Reproductive BioMedicine Online

2010-03-01

Rocking the human embryo – pari passu

Jacques Cohen — 2010-03-01

The human embryo in vivo is exposed to biochemically and biophysically dynamic conditions when it traverses the Fallopian tube. Artificial culture systems appear static in comparison, although this relative calm is interrupted periodically by hand-carrying dishes to and from the microscope concurrent with culture media changeovers. Experimental embryologists have been aware of this presumed discrepancy between in-vitro and in-vivo culture and as far back as the 1970s developed various devices to generate continuous movement around embryos; this was to replicate natural conditions. Gerard Zeilmaker of Erasmus University in Rotterdam in The Netherlands applied a gently shaking heated platform placed in a room warmed to 37°C (). The same system was used in a study involving the in-vitro effects of dihydrotestosterone inhibition on mouse embryo development (). Relatively small droplets of culture medium were placed under paraffin oil in individually gassed Petri dishes with the help of an ingeniously placed tubing system bubbling gas into each dish individually. The system was calibrated to reduce oil spillage and promote embryo development. The humidified gas phase had 5% O2, 5% CO2 and 90% N2 and the movement was circular in the horizontal plane. Neither reduced oxygen tension nor dynamic culture systems were investigated in depth until clinical embryologists set out to methodically optimize embryo culture systems many years later (). Dynamic culture systems, particularly microfluidics, have led the way to study physical phenomena such as shear stress and kinetic friction. In this re-emerging area of interest, there is considerable room for investigation, particularly since it is unclear what physical conditions are conducive to better embryo development or whether there are species differences and specific levels of tolerance. Accurately describing and testing artificial dynamic systems in preclinical studies is therefore both necessary and useful. There are two very recent papers that are worth mentioning in this context. In January, the pioneering group of Gary Smith in Ann Arbor presented an elegant comparative study describing a dynamic microfunnel system (). In this issue of Reproductive BioMedicine Online, a multicenter investigation from Japan by Matsuura and co-workers presents the application of a tilting embryo culture system called TECS placed inside an incubator and its effect on mouse and human embryos (). The two studies are similar in that they both show modestly positive effects on embryo development to the blastocyst stage. Whereas microfluidics may have advantages related to controlled biochemical changes, movement, shear stress, flow, compression and other factors, it is challenging to pinpoint the cause(s) of its development-enhancing effects. The experiments by the Japanese team using TECS were conducted in larger volumes than those utilized in the microfluidics system. The positive effects of TECS must be mechanical in nature, begging the question whether the microfluidic system operates in a similar way?

Assessment of presence and characteristics of multipotent stromal cells in human endometrium and decidua

Stanimir Kyurkchiev, Atanas Shterev, Rumen Dimitrov — 2010-02-01

Abstract: This review discusses the presence and characteristics of multipotent stromal cells in human endometrium and decidua. A number of research groups have reported the isolation and characterization of multipotent stromal cells from the basal layer of the endometrium, and in a single case just from the menstrual blood, i.e. the superficial functional layer. Similarly, multipotent pre-decidual stromal cells are isolated from early decidua and characterized accordingly. Multipotent endometrial stromal cells and multipotent decidual stromal cells are shown to express the basic features of adult stem cells, which are clonogenicity, self-renewal, a potential to differentiate into adipogenic, osteogenic, chrondrogenic, endothelial-like cells and a specific set of surface molecules (CD73, CD90 and CD105). So far, it is not clear whether the same population of multipotent stromal cells is isolated from the basal endometrium or early decidua because it has been shown that in some cases the differentiation potential of endometrial stromal cells is more restricted in comparison to the decidual stromal cells. It is reasonable to assume that it is one cell population under different control by hormonal, paracrine and autocrine factors. Thus far, the functions of these cells have not been convincingly revealed.

