ART Outcomes Research Articles

AFRICAN AMERICAN WOMEN HAVE LOWER ODDS OF LIVE BIRTH FROM DONOR EGG IVF

African American women have poorer ART outcomes compared to Caucasian women and the etiology is unknown. Studies have found African American women to have fewer mature oocytes, fertilized oocytes, and lower blastocyst development rates compared to Caucasian women, suggesting that competence of the oocyte may play a role. Our objective is to assess ART clinical outcomes in African American women, while controlling for oocyte quality by using the oocyte donor–recipient model.

THERE IS A DISPARITY IN ART OUTCOMES BETWEEN ASIAN AND CAUCASION WOMEN IN OOCYTE DONATION CYCLES

To assess ART clinical outcomes in Asian patients while controlling for oocyte quality by using the oocyte donor–recipient model, given that several studies have shown that Asian women have poorer ART outcomes compared to Caucasian women and the etiology of this disparity is unknown.

IS EARLY HCG PREDICTIVE OF PREGNANCY AFTER ESET IN BOTH FRESH AND FET CYCLES?

Most ART programs perform β-hCG measurement 9-12 days after embryo transfer(ET) to detect a pregnancy. A prior study using hyperglycosylated hCG in a small sample size showed that a single measurement 6 days after ET had 100% sensitivity and specificity in identifying biochemical and ongoing pregnancies. We sought to determine whether routine serum β-hCG measurement at 5-6 days after ET is predictive of ART outcome. This is important in patient counseling if we can stop P supplementation early in cases of negative tests, especially if taking painful IM P supplementation. Prospective single center. A total of 241 patients undergoing eSET (elective single embryo transfer) had their “early” serum β-hCG measured 5-6 days after ET, and the “official” serum β-hCG was done 9-10 days after ET. There were 91 fresh ET and 150 FET cycles. A test was positive if the β-hCG measurement was ≥ 3 IU/L. All tests were performed at a commercial laboratory with offices around the US (LabCorp). In the 91 fresh ET cases observed, 65 had positive and 26 had negative “early”β-hCG tests measured 5-6 days post ET. Of the 65 positive β-hCG tests, 10 (15.4%) were biochemical, 9 (13.8%) were pregnancy losses (SAB), and 46 (70.8%) were live births. Of the 26 negative tests, 24 (92.3%) were negative on days 9-10 and 2 (7.6%) were positive on days 9-10. Both positive results on day 9-10 ended with biochemical losses. In the 150 FETs observed, 81 had positive and 69 had negative “early” β-hCG. Of the 81 positive, 19 (23.5%) were biochemical pregnancies, 7 (8.6%) had SAB, and 55 (67.9%) were ongoing/live births. Of the 69 negative β-hCG tests measured 5-6 days post FET, 4 (5.7%) were then positive on day 9-10, 3 resulting in biochemical pregnancies and one live birth. The mean “early” β-hCG levels in the IVF group was 27.03 IU/L which was significantly higher than in the FET 14.09 IU/L (P<0.001). There were significant differences in early β-hCG results between ongoing/delivered and biochemical pregnancies in both fresh and FET groups (P<0.001), but not between ongoing/LB and SAB. However, by first β-hCG level on days 9-10 there were no differences in the mean β-hCG between the 2 groups (P=0.04). ROC for fresh ET showed a cut off value of 7 IU/L. The test can detect with 90% sensitivity a 96% specificity with 3.8% false positive (AUC=0.972). For FET it showed a cut off value of 3.7 IU/L. The test can detect with 89% sensitivity a specificity of 94% with 5.7% false positive (AUC=0.964) (Figure 1). Early serum β-hCG measured 5-6 days after ET in eSET cycles is very predictive of successful pregnancies. A negative test 5-6 days after ET is associated with a negative 9-10 day β-hCG test in both fresh and FET cycles. In the fresh group, an early negative β-hCG was 100% predictive of no live births, but in the FET group an early negative in the FET group led to a single live birth (99.33% predictive of no live births). FET cycles were associated with lower early β-hCG levels than fresh transfers but became similar to fresh cycles on the first day of actual pregnancy test. This information is of potential benefit in counseling women undergoing ART.

