Reproductive BioMedicine Online - Articles in Press

Double measurements of serum HCG concentration and its ratio may predict IVF outcome - Corrected Proof

Hongbin Chi, Jie Qiao, Hongzhen Li, Ping Liu, Caihong Ma — 2010-03-08

Abstract: Serum human chorionic gonadotrophin (HCG) concentration is nearly always used to predict pregnancy but there is little data on the clinical utility of the ratio of HCG21/HCG14 combined with double measurement of serum HCG. A total of 1762 cycles were retrospectively analysed for serum HCG concentration and ratio of HCG21/HCG14 on days 14 and 21 after embryo transfer to determine whether the ratio combined with concentration is the optimal predictor of pregnancy. The medians of HCG concentration on days 14 and 21 combined with the ratio of HCG21/HCG14 were calculated for non-viable, viable and heterotopic pregnancies. HCG concentrations of 290IU/l on day 14 and 2970IU/l on day 21 were regarded as the cut-off values to predict viable pregnancy, and values of 630 and 12,000IU/l, respectively, were regarded as the cut-off values to predict multiple pregnancy. The ratio of HCG21/HCG14 in the viable pregnancy group was significantly higher than that in the non-viable pregnancy group (15.86 versus 5.27, P<0.0001). For heterotopic pregnancy, the ratio of HCG21/HCG14 was 11.93. It was concluded that HCG concentration on days 14 and 21 combined with the ratio of HCG21/HCG14 provides a useful predictor of pregnancy outcome. A ratio >15 may predict viable pregnancy.

Pronuclear morphology, embryo development and chromosome constitution - Corrected Proof

2010-03-08

Abstract: The aim of the present study was to evaluate the usefulness of pronuclear patterns, according to the classifications of Tesarik and Scott, as predictors of embryo chromosome constitution. Up to 73 preimplantation genetic diagnosis/preimplantation genetic screening (PGD/PGS) cycles were analysed in this retrospective study including 17 cycles of translocation carriers and 56 PGS cycles. A total of 331 biopsied embryos were studied assessing pronuclear (PN) pattern, embryo quality and chromosome constitution. As regards to the relationship between PN pattern and embryo quality, the data obtained in this study show no correlation between both parameters. Although there were no significant differences when comparing the distribution of chromosomally normal and abnormal embryos with respect to embryo quality, such differences were observed when distinguishing between normal, aneuploid and polyploid embryos. The results show that the PN pattern using Tesarik’s and Scott’s classification systems is not related to the embryo developmental potential or its chromosome constitution. Therefore, in the context of a PGD/PGS programme, the PN pattern cannot be used as a tool to predict embryo quality or chromosome status.

Results of 2500 office-based diagnostic hysteroscopies before IVF - Corrected Proof

2010-03-08

Abstract: The aim of the study is to assess the diagnostic accuracy, findings and feasibility of office-based diagnostic hysteroscopy in an IVF population. A total of 2500 consecutive infertile patients were enrolled prospectively prior to IVF treatment. Diagnostic hysteroscopy was performed on each subject in an office setting in the study IVF centre. A total of 1927 patients (77.1%) had a normal uterine cavity, while the remainder of the sample (n=573) demonstrated endometrial pathology on hysteroscopy (22.9%). Of the patients with endometrial pathology, 192 patients had endometrial polyps (7.68%), 96 patients had submucosal fibroids (3.84%), 31 patients had polypoid endometria (1.24%), 27 patients had intrauterine adhesions (1.08%) and 73 patients had uterine septa (2.92%). Diagnostic office-based hysteroscopy is routinely performed in the IVF clinic to assess the endometrial cavity. In such an unselected population, a significant percentage of patients had evidence of uterine pathology that may have impaired the success of IVF. Safety, ease of use, high diagnostic accuracy and high patient tolerance makes office-based hysteroscopy an ideal procedure.

