1016/j.rbmo.2010.04.012Reproductive BioMedicine Online 21, 3 (2010)2010-07-20Reproductive BioMedicine Online2010-07-20213S1472-6483(10)X0011-6Infertility349359http://www.rbmojournal.com/article/PIIS1472648310002130/abstract?rss=yesAbstract: Dehydroepiandrosterone (DHEA) has been reported to improve oocyte/embryo yields and oocyte/embryo quality in women with diminished ovarian reserve. Whether DHEA objectively improves ovarian reserve is, however, unknown. This study investigated 120 consecutive patients with diminished ovarian reserve, supplemented for 30–120days (mean 73±27) with DHEA (25mg three times daily). Anti-Müllerian hormone (AMH) concentrations were determined in relationship to DHEA supplementation using linear regression and, longitudinally, by examining interaction between days of DHEA treatment and pregnancy success in respect to changes in AMH. AMH concentrations significantly improved after DHEA supplementation over time (P=0.002). Women under age 38years demonstrated higher AMH concentrations and improved AMH concentrations more than older females. AMH improved longitudinally by approximately 60% (P<0.0002). Women reaching IVF experienced a 23.64% clinical pregnancy rate and conceiving women showed significantly improved AMH concentrations compared with those who did not (P=0.001). DHEA supplementation, thus, significantly improved ovarian reserve in parallel with longer DHEA use and was more pronounced in younger women.Improvement in diminished ovarian reserve after dehydroepiandrosterone supplementationNorbert Gleicher, Andrea Weghofer, David H. Barad10.1016/j.rbmo.2010.04.006Reproductive BioMedicine Online 21, 3 (2010)2010-07-20Reproductive BioMedicine Online2010-07-20213S1472-6483(10)X0011-6Infertility360365http://www.rbmojournal.com/article/PIIS1472648310001859/abstract?rss=yesAbstract: This prospective, randomized, controlled and double-blinded trial studied whether acupuncture in relation to embryo transfer could increase the ongoing pregnancy rates and live birth rates in women undergoing assisted reproductive therapy. A total of 635 patients undergoing IVF or intracytoplasmic sperm injection (ICSI) were included. In 314 patients, embryo transfer was accompanied by acupuncture according to the principles of traditional Chinese medicine. In the control group, 321 patients received placebo acupuncture using a validated placebo needle. In the acupuncture group and the placebo group, the ongoing pregnancy rates were 27% (95% CI 22–32) and 32% (95% CI 27–37), respectively. Live birth rates were 25% (95% CI 20–30) in the acupuncture group and 30% (95% CI 25–30) in the placebo group. The differences were not statistically significant. These results suggest that acupuncture administered in relation to embryo transfer has no effect on the outcome of IVF and ICSI.Acupuncture on the day of embryo transfer: a randomized controlled trial of 635 patientsDorthe Andersen, Kristine Løssl, Anders Nyboe Andersen, Jeanette Fürbringer, Helle Bach, Jannie Simonsen, Elisabeth C. Larsen10.1016/j.rbmo.2010.03.029Reproductive BioMedicine Online 21, 3 (2010)2010-07-20Reproductive BioMedicine Online2010-07-20213S1472-6483(10)X0011-6Infertility366372http://www.rbmojournal.com/article/PIIS1472648310001847/abstract?rss=yesAbstract: This study evaluated the results of a management protocol combining a number of investigations and interventions, previously proven beneficial in randomized controlled trials in IVF/intracytoplasmic sperm injection (ICSI) patients with apparently unexplained recurrent implantation failure (defined as two or more previous failed cycles, during which at least six good-quality embryos were transferred). It was a prospective cohort study and included 273 couples with previous recurrent implantation failure. Each patient (all under 40) underwent a pre-treatment work-up, consisting of pelvic ultrasound scan for hydrosalpinx, hysteroscopy and screening for acquired and congenital thrombophilia. Detected abnormalities were dealt with accordingly: proximal occlusion for hydrosalpinx, hysteroscopic management for intrauterine pathology and thromboprophylaxis with daily low-molecular weight heparin from the day of embryo transfer for thrombophilia. The patients then underwent IVF/ICSI with laser-assisted hatching. 