THE ASSOCIATION BETWEEN PRIOR CESAREAN SECTION AND ASSISTED REPRODUCTIVE TECHNOLOGY (ART) OUTCOMES IN WOMEN UNDERGOING AUTOLOGOUS SINGLE THAWED EUPLOID EMBRYO TRANSFER

Rates of cesarean section (CS) continue to increase worldwide[1]. Although a CS is often a necessary intervention, it presents increased risk for short and long-term sequelae in mother and infant[2]. Previous work suggests an association between prior CS and reduced fertility in both natural and ART cycles [3-5]. To our knowledge, there is no published research exploring the relationship between a prior CS and subsequent single thawed euploid embryo transfer (euploid SET). The objective of this study was to determine whether prior mode of delivery correlates with subsequent ART outcomes in patients undergoing euploid SET.

Is vanishing twin syndrome associated with adverse obstetric outcomes of ART singletons? A systematic review and meta-analysis.

The objective of our meta-analysis was to estimate the effect of VTS on obstetric outcomes of ART singletons. PubMed, Embase, MEDLINE, and ClinicalTrials.gov were searched up to January 2019 to find studies reporting the obstetric outcomes of ART singletons with VTS. Dichotomous data were expressed as odds ratios (OR) with 95% confidence intervals (CI). Continuous data were expressed as weighted mean difference (WMD) with 95% CI. A total of 17 observational studies encompassing more than 60,000 ART singletons were included in this meta-analysis. The impact of VTS on singletons was highly dependent on the definition of VTS, precisely, the vanishing timing and intrauterine growth stage. When VTS happened at or before 14 weeks, regardless of intrauterine growth stage, there were no differences in terms of gestational age (GA) [WMD = - 0.08, 95% CI = - 0.27, 0.10], preterm birth (< 37 weeks) (PTB) [OR = 1.23, 95% CI = 0.89, 1.70], and low birth weight (< 2.5 kg) (LBW) [OR = 1.56, 95% CI = 1.00, 2.43] in original singletons versus singleton with VTS. On the contrary, VTS occurred after 14 weeks was associated with significantly shorter GW and lower BW, as well as higher risks of PTB and LBW. When the sac reduced in VTS was an empty gestational sac, there would be no differences in GW, PTB, and LBW between singletons versus singletons with VTS, whereas the loss of a fetus with cardiac-activity was associated with adverse obstetric outcomes. This meta-analysis suggests whether or not VTS is harmful to obstetric outcomes is highly dependent on the vanishing timing and intrauterine growth stage.

Maternal C-reactive protein and in vitro fertilization (IVF) cycles.

Embryo implantation is accompanied by a potent inflammatory response, and a gradient of cytokines and chemokines produced by endometrial cells supports the embryo-endometrial interaction. C-reactive protein (CRP) serves as an early marker of inflammation and recent studies have illustrated that controlled ovarian hyperstimulation (COH) could increase its levels. Interestingly, a high chance of pregnancy has been reported in women who had an elevated CRP level on the day of embryo transfer. It seems an elevated systemic inflammation in the in vitro fertilization (IVF) cycle can increase the implantation and pregnancy rates. However, the results regarding the association of CRP with ART outcomes are controversial. Therefore, in this review, we aimed to describe how CRP levels change during a cycle of IVF treatment and which factors can potentially affect this pattern of change. Furthermore, the association of CRP with ART outcomes has been discussed.

The continuum of ovarian response leading to BIRTH, a real world study of ART in Spain

BackgroundThe first biosimilar of recombinant follicle stimulating hormone (rFSH) launched in Europe was Bemfola® in 2014 following a clinical development programme demonstrating efficacy and safety to the satisfaction of the European Medicines Agency. Since then the increasing use of biosimilar rFSH has provided the opportunity to study both effectiveness across the whole population and the variation of rFSH use during routine clinical care in a real-world setting in Spain.MethodsThis is a real-world study of 1222 women treated in 26 assisted reproduction treatment centres throughout Spain providing experience of the use of a biosimilar recombinant follicle stimulating hormone in four distinct populations. The four populations studied were poor responders, suboptimal responders, normal responders and oocyte donors. The primary endpoint was the total number of oocytes retrieved. Secondary endpoints included number of days of rFSH stimulation, total dose of rFSH administered, number of MII oocytes, number of fertilized oocytes, quality of embryos, number of embryos transferred, implantation rates, clinical pregnancy rates following embryo transfer, number of multiple pregnancies and number of serious adverse reactions, including moderate-to-severe OHSS.ResultsDifferences were seen across the populations both in the characteristics of the women and ART outcomes suggestive of a continuum of fertility prognosis. In the poor responders, suboptimal responders, normal responders and oocyte donor populations the mean age in years was 39.9 (±SD 3.4), 38.4 (±SD 2.9), 34.4 (±SD 3.3) and 26 (±SD 4.6) respectively and number of oocytes retrieved was 4.1 (±SD 2.7), 8.6 (±SD 6.0), 12.2 (±SD 7.2) and 19.5 (±SD 9.5) respectively. The proportion of embryos graded as best quality was 18.5%, 33.0% and 43.8%, and graded as worst quality was 20.4%, 5.8% and 5.8% for poor responders, suboptimal responders and normal responders respectively. In a similar pattern, for poor responders, suboptimal responders and normal responders the implantation rates were 16.0%, (8/50), 22.4% (49/219), 30.6% (97/317) respectively and clinical pregnancy rates were 23.2% (10/43), 30.4% (59/194) and 37.0% (114/308) respectively. Adverse events were reported in only 7 of 1222 women (0.6%).ConclusionsOverall the results were consistent with the national ART results reported for Spain, hence this study provides reassurance of the clinical effectiveness of a biosimilar rFSH used in a real world setting.Trial registrationClinicalTrials.gov identifier - NCT02941341.

