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Are cleavage anomalies, multinucleation, or specific cell cycle kinetics observed with time-lapse imaging predictive of embryo developmental capacity or ploidy?
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Are cleavage anomalies, multinucleation, or specific cell cycle kinetics observed with time-lapse imaging predictive of embryo developmental capacity or ploidy?

Fertil Steril. 2018 Feb 13;:

Authors: Desai N, Goldberg JM, Austin C, Falcone T

Abstract
OBJECTIVE: To determine whether cleavage anomalies, multinucleation, and specific cellular kinetic parameters available from time-lapse imaging are predictive of developmental capacity or blastocyst chromosomal status.
DESIGN: Retrospective analysis of prospectively collected data.
SETTING: Single academic center.
PATIENT(S): A total of 1,478 zygotes from patients with blastocysts biopsied for preimplantation genetic screening were cultured in the EmbryoScope.
INTERVENTION(S): Trophectoderm biopsy.
MAIN OUTCOME MEASURE(S): Embryo dysmorphisms, developmental kinetics, and euploidy.
RESULT(S): Of the 767 biopsied blastocysts, 41.6% (95% confidence interval [CI], 38%-45%) were diagnosed as euploid. Individual dysmorphisms such as multinucleation, reverse cleavage, irregular chaotic division, or direct uneven cleavage were not associated with aneuploidy. Direct uneven cleavage and irregular chaotic division embryos did, however, exhibit lower developmental potential. The presence of two or more dysmorphisms was associated with an overall lower euploidy rate, 27.6% (95% CI 19%-39%). Early embryo kinetics were predictive of blastocyst development but not ploidy status. In contrast, chromosomal status correlated significantly with start time of blastulation (tSB), expansion (tEB), and the tEB-tSB interval. A lower euploidy rate, 36.6% (95% CI 33%-42%) was observed with tSB ≥ 96.2 hours, compared with 48.2% with tSB < 96.2 (95% CI 42%-54%). A drop in euploidy rate to 30% (95% CI 25%-37%) was observed in blastocysts with delayed expansion (tEB > 116). The proportion of euploid blastocysts was increased with tEB-tSB intervals of ≤13 hours. A logistic regression model to enhance the probability of selecting a euploid blastocyst was constructed.
CONCLUSION(S): Morphokinetics may aid in selection of euploid embryos from a cohort of day 5/6 blastocysts.

PMID: 29452698 [PubMed - as supplied by publisher]




Prevention of in vitro fertilization twins should focus on maximizing single embryo transfer versus twins are an acceptable complication of in vitro fertilization.
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Prevention of in vitro fertilization twins should focus on maximizing single embryo transfer versus twins are an acceptable complication of in vitro fertilization.

Fertil Steril. 2018 Feb;109(2):223-229

Authors: Meldrum DR, Adashi EY, Garzo VG, Gleicher N, Parinaud J, Pinborg A, Van Voorhis B

PMID: 29447664 [PubMed - in process]




Prenatal diagnosis by chromosomal microarray analysis.
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Prenatal diagnosis by chromosomal microarray analysis.

Fertil Steril. 2018 Feb;109(2):201-212

Authors: Levy B, Wapner R

Abstract
Chromosomal microarray analysis (CMA) is performed either by array comparative genomic hybridization or by using a single nucleotide polymorphism array. In the prenatal setting, CMA is on par with traditional karyotyping for detection of major chromosomal imbalances such as aneuploidy and unbalanced rearrangements. CMA offers additional diagnostic benefits by revealing sub-microscopic imbalances or copy number variations that are too small to be seen on a standard G-banded chromosome preparation. These submicroscopic imbalances are also referred to as microdeletions and microduplications, particularly when they include specific genomic regions that are associated with clinical sequelae. Not all microdeletions/duplications are associated with adverse clinical phenotypes and in many cases, their presence is benign. In other cases, they are associated with a spectrum of clinical phenotypes that may range from benign to severe, while in some situations, the clinical significance may simply be unknown. These scenarios present a challenge for prenatal diagnosis, and genetic counseling prior to prenatal CMA greatly facilitates delivery of complex results. In prenatal diagnostic samples with a normal karyotype, chromosomal microarray will diagnose a clinically significant subchromosomal deletion or duplication in approximately 1% of structurally normal pregnancies and 6% with a structural anomaly. Pre-test counseling is also necessary to distinguish the primary differences between the benefits, limitations and diagnostic scope of CMA versus the powerful but limited screening nature of non-invasive prenatal diagnosis using cell-free fetal DNA.