Ovarian stimulation in women with high and low body mass index: GnRH agonist versus GnRH antagonist

2010-01-21

Abstract: This study evaluated women with a high body mass index (BMI) (>40kg/m2) and low BMI (<18kg/m2) undergoing assisted reproduction treatment and determined whether the type of gonadotrophin-releasing hormone (GnRH) analogue used has an impact on cycle parameters and outcome. The study analysed 65 women with high BMI and 118 with low BMI. In the former group, polycystic ovarian syndrome was significantly more prevalent in the agonist long protocol (ALP) group (P=0.01) and gonadotrophin consumption was lower, peak oestradiol concentrations and total number of oocytes retrieved were higher in the ALP group compared with the antagonist (ANT) group. Implantation rate (IR), pregnancy rate (PR) per embryo transfer and early pregnancy loss rate (EPLR) were similar in both stimulation groups, with overall rates of 21.6%, 55.4% and 44.4%, respectively. In women with low BMI, peak oestradiol concentrations, total oocytes retrieved, mature oocytes and transferred embryos were higher in the ALP group compared with ANT group. IR, PR/embryo transfer and EPLR were similar in both groups, with overall rates of 24.3%, 52.5% and 16.1%, respectively. In all patients, no difference was found between ALP and ANT protocols concerning treatment outcome. Contrary to the reasonable EPLR observed in women with low BMI, the high rate found in women with high BMI is remarkable.

Healthy baby born after reduction of sperm DNA fragmentation using cell sorting before ICSI

2010-01-22

Abstract: Magnetic activated cell sorting (MACS) with annexin V microbeads recognizes externalized phosphatidylserine (PS) residues on the surface of apoptotic spermatozoa. The successful use of this novel technique applied to a highly apoptotic semen sample before performing intracytoplasmic sperm injection (ICSI) is reported here. The use of annexin V microbeads for selecting non-apoptotic spermatozoa seems to reduce the percentage of altered cells, improving the chance of pregnancy after ICSI.

Progressive alcohol-induced sperm alterations leading to spermatogenic arrest, which was reversed after alcohol withdrawal

2010-02-01

Abstract: This is a report of a 6-year follow-up of a male patient’s semen parameters during heavy chronic alcohol intoxication and after withdrawal. A slowly progressive negative impact of alcohol could be observed: isolated moderate teratozoospermia was firstly noted followed by oligoasthenoteratospermia. Then a severe worsening resulted in cryptozoospermia and ultimately in azoospermia. At this moment, the histological analysis of a testicular biopsy revealed a maturation arrest of the germinal cells at the pachytene stage with no mature sperm cells. Alcohol withdrawal was then obtained, allowing a very fast and drastic improvement of semen characteristics; strictly normal semen parameters were observed after no more than 3months. Taking into consideration these data, patients should be questioned about their alcohol intake before assisted reproductive technology and should be informed about this adverse effect. Moreover, this case report emphasizes how quickly benefits can be obtained after withdrawal, even in the case of heavy chronic alcohol intake.

Addition of sphingosine-1-phosphate to human oocyte culture medium decreases embryo fragmentation

2010-01-21

Abstract: Apoptosis is implicated in the fragmentation of preimplantation mammalian embryos, yet the extent of this association remains controversial. The aim of this study was to assess the ability of sphingosine-1-phosphate (S1P), a known anti-apoptotic substance, to reduce the fragmentation rate of human preimplantation embryos when added to their culture microenvironment. Mature human oocytes were inseminated using intracytoplasmic sperm injection, incubated for 3 days and evaluated for embryo quality and fragmentation by the same embryologist. Oocytes in the study group were manipulated and cultured in culture medium supplemented with S1P to a 20μmol/l concentration. A total of 46 patients donated 177 mature oocytes for the study group and 546 oocytes for the control group. The fertilization rate was significantly lower in the S1P-supplemented group (52.4% versus 67.3%; P=0.002) and the proportion of grade I embryos with less than 15% fragmentation was significantly higher in the same group (79.5% versus 53.9%; P<0.0001). Sphingosine-1-phosphate added to the culture medium of human preimplantation embryos is associated with a significantly lower fragmentation rate and hence better quality embryos. The clinical significance of these findings on reproductive outcome remains highly speculative awaiting further studies to translate this improvement in embryo quality into better pregnancy rates.

Contribution of in-vitro maturation in ovarian stimulation cycles of poor-responder patients

2010-02-01

Abstract: This cohort study evaluated whether rescue spontaneous maturation (RSM) could be a valid method to increase the number of embryos available for transfer and whether transfers with RSM-derived embryos would contribute to clinical outcomes of poor-responder patients in ovarian stimulation cycles. The study included 440 patients undergoing intracytoplasmic sperm injection cycles in which fewer than five metaphase II (MII) oocytes and at least one immature oocyte were retrieved after follicle aspiration. Patients were allocated into two groups based on the injected oocytes’ nuclear maturation status: MII group (n=330), in which only embryos derived from MII oocytes were transferred, and RSM group (n=110), in which at least one embryo derived from an RSM oocyte was transferred. No differences between the MII and RSM groups were observed for pregnancy (16.7% versus 16.5%) or miscarriage (25.5% versus 29.4%) rates, respectively. The RSM group had a higher number of transferred embryos (1.87±1.24 versus 2.35±1.22; P<0.001), a lower embryo transfer cancellation rate (14.5% versus 6.36%; P=0.025) and lower implantation rate (15.4±31.5% versus 10.5±22.3%; not significant). These findings suggest that RSM did not contribute to the outcomes in poor-responder cycles.