Skewed X inactivation and IVF-conceived infants - Corrected Proof

2010-03-08

Abstract: The objective of this study was to investigate whether skewed X chromosome inactivation (XCI) is associated with IVF. A retrospective cohort study was performed comprising 30 female infants conceived by IVF and 44 naturally conceived control infants matched for gestational age and sex. Cord blood DNA samples were obtained and XCI patterns were analysed using a methylation-sensitive assay. Eight IVF samples and 13 control samples were excluded from the study because they were either homozygous or alleles were too similar for the assay to determine skewing. Mildly skewed XCI (80–90% inactivation of one allele) was present in two of 22 (9.1%) IVF samples and two of 31 (6.5%) control samples. Extremely skewed XCI (>90% inactivation of one allele) was found in two of 22 (9.1%) IVF samples and none of 31 control samples. Neither difference was statistically significant. However, the mean degree of skewed XCI in the IVF group was 72.0% and in the control group was 62.4% (P=0.002). Larger studies are needed to clarify the relationship between IVF and skewed XCI.

Urine neopterin concentrations as a marker for successful blastocyst implantation after assisted reproductive technologies - Corrected Proof

V. Melichar, E. Soelder, K. Schroecksnadel, C. Murr, P. Arck, L. Wildt, D. Fuchs — 2010-03-08

Abstract: Successful blastocyst implantation requires intricately orchestrated adaptation processes involving maternal and fetal mediators. The pivotal role of distinct immune response pathways in early pregnancy is widely acknowledged. Pro-inflammatory cytokines, e.g. interferon-γ (IFN-γ), are the primary inducers of tryptophan-degrading enzyme indoleamine 2,3-dioxygenase (IDO) and of neopterin biosynthesis by GTP-cyclohydrolase I. IDO activity has been proposed to be of high clinical relevance in the context of pregnancy. To date, insights arising from clinical studies on IDO activity and neopterin concentration during the very early days of pregnancy are still few. Early morning urinary neopterin concentrations in 61 women undergoing assisted reproduction treatment (72 cycles in total) were examined, upon exclusion of infections, daily over a period of 2weeks after embryo transfer. Twenty of the study participants (28%) became successfully pregnant, and four women experienced abortion. Neopterin concentrations significantly increased after blastocyst transfer when implantation was successful (chi-squared=23.291, P<0.01; Friedman test), opposed to non-significant changes of neopterin in women with unsuccessful treatment (chi-squared=8.203). The steady increase of neopterin concentrations upon blastocyst transfer indicates that heightened production of neopterin in very early phases of pregnancy may serve as an early predictor of successfully progressing pregnancies in humans.

Superfetation after ovulation induction and intrauterine insemination performed during an unknown ectopic pregnancy - Corrected Proof

2010-03-08

Abstract: This report describes the first case of superfetation after ovarian stimulation with gonadotrophins and intrauterine insemination (IUI) that were performed in the presence of an undiagnosed tubal pregnancy. A 32-year-old woman who underwent repeated attempts of ovarian stimulation and IUI was hospitalized for severe pelvic pain and submitted to laparoscopic salpingectomy because of ruptured salpynx containing a 6-week pregnancy. Transvaginal ultrasound examination showed a simultaneous intrauterine 2-week pregnancy that had been conceived by ovarian stimulation and IUI while the tubal pregnancy was already ongoing and still undiagnosed. The intrauterine pregnancy went on until term and ended with the spontaneous delivery of a healthy baby. This report demonstrates that human superfetation may occur after gonadotrophin treatment and IUI in the presence of an ongoing tubal pregnancy. It is recommended to perform a pregnancy test before starting ovulation induction even when an apparently normal blood discharge appeared.

Increased exposure to dioxin-like compounds is associated with endometriosis in a case–control study in women - Corrected Proof

2010-03-08

Abstract: Although endometriosis is thought to be an environmental disorder initiated by dioxin exposure, this association is controversial. This study was performed to test the hypothesis that endometriosis occurs more often in women exposed to higher concentrations of dioxin-like compounds (DLC) than in those women exposed to lower concentrations. Plasma samples collected prior to laparoscopic surgery from 96 women with endometriosis and 106 control patients with a normal pelvis were measured for DLC concentrations using the dioxin-responsive chemical-activated luciferase expression bioassay. The results showed that concentration (mean±SD) of DLC was marginally higher in patients with endometriosis (22.3±9.3pg CALUX-TEQ/g lipid) than in controls (20.5±10.8pg). After categorization of patients in a group with ‘low’ plasma concentrations (<25th centile) and a group with ‘high’ plasma concentrations (>75th centile) of DLC, the age-adjusted odds ratio to have endometriosis was 2.44 (95% CI 1.04–5.70; P=0.04) for women with high concentrations of DLC and it increased to 3.01 (95% CI 1.06–9.04; P=0.03) when only women with moderate severe endometriosis were considered. In conclusion, women exposed to higher plasma concentrations of DLC were at higher risk of having endometriosis than women exposed to lower concentrations of DLC within normal environmental concentrations.