PMID: 29447663 [PubMed - in process]




Cell-free DNA for the detection of fetal aneuploidy.
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Cell-free DNA for the detection of fetal aneuploidy.

Fertil Steril. 2018 Feb;109(2):195-200

Authors: Goldwaser T, Klugman S

Abstract
Screening for fetal aneuploidy via cell-free DNA was described more than two decades ago and has been used clinically by obstetric providers in the United States for more than 5 years. Cell-free DNA affords excellent detection of fetal Down syndrome and other common aneuploidies and thus is sought by patients and providers. However, owing to the source of the DNA and the nature of the screening test, scenarios may arise that require expert counseling about complex issues regarding fetal and maternal health, test interpretation, and management. It is essential that infertility specialists understand the specific issues related to the strengths and limitations of this screening test, especially in light of expanded genetic testing of embryos.

PMID: 29447662 [PubMed - in process]




Ethical quandaries around expanded carrier screening in third-party reproduction.
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Ethical quandaries around expanded carrier screening in third-party reproduction.

Fertil Steril. 2018 Feb;109(2):190-194

Authors: Mertes H, Lindheim SR, Pennings G

Abstract
Although current screening methods of gamete donors are capable of reducing the incidence of genetic anomalies in donor offspring below general population levels, targeted screening for a large number of conditions (expanded carrier screening or ECS) could be considered as part of the routine selection procedure for gamete donors. There are, however, important drawbacks to its practical implementation. Excluding all carriers of severe recessive monogenic pediatric disorders would disqualify virtually all donors, and other approaches negatively affect cost (and therefore access), present dilemmas in regard to disclosure of genetic findings, and/or overburden the intended parents. In all of the scenarios considered, adequate genetic counseling will be of central importance. Besides looking at benefits and drawbacks of possible ways of implementing ECS, we also examine whether a moral obligation exists to adopt ECS at all and on whose shoulders such an alleged obligation would rest: policymakers, medical staff at fertility clinics, sperm and egg banks, the intended parents? We argue that given the small risk reduction brought about by ECS, the possible negative effects of its implementation, and the absence of widespread preconception carrier screening in the general population, it is inconsistent to argue that there is a moral obligation to perform ECS in the context of donor conception. Finally, implications for the donors are discussed.

PMID: 29447661 [PubMed - in process]




Expanded carrier screening: what the reproductive endocrinologist needs to know.
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Expanded carrier screening: what the reproductive endocrinologist needs to know.

Fertil Steril. 2018 Feb;109(2):183-189

Authors: Dungan J

Abstract
Expanded carrier screening refers to identification of carriers of single-gene disorders outside of traditional screening guidelines. New genetic testing technologies allow for such screening at costs that are comparable to single-gene testing. There is a high degree of variability among genetic testing laboratories as to the inclusion of different disorders, some of which have mild or unpredictable phenotypes. This review discusses the pros and cons of using expanded carrier screening in the preconceptional patient and reviews guidelines currently endorsed by professional organizations.

PMID: 29447660 [PubMed - in process]




Association of testosterone and antimüllerian hormone with time to pregnancy and pregnancy loss in fecund women attempting pregnancy.
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Association of testosterone and antimüllerian hormone with time to pregnancy and pregnancy loss in fecund women attempting pregnancy.