112 patients (41%; group 1) had abnormalities detected (17 hydrosalpinx, 11 intrauterine pathology, 63 congenital thrombophilia, 21 acquired thrombophilia) and the remaining 161 (59%; group 2) had normal work-up. The pregnancy rates per cycle started for all patients, group 1 and group 2 were 47%, 55% and 41%, respectively. This suggests that using the described management protocol in couples with previous recurrent implantation failure leads to a favourable chance of success.Management of 273 cases of recurrent implantation failure: results of a combined evidence-based protocolK.W. Sharif, S. Ghunaim10.1016/j.rbmo.2010.03.028Reproductive BioMedicine Online 21, 3 (2010)2010-07-16Reproductive BioMedicine Online2010-07-16213S1472-6483(10)X0011-6Infertility373380http://www.rbmojournal.com/article/PIIS1472648310003081/abstract?rss=yesAbstract: The delivery rates of 298 patients having preimplantation genetic diagnosis with aneuploidy screening (PGS) were compared with the delivery rates of 144 PGS patients that cancelled the plan for PGS with embryo transfer on day 2 or day 3. The goal of this study was to compare the impact of embryo de-selection with PGS to embryo selection using sequential embryo scoring (SES) on outcome in poor-prognosis patients. Embryos with good sequential scores were more likely to have a normal PGS result than embryos with poor SES scores (34% versus 12%; P<0.05). Patients proceeding with PGS had an overall delivery rate of 15% per oocyte retrieval. There was a significant difference in delivery rates between patients with less than six embryos and patients with greater than six embryos (6% versus 19%; P<0.005). The overall delivery rate for patients having transfers without PGS was 23% (P<0.05 compared with PGS patients) with no difference between low and good responders. It was concluded that PGS neither enhanced nor impaired delivery rates in high responding poor-prognosis patients yet SES may be more accurate than PGS as a means of selection for low-responding poor-prognosis patients.Preimplantation genetic diagnosis for aneuploidy screening (PGS) is a technology used to determine the chromosome complement of an embryo prior to its transfer into the uterus. Despite promising initial results, PGS has not drastically increased delivery rates. This study compares the delivery rates of patients having PGS and those canceling the plan for PGS opting for an embryo transfer without it. Embryos were selected by the PGS result (normal or abnormal) for PGS patients or based on embryo morphology for those patients who did not undergo PGS. The results of this study showed that there was no difference in delivery rates between these two groups of patients and, in fact, a lower delivery rate after PGS in patients having less than six embryos.Sequential embryo scoring as a predictor of aneuploidy in poor-prognosis patientsA. Finn, L. Scott, Thomas O’Leary, D. Davies, J. Hill10.1016/j.rbmo.2010.05.004Reproductive BioMedicine Online 21, 3 (2010)2010-07-20Reproductive BioMedicine Online2010-07-20213S1472-6483(10)X0011-6Genetics and PGD381390http://www.rbmojournal.com/article/PIIS1472648310002221/abstract?rss=yesAbstract: Human mesenchymal stem cells (MSC) are non-controversial multipotent stem cells. Their presence in umbilical cord blood (UCB) has been debated in some studies and others report low counts per cord blood unit and poor proliferation rates. On the other hand, Wharton’s jelly of human umbilical cords appears to be a rich source of human MSC. This study derived 13 human Wharton’s jelly stem cell (WJSC) lines from 13 human umbilical cords (100%) and recovered 4.7 ± 0.2×106 live WJSC/cm of cord before culture. Complex culture medium produced greater proliferation rates of the WJSC in culture compared with simple medium. The mean population doubling times were 24.47 ± 0.33 to 26.25 ± 0.50h in complex medium. The stem-cell markers of the WJSC were retained for at least 10 passages in both media. After programmed machine freezing, the thaw-survival rates of WJSC were 85–90% and they could be differentiated into neurons. Given the high derivation efficiency, availability of large numbers of fresh live cells, high expansion capabilities, prolonged maintenance of stem-cell properties and differentiation potential, it is proposed that human WJSC may be frozen at the same time as UCB in cord blood banks for regenerative medicine purposes.Derivation efficiency, cell proliferation, freeze–thaw survival, stem-cell properties and differentiation of human Wharton’s jelly stem cellsChui-Yee Fong, Arjunan Subramanian, Arijit