Dr TC Anand Kumar (1936–2010) - Corrected Proof

Rajvi H Mehta — 2010-03-08

Dr TC Anand Kumar, one of the founding editors of Reproductive BioMedicine Online and an emeritus member of the journal’s current Editorial Board, passed away on 26 January, 2010. A reproductive biologist of international repute, he will always be remembered for his diverse contributions to the field ranging from the role of the neuro-endocrine system in reproduction to developing the means of administering hormones via the nasal route and spear-heading the team that produced India’s first scientifically documented in-vitro fertilized baby at the ICMR’s Institute for Research in Reproduction and the KEM Hospital, Mumbai in 1986. After his retirement as the Director of the Institute for Research in Reproduction, Mumbai, India, he founded the Hope Infertility Clinic in Bangalore in 1991 where many of the first generation of assisted reproductive specialists in the country were trained and started their careers in this field.

Embryo culture: can we perform better than nature? - Corrected Proof

Gábor Vajta, Laura Rienzi, Ana Cobo, John Yovich — 2010-03-04

Abstract: Culture of preimplantation-stage embryos has always been a key element of laboratory embryology and has contributed substantially to the success of many assisted reproduction procedures. During the past decade, its importance has increased as extended in-vitro embryo culture and single blastocyst transfer have become indispensable parts of the approach to decreasing the chance of multiple pregnancy while preserving the overall efficiency of the treatment. However, in spite of the scientific and commercial challenge stimulating research worldwide to optimize embryo culture conditions, a consensus is missing even in the basic principles, including composition and exchange of media, the required physical and biological environment and even the temperature of incubation. This review attempts to summarize the controversies, demonstrate the fragility of some widely accepted dogmas and generate an open-minded debate towards rapid and efficient optimization. New approaches expanding the traditional frames of mammalian embryo culture are also discussed. Although some researchers suppose that the efficiency of the presently applied in-vitro culture systems have already approached the biological limits, authors are confident that substantial improvement may be achieved that may expand considerably the possibilities of future assisted reproduction in humans.

Saviour embryos? Preimplantation genetic diagnosis as a therapeutic technology - Corrected Proof

Robert Sparrow, David Cram — 2010-03-02

Abstract: The creation of ‘saviour siblings’ is one of the most controversial uses of preimplantation genetic diagnosis (PGD). This paper outlines and invites ethical discussion of an extension of this technology, namely, the creation of ‘saviour embryos’ to serve as a source of stem cells to be used in potentially life-saving therapy for an existing child. A number of analogies between this hypothetical use of PGD and existing uses of IVF are offered and, in addition, between saviour embryos and proposed therapeutic applications of stem cell technology. The ethical significance of a number of disanalogies between these cases are explored and investigated. While the creation of saviour embryos would involve a significant shift in the rationale for IVF and PGD, it is suggested here that the urgent need of an existing individual should be prioritised over any obligations that might exist in relation to the creation or destruction of human embryos.

Role of vascular endothelial growth factor in women with PCO and PCOS: a systematic review - Corrected Proof

Panagiotis Peitsidis, Rina Agrawal — 2010-02-16

Abstract: The aim of this study was to investigate the strategic role of vascular endothelial growth factor (VEGF) in the pathophysiology of polycystic ovary syndrome (PCOS) and to critically review the published trials that have evaluated VEGF in women with PCOS. An electronic database search of Medline, Embase, Cinahl and Cochrane library was conducted. Studies were included if they evaluated VEGF either in the circulation or in granulosa lutein cell culture media in in-vitro laboratory studies of women with a polycystic ovary (PCO) or PCOS. Studies analysing immunohistochemical expression of VEGF in PCO were also included. This review concluded that VEGF may have a strategic role in the pathophysiology of PCOS and is the key mediator in the pathogenesis of ovarian hyperstimulation syndrome (OHSS) in women undergoing assisted reproductive procedures. Its role is perhaps not singular and several other factors such as the bioavailability of its soluble receptor sFlt-1 and a multidisciplinary orchestration of other cytokines and growth factors may be involved in the pathophysiology of PCOS and OHSS.