Fertil Steril. 2018 Feb 07;:

Authors: Sjaarda LA, Mumford SL, Kuhr DL, Holland TL, Silver RM, Plowden TC, Perkins NJ, Schisterman EF

Abstract
OBJECTIVE: To examine whether higher T and/or antimüllerian hormone (AMH) was associated with anovulation, time to pregnancy (TTP), or pregnancy loss risk among healthy, fecund women without diagnosed polycystic ovary syndrome.
DESIGN: Prospective cohort study conducted as a secondary analysis from the Effects of Aspirin in Gestation and Reproduction randomized trial.
SETTING: University medical centers.
PATIENT(S): A total of 1,198 healthy, eumenorrheic women aged 18-40 years attempting spontaneous pregnancy with one to two prior pregnancy losses were included. Women were categorized by baseline antimüllerian hormone (AMH), as a surrogate marker of antral follicle count, and T concentrations; the highest quartile for each was "high," and below the top quartile (i.e., lower 75% of values) was "norm," forming four groups: norm T/norm AMH (n = 742), norm T/high AMH (n = 156), high T/norm AMH (n = 157), and high T/high AMH (n = 143).
INTERVENTION(S): Not applicable.
MAIN OUTCOME MEASURE(S): Anovulation, pregnancy incidence, TTP, and pregnancy loss incidence.
RESULT(S): Women with high T/high AMH had a greater anovulation risk (risk ratio 1.58, 95% confidence interval 1.13-2.22) compared with women with norm T/norm AMH, but with imprecise differences in incidence of pregnancy, TTP, or pregnancy loss.
CONCLUSION(S): Women with higher T and AMH had more frequent anovulatory cycles but with marginal impacts on TTP or pregnancy loss. A continuum of mild inefficiency in reproductive function may be related to higher T and AMH, including in fecund women with normal menstrual cycles and no clinical diagnosis of polycystic ovary syndrome, but with unclear effects on fecundability and pregnancy loss.
CLINICAL TRIAL REGISTRATION NUMBER: NCT00467363.

PMID: 29428315 [PubMed - as supplied by publisher]




Gestational carrier in assisted reproductive technology.
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Gestational carrier in assisted reproductive technology.

Fertil Steril. 2018 Feb 07;:

Authors: Murugappan G, Farland LV, Missmer SA, Correia KF, Anchan RM, Ginsburg ES

Abstract
OBJECTIVE: To compare clinical outcomes of in vitro fertilization (IVF) cycles with the use of gestational carriers (GCs) with non-GC IVF cycles.
DESIGN: Retrospective cohort study of assisted reproductive technology (ART) cycles performed with (24,269) and without (1,313,452) the use of a GC.
SETTING: ART centers.
PATIENT(S): Infertile patients seeking IVF with or without use of a GC.
INTERVENTIONS(S): Autologous and donor oocyte cycles, fresh and cryopreserved embryo transfer cycles.
MAIN OUTCOME MEASURE(S): Live birth rate (LBR), twin and high-order multiple birth rates.
RESULT(S): Approximately 2% of embryo transfers used a GC. Per embryo transfer, GCs had greater pregnancy rate and LBR across all IVF types compared with non-GC cycles in crude models and models adjusted a priori for potential confounders. For women with uterine-factor infertility, embryo transfer with the use of a GC resulted in a higher odds of live birth for autologous fresh embryos and for cryopreserved embryos compared with patients with non-uterine-factor infertility diagnoses.
CONCLUSION(S): GC benefits LBRs for some patients seeking ART. The highest LBRs occurred when the indication for GC was uterine-factor infertility.

PMID: 29428314 [PubMed - as supplied by publisher]




Clinical outcomes in carriers of complex chromosomal rearrangements: a retrospective analysis of comprehensive chromosome screening results in seven cases.
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Clinical outcomes in carriers of complex chromosomal rearrangements: a retrospective analysis of comprehensive chromosome screening results in seven cases.