Biswas, Kalamegam Gauthaman, Prarthana Srikanth, Manoor Prakash Hande, Ariff Bongso10.1016/j.rbmo.2010.04.010Reproductive BioMedicine Online 21, 3 (2010)2010-07-20Reproductive BioMedicine Online2010-07-20213S1472-6483(10)X0011-6Stem cells391401http://www.rbmojournal.com/article/PIIS1472648310002889/abstract?rss=yesAbstract: Atmospheric oxygen (∼20%) in culture significantly impairs preimplantation embryo development. However, it is not known whether all stages of preimplantation embryo development are susceptible to oxygen toxicity. This study investigated the temporal responses of preimplantation embryos to oxygen conditions in vitro. Mouse embryos were cultured in atmospheric (∼20%) or lower (5%) oxygen concentrations for the first 48h, followed by culture in the same or reciprocal oxygen concentrations for another 48h: group 1 (control, 5 and 5%); group 2 (5 and 20%); group 3 (20 and 5%); and group 4 (20 and 20%). Time-lapse microscopy was performed with imaging of individual embryos at 15-min intervals. Compared with embryos cultured in 5% oxygen, embryos cultured in 20% oxygen were delayed at the 1st cleavage by 0.45h (P<0.05), at the 2nd cleavage by 0.84h (P<0.01) and at the 3rd cleavage by 3.19h (P<0.001). Switching from 20% to 5% oxygen after 48h did not completely alleviate earlier induced perturbations. Partial or complete culture in atmospheric oxygen resulted in significantly fewer blastocyst cell numbers compared with control (P<0.05). Oxygen can influence mouse embryo development at both the cleavage and post-compaction stages.Time-lapse analysis of mouse embryo development in oxygen gradientsP.L. Wale, D.K. Gardner10.1016/j.rbmo.2010.04.028Reproductive BioMedicine Online 21, 3 (2010)2010-08-02Reproductive BioMedicine Online2010-08-02213S1472-6483(10)X0011-6Embryology402410http://www.rbmojournal.com/article/PIIS1472648310002178/abstract?rss=yesAbstract: This retrospective cohort study compared outcomes from transfer of embryos cryopreserved at the pronuclear versus blastocyst stage following ‘freeze-all’ IVF cycles without fresh transfer for 87 consecutive IVF patients <40 years, who underwent cryopreservation of all viable embryos followed by at least one subsequent frozen embryo transfer (FET) between January 2003 and July 2007. Cryopreservation of all embryos from one oocyte retrieval was performed at either the pronuclear (1.5mol/l propanediol and 0.1mol/l sucrose) (group A) or blastocyst (10% glycerol) (group B) stage. Main outcome measures included survival, live birth and implantation rates. A total of 110 FET cycles were analysed. Live birth and implantation rates observed after the first FET were significantly higher (P=0.025 and P=0.002) in group B (67.7% and 40.8%) than in group A (41.1% and 21.5%) despite a higher survival rate in group A. After two FET cycles, 32.1% of group A had not conceived despite thaw of all available embryos, compared with 6.5% of group B. When freeze-all is necessary, blastocyst cryopreservation leads to higher implantation and live birth rates compared with pronuclear-stage cryopreservation despite lower survival rates. Prolonged embryo culture may allow for more optimal embryo selection.Freeze-all: enhanced outcomes with cryopreservation at the blastocyst stage versus pronuclear stage using slow-freeze techniquesEric Surrey, Jennifer Keller, John Stevens, Robert Gustofson, Debra Minjarez, William Schoolcraft10.1016/j.rbmo.2010.04.008Reproductive BioMedicine Online 21, 3 (2010)2010-07-20Reproductive BioMedicine Online2010-07-20213S1472-6483(10)X0011-6Embryology411417http://www.rbmojournal.com/article/PIIS1472648310001860/abstract?rss=yesAbstract: This report describes an unusual case of ovarian torsion during an IVF cycle prior to vaginal oocyte retrieval and the subsequent embryo development. A 27-year-old, whose husband carries a balanced translocation, presented on stimulation day 11 (day after human chorionic gonadotrophin administration) with signs of right ovarian torsion. Transvaginal ultrasound identified decreased right ovarian venous flow but preservation of right ovarian arterial flow. She underwent emergency laparoscopic right ovarian detorsion followed by vaginal oocyte retrieval on postoperative day 1. Ten oocytes were retrieved from the right detorted ovary, 4/10 (40%) were fertilized and 3/4 (75%) became blastocysts. Fifteen oocytes were retrieved from the left ovary, 14/15 (93%) were fertilized and 9/14 (64%) became