序贯培养体系和单一培养体系对人卵母细胞受精和早期胚胎发育的影响

目的：比较在体外受精/卵胞质内单精子显微注射（IVF/ICSI）治疗周期中序贯培养体系和单一培养体系对人类早期胚胎发育的影响，为人类辅助生殖技术中胚胎培养体系的选择和评估提供参考。方法：选取155例行IVF/ICSI助孕的患者，将同一个患者的卵子分为2组，分别在Vitrolife的序贯培养体系G-IVF/G1/G2培养液（序贯培养组）和Irvine的单一培养体系CSCC培养液（单一培养组）中进行体外受精和胚胎培养，观察2组不同培养体系中胚胎受精和胚胎早期发育情况。结果：与单一培养组比较，序贯培养组受精率、双原核（2PN）受精率和多核受精率差异均无统计学意义（P>0.05）。在IVF患者中，序贯培养组和单一培养组的卵裂率、可用胚胎率、优质胚胎率和囊胚形成率比较差异均无统计学意义（P>0.05）；在ICSI患者中，序贯培养组和单一培养组的卵裂率、可用胚胎率和囊胚形成率比较差异均无统计学意义（P>0.05），但序贯培养组优质胚胎率明显高于单一培养组（P=0.015）。在IVF和ICSI患者中，单一培养组第3天胚胎致密化的比例均明显高于序贯培养组（P=0.001）。在序贯培养组中胚胎形态表面光滑均匀，单一培养组中胚胎表面较为粗糙且有颗粒状。结论：G-IVF/G1/G2序贯培养体系和CSCC单一培养体系对人卵母细胞受精和早期胚胎发育的影响无明显差异。     

Length of ovarian stimulation does not impact live birth rate in fresh donor oocyte cycles: a SART CORS study

PurposeTo evaluate the effect of controlled ovarian hyperstimulation length and total gonadotropin (GN) dose on recipient live birth rate (LBR) in fresh donor oocyte cycles.MethodsData was obtained from SART CORS on all fresh donor oocyte GnRH antagonist cycles (n = 1049) between 2014 and 2015 which resulted in a single embryo transferred. Donor and recipient demographic information and cycle characteristics were extracted. Binomial regression was used to estimate LBR with respect to days of stimulation (DOS) and total GN dose. Multivariate analysis was performed to evaluate these relationships after controlling for confounders.ResultsOverall LBR in fresh donor oocyte cycles was 57%. Average stimulation length was 14.3 ± 4.9 days, and total GN dose was 2464 ± 1062 IU. On univariate analysis, neither days of stimulation (p = 0.5) nor total GN dose (p = 0.57) was independently correlated with LBR. However, in prolonged stimulations (> 15 days) with high total GN dose (> 3000 IU), as both the cycle length and total GN dose increased, LBR significantly decreased from 63.81 to 48.15% (p = 0.02) and from 67.61 to 48.15% (p = 0.01), respectively. Multivariate analysis showed no significant effect of either DOS or total GN dose on LBR.ConclusionsLBR is significantly decreased in fresh donor oocyte cycles when cycles are prolonged with high total GN dose. However, after controlling for confounders neither DOS nor total GN dose significantly affects LBR.     

Innovations ‘Out of Place’: Controversies Over IVF Beginnings in India Between 1978 and 2005

ABSTRACT

In 1978, the year the first in vitro fertilization (IVF) baby was born in the United Kingdom, a research team in Kolkata reported that it too had successfully produced an IVF baby in India. However, the claim was dismissed at the time, because the experiment was conducted outside authorized institutions and recognized centers of innovation—in short, because it was an innovation ‘out of place.’ Tracing controversies over the case between 1978 and 2005, I show the importance of space or place in processes of knowledge production and recognition. Further, I explain the initial repudiation and subsequent partial recognition of the claim through shifts in the landscape of legitimate spaces of innovation. By discussing this specific case of the production of science and technology in the Global South, I challenge conventional narratives of diffusion that are prevalent in studies on the worldwide proliferation of reproductive technologies.     