Fertil Steril. 2018 Feb 07;:

Authors: Hu L, Wei Y, Luo K, Xie P, Gong F, Xiong B, Tan Y, Lu G, Lin G

Abstract
OBJECTIVE: To evaluate the clinical outcomes in carriers of complex chromosomal rearrangements (CCRs).
DESIGN: Case series.
SETTING: An institute for reproductive and stem cell engineering.
PATIENT(S): Seven couples with CCRs.
INTERVENTION(S): Assisted reproduction with preimplantation genetic diagnosis (PGD).
MAIN OUTCOME MEASURE(S): PGD results, embryo rating, pregnancy outcomes.
RESULT(S): In cases 1, 2, 3, 4, 5, and 6, each woman underwent one cycle of PGD. Case 7 underwent two PGD cycles. We obtained 51 blastocysts from seven couples with CCR, of which 47 were eligible for biopsy; only 3 (5.9%) were normal/balanced, and 2 (3.9%) conceptions resulted. One healthy baby girl was born (the other was not yet born at the time of publication). Karyotyping revealed that the healthy baby girl was 46,XX. Although the patient with both a balanced translocation and a CCR (case 7) had 12 embryos available for biopsy, all were chromosomally unbalanced. It is interesting that 22 (57.9%) of the total 38 blastocysts were of high quality for type A CCRs, and 2 (15.4%) of the total 13 blastocysts were of high quality for type B CCR at day 6 after fertilization.
CONCLUSION(S): The chances of identifying normal/balanced blastocysts in patients with CCR are <6%; the chances of a pregnancy are <4%. Greater complexity CCRs result in fewer transplantable embryos. Moreover, CCRs of greater complexity have a lower rate of high quality blastocysts than CCRs of less complexity.

PMID: 29428313 [PubMed - as supplied by publisher]




Reproductive and metabolic determinants of granulosa cell dysfunction in normal-weight women with polycystic ovary syndrome.
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Reproductive and metabolic determinants of granulosa cell dysfunction in normal-weight women with polycystic ovary syndrome.

Fertil Steril. 2018 Feb 07;:

Authors: Guedikian AA, Lee AY, Grogan TR, Abbott DH, Largaespada K, Chazenbalk GD, Dumesic DA

Abstract
OBJECTIVE: To determine the degree to which E2 hyperresponsiveness to FSH and antimüllerian hormone (AMH) overproduction in normal-weight women with polycystic ovary syndrome (PCOS) correlate with increased antral follicle number (AFN), hyperandrogenism, and/or metabolic dysfunction.
DESIGN: Prospective cohort study.
SETTING: Academic medical center.
PATIENT(S): Seven normal-weight women with PCOS (1990 National Institutes of Health criteria) ages 20-34 years and 13 age- and body mass index- (BMI-; 18.5-25 kg/m2) matched normoandrogenic ovulatory women were studied.
INTERVENTION(S): All women underwent basal serum hormone and metabolic measurements, FSH stimulation testing with transvaginal ovarian sonography, frequently sampled IV glucose tolerance testing, and whole-body dual-energy x-ray absorptiometry.
MAIN OUTCOME MEASURE(S): Serum hormone/metabolite levels, 24-hour serum E2 response to 150 IU recombinant human (rh) FSH infusion, AFN, insulin sensitivity, and body mass measurements.
RESULT(S): Serum E2 responsiveness to rhFSH and AMH levels were greater in women with PCOS than in BMI- and age-matched control women, as were serum androgen levels, AFN, and abdominal fat mass. In all women combined, serum E2 responsiveness to rhFSH was associated with AFN. Serum AMH levels, however, positively correlated with AFN but remained positively correlated with serum LH and free T levels and negatively correlated with total body fat and percent body fat, adjusting for AFN.
CONCLUSION(S): In normal-weight women with PCOS, serum E2 hyperresponsiveness to rhFSH represents increased AFN, while elevated serum AMH levels reflect opposing effects of stimulatory reproductive (hyperandrogenism and increased AFN) versus inhibitory metabolic (body fat) factors. Given the small number of subjects reported, additional follow-up studies are required to confirm these data.

PMID: 29428312 [PubMed - as supplied by publisher]




Impact of cancer treatment on risk of infertility and diminished ovarian reserve in women with polycystic ovary syndrome.
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Impact of cancer treatment on risk of infertility and diminished ovarian reserve in women with polycystic ovary syndrome.