blastocysts. All 18 embryos biopsied for preimplantation genetic diagnosis carried unbalanced translocations and none were transferred. The markedly reduced fertilization rate of the oocytes from the previously torted ovary is similar to the rate described in a prior report and likely related to decreased but maintained ovarian arterial flow. This report is unique because not only was the patient’s ovarian torsion surgically corrected prior to oocyte retrieval but also the embryos originating from the previously torted ovary had excellent development with 75% progressing to the blastocyst stage.IVF and embryo development subsequent to ovarian torsion occurring during the resumption of meiosisLaura P. Smith, Selwyn P. Oskowitz, Brent Barrett, Steven R. Bayer10.1016/j.rbmo.2010.03.030Reproductive BioMedicine Online 21, 3 (2010)2010-07-20Reproductive BioMedicine Online2010-07-20213S1472-6483(10)X0011-6Embryology418421http://www.rbmojournal.com/article/PIIS1472648310002166/abstract?rss=yesAbstract: Studies comparing the outcome of spontaneous versus IVF twin pregnancies report heterogeneous results. This may depend on differences in the studied populations and/or in the management approach to twin pregnancy. The aim of the present study was to compare both maternal and perinatal outcomes in dichorionic diamniotic twin pregnancies who where spontaneously conceived or originated by successful homologous IVF. In order to get homogeneous observations, monochorionic twin pregnancies and triplet pregnancies were excluded. Moreover, to avoid any possible bias deriving from differences in the obstetric management, all pregnancies were managed by the same team applying fixed obstetric protocols. The study included 223 twin pregnancies, 84 conceived by IVF and 139 spontaneously conceived. Overall, maternal and perinatal outcomes were similar in the two groups: no significant differences were observed as far as gestational age at delivery, birthweight, perinatal morbidity and mortality, and rate of malformations were concerned. The rate of Caesarean section was slightly, but not significantly, higher in IVF pregnancies. In conclusion, the outcome of IVF twin pregnancies is comparable to that of spontaneously conceived twin pregnancies, provided that the same management criteria are applied.IVF twins have similar obstetric and neonatal outcome as spontaneously conceived twins: a prospective follow-up studyElena Vasario, Valentina Borgarello, Carlotta Bossotti, Enrico Libanori, Marilisa Biolcati, Silvana Arduino, Rita Spinelli, Luisa Delle Piane, Alberto Revelli, Tullia Todros10.1016/j.rbmo.2010.04.007Reproductive BioMedicine Online 21, 3 (2010)2010-07-20Reproductive BioMedicine Online2010-07-20213S1472-6483(10)X0011-6Fetus and birth422428http://www.rbmojournal.com/article/PIIS1472648310001835/abstract?rss=yesAbstract: This study compared the effect on semen quality of different handling methods used in the preparation of stallion semen doses for artificial insemination. The three methods were (i) extending the ejaculate to 30–50×106/ml, (ii) single layer centrifugation (SLC) and (iii) sperm washing (centrifugation without a colloid). An additional treatment was to add seminal plasma (SP) in various proportions to some SLC preparations. The resulting samples were evaluated for sperm motility by computer assisted sperm analysis, membrane integrity using the Nucleocounter SP-100 and chromatin integrity by the sperm chromatin structure assay. SLC samples consistently had better sperm quality than the extended samples. Sperm washing did not confer any beneficial effect compared with the extended samples and these samples had significantly worse sperm quality than the SLC samples (motility, P<0.01; viability, P<0.001). There was no evidence to suggest that adding SP to the SLC samples could enhance sperm motility for more than a few hours. Longer term cold storage of spermatozoa in the presence of small concentrations of SP resulted in a reduction in total motility and progressive motility compared with SLC alone. High concentrations of SP were detrimental to sperm survival.Single layer centrifugation of stallion spermatozoa improves sperm quality compared with sperm washingJ.M. Morrell, H. Rodriguez-Martinez, A. Johannisson10.1016/j.rbmo.2010.03.027Reproductive BioMedicine Online 21, 3 (2010)2010-08-02Reproductive BioMedicine Online2010-08-02213S1472-6483(10)X0011-6Reproductive physiology429436