Oxidative stress status and lipid profiles of diabetic pregnant rats exposed to cigarette smoke - Corrected Proof

2010-02-15

Abstract: This study aimed to evaluate the oxidative stress status and the concentrations of triglycerides, cholesterol and total proteins of pregnant rats exposed to the association of diabetes and cigarette smoke. Female Wistar rats were randomly distributed in four experimental groups, according to presence or not of diabetes and the exposure or not to cigarette smoke. Diabetes was induced by streptozotocin (40mg/kg i.v.) and exposure to cigarette smoke was for 30min, twice a day, for 2months. At day 21 of pregnancy, blood was collected for total protein, triglyceride, cholesterol and oxidative stress determinations. Data were analysed by ANOVA followed by Student–Newman–Keuls test (P<0.05). The association of diabetes and exposure to cigarette smoke was related to the indidence of hypertriglyceridaemia, and this result was due to the severe diabetes and not to exposure to smoke. There was no alteration to protein metabolism in pregnant rats. Diabetes and cigarette smoke exposure led to the activation of the antioxidant system in an attempt to detoxify the organism in face of high lipid peroxidation, which can be characterized by the determination of reactive substances to thiobarbituric acid.

Human ovarian tissue cryopreservation: quality of follicles as a criteria of effectiveness - Corrected Proof

V Isachenko, E Isachenko, R Kreienberg, M Woriedh, JM Weiss — 2010-02-12

Abstract: Experiments comparing vitrification and conventional freezing of mammalian ovarian tissue show that vitrification can also guarantee the storage of viable follicles after warming, but conventional freezing is more effective. The central goal of cryotechnology is the preservation of intact follicles. This article presents a critical opinion about the normality of follicles after vitrification of human ovarian tissue and microbial contamination as a result of direct contact of this tissue with liquid nitrogen at vitrification.

Effects of race/ethnicity on triple CGG counts in the FMR1 gene in infertile women and egg donors - Corrected Proof

Norbert Gleicher, Andrea Weghofer, David H. Barad — 2010-02-11

Abstract: This cross-sectional cohort study investigated 385 females (344 infertile women and 41 oocyte donors), the numbers of CGG repeats on the FMR1 gene and differences between races/ethnicities. Traditional definitions of neuropsychiatric risks are classified as common, intermediate, premutation and full mutation ranges. Normal CGG count range was here, however, defined by box and whisker plot as 26–32 repeats (median 30). Distribution of abnormal outliers in CGG counts from this normal range was then compared between women of Caucasian, African and Asian descent. African and Asian women demonstrated a higher prevalence of two normal count alleles (65%) than Caucasians (54.3%; P=0.03). Caucasians demonstrated the highest rate of allele abnormalities (43.3%) and were the only race/ethnicity also demonstrating abnormalities in both FMR1 alleles. Asian women demonstrated significantly fewer low outlier counts than Caucasians (P=0.002) and Africans (P=0.03). This study, thus, suggests significant racial/ethnic differences in triple CGG counts on the FMR1 gene between races/ethnicities. Since CGG counts on FMR1 are associated with ovarian reserve, these findings may reflect potential differences between races/ethnicities in ovarian function and female fertility reported in the literature.

Angiotensin-converting enzyme gene polymorphism and risk of insulin resistance in PCOS - Corrected Proof

2010-02-08

Abstract: The aim of this study was to establish the frequency of angiotensin-converting enzyme (ACE) insertion (I) or deletion (D) gene polymorphism in women with polycystic ovary syndrome (PCOS) and to examine the association of this polymorphism with insulin resistance. A total of 32 women with PCOS and 31 healthy, age- and body mass index-matched controls were studied. Serum lipids, fasting glucose, insulin and other hormones concentrations were measured. Homeostasis model assessment was used to estimate insulin resistance (HOMA-IR). DNA was extracted from peripheral blood leukocytes and genotyping of ACE I/D polymorphism was carried out by polymerase chain reaction. ACE genotypes were distributed as follows: DD was present in 16 (50%), ID in 12 (37.5%) and II in four (12.5%) PCOS patients, and DD in seven (22.6%), ID in 20 (64.5%) and II in four (12.9%) of healthy subjects. The frequency of D and I alleles were found in 69% and 31% of the PCOS group and 55% and 45% in the control group, respectively. There were no significant differences regarding the genotypic distribution and allelic frequency between the groups. However the ACE DD genotype was significantly associated with serum insulin concentrations and HOMA-IR measurement (both P=0.005). ACE DD genotype is associated with an increased insulin resistance in women with PCOS.