Fertil Steril. 2018 Feb 07;:

Authors: Shandley LM, Fothergill A, Spencer JB, Mertens AC, Cottrell HN, Howards PP

Abstract
OBJECTIVE: To compare markers of fertility and ovarian reserve between cancer survivors and cancer-free women with and without polycystic ovary syndrome (PCOS).
DESIGN: Furthering Understanding of Cancer, Health, and Survivorship in Adult (FUCHSIA) Women's Study-a population-based cohort study.
SETTING: Not applicable.
PATIENT(S): Female cancer survivors (n = 1,090) aged 22-45 years, diagnosed between ages 20 and 35 years, and at least 2 years after diagnosis; 369 participated in a clinic visit. Three hundred seventy-four reproductive-aged women without cancer also completed a clinic visit.
INTERVENTION(S): None.
MAIN OUTCOME MEASURE(S): Infertility, time to first pregnancy after cancer diagnosis, and measures of ovarian reserve (antimüllerian hormone [AMH] and antral follicle count [AFC]).
RESULTS: Seventy-eight cancer survivors (7.2%) reported a PCOS diagnosis, with 41 receiving gonadotoxic treatment. Survivors with PCOS exposed to gonadotoxic treatment (odds ratio [OR] 2.3, 95% confidence interval [CI] 1.2-4.5) and unexposed (OR 3.4, 95% CI 1.7-6.9) were more likely to report infertility than unexposed survivors without PCOS and were more likely to have fewer children than desired (exposed: OR 2.1, 95% CI 1.0-4.2; unexposed: OR 3.0, 95% CI 1.4-6.8). After adjusting for age, comparison women with PCOS had the highest markers of ovarian reserve (AMH: 2.43 ng/mL, 95% CI 1.22-4.82 ng/mL; AFC: 20.7, 95% CI 15.3-27.8), and cancer survivors without PCOS treated with gonadotoxic agents had the lowest levels (AMH: 0.19 ng/mL, 95% CI 0.14-0.26 ng/mL; AFC: 7.4, 95% CI 6.4-8.5).
CONCLUSION(S): Despite having higher AMH and AFC on average after cancer treatment, cancer survivors with PCOS were less likely to meet their reproductive goals compared with survivors without PCOS.

PMID: 29428311 [PubMed - as supplied by publisher]




Assessing access to assisted reproductive services for serodiscordant couples with human immunodeficiency virus infection.
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Assessing access to assisted reproductive services for serodiscordant couples with human immunodeficiency virus infection.

Fertil Steril. 2018 Feb 07;:

Authors: Leech AA, Bortoletto P, Christiansen C, Drainoni ML, Linas BP, Roeca C, Curtis M, Sullivan M

Abstract
OBJECTIVE: To understand the barriers that serodiscordant couples with human immunodeficiency virus (HIV) face in accessing services for risk reduction and infertility using assisted reproductive technology (ART).
DESIGN: Two-arm cross-sectional telephone "secret shopper" study.
SETTING: Infertility clinics designated by the Society for Assisted Reproductive Technology (SART), 140 from 15 American states with the highest prevalence of heterosexual HIV-infected men.
PATIENT(S): Clinical and nonclinical staff at SART-registered clinics.
INTERVENTION(S): Standardized telephone calls to SART-registered clinics by investigators in the roles of physician and patient callers.
MAIN OUTCOME MEASURE(S): Availability and difference in services offered to callers and the rate of referral if the clinic did not provide these services.
RESULT(S): Of the 140 sampled SART clinics across 15 states, callers in both patient and physician roles spoke to a staff member at greater than 90% of targeted clinics (127 clinics total). Of the physician callers 63% were told that the clinic could offer services, as compared to 40% of patient callers. Of the 55 clinics that were unable to provide services to the patient caller, 51% referred to other clinics with confidence that they could offer these services; 67% of clinics would provide services for both prevention and infertility purposes.
CONCLUSION(S): Risk reduction services for HIV were more available at the sampled fertility clinics than previously reported in the literature. However, the responses depended on the person calling. The clinics demonstrated low rates of concordance with the American Society for Reproductive Medicine's guidelines, which endorse referral of patients to other facilities from sites unable to offer services.

