Does In Vitro Fertilization (IVF) Influence the Levels of Sperm and Zona Pellucida (ZP) Antibodies in Infertile Women?

The levels of sperm and zona pellucida antibodies in 250 women divided into four groups according to number of recurrent IVF failures (1–4) were analysed and compared with results of a control group of 211 unexplained infertile women never treated by IVF. Sperm antibodies in serum and in ovulatory cervical mucus were determined by mixed antiglobulin reaction (MAR) test, serum zona pellucida antibodies were detected using passive haemagglutination and ELISA. These tests showed increased occurrence of zona pellucida antibodies in women after repeated IVF. Zona pellucida antibodies were found in 20% after one unsuccessful IVF (similarly to 27% in the control group), but in 64% after two, in 91% after three and in 4 of 5 cases after four IVF failures. Sperm IgG, A, M and E antibodies in serum and in ovulatory cervical mucus do not seem to be influenced by IVF procedure. The results show evolution of autoimmune process due to repeated ovarial intervention during oocyte collections. Presence of zona pellucida antibodies, on the other hand, may become a cause of IVF failure.     

A prospective clinical trial investigating the efficacy of a method of preparing subpopulations of antibody-free spermatozoa from the ejaculates of antibody-positive patients

Couples undergoing in vitro fertilization treatment (IVF) were invited to take part in a controlled prospective clinical trial. The aim was to determine the effect on the fertilization rate of a technique devised to obtain an antibody-free preparation of spermatozoa from an antibody-positive ejaculate. Oocytes collected during IVF were allocated into one of two groups, ensuring that quality and maturity were comparable in each. One group, the control, was inseminated with Percoll-processed spermatozoa. The experimental group was inseminated with identical numbers of Percoll-processed spermatozoa which had been treated to obtain an antibody-free preparation. The treatment was found to have no beneficial effect on the fertilization rate at IVF. Laboratory studies were also performed on the ejaculates of antibody-positive volunteers to determine whether this treatment led to any effects, whether beneficial or detrimental, on sperm function. Membrane integrity was found to be unaffected, as was the percentage of spermatozoa undergoing the spontaneous acrosome reaction following overnight incubation. The percentage of spermatozoa undergoing the ionophore-induced acrosome reaction following treatment, however, was higher than that of the controls. The results of sperm–zona pellucida binding studies were equivocal. The findings indicated that the treatment procedure could not be justified for use in IVF, but may be beneficial for intrauterine insemination.     

Unsuccessful in vitro fertilization: A follow-up study

Results from a follow-up questionnaire completed by 28 women who had unsuccessfully completed one or more trials of in vitro fertilization (IVF) are reported. The mean time lapse since completing IVF was 8.4 months. During that period, 33% of the respondents had applied for adoption and 11% had secured an adoptive child. More than half the respondents had abandoned biological attempts to conceive and 52% felt as though they had resolved the infertility crisis. Nevertheless, 93% of the respondents indicated that they would participate in any new reproductive options that would enhance the likelihood of a biological pregnancy! The results and implications of this study are discussed.     

自发性心室颤动的基因基础和分子机制

目的 通过研究心脏钠离子通道基因SCN5A的突变来了解是否离子通道的失常能够引起自发性心室颤动(IVF)，以帮助IVF的基因诊断和合理治疗。方法 我们用单链构型多态性(SSCP)和DNA序列分析法对伴有IVF的六个小家系和两个散发的病人的血样，在已知离子通道基因，包括心脏钠离子通道基因SCN5A上进行了识别突变的研究。并通过测试突变通道和正常通道在卵母细胞中的电生理活动来判定突变对IVF发生机制的影响。结果 我们已经在三个IVF家族中从SCN5A密码范围内识别了一个错义突变和一个读码突变。电生理研究显示含有错义突变的钠离子通道比正常通道从静止中恢复的更快，而读码突变使钠离子通道失去功能。结论 我们的工作显示了伴有RBBB和ST段抬高的IVF是一种明显的综合症，并且心脏钠通道基因SCN5A与IVF的发生密切相关。     

卵巢低反应患者高孕激素状态下促排卵的有效性研究

目的:探讨高孕激素状态下促排卵对卵巢低反应患者LH水平的影响及促排卵效果。方法:将100例存在卵巢低反应的患者随机分为观察组、对照组,每组各50例。观察组采用醋酸甲羟孕酮联合注射用尿促性素促排卵,对照组采用超短方案。分析观察组促排卵过程中LH水平的变化,比较两组患者的获卵数、成熟卵数、优质胚胎数及行冻融胚胎移植(FET)后的妊娠率等。结果:观察组在促排卵过程中未监测到LH峰;两组的获卵数、成熟卵数、受精数等比较,差异均无统计学意义(P0.05),两组行FET后的妊娠率、胚胎种植率比较,差异无统计学意义(P0.05)。结论:高孕激素状态下促排卵能有效抑制LH峰,对于卵巢低反应者能达到较好的促排卵效果,可作为一种备选方法。     

Multiple thrombophilic single nucleotide polymorphisms lack a significant effect on outcomes in fresh IVF cycles: an analysis of 1717 patients

Purpose

The aim of the study is to determine if thrombophilic single nucleotide polymorphisms (SNPs) affect outcomes in fresh in vitro fertilization (IVF) cycles in a large general infertility population.