International Committee for Monitoring Assisted Reproductive Technologies world report: assisted reproductive technology 2012†.

What was the utilization, effectiveness and safety of practices in ART globally in 2012 and what global trends could be observed? The total number of ART cycles increased by almost 20% since 2011 and the main trends were an increase in frozen embryo transfers (FET), oocyte donation, preimplantation genetic testing and single embryo transfers (SET), whereas pregnancy and delivery rates (PR, DR) remained stable, and multiple deliveries decreased. ART is widely practiced throughout the world, but continues to be characterized by significant disparities in utilization, availability, practice, effectiveness and safety. The International Committee for Monitoring Assisted Reproductive Technologies (ICMART) annual world report provides a major tool for tracking trends in ART treatment for over 25 years and gives important data to ART professionals, public health authorities, patients and the general public. A retrospective, cross-sectional survey on the utilization, effectiveness and safety of ART procedures performed globally during 2012 was carried out. Sixty-nine countries and 2600 ART clinics submitted data on ART cycles performed during the year 2012, and their pregnancy outcome, through national and regional ART registries. ART cycles and outcomes are described at country, regional and global levels. Aggregate country data were processed and analyzed based on methods developed by ICMART. A total of 1149817 ART cycles were reported for the treatment year 2012. After imputing data for missing values and non-reporting clinics in reporting countries, 1948898 cycles (an increase of 18.6% from 2011) resulted in >465286 babies (+17.9%) in reporting countries. China did not report and is not included in this estimate. The best estimate of global utilization including China is ∼2.8 million cycles and 0.9 million babies. From 2011 to 2012, the number of reported aspirations and FET cycles increased by 6.9% and 16.0%, respectively. The proportion of women aged 40 years or older undergoing non-donor ART increased from 24.0% in 2011 to 25.2% in 2012. ICSI, as a percentage of non-donor aspiration cycles, increased from 66.5% in 2011 to 68.9% in 2012. The IVF/ICSI combined delivery rates per fresh aspiration and FET cycles were 19.8% and 22.1%, respectively. In fresh non-donor cycles, SET increased from 31.4% in 2011 to 33.7% in 2012, while the average number of transferred embryos decreased from 1.91 to 1.88, respectively-but with wide country variation. The rates of twin deliveries following fresh non-donor transfers decreased from 19.6% in 2011 to 18.0% in 2012, and the triplet rate decreased from 0.9% to 0.8%. In FET non-donor cycles, SET was 54.8%, with an average of 1.54 embryos transferred and twin and triplet rates of 11.1% and 0.4%, respectively. The cumulative DR per aspiration increased from 28.0% in 2011 to 28.9% in 2012. The overall perinatal mortality rate per 1000 births was 21.4 following fresh IVF/ICSI and 15.9 per 1000 following FET. The data presented depend on the quality and completeness of data submitted by individual countries to ICMART directly or through regional registries. This report covers approximately two-thirds of` world ART activity, with a major missing country, China. Continued efforts to improve the quality and consistency of reporting ART data by registries are still needed, including the use of internationally agreed standard definitions (International Glossary of Infertility and Fertility Care). The ICMART world reports provide the most comprehensive global statistical census and review of ART utilization, effectiveness, safety and quality. While ART treatment continues to increase globally, the wide disparities in access to treatment, procedures performed and embryo transfer practices warrant attention by clinicians and policy makers. With the increasing practice of SET and of freeze all and resulting increased proportion of FET cycles, it is clear that PR and DR per aspiration in fresh cycles do not give an overall accurate estimation of ART efficiency. It is time to use cumulative live birth rate per aspiration, combining the outcomes of FET cycles with the associated fresh cycle from which the embryos were obtained, and to obtain global consensus on this approach. The authors declare no conflict of interest and no specific support from any organizations in relation to this manuscript. ICMART gratefully acknowledges financial support from the following organizations: American Society for Reproductive Medicine; European Society for Human Reproduction and Embryology; Fertility Society of Australia; Japan Society for Reproductive Medicine; Japan Society of Fertilization and Implantation; Red Latinoamericana de Reproduccion Asistida; Society for Assisted Reproductive Technology; Ferring Pharmaceuticals and Abbott (both providing ICMART unrestricted grants unrelated to world reports). NA.