PMID: 29428310 [PubMed - as supplied by publisher]




Mycoplasma genitalium can modulate the local immune response in patients with endometriosis.
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Mycoplasma genitalium can modulate the local immune response in patients with endometriosis.

Fertil Steril. 2018 Feb 07;:

Authors: Campos GB, Marques LM, Rezende IS, Barbosa MS, Abrão MS, Timenetsky J

Abstract
OBJECTIVE: To detect Mollicutes in women with endometriosis and healthy peritoneal tissues and evaluate the participation of these bacteria in the immune response during endometriosis.
DESIGN: Cross-sectional study.
SETTING: University hospitals.
PATIENT (S): Women with endometriosis (n = 73) and without endometriosis (n = 31).
INTERVENTION(S): Endocervical swabs, peritoneal fluid, and biopsied lesions of endometriosis of women with endometriosis (study group) and healthy peritoneal tissues (control group) were collected during surgery. Clinical characteristics were registered before surgery.
MAIN OUTCOME MEASURE(S): We determined the infectious agents with the use of quantitative polymerase chain reaction (PCR). The cytokine secretion profile was determined with the use of Luminex. The expression of immune response related genes was determined with the use of a PCR array kit.
RESULT(S): All target microorganisms were detected at least once in the swab samples analyzed. It was possible to observe higher diversity of microorganisms in the samples of swab and peritoneal fluid in the study group compared with the control. Ureaplasma parvum was associated with the severity of the symptom dyspareunia. Mycoplasma genitalium was associated with higher production of interferon-γ and interleukin-1β. Genes of inflammatory response activation and antigen presentation were up-regulated in biopsied tissue of women with endometriosis. In women with endometriosis, peritoneal fluid cells showed a down-regulation of genes associated with the inflammatory response. This down-regulation profile was higher in presence of M. genitalium.
CONCLUSION(S): Mycoplasma genitalium may play a key role in the immune tolerance process and, especially, the aggravation of this profile. More studies are needed to understand this immune tolerance profile of bacterial infections.

PMID: 29428309 [PubMed - as supplied by publisher]




Differential rate in decline in ovarian reserve markers in women with polycystic ovary syndrome compared with control subjects: results of a longitudinal study.
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Differential rate in decline in ovarian reserve markers in women with polycystic ovary syndrome compared with control subjects: results of a longitudinal study.

Fertil Steril. 2018 Feb 07;:

Authors: Ahmad AK, Kao CN, Quinn M, Lenhart N, Rosen M, Cedars MI, Huddleston H

Abstract
OBJECTIVE: To estimate rates of ovarian aging in polycystic ovary syndrome (PCOS) subjects versus a community control population.
DESIGN: Longitudinal.
SETTING: Tertiary academic center.
SUBJECT(S): PCOS subjects diagnosed according to the 2004 Rotterdam criteria were systematically enrolled in a PCOS cohort study. The comparison control subjects were from the Ovarian Aging study, a prospective longitudinal study of ovarian aging in healthy women with regular menstrual cycles.
INTERVENTION(S): Clinical data collection over two study visits.
MAIN OUTCOME MEASURE(S): Antral follicle count (AFC), ovarian volume (OV), and antimüllerian hormone level (AMH).
RESULT(S): PCOS subjects were found to have higher baseline values for all ovarian reserve markers compared with control subjects. Univariate models indicated that, compared with control subjects, PCOS patients experienced significantly faster rates of decline for both AFC and AMH. Change in OV did not differ significantly. To account for potential confounder effects, multiple analysis of covariance models were evaluated for the best fit, considering age, body mass index, and baseline ovarian reserve markers. Adjusted models demonstrated that PCOS patients do not experience a significant difference in AFC decline compared with control subjects, but they do experience a faster rate of decline in AMH (P<.01) and slower rate of decline in OV (P<.01).
CONCLUSION(S): Ovarian aging in PCOS is characterized by a more rapid decline in AMH and a slower decline in OV compared with control subjects.