Low oxygen tension during IVM improves bovine oocyte competence and enhances anaerobic glycolysis

P. Bermejo-Álvarez, P. Lonergan, D. Rizos, A. Gutiérrez-Adan — 2010-01-21

Abstract: This study evaluated the effect of two oxygen concentrations (20 and 5%) on bovine embryo development (kinetics of first cleavage and blastocyst development) during maturation (M) and fertilization (F) and analysed differences in gene expression between cumulus–oocyte complexes (COC) matured at 5 or 20% oxygen and the resulting blastocysts. A total of 1179 COC were divided into four groups according to the oxygen tension used (M5F5, M5F20, M20F5 and M20F20). Relative poly(A) mRNA abundance of GLUT1, GAPDH, LDHA, G6PD, MNSOD, GPX1, IGFR2, BAX, CCNB1, PTGS2 and GREM1 was analysed in COC, whereas 10 quality-related genes were analysed in blastocysts. M20F5 group developmental rates were significantly lower than all other groups (one-way ANOVA, P⩽0.05). Two-way ANOVA showed a beneficial effect of low oxygen tension during in-vitro maturation on developmental rates, whereas the opposite situation was obtained in fertilization (P⩽0.05). GAPDH, IGFR2, CCNB1, and GREM1 were up-regulated in the oocytes matured in low oxygen, whereas GLUT1, GAPDH, LDHA and GREM1 were up-regulated and PTGS2 down-regulated in the cumulus cells from the M5 group (P⩽0.05). No differences were observed in blastocysts. Low oxygen tension during maturation alters the expression of genes related to oocyte competence and glucose metabolism and significantly (P⩽0.05) improves embryo development, but not blastocyst quality.

Outcomes after early or midfollicular phase LH supplementation in previous inadequate responders

M. Sönmezer, C. İltemir Duvan, B. Özmen, T. Taşçı, S. Özkavukçu, C.S. Atabekoğlu — 2010-01-21

Abstract: Second cycle outcomes of 75 patients who had previous inadequate ovarian response with recombinant FSH (rFSH)-only ovarian stimulation during gonadotrophin-releasing hormone analogue (GnRHa) down-regulated cycles were evaluated retrospectively. In these second cycles, both rFSH and human menopausal gonadotrophin (HMG) in GnRHa long down-regulation were given to all patients, HMG initiated either on day 1 (group A, n=37) or day 5–6 of the ovarian stimulation (group B, n=38). Total HMG dose was higher (1198±514 IU versus 726±469IU; P<0.001), cumulative rFSH consumption was lower (1823±804 IU versus 2863±1393IU; P=0.001) and duration of stimulation was shorter (8.94±1.15days versus 10.37±1.80days; P<0.001) in group A than in group B. No significant differences were found regarding fertilization, implantation or pregnancy rates and embryo quality between the groups. Further analysis by supplementary HMG dose (75IU versus 150IU) revealed that total gonadotrophin and HMG consumption was lower in 75IU-supplemented subgroups. Notably, pregnancy rate was higher in patients where 75IU HMG was supplemented on day 5–6 of ovarian stimulation, which deserves further evaluation.

Improved development of mouse and human embryos using a tilting embryo culture system

2010-01-21

Abstract: Mammalian embryos experience not only hormonal but also mechanical stimuli, such as shear stress, compression and friction force in the Fallopian tube before nidation. In order to apply mechanical stimuli to embryos in a conventional IVF culture system, the tilting embryo culture system (TECS) was developed. The observed embryo images from the TECS suggest that the velocities and shear stresses of TECS embryos are similar to those experienced in the oviduct. Use of TECS enhanced the development rate to the blastocyst stage and significantly increased the cell number of mouse blastocysts (P<0.05). Although not statistically significant, human thawed embryos showed slight improvement in development to the blastocyst stage following culture in TECS compared with static controls. Rates of blastocyst formation following culture in TECS were significantly improved in low-quality embryos and those embryos cultured under suboptimal conditions (P<0.05). The TECS is proposed as a promising approach to improve embryo development and blastocyst formation by exposing embryos to mechanical stimuli similar to those in the Fallopian tube.