基于行动研究理论的健康教育在体外受精胚胎移植术后异位妊娠病人中的应用

[目的]探讨基于行动研究理论的健康教育对体外受精胚胎移植术后异位妊娠病人生育压力和生活质量的影响。[方法]采用随机数字表法将2018年1月—2018年9月深圳市某三级甲等综合医院生殖医学中心的102例体外受精胚胎移植术后异位妊娠病人分为观察组和对照组各51例,对照组采用常规护理健康教育,观察组采用基于行动研究理论的健康教育方法。采用生育压力量表(FPI)和生活质量量表(FertiQoL)比较两组病人干预后生育压力和生活质量状况。[结果]观察组病人干预后FPI评分低于对照组,FertiQoL评分高于对照组,差异有统计学意义(P<0.05)。[结论]基于行动研究理论的健康教育方法有利于改善体外受精胚胎移植术后异位妊娠病人的压力状况,提高其生活质量。     

Effectiveness of acupuncture on pregnancy success rates for women undergoing in vitro fertilization: A randomized controlled trial

ObjectiveTo investigate the effect of acupuncture on pregnancy success rates applied before and after embryo transfer (ET) among women undergoing in vitro fertilization (IVF).Materials and methodsIn this randomized controlled trial, 72 infertile women undergoing IVF were randomized to acupuncture (AG; n = 36) and control group (CG; n = 36). Three sessions of acupuncture were applied to AG, the first was one week before ET, the second was 30 min before ET, and the third was 30 min after ET. CG received no acupuncture. The primary outcome was pregnancy success rate (Beta-HCG level, clinical pregnancy, ongoing pregnancy, live birth). Secondary outcome was anxiety level (STAI-1 state anxiety scale). Beta-HCG levels were assessed for conception 12 days after ET. Additionally, STAI-1 state anxiety scale was administered 30 min before and after ET to measure anxiety levels in both groups.ResultsThe mean age was 30.9 ± 3.7 years. Positive Beta HCG was detected in 63.9% (n = 23) of the AG and 33.3% (n = 12) of CG (p = 0.009). Clinical pregnancy, ongoing pregnancy, and live birth rates were higher in AG (p < 0.05). There was no difference between the groups concerning anxiety scores before ET (p > 0.05). The mean STAI-1 score was decreasing from 57.3 ± 9.8 to 28.8 ± 3.3 in AG, while it was decreasing from 57.0 ± 8.0 to 41,1 ± 6,8 in CG after ET (p < 0.000).ConclusionsIt was observed that three sessions of acupuncture before and after ET significantly increased the pregnancy rates in women with unexplained infertility. It was also found that acupuncture significantly reduced anxiety levels that occurred before ET.     

An overview of the current and emerging platforms for preimplantation genetic testing for aneuploidies (PGT-A) in in vitro fertilization programs

Preimplantation genetic testing for aneuploidies (PGT-A) and PGT for monogenic disorders (PGT-M) have currently been used widely, aiming to improve IVF outcomes. Although with many years of unsatisfactory results, PGT-A has been revived because new technologies have been adopted, such as platforms to examine all 24 types of chromosomes in blastocysts. This report compiles current knowledge regarding the available PGT platforms, including quantitative PCR, array CGH, and next-generation sequencing. The diagnostic capabilities of are compared and respective advantages/disadvantages outlined. We also address the limitations of current technologies, such as assignment of embryos with balanced translocation. We also discuss the emerging novel PGT technologies that likely will change our future practice, such as non-invasive PGT examining spent culture medium. Current literature suggest that most platforms can effectively reach concordant results regarding whole-chromosome ploidy status of all 24 types of chromosomes. However, different platforms have different resolutions and experimental complexities; leading to different turnaround time, throughput and differential capabilities of detecting mosaicism, segmental mutations, unbalanced translocations, concurrent PGT-A and PGT-M etc. Based on these information, IVF staff can more appropriately interpret PGT data and counsel patients, and select suitable platforms to meet personalized needs. The present report also concisely discusses some crucial clinical outcomes by PGT, which can clarify the role of applying PGT in daily IVF programs. Finally the up-to-date information about the novel use of current technologies and the newly emerging technologies will also help identify the focus areas for the design of new platforms for PGT in the future.     

Oocyte maturation arrest produced by TUBB8 mutations: impact of genetic disorders in infertility treatment

Abstract

Oocyte maturation defect is a challenging situation in the management of infertility, the etiology may be related to endocrine causes, protocols used in ovarian stimulation, oocyte intrinsic defects or procedures in embryology laboratory. We report three Mexican females in treatment for primary infertility with non-mature oocytes after ovary stimulation and oocyte capture in whom a genetic diagnosis of TUBB8-oocyte maturation defect was revealed by exome sequencing. Two couples achieved pregnancies though oocyte donation after establishing the genetic etiology. Our results expand the role of TUBB8-disorders in patients of non-Asian ethnicity. Oocyte maturation defects of monogenic origin are a growing group of disorders that endocrinologists and reproductive medicine specialists should be aware in order to provide referral to genetics for establish a correct and opportune diagnosis.