PMID: 29428308 [PubMed - as supplied by publisher]




Oocyte vitrification versus ovarian cortex transplantation in fertility preservation for adult women undergoing gonadotoxic treatments: a prospective cohort study.
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Oocyte vitrification versus ovarian cortex transplantation in fertility preservation for adult women undergoing gonadotoxic treatments: a prospective cohort study.

Fertil Steril. 2018 Feb 07;:

Authors: Diaz-Garcia C, Domingo J, Garcia-Velasco JA, Herraiz S, Mirabet V, Iniesta I, Cobo A, Remohí J, Pellicer A

Abstract
OBJECTIVE: To compare the efficacy of oocyte vitrification (OV) with that of ovarian cortex cryopreservation and transplantation (OCT) in women undergoing gonadotoxic treatments.
DESIGN: Prospective observational cohort study.
SETTING: Not applicable.
PATIENT(S): Candidates for chemo-/radiotherapy who joined our fertility preservation (FP) program were included in this study between 2005 and 2015. One cohort included 1,024 patients undergoing OV; the other cohort included 800 patients undergoing OCT.
INTERVENTION(S): OV using the cryotop device and OCT using a slow freezing protocol.
MAIN OUTCOME MEASURE(S): Live-birth rate (LBR) and clinical pregnancy rate (CPR).
RESULT(S): Basal antimüllerian hormone levels of the patients revealed no differences in ovarian reserve before FP (OV, 11.6 pM [5.4-24.7]; OCT, 11.8 pM [6.4-21.9]). In the OV cohort, 49 patients used the vitrified oocytes after a mean storage time of 3.9 years. In the OCT cohort, 44 sought pregnancy after a mean storage time of 5.5 years. A trend toward higher CPR and LBR (per patient) was observed in the OV group (risk ratio [RRCPR], 1.31 [95% confidence interval, 0.90-1.92]; RRLBR 1.39 [95% confidence interval, 0.95-2.03]), although differences were not statistically significant. In the OCT group, 46.7% of pregnancies occurred spontaneously and no pregnancy was achieved when the tissue was harvested beyond the age of 36 years. All patients except three undergoing OCT resumed or improved endocrine ovarian function.
CONCLUSION(S): Although we observed a trend toward higher LBR after OV, OCT is a very effective method to preserve fertility, allows for natural pregnancy, and restores ovarian function. In clinical scenarios where OV is not feasible, OCT remains the FP technique of choice and should no longer be considered experimental.

PMID: 29428307 [PubMed - as supplied by publisher]




Cumulus cell transcriptome profiling is not predictive of live birth after in vitro fertilization: a paired analysis of euploid sibling blastocysts.
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Cumulus cell transcriptome profiling is not predictive of live birth after in vitro fertilization: a paired analysis of euploid sibling blastocysts.

Fertil Steril. 2018 Feb 07;:

Authors: Green KA, Franasiak JM, Werner MD, Tao X, Landis JN, Scott RT, Treff NR

Abstract
OBJECTIVE: To compare the transcriptome of cumulus cells associated with a euploid embryo that resulted in live birth with that of a sibling euploid embryo without sustained implantation.
DESIGN: Paired analysis.
SETTING: Academic institution.
PATIENT(S): Couples undergoing in vitro fertilization (IVF)/intracytoplasmic sperm injection with preimplantation genetic screening with female age ≤42 years and normal ovarian reserve.
INTERVENTION(S): Transcriptome profiling of cumulus cells from sibling oocytes for correlation with live birth after euploid blastocyst transfer. Embryos were individually cultured to facilitate association with clinical outcomes. The cumulus cell transcriptome from the embryo resulting in live birth was compared with that of its sibling embryo without sustained implantation to investigate potential biomarkers that may aid in embryo selection.
MAIN OUTCOME MEASURE(S): Differential gene expression in cumulus cells associated with a euploid embryo resulting in live birth and its sibling euploid embryo without sustained implantation using next-generation RNA sequencing (RNAseq).
RESULT(S): Cumulus cell RNAseq of 34 samples (from 17 patients) generated an average of 10.4 ± 4 × 106 reads per sample. A total of 132 differentially expressed genes between sibling embryos that resulted in a live birth and those that did not were identified (P<.05). However, after correcting for multiple testing none of the genes remained significantly differentially expressed (false discovery rate < .05).
CONCLUSION(S): The RNAseq profiles were similar between cumulus cells associated with a euploid embryo resulting in live birth and its sibling embryo that did not sustain implantation. The cumulus cell transcriptome is not predictive of live birth within an individual patient's cohort of euploid embryos.