Methods

A prospective cohort analysis was performed at a university-affiliated private IVF center of female patients undergoing fresh non-donor IVF cycles. The effect of the following thrombophilic SNPs on IVF outcomes were explored: factor V (Leiden and H1299R), prothrombin (G20210A), factor XIII (V34L), β-fibrinogen (-455G → A), plasminogen activator inhibitor-1 (4G/5G), human platelet antigen-1 (a/b9L33P), and methylenetetrahydrofolate reductase (C677T and A1298C). The main outcome measures included positive pregnancy test, clinical pregnancy, embryo implantation, live birth, and pregnancy loss.

Results

Patients (1717) were enrolled in the study, and a total of 4169 embryos were transferred. There were no statistically significant differences in positive pregnancy test, clinical pregnancy, embryo implantation, live birth, or pregnancy loss in the analysis of 1717 patients attempting their first cycle of IVF. Receiver operator characteristics and logistic regression analyses showed that outcomes cannot be predicted by the cumulative number of thrombophilic mutations present in the patient.

Conclusions

Individual and cumulative thrombophilic SNPs do not affect IVF outcomes. Therefore, initial screening for these SNPs is not indicated.

Electronic supplementary material

The online version of this article (doi:10.1007/s10815-015-0606-z) contains supplementary material, which is available to authorized users.     

Monochorionic quadramniotic and triamniotic pregnancies following single embryo transfers: two case reports and a review of the literature

Purpose

The purpose of this study is to report two cases of monozygotic quadruplet and triplet pregnancies following single embryo transfer (ET).

Methods

A 29-year-old woman and a 34-year-old woman underwent ART treatment in two affiliated University based ART units. The first woman underwent ICSI with day 3 embryo biopsy for pre-implantation genetic diagnosis (PGD) followed by day 4 transfer, which resulted in a monochorionic quadramniotic (MCQA) quadruplet pregnancy. The second woman underwent conventional IVF with transfer of a single blastocyst, which resulted in a monochorionic triamniotic (MCTA) triplet pregnancy.

Results

The first patient underwent successful selective foetal reduction at 16 + 3 and 17 + 4 weeks of gestation. Two healthy twin girls were delivered by elective caesarean section at 35 + 6 weeks of gestation. The second patient underwent successful selective foetal reduction at 14 + 1 weeks of gestation. The remaining monochorionic diamniotic (MCDA) twins are well at the time of writing this article.

Conclusions

To our knowledge, these cases represent the first case of viable MCQA pregnancy following single ET in the world and the third case of a viable MCTA pregnancy following conventional IVF with single ET. Several factors including blastocyst stage transfer and zona pellucida manipulation have been thought to contribute to monozygotic twinning in the context of ART. These two cases add to the growing literature of monozygotic multiple pregnancies following ART.     

诱发日内源性孕酮升高对PCOS患者的IVF/ICSI临床结局的影响

目的:在高孕激素超促排卵(progestin-primed ovarian stimulation,PPOS)及全胚胎冷冻移植的背景下,探讨诱发排卵日内源性孕酮(P)水平与多囊卵巢综合征(polycystic ovary syndrome,PCOS)患者体外受精/卵胞质内单精子显微注射(IVF/ICSI)临床结局的关系。方法:回顾性纳入180例PCOS患者行IVF/ICSI-冻融胚胎移植(FET)的资料,所有患者均采用促性腺激素(gonadtropin,Gn)联合孕激素的超促排卵方案,取卵后全部胚胎冷冻,择期行FET,根据诱发排卵日P水平分为A组(P1.0μg/L,n=125)和B组(P≥1.0μg/L,n=55),比较两组患者的促排卵结局和妊娠结局。结果:A组与B组的Gn总用量(1950.8±384.5 IU vs 1931.2±308.9 IU)及周期治疗时间(11.2±1.4 d vs 11.1±1.1 d)均无统计学差异(P0.05)。A组诱发日直径14 mm卵泡数(14.1±7.7 vs21.0±10.3)、获卵数(14.0±7.8 vs 24.1±10.3)、成熟卵数(12.1±7.1 vs 21.1±9.0)、正常受精卵数(9.8±6.1 vs 16.8±8.2)及冷冻胚胎数(5.3±3.6 vs 7.2±3.4)均较B组低,且差异均具有统计学意义。成熟卵率、正常受精卵率、周期取消率、临床妊娠率及种植率组间均无统计学差异(P0.05)。结论:在FET的前提下,高孕激素超促排卵过程中诱发日内源性P水平的升高提示卵巢反应良好,对PCOS患者的IVF/ICSI临床结局无明显影响。