Clinical pregnancy is significantly associated with the blastocyst width and area: a time-lapse study

Journal of Assisted Reproduction and Genetics - In order to maintain pregnancy rates following single embryo transfer, optimisation of embryo culture and selection is vital. Time-lapse monitoring...     

Efficacy of growth hormone supplementation with ultrashort GnRH antagonist in IVF/ICSI for poor responders; randomized controlled trial

ObjectivesTo compare the ICSI-ET outcomes in poor responders who underwent ovarian stimulation by the ultrashort GnRH antagonist protocol with or without adjuvant GH injection.Material and methodsThis randomized controlled study was conducted at Al-Azhar University from December-2018 to June-2019 upon 156 participants. All patients received the same preparations. After randomization, in the study group, women have received GH 4 IU/day subcutaneous injection from the second day of the cycle stopped one day before ovum pickup. While in the control group, women have received subcutaneous saline in the same dosing as in the study group. After intervention, all procedures were the same in both groups. The main outcome measure was the clinical pregnancy rate. Statistical analysis was based on the intention-to-treat population.ResultsBoth groups were comparable with regard their baseline characteristics (p-values > 0.05). Ovulation characteristics were comparable (p-values > 0.05). The level of E2 is significantly (p-value = 0.003) higher in the GH group. The oocyte retrieved number was significantly (p-value < 0.001) higher in the GH group 4.94 ± 1.77 than in the control group 3.74 ± 1.82. The mean number of MII oocytes was significantly (p-value < 0.001) higher in the GH group 3.3 ± 1.36 than in the control group 2.29 ± 1.24. Fertilization characteristics, implantation rate, pregnancy rate were comparable (p-values > 0.05).ConclusionDespite the fact that this study showed no significant increase in the clinical and chemical pregnancy rates by the addition of GH to the ultrashort antagonist protocol in poor responders, the number of retrieved oocytes was significantly higher in the GH group.Clinical trial registrationClinicalTrials.gov Identifier: NCT03759301.     

Clinical benefits of preimplantation genetic testing for aneuploidy (PGT-A) for all in vitro fertilization treatment cycles

The clinical application of a PGT-A program implementing single euploid embryo transfer is evaluated over a 6.5 year period, beginning with its early validation phases. Euploidy embryo status is inversely correlated to oocyte source age and positively correlated to blastocyst quality grades. However, once a single euploid embryo is transferred, high levels of implantation and live birth success are attained independent of patient age and embryo quality, with only AA blastocysts exhibiting improved implantation. Factors influencing successful outcomes are discussed, including the management of mosaic NGS profiles. Overall, distinct advantages to a dedicated PGT-A/single euploid embryo transfer program are clearly evident in per cycle start comparisons to control cycles and national average statistics by age groups.     

GnRHa超长方案对不同分期子宫内膜异位症患者IVF/ICSI-ET结局影响的Meta分析

目的：通过Meta分析综合评价促性腺激素释放激素激动剂（GnRHa）超长方案是否能改善不同分期子宫内膜异位症（EMs）患者体外受精/胞浆内单精子注射-胚胎移植（IVF/ICSI-ET）助孕结局。方法：检索PubMed、EMBASE、Web of Science、Cochrane Library、中国知网（CNKI）、万方全文数据库、维普中文科技期刊数据库、中国生物医学文献数据库和Google学术搜索等，并辅以手工检索。纳入2018年8月1日前公开发表的关于GnRHa超长方案及长方案对EMs患者IVF/ICSI-ET结局影响的临床研究。由2名研究者提取数据进行Meta分析。结果：共纳入9篇文献。与长方案相比，Ⅰ～Ⅱ期EMs患者使用超长方案的促性腺激素（Gn）用量较大（SMD=0.36，95%CI：0.01～0.70，P＜0.05）、获卵数较少（SMD=-0.26，95%CI：-0.48～-0.04，P＜0.05），但着床率较高（RR=1.19，95%CI：1.04～1.37，P＜0.05），基础卵泡刺激素（FSH）、Gn天数、临床妊娠率差异无统计学意义（均P＞0.05）；Ⅲ～Ⅳ期患者使用超长方案的临床妊娠率较高（RR=1.38，95%CI：1.06～1.80，P＜0.05），基础FSH、Gn天数、Gn用量、获卵数、着床率差异无统计学意义（均P＞0.05）。结论：超长方案不能明显改善Ⅰ～Ⅱ期EMs患者的妊娠率，且Gn用量较大、获卵数较少；但超长方案可明显改善Ⅲ～Ⅳ期EMs患者的妊娠率。     