PMID: 29428306 [PubMed - as supplied by publisher]




High-molecular-weight adiponectin is inversely associated with sympathetic activity in polycystic ovary syndrome.
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High-molecular-weight adiponectin is inversely associated with sympathetic activity in polycystic ovary syndrome.

Fertil Steril. 2018 Feb 07;:

Authors: Shorakae S, Abell SK, Hiam DS, Lambert EA, Eikelis N, Jona E, Sari CI, Stepto NK, Lambert GW, de Courten B, Teede HJ

Abstract
OBJECTIVE: To examine the role of high-molecular-weight (HMW) adiponectin and its relationship to sympathetic activity in women with polycystic ovary syndrome (PCOS).
DESIGN: Cross sectional study using biobanked samples.
SETTING: Not applicable.
PATIENT(S): Premenopausal women with PCOS (n = 46, Rotterdam diagnostic criteria) and without PCOS (n = 22).
INTERVENTION(S): None.
MAIN OUTCOME MEASURE(S): High-molecular-weight adiponectin levels with secondary outcomes of sympathetic activity and leptin levels.
RESULT(S): The high-molecular-weight adiponectin level was lower in women with PCOS (median 2.2 [interquartile range (IQR)2.3] μg/mL) than in controls (median 3 [IQR2.5] μg/mL) (age and BMI adjusted), and it correlated inversely with the values measured for homeostatic model of assessment of insulin resistance (HOMA-IR), fasting insulin, triglycerides, and free androgen index and positively with sex hormone-binding globulin (SHBG) and high-density lipoprotein cholesterol in all participants and in the PCOS group. In the PCOS group, sympathetic activity (burst frequency) was statistically significantly higher than in controls (median 26 [IQR11] vs. median 22 [IQR14], respectively) and correlated inversely with HMW adiponectin (r = -0.230). The leptin levels were similar between the women with PCOS and controls and did not statistically significantly correlate with HMW adiponectin or sympathetic activity. On multiple regression analysis, burst frequency and SHBG explained 40% of the HMW adiponectin variability (B = -0.7; 95% CI -1.2 to -0.2; and B = 0.01; 95% CI 0.004-0.01) in PCOS.
CONCLUSION(S): Alongside insulin resistance, increased sympathetic activity is associated with and may modulate HMW adiponectin levels in women with PCOS.

PMID: 29428305 [PubMed - as supplied by publisher]




Novel approach to recurrent implantation failure: short-term copper intrauterine device placement.
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Novel approach to recurrent implantation failure: short-term copper intrauterine device placement.

Fertil Steril. 2017 07;108(1):42-43

Authors: Goodman LR, Franasiak JM

PMID: 28602475 [PubMed - indexed for MEDLINE]




Recurrent implantation failure is another indication for the freeze-all strategy.
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Recurrent implantation failure is another indication for the freeze-all strategy.

Fertil Steril. 2017 07;108(1):44

Authors: Shapiro BS, Garner FC

PMID: 28579414 [PubMed - indexed for MEDLINE]




Sex and gender: you should know the difference.
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Sex and gender: you should know the difference.

Fertil Steril. 2017 06;107(6):1294-1295

Authors: Broughton DE, Brannigan RE, Omurtag KR

PMID: 28501363 [PubMed - indexed for MEDLINE]




Inform and consent: more than just "sign here".
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Inform and consent: more than just "sign here".

Fertil Steril. 2017 07;108(1):40-41

Authors: Madeira JL, Coyne K, Jaeger AS, Parry JP, Lindheim SR

PMID: 28434753 [PubMed - indexed for MEDLINE]