C-reactive protein and ART outcomes: a systematic review.

A dynamic balance between pro- and anti-inflammatory factors contributes to regulating human female reproduction. Chronic low-grade inflammation has been detected in several female reproductive conditions, from anovulation to embryo implantation failure. C-reactive protein (CRP) is a reliable marker of inflammation that is extensively used in clinical practice. Recent studies quantified CRP in the serum of infertile women undergoing ART and suggested its potential for the prediction of ART reproductive outcomes. The first objective of this systematic review of the available literature was to evaluate the association between pre-implantation circulating CRP concentration and pregnancy rates in women undergoing ART. The second objective was to describe serum CRP concentration changes after early embryo implantation. The changes in circulating CRP throughout the ART cycle, clinical implications of CRP quantification for the management of women undergoing ART, and future therapeutic options will also be discussed. The MEDLINE database was systematically searched from inception to March 2019 using the following key words: (C-reactive protein) AND (assisted reproductive techniques OR ovulation induction OR insemination OR in vitro fertilization). Only articles in English were considered. Studies were selected based on title and abstract. The full text of potentially relevant articles was retrieved and assessed for inclusion by two reviewers (S.B. and S.H.). The protocol was registered in the International prospective register of systematic reviews (PROSPERO; registration number: CRD148687). In total, 10 studies were included in this systematic review. Most of these studies reported lower circulating CRP values before the window of implantation and higher circulating CRP values during the peri-implantation period in women with successful ART outcome (biochemical or clinical pregnancy) compared to women without a successful outcome. Several lifestyle factors and/or drugs that reduce the concentration of circulating CRP significantly improve ART outcomes. Subgroup analyses according to female BMI and baseline circulating CRP concentration are highly recommended in future analyses. These findings highlight a possible detrimental impact of preconception high circulating CRP concentration on ART outcomes. However, the biochemical or clinical pregnancy rate endpoints used in the studies examined here are insufficient (there were no data on live birth outcome), and the impact of major variables that can influence CRP and/or ART, for example maternal age, BMI, number of transferred embryos, and use of anti-inflammatory drugs, were not considered in the analyses. CRP quantification may be a potential marker of ART outcome, but its predictive value still needs to be investigated in large prospective studies. In future, the quantification of circulating CRP before starting ART could help to identify patients with a poor ART prognosis, leading to ART cycle cancellation or to preconception treatment to minimize the medical risks and costs.

PENGARUH PENGGUNAAN MODEL Contextual Teaching &amp; Learning (CTL) TERHADAP HASIL BELAJAR SENI TARI DI SMPN 1 LUHAK NAN DUO

AbstrackThis class action research aims to increase the activity of student learning outcomes in cultural art (dance) at class VII in SMP N 1 Luhak Nan Duo. This research was a quantitative research with using experimental method. This study used data that were derived from the results of cultural art learning of students class VII at SMPN 1 Luhak Nan Duo or learning outcomes after the experiments were carried out. Techniques of data collection used in this study were tests given at the end of the cycle. Data collection were done by taking observation, tests and documentation. Meanwhile, technique of data analysis in quantitative research used statistics. The results of the study show that there is an effect of the student learning outcomes using learning model (CTL) on dance motion material based on time and energy, rather than the student learning outcomes that is taught with an experimental class average only gets 78.2 and 71.3 for the value of the control class. Keywords: effect, (CTL), learning outcomes. dance art