心理因素对体外受精-胚胎移植治疗结局的影响

不孕症对患者夫妇双方都是严重的负性生活事件,体外受精-胚胎移植(IVF-ET)及其衍生技术的发展为患者带来了生育的希望,然而治疗过程的痛苦、对结局的忧虑、经济负担等又同时加重了患者的心理压力。这种心理压力影响着治疗的过程及结局,值得生殖医学和心理学工作者的共同关注和深入研究。文章系统回顾了心理因素对IVF-ET/胞浆内单精子注射(ICSI)治疗影响的相关研究,就心理因素及心理干预对IVF-ET/ICSI治疗结局的影响以及可能的神经生物学机制进行探讨,同时提出了新的思考和建议。     

瘦素对小鼠胚胎体外发育的影响

目的:探讨瘦素在体外对小鼠胚胎发育的影响。方法:将受精后的2-细胞胚胎分别置于含不同剂量瘦素的培养液中进行体外培养观察胚胎发育情况。结果:瘦素能提高2-细胞胚胎体外发育的发育率,当瘦素剂量为50 ng/ml时各期发育率最好。结论:瘦素参与了小鼠胚胎的发育,能提高胚胎发育率。     

胚胎停育的原因分析与护理对策

目的分析胚胎停育的原因分析与探讨相应的护理对策。方法选择我院2009年2～11月经确诊的124例胚胎停育患者的相关资料进行统计分析。结果胚胎停育患者中的原因以感染因素、染色体异常和血型不符多见,分别占66.3%、25%、8.87%。结论母体相关疾病等不良因素是导致胚胎停育的母体因素的主要原因,具有针对性的护理对于患者的康复有着举足轻重的重用。     

水通道蛋白与胚胎着床

水通道蛋白作为水分子及其他小分子物质选择性通透的孔道,在哺乳动物的生殖系统广泛分布。研究发现,水通道蛋白参与哺乳动物生殖过程中的很多重要环节,如卵泡发育、囊胚形成、胚胎着床、羊水量的调节等。在囊胚形成及胚胎着床过程中,水通道蛋白的表达及分布发生一系列变化,表明水通道蛋白在该过程中发挥着重要的作用。     

电针干预对卵巢低反应患者体外受精胚胎移植的影响

目的:观察卵巢低反应或储备下降患者体外受精(IVF)过程中进行电针干预对卵细胞质量及妊娠结局的影响.方法:将接受体外受精-胚胎移植(IVF-ET)助孕的60例卵巢低反应或储备下降患者随机分为观察组和对照组,每组30例.两组均给予拮抗剂方案促排卵,观察组加用电针干预,穴取关元、太溪、三阴交等,比较两组疗效.结果:两组患者治疗前各项指标无明显差异.治疗后观察组肾虚症状改善明显,绒毛膜促性腺激素(hCG)注射日血清雌二醇(E2)水平、受精率、卵母细胞成熟率、优质胚胎率、种植率均优于对照组(均P＜0.05);观察组卵泡液和血清中干细胞因子(SCF)水平均明显高于对照组(均P＜0.05);观察组与对照组相比,临床妊娠率高而流产率低,但组间差异均无统计学意义(均P＞0.05).结论:电针干预对卵巢储备下降的IVF患者有良好的临床效果,可提高卵细胞质量及妊娠结局.     

A private matter: how patients decide what to do with cryopreserved embryos after infertility treatment

This study describes patients’ satisfaction with the information they received regarding the disposition of supernumerary embryos in the context of their decision making, as well as partners’ roles and the involvement of others. An anonymous mail questionnaire was sent to 412 female patients from the Department of Reproductive Medicine (Ghent University Hospital, Ghent, Belgium). The questionnaire had a response rate of 79%. The majority of patients who did not want to continue the storage of their embryos (87.9%) thought the information provided was sufficient to make a decision. Patients who were not satisfied more often failed to reach a decision compared to other patients (4/25 vs. 6/173, p = 0.0248). The majority of couples (81.7%) reached a decision jointly between partners. Nonetheless, in 15.6% of couples, one of the partners had made the decision alone, mostly after consulting their partners. Only a minority of the couples (13.2%) consulted others (mostly family members or close friends), suggesting that patients view these decisions as a private matter. Only 1.1% of all patients had talked to someone at the centre about their decision. To conclude, for most patients, the information provided was adequate in light of their disposition decision making. Overall, patients’ decision making appears to be a private matter which happens out of sight from medical staff, making it hard to assist patients who face difficulties.