Preimplantation genetic haplotyping: 127 diagnostic cycles demonstrating a robust, efficient alternative to direct mutation testing on single cells - Corrected Proof

2010-02-08

Abstract: Preimplantation genetic diagnosis using whole genome amplification and a haplotyping approach (PGH) was first described in 2006 and suggested as an efficient alternative to single-cell PCR for monogenic disorders. DNA from single cells was amplified using multiple displacement amplification; the resulting products were then tested using disease-specific PCR multiplexes applied under standard laboratory conditions to determine the haplotypes in the embryo. This study reports on a total of 127 completed biopsy cycles for 101 couples at risk of: autosomal recessive disease (71 cycles, 53 couples including one germ-line mosaic carrier), autosomal dominant disease (31 cycles, 26 couples including one germ-line mosaic carrier), X-linked recessive disease (18 cycles, 16 couples including one germ-line mosaic carrier), X-linked dominant disease (six cycles, five couples) and a double inheritance of both autosomal and X-linked recessive diseases (one cycle, one couple). Of these, 107 cycles reached embryo transfer. Overall success rates were: fetal heart beat-positive pregnancies (FHB+)/biopsy cycle=28%; FHB+/embryo transfer=34%; FHB+/couple=36%; 26 babies born, 13 ongoing pregnancies. These data demonstrate that PGH provides a robust, efficient and successful alternative to single-cell PCR for monogenic diseases.

LH concentrations do not correlate with pregnancy in rFSH/GnRH antagonist cycles - Corrected Proof

Kevin Doody, Paul Devroey, Keith Gordon, Han Witjes, Bernadette Mannaerts — 2010-02-04

Abstract: The possible relationship between endogenous LH concentrations and clinical outcome was evaluated in 750 patients treated with a standardized gonadotrophin-releasing hormone (GnRH) antagonist and recombinant FSH (rFSH)-only protocol. Serum LH concentrations were measured during stimulation by a central laboratory and patients were stratified into quantiles of P75. The P25 values were 3.38IU/l, 0.93IU/l, and 0.91IU/l on stimulation days 1, 5, and 8, respectively. The ongoing pregnancy rates per started cycle of patients within the P75 subsets and ranged in the various subsets between 35.0% and 39.5%. In keeping with previous, smaller studies, these findings demonstrate that in good prognosis, non-obese patients endogenous LH in a GnRH antagonist protocol is able to support treatment with rFSH only.

Complete globozoospermia associated with PLCζ deficiency treated with calcium ionophore and ICSI results in pregnancy - Corrected Proof

2010-02-04

Abstract: Globozoospermia is an infrequent pathology in which spermatozoa lack acrosomes. Patients are considered sterile without IVF augmented with intracytoplasmic sperm injection (ICSI), as fertilization is impaired due to absence of oocyte activation. As far as is known, this is the first study to report results of a comprehensive approach to the treatment of the semen parameters, sperm DNA fragmentation, aneuploidy, transmission electron microscopy, Western blotting and immunofluorescence for detection of phospholipase C zeta (PLCζ), as well as ICSI outcome, of an affected patient. Morphological evaluation and transmission electron microscopy revealed complete globozoospermia with significant duplicate heads and tails. Analysis for DNA damage revealed fragmentation rates of approximately 80% in semen and 15–23% in swim-up fractions. PLCζ was not detected by immunofluorescence or Western blotting. Aneuploidy rates were within normal ranges. ICSI followed by oocyte activation with calcium ionophore resulted in high rates of fertilization, and an ongoing pregnancy was established after transfer of cryopreserved–thawed embryos.