Evaluation of human papilloma virus in semen as a risk factor for low sperm quality and poor in vitro fertilization outcomes: a systematic review and meta-analysis

To analyze the effect of human papilloma virus (HPV) sperm infection on sperm parameters and invitro fertilization (IVF) outcomes. Systematic review and meta-analysis. Not applicable. Men with HPV sperm infection and couples undergoing IVF. Searches were conducted in the following databases: Medline(R), PubMed, Embase, Web of Science, Scopos, and the Cochrane Library. We included studies examining sperm parameters and IVF results in patients with and without HPV sperm infection. Sperm analysis (concertation, count, volume, motility, morphology), according to the World Health Organization manual, pregnancy rate (PR), and miscarriage rate (MR). Sixteen studies were included in this meta-analysis. The presence of HPV had a significant association with impaired sperm parameters in terms of concentration (mean difference [MD] -4.48, 95% confidence interval [CI] - 6.12 to -2.83), motility (MD -11.71, 95% CI - 16.15 to -7.26), and morphology (MD -2.44, 95% CI - 4.08 to -0.79. A review of the literature regarding ART outcomes showed an association between HPV infection and decreased PR, and an even stronger association between HPV infection and increased MR. Our meta-analysis shows a negative effect of HPV on sperm concentration, motility, and morphology. Further subgroup and categorical analysis confirmed the clinical significance of impaired sperm motility in HPV-infected sperm, although the sperm count and morphology must be carefully analyzed. The studies reviewed reported lower PR and increased MR in couples with HPV-infected sperm. As most studies had a moderate risk of bias, these observations warrant further large, well-designed studies before introducing clinical management recommendations. CRD42019127419.

PD25-10 TESTING FOR GENETIC MUTATIONS IN SEVERE TESTICULAR FAILURE USING COMMERCIALIZED GENE SEQUENCING OFFERS NOVEL INSIGHT FOR PHYSICIANS AND PATIENTS

You have accessJournal of UrologyInfertility: Epidemiology & Evaluation II (PD25)1 Apr 2020PD25-10 TESTING FOR GENETIC MUTATIONS IN SEVERE TESTICULAR FAILURE USING COMMERCIALIZED GENE SEQUENCING OFFERS NOVEL INSIGHT FOR PHYSICIANS AND PATIENTS Matthew Pollard*, Saneal Rajanahally, Michael Jansen, Alexander Bisignano, Malgorzata Jaremko, and Larry Lipshultz Matthew Pollard*Matthew Pollard* More articles by this author , Saneal RajanahallySaneal Rajanahally More articles by this author , Michael JansenMichael Jansen More articles by this author , Alexander BisignanoAlexander Bisignano More articles by this author , Malgorzata JaremkoMalgorzata Jaremko More articles by this author , and Larry LipshultzLarry Lipshultz More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000882.010AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Unexplained non-obstructive azoospermia (NOA) is a challenging diagnosis for clinicians and patients. Next-generation sequencing has allowed the identification of over 500 monogenic mutations with a potential impact on male fertility. Commercialization of this sequencing offers cost effective analyses of gene panels related to testicular failure. Our objective was to examine the data from available panels for unexplained oligospermia or NOA. METHODS: After IRB approval, we reviewed deidentified data from infertile men evaluated by a gene sequencing facility. Two panels were offered based on the amount and quality of published data describing the genetic association with infertility: a standard panel (>20 publications per gene) and an emerging genes panel (<10 publications per gene). Each panel is described in Table 1. RESULTS: A total of 37 patients were included in our analysis. Fourteen patients were azoospermic (38%), 11 were oligospermic (30%), and 12 oligospermic but unspecified sperm density (32%). In total, 25 patients (68%) tested positive for a mutation in at least one of the 16 genes (Table 2). Thirteen patients (35%) had more than one genetic mutation detected. Of 33 mutations, 16 (48%) were in the standard panel and 17 (51%) were in the emerging genes panel. PRDM9, an emerging gene involved in transcription regulation in germ cells, yielded 9 mutations - 6 deletion/duplications and 3 single-nucleotide polymorphisms. CONCLUSIONS: Testing patients diagnosed with severe oligospermia or NOA for mutations in targeted genetic panels yields significant results. The incidence of mutations detected in PRDM9 is greater than one would predict for Y chromosome microdeletion in this sample of infertile men. Future research should focus on the impact of mutations on ART outcomes, consequences for offspring, and establishing a semen analysis-based threshold for testing. Large population analysis will be essential in identifying additional single gene mutations that deserve further research. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e542-e542 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Matthew Pollard* More articles by this author Saneal Rajanahally More articles by this author Michael Jansen More articles by this author Alexander Bisignano More articles by this author Malgorzata Jaremko More articles by this author Larry Lipshultz More articles by this author Expand All Advertisement PDF downloadLoading ...