Long-distance transportation of primate embryos developing in culture: a preliminary study

2010-01-21

Abstract: Non-human primate embryos are invaluable for conducting research relevant to human infertility and stem cells, but their availability is restricted. In this preliminary study, rhesus monkey embryos were produced by IVF at the Caribbean Primate Research Centre and shipped in tubes of gassed culture medium within a battery-powered transport incubator by overnight courier to Wayne State University in Michigan. Upon arrival, the embryos were incubated in fresh culture medium to evaluate further development. In 11 shipments comprising 98 cleavage-stage embryos developing from oocytes that were mature (MII) upon collection, 51 (52%) reached advanced preimplantation stages (morula to hatched blastocyst) during prolonged culture following transportation. However, most embryos produced from oocytes that were immature (MI) at collection arrested and only 5/51 (10%) reached advanced stages of development. This study demonstrates that non-cryopreserved primate embryos can be routinely transported between distant sites without loss of developmental ability. In this way, the processes of production and study of non-cryopreserved primate embryos need not be restricted to the same or nearby laboratories. This will expand the use of these embryos for research and facilitate generation of translationally relevant information.

Prediction of in-vitro developmental competence of early cleavage-stage mouse embryos with compact time-lapse equipment

2010-01-21

Abstract: Single blastocyst transfer is regarded as an efficient way to achieve high pregnancy rates and to avoid multiple pregnancies. Risk of cancellation of transfer due to a lack of available embryos may be reduced by early prediction of blastocyst development. Time-lapse investigation of mouse embryos shows that the time of the first and second cleavage (to the 2- and 3-cell stages, respectively) has a strong predictive value for further development in vitro, while cleavage from the 3-cell to the 4-cell stage has no predictive value. In humans, embryo fragmentation during preimplantation development has been associated with lower pregnancy rates and a higher incidence of developmental abnormalities. Analysis of time-lapse records shows that most fragmentation is reversible in the mouse and is resorbed in an average of 9h. Daily or bi-daily microscopic checks of embryo development, applied routinely in human IVF laboratories, would fail to detect 36 or 72% of these fragmentations, respectively. Fragmentation occurring in a defined time frame has a strong predictive value for in-vitro embryo development. The practical compact system used in the present trial, based on the ‘one camera per patient’ principle, has eliminated the usual disadvantages of time-lapse investigations and is applicable for the routine follow-up of in-vitro embryo development.

Factors affecting pregnancy in IVF: age and duration of embryo transfer

M.T. Cetin, Y. Kumtepe, H. Kiran, G. Seydaoglu — 2010-02-01

Abstract: The aim of this retrospective study was to investigate factors affecting clinical pregnancy rates, especially age and duration of embryo transfer, in IVF/intracytoplasmic sperm injection cycles (1313 embryo transfers). Overall clinical pregnancy rate was 30.0% (n=394). Clinical pregnancy rates were found to be 31.6% for the <44s interval, 25.9% for the 45–59 s interval and 23.6% for the ⩾60s interval (P=0.020). In the <35year age group, clinical pregnancy rates were 35.1%, 29.9% and 30.6%, and in the ⩾35year age group, they were 26.9%, 21.0% and 13.4% (P=0.013), respectively. According to logistic regression analyses, the odds of failed pregnancy increased by 1.61 times [95% confidence interval (CI) 1.07–2.41] for embryo transfer durations longer than 60s and odds ratios of a failed pregnancy were 1.53 (95% CI 1.18–1.99) in the ⩾35year age group, 1.49 (95% CI 1.05–2.12) for fewer than five oocytes and 3.38 (95% CI 2.10–5.43) for fewer than two transferred embryos. In conclusion, to increase the likelihood of a successful pregnancy in women over 35years of age, the duration of embryo transfer must be kept below 60s. The number of oocytes obtained and the number of transferred embryos also play a role in the success of pregnancy.

Two singleton live births after the transfer of cryopreserved–thawed day-3 embryos following an unstimulated in-vitro oocyte maturation cycle

2010-01-21

Abstract: The objective was to report two singleton live births after transfer of cryopreserved–thawed day-3 embryos resulting from an unstimulated in-vitro oocyte maturation (IVM) cycle. A 29-year-old female patient with polycystic ovaries (PCO) underwent an unstimulated IVM cycle. A total of 43 prophase-I oocytes were retrieved; 21 oocytes achieved in-vitro maturation to the metaphase-II stage at 36h post-retrieval and 18 oocytes were fertilized (two pronuclei) after intracytoplasmic sperm injection. Two embryos were transferred in the fresh cycle (no pregnancy) and 15 day-3 embryos (post-oocyte microinjection) were cryopreserved. Subsequently, the patient became pregnant after each of two embryo transfer cycles from cryopreserved–thawed embryos (three and two embryos transferred respectively), with delivery of a single, term, healthy baby after each transfer. It is concluded that healthy live births were documented in a PCO patient undergoing unstimulated IVM followed by transfer of day-3 cryopreserved (slow-freeze)–thawed embryos, adding these methodologies to the armamentarium of assisted reproductive technologies.

Assessment of vision and hearing in children conceived spontaneously and by ICSI: a prospective controlled, single-blinded follow-up study

2010-01-21

Abstract: Long-term follow-up studies on the health of children born after assisted reproduction technologies are mandatory. Vision and hearing are the most important senses that continue to develop during childhood. There are few reports on vision and hearing in preschool children born after assisted conception. This prospective controlled blinded follow-up study examined 276 term-born singleton intracytoplasmic injection (ICSI) children and 273 spontaneously conceived controls at a mean age of 5.5years and performed detailed vision and hearing test and clinically examined eyes and ears. There was no significant difference between ICSI and control children regarding the occurrence of vision or hearing impairments. Unsurprisingly, children with abnormalities in otoscopy were more likely to have an abnormal hearing test compared with children without abnormalities. Only 8.5% of ICSI parents and 25.4% of control parents whose children showed an abnormal hearing test knew about the hearing problems of their child. In conclusion, there was no difference in the development of hearing and vision in ICSI children and spontaneously conceived controls. But only few parents knew about hearing problems of their child after undergoing routine screening examinations. Parental interviews would therefore not be sufficient in order to assess vision and hearing in follow-up studies.

The Italian Constitutional Court modifies Italian legislation on assisted reproduction technology

Giuseppe Benagiano, Luca Gianaroli — 2010-01-21

Abstract: On 8 May 2009, the Italian Constitutional Court declared, at least in part, that the law regulating assisted reproduction technology in Italy (Law 40/04) is unconstitutional. The most important theoretical point made by the Court is that the law does not provide unlimited protection to embryos, since it admits that some of them may not produce a viable fetus. Embryo protection is therefore limited by the imperative to ensure a concrete possibility to achieve a successful pregnancy. The Court also reaffirmed the need to empower the attending physician with the means to carry out a full evaluation. At present, the situation is not clear and, theoretically, requires a new intervention by Parliament. This, however, is unlikely.

Effect of N-acetyl-cysteine after ovarian drilling in clomiphene citrate-resistant PCOS women: a pilot study

A. Nasr — 2010-01-21

Abstract: The aim of this randomized double-blind placebo-controlled pilot study was to evaluate N-acetyl-cysteine (NAC) as an adjunctive therapy following unilateral laparoscopic ovarian drilling (LOD) for clomiphene citrate-resistant women with polycystic ovary syndrome (PCOS). A total of 60 patients with clomiphene citrate-resistant PCOS who underwent unilateral LOD were assigned randomly to receive either NAC 1.2g/d (group A=30) or placebo (group B=30) for 5days starting at day 3 of the cycle for 12 consecutive cycles. The primary outcome was pregnancy rate; secondary outcomes were ovulation rates, endometrial thickness and pregnancy outcome. Baseline clinical, endocrine, and sonographic characteristics were similar in the two groups. A significant increase in both ovulation and pregnancy rates was observed in the NAC group, compared with placebo [87% versus 67% (RR 1.3; 95% CI 1.2–2.7) and 77% versus 57% (RR 1.4; 95% CI 1.1–2.7), respectively, P<0.01]. Moreover, miscarriage rates were significantly lower and live birth rates were significantly higher in the NAC group [8.7% versus 23.5% (RR 0.4; 95% CI 0.1–3.7) and 67% versus 40% (RR 1.7; 95% CI 0.3–3.5), respectively, P<0.01]. In conclusion, NAC is a novel adjuvant therapy after unilateral LOD which might help improve overall reproductive outcome.

Effect of delaying post-operative conception after conservative surgery for endometriosis

2010-01-25

Abstract: The objective of this study was to determine whether delaying attempts to conceive after surgery for endometriosis impacts on reproductive prognosis. Patients operated on for endometriosis who were not seeking pregnancy at the time of surgery were selected (n=124) from a large survey regarding reproductive outcome of women with the disease. Pregnancy rate and rate of second surgery were compared between women who attempted conception within 12 months after surgery (n=61) and those compared who postponed attempts for 12 months or more (n=63). In women delaying attempted conception, the adjusted incidence rate ratio for pregnancy and repetitive surgery was 0.79 (95% CI 0.46–1.35) and 1.70 (95% CI 0.86–3.38), respectively. In conclusion, attempting conception shortly after surgery appears advisable since delaying is associated with a lower pregnancy rate and a higher rate of recurrence. However, these differences did not reach statistical significance and this advice is thus not mandatory. Larger studies are warranted to validate these conclusions.

The pattern of pregnancy loss in women with congenital uterine anomalies and recurrent miscarriage

Sotirios H. Saravelos, Karen A. Cocksedge, Tin-Chiu Li — 2010-01-21

Abstract: Congenital uterine anomalies (CUA) are a known cause of recurrent miscarriage (RM), but the pattern of pregnancy loss that different CUA produce remains unknown. This study included 665 women with RM who were screened for CUA using a combined two-dimensional ultrasound (2D-US) and hysterosalpingography (HSG) approach. All suspected CUA were definitively diagnosed and classified via a combined hysteroscopy/laparoscopy procedure. Pregnancy outcomes were evaluated and compared for each type of CUA versus a control group of women with no identifiable cause of RM (unexplained RM). Fifty-six women with CUA and 107 women with unexplained RM were identified. In total, 881 pregnancies were analysed. Analysis showed that women with a septate or bicornuate uterus suffered from significantly increased second-trimester miscarriages compared with controls (13.2% and 13.8% versus 1.0%; P<0.001 and P<0.05, respectively). Women with an arcuate, septate or bicornuate uterus showed significantly reduced rates of biochemical pregnancy losses compared with controls (9.5%, 11.1% and 11.1% versus 30.4%; P<0.01, P<0.01 and P<0.05, respectively). Pregnancies of women with RM and CUA are not associated with early implantation failure and are compromised at a more advanced gestational age.

See-and-treat outpatient hysteroscopy: an analysis of 1109 examinations

2010-01-22

Abstract: The aim of this study was to assess the feasibility of diagnostic and therapeutic outpatient hysteroscopy. Data were collected prospectively from 1109 consecutive hysteroscopy examinations. The main outcome measure was success and failure of diagnostic and therapeutic outpatient hysteroscopy examination. The mean age (sd) was 47.7 (11.8) years and 53.3% and 39.5% of subjects were post-menopausal and nulliparous, respectively. The most common indications for referral were post-menopausal bleeding (39.8%), menorrhagia (25.7%) and irregular periods (14.5%). Hysteroscopy examination was successfully completed in 96.2% (1067/1109) of the subjects. Success was negatively influenced by age and menopausal status but not parity, although the differences between the age groups and pre- versus post-menopausal groups were minimal. The most common abnormalities were intrauterine polyps (425/1109, 38.3%) and submucous fibroids (142/1109, 12.8%). Of these two groups, respectively, 285/425 (67.1%) and 23/142 (16.2%) subjects had complete polyp and fibroid resection in the outpatient setting and 116/425 (27.3%) and 63/142 (44.4%) underwent polyp and fibroid resection under general anaesthesia. In conclusion, diagnostic and therapeutic hysteroscopy is feasible and highly successful in an outpatient setting. The majority of subjects with endometrial polyps and intrauterine adhesions are amenable to a see-and-treat approach.

The intrauterine to intra-arterial pressure ratio: a new parameter for the study of uterine contractility physiology

2010-01-21

Abstract: The objective of the study was to examine the uterine contractions and the arterial perfusion pressure changes after application of oxytocin, endothelin 1, prostaglandins PGE1, PGE2 and PGF2α, in order to identify the substance with the greatest intrauterine pressure (IUP)/intra-arterial pressure (IAP) ratio, which means the substance most suitable for inducing uterine contractility without raising the systemic vascular pressure. Increasing doses of oxytocin, endothelin 1, PGE1, PGE2 and PGF2α were applied as bolus injection through the uterine artery of perfused swine uteri and the intrauterine and intra-arterial pressure rises were recorded. All substances showed a significant cervicofundic pressure gradient and, with the exception of PGF2α, the uterine peristalsis moved towards the cervix uteri. The perfusion pressure after application of oxytocin, PGE1, PGE2 and PGF2α reached a maximum value and started to decrease, whereas endothelin 1 caused a continuous increase in the perfusion pressure. Endothelin 1 showed the lowest IUP/IAP ratio and oxytocin the greatest. In conclusion, the IUP/IAP ratio provides a promising new parameter for the study of uterine contractility physiology. Besides oxytocin, PGE2 and PGF2α emerged as the best candidate substances to improve uterine contractility without raising the intra-arterial pressure.

Risks in injecting hyaluronic acid non-bound spermatozoa

Lodovico Parmegiani, Graciela Estela Cognigni, Marco Filicori — 2010-01-20

We read with interest the recent article of . The aim of their study was to determine whether the early stages of embryo development, as assessed by the zygote score (Z-score), could be influenced by the injection of spermatozoa that had been selected on the basis of their binding to hyaluronic acid (HA). To this purpose they injected, in a prospective randomized way, 407 sibling metaphase II oocytes, with either hyaluronic acid-bound (HA+) or non-bound (HA−) spermatozoa. We would, however, like to express some reservations about this approach.

Response: Risks in injecting hyaluronic acid-nonbound spermatozoa

Marc Van den Bergh — 2010-01-20

have recently published a paper in which they compare PVP and Spermslow. In spite of the fact that the authors acknowledge in their references that in 1998 it was already demonstrated that PVP induces chromatin damage (), they conducted a study with PVP at a time when a much safer product was already available. Whether this voluntary harming was needed is as questionable as the injection of spermatozoa unbound to HA, a situation that is frequently encountered in cryptozoospermia. Our work has at least demonstrated that in the latter situation the treatment outcome is not affected. The absence of HA-bound spermatozoa is therefore not a reason to refuse ICSI treatment.

Reproductive BioMedicine Online

Contents

Rocking the human embryo – pari passu

Assessment of presence and characteristics of multipotent stromal cells in human endometrium and decidua

Ovarian stimulation in women with high and low body mass index: GnRH agonist versus GnRH antagonist

Healthy baby born after reduction of sperm DNA fragmentation using cell sorting before ICSI

Progressive alcohol-induced sperm alterations leading to spermatogenic arrest, which was reversed after alcohol withdrawal

Addition of sphingosine-1-phosphate to human oocyte culture medium decreases embryo fragmentation

Contribution of in-vitro maturation in ovarian stimulation cycles of poor-responder patients

Low oxygen tension during IVM improves bovine oocyte competence and enhances anaerobic glycolysis

Outcomes after early or midfollicular phase LH supplementation in previous inadequate responders

Improved development of mouse and human embryos using a tilting embryo culture system

Long-distance transportation of primate embryos developing in culture: a preliminary study

Prediction of in-vitro developmental competence of early cleavage-stage mouse embryos with compact time-lapse equipment

Factors affecting pregnancy in IVF: age and duration of embryo transfer

Two singleton live births after the transfer of cryopreserved–thawed day-3 embryos following an unstimulated in-vitro oocyte maturation cycle

Assessment of vision and hearing in children conceived spontaneously and by ICSI: a prospective controlled, single-blinded follow-up study

The Italian Constitutional Court modifies Italian legislation on assisted reproduction technology

Effect of N-acetyl-cysteine after ovarian drilling in clomiphene citrate-resistant PCOS women: a pilot study

Effect of delaying post-operative conception after conservative surgery for endometriosis

The pattern of pregnancy loss in women with congenital uterine anomalies and recurrent miscarriage

See-and-treat outpatient hysteroscopy: an analysis of 1109 examinations

The intrauterine to intra-arterial pressure ratio: a new parameter for the study of uterine contractility physiology

Risks in injecting hyaluronic acid non-bound spermatozoa

Response: Risks in injecting hyaluronic acid-nonbound spermatozoa