Altered first-trimester screening markers after IVF/ICSI: no relationship with small-for-gestational-age and number of embryos transferred - Corrected Proof

2010-02-04

Abstract: First-trimester serum markers in 110 in-vitro fertilization (IVF) and 331 intracytoplasmatic sperm injection (ICSI) pregnancies were compared with 1431 pregnancies with spontaneous conception. Alterations of serum markers were evaluated with respect to small-for-gestational-age (SGA) growth and number of embryos transferred. For pregnancy-associated plasma protein A (PAPP-A), significantly lower concentrations were observed in IVF and ICSI pregnancies compared with controls (0.86 and 0.9 versus 1.06; P<0.001). Free β-human chorionic gonadotrophin (βHCG) values were significantly higher in the IVF/ICSI groups than in controls (1.1 and 1.1 versus 0.94; P<0.005). IVF and ICSI pregnancies showed higher rates of SGA (10.0% and 8.2%) compared with natural conception (4.6%), but differences in PAPP-A concentrations remained significant (P<0.005) after the exclusion of SGA pregnancies. No relationship between serum values and the transfer of one, two or three embryos was observed. Centre-specific corrections may be needed to adjust screening parameters for assisted reproductive technology.

Variation in guideline adherence in intrauterine insemination care - Corrected Proof

2010-02-03

Abstract: Health-care delivery according to clinical practice guidelines is thought to be critical in achieving optimal outcomes. This study aimed to assess the extent to which practice performance in intrauterine insemination (IUI) care is consistent with guideline recommendations and to evaluate the association between guideline adherence and outcome of IUI care. In a retrospective cohort study, 1100 infertile couples who underwent IUI treatment at 10 Dutch hospitals were asked to grant access to their medical record for assessment of guideline adherence using 25 systematically developed guideline-based performance indicators. A total of 558 couples who started 2334 IUI cycles participated. Guideline adherence regarding 20 process and five structure aspects of IUI care was often substandard and varied considerably between hospitals. Out of 10 possible associations investigated, guideline adherence regarding sperm quality and guideline adherence regarding the total number of IUI cycles were associated with improved ongoing pregnancy rates after IUI. Thus, guideline adherence in IUI care is far from optimal and varies substantially between hospitals. As associations between guideline adherence and ongoing pregnancy after IUI were mainly non-significant, further research is needed to evaluate associations between guideline adherence and other outcomes of IUI care besides ongoing pregnancy, such as patient safety and cost effectiveness.

Culture of human oocytes with granulocyte-macrophage colony-stimulating factor has no effect on embryonic chromosomal constitution - Corrected Proof

2010-02-03

Abstract: The effect on ploidy rate in donated human oocytes after in-vitro culture with recombinant human granulocyte-macrophage colony-stimulating factor (GM-CSF; 2ng/ml) from fertilization until day 3 was examined in a multicentre, prospective placebo-controlled and double-blinded study including 73 women donating 86 oocytes. The primary endpoint was to investigate the chromosomal constitution of human embryos (fluorescence in-situ hybridization analysis for chromosomes 13, 16, 18, 21, 22, X and Y) cultured with or without GM-CSF. The secondary endpoints were number of top-quality embryos (TQE) and number of normally developed embryos evaluated morphologically on day 3. The cytogenetic analyses demonstrated non-inferiority and therefore the chromosomal constitution of human embryos cultured in vitro in the presence of 2ng/ml GM-CSF was no worse than the control group cultured without GM-CSF. In-vitro culture of human embryos in the presence of 2ng/ml GM-CSF resulted in 34.8% (8/23) uniformly normal embryos. Culture without 2ng/ml GM-CSF resulted in 33.3% (9/27) uniformly normal embryos. A trend towards a higher number of TQE in the test group was observed; however, due to lack of TQE in the control group, this was considered a random finding.

Reduction in exposure of human embryos outside the incubator enhances embryo quality and blastulation rate - Corrected Proof

2010-02-03

Abstract: Embryo quality is strongly dependent on the in-vitro culture environment. Conventionally, IVF/intracytoplasmic sperm injection (ICSI) embryos are examined microscopically every morning (from day 1 to day 6) to assess fertilization, cleavage and embryo quality. Consequently, the frequent exposure to non-optimal conditions outside the incubator may adversely affect embryonic viability and quality. Hence, this study investigated whether reduction of observation frequency outside the incubator can enhance blastocyst formation rate. A total of 285 IVF/ICSI cycles were divided into two groups. Embryos in the control group (103 cycles) were assessed out-of-incubator every day after insemination (day 1 to day 6; six times). In the experimental group (182 cycles), embryos were assessed four times, on days 1, 3, 5 and 6. The total blastocyst formation rate, day-5 blastocyst formation rate, proportion of good blastocysts and number of cryopreserved blastocysts per patient were significantly lower for the control group compared with the experimental group (42.5%, 31.4%, 50.7%, 1.72±1.55 versus 52.6%, 40.7%, 60.1%, 2.64±2.59, respectively, P<0.05); although there were no significant differences in the proportions of good embryos on day 3, blastocyst formation rate on day 6, clinical pregnancy rate and implantation rate. Hence, reduction of the observation frequency of embryos outside the incubator can enhance embryo quality and blastocyst formation rate.

Experiences of offspring searching for and contacting their donor siblings and donor - Corrected Proof

Vasanti Jadva, Tabitha Freeman, Wendy Kramer, Susan Golombok — 2010-02-03

Abstract: This study investigates a new phenomenon whereby individuals conceived by donor insemination are searching for and contacting their donor and/or ‘donor siblings’ (i.e. donor offspring conceived by the same donor who are their genetic half siblings). On-line questionnaires were completed by members of the Donor Sibling Registry (DSR), a US-based registry that facilitates contact between donor conception families who share the same donor. Of the 165 donor offspring who completed the survey, 15% were searching for their donor siblings, 13% were searching for their donor, and 64% were searching for both. Differences were found according to family type and age of disclosure. Fewer offspring from heterosexual couple families had told their father about their search when compared with offspring from lesbian couple families who had told their co-parent. Offspring who had found out about their conception after age 18 were more likely to be searching for medical reasons, whereas those who had found out before age 18 tended to be searching out of curiosity. Some offspring had discovered large numbers of half siblings (maximum=13). The majority of offspring who had found their donor relations reported positive experiences and remained in regular contact with them.

Prospective randomized study for hydrotubation versus no hydrotubation before intrauterine insemination in unexplained infertility - Corrected Proof

2010-02-03

Abstract: The purpose of the study was to investigate the value of hydrotubation before intrauterine insemination (IUI). In 228 patients with the diagnosis of unexplained infertility, ovarian stimulation was performed before IUI, using 100mg of clomiphine citrate for 5days from day 3 of the cycle and one ampoule of human menopausal gonadotrophin for 5days from day 6 of the cycle. Folliculometry and determination of LH concentration in urine were performed daily until LH became positive, then randomization for hydrotubation before IUI versus no hydrotubation was performed. Fifteen patients were cancelled from the study due to poor response or stimulation of three or more follicles. A total of 213 patients were randomized as follows: 103 patients undergoing hydrotubation using 50ml of saline and 110 patients with no hydrotubation. IUI was performed the following day and ongoing pregnancy occurred in 13 patients (12.6%) in the hydrotubation group and nine patients (8.2%) in the non-hydrotubation group with no significant difference (OR 1.66; 95% CI 0.62–4.63). In conclusion, hydrotubation before IUI does not improve pregnancy rate.

Histology of genital tract and breast tissue after long-term testosterone administration in a female-to-male transsexual population - Corrected Proof

2010-02-01

Abstract: Growing evidence indicates that androgens play a positive role in follicle proliferation and growth. Hence, many authors have assumed that androgen supplementation in women with poor ovarian reserve might improve the number of antral follicles available for ovarian stimulation. As androgen administration may become more frequently used in reproductive medicine, this study aimed at describing the histological changes observed in the genital tract and the breast of female-to-male (FTM) transsexuals. A pathological analysis of the genital tract of 112 FTM subjects who were given androgen for at least 6months before hystero-salpingo-oophorectomy was performed. In addition, 100 bilateral mastectomies were performed, allowing a study of the breast tissue. Mean ovarian volume was increased, with histological characteristics of polycystic ovaries (PCO), defined as >12 antral follicles per ovary, observed in 89 patients (79.5%). Endometrial atrophy was observed in 45%. Breast examination revealed marked reduction of glandular tissue and increase of fibrous connective tissue in 93%, without atypical hyperplasia or carcinoma. The present data confirms and expands the putative associations between long-term androgen administration and abnormalities in ovarian architecture with macroscopic and microscopic characteristics of PCO, increased risk of endometrial atrophy and fibrotic breast tissue with marked glandular reduction.