Assisted reproductive technology outcome in United States of America and Australia with New Zealand: comparison of annual reports 2005–2016

In vitro fertilization can be considered as causative factor of increasing rate of multiple pregnancies. Analysis of factors contributing to reduction in the percentage of multiple pregnancies may contribute to overall improvement of ART results. We compared annual reports from The Australian and New Zealand Assisted Reproduction Database and US National Summary Reports presented by The Centers for Disease Control and Prevention. The aim of this study was to analyze results of ART outcomes in two countries presenting opposite approach to ART, particularly to number of transferred embryos and number of eSETs (elective single embryo transfers). We found significant increase in total number of initiated cycles and transfers with significant shift toward frozen cycles and transfers in both countries. Percentage of eSET increased while average number of embryos transferred per one transfer decreased significantly in both countries without significant difference between countries. We also noticed significant decrease in the rate of multiple pregnancies and percentage of pregnancies resulting in triplets in Australia with New Zealand. Decreasing number of multiple pregnancies and higher percentage of transfers and pregnancies resulting in singleton live birth are the changes in ART politics found in our analysis. United States of America have more significant changes toward eSET, although Australia and New Zealand have significantly higher percentage of eSET from the beginning of analysis.

High serum Antimullerian hormone levels are associated with lower live birth rates in women with polycystic ovarian syndrome undergoing assisted reproductive technology

IntroductionAntimullerian hormone (AMH) strongly correlates with ovarian reserve and response to controlled ovarian stimulation. Emerging data suggests that serum AMH level may also predict ART outcomes. However, AMH is characteristically elevated in PCOS women and it is unknown whether it may predict live birth outcomes in this population.MethodsThis was a retrospective cohort study of 184 PCOS women (Rotterdam criteria) who underwent their first fresh IVF/ICSI cycle. Women were divided into 3 groups according to the <25th (low), 25 to 75th (average), or > 75th (high) percentile of serum AMH concentration. Cycle stimulation parameters and reproductive outcomes were compared between groups.ResultsWomen in the low serum AMH group were older than those in the average or high AMH (p < 0.05), and required greater gonadotropin dose for stimulation compared to the high AMH group (p < 0.05). Women with high AMH had greater testosterone level compared to women in the low or average AMH groups. No differences were noted between groups in terms of maximal E2, oocytes retrieved and fertilization rate. However, low serum AMH women had significantly greater live birth rates (p < 0.05) and showed a trend towards greater clinical pregnancy rates compared to women in the average and high AMH groups (p = 0.09). The significant association of AMH with live birth rate remained after adjusting for age, BMI, day of transfer and number of embryos transferred.ConclusionsIn PCOS women, elevated AMH concentrations are associated with hyperandrogenism and lower live birth rates.

Characteristics of the development of mural art in Kharkiv

Characteristics of the development of mural art in Kharkiv

Identifying biomarkers for predicting successful embryo implantation: applying single to multi-OMICs to improve reproductive outcomes.

Successful embryo implantation is a complex process that requires the coordination of a series of events, involving both the embryo and the maternal endometrium. Key to this process is the intricate cascade of molecular mechanisms regulated by endocrine, paracrine and autocrine modulators of embryonic and maternal origin. Despite significant progress in ART, implantation failure still affects numerous infertile couples worldwide and fewer than 10% of embryos successfully implant. Improved selection of both the viable embryos and the optimal endometrial phenotype for transfer remains crucial to enhancing implantation chances. However, both classical morphological embryo selection and new strategies incorporated into clinical practice, such as embryonic genetic analysis, morphokinetics or ultrasound endometrial dating, remain insufficient to predict successful implantation. Additionally, no techniques are widely applied to analyse molecular signals involved in the embryo-uterine interaction. More reliable biological markers to predict embryo and uterine reproductive competence are needed to improve pregnancy outcomes. Recent years have seen a trend towards 'omics' methods, which enable the assessment of complete endometrial and embryonic molecular profiles during implantation. Omics have advanced our knowledge of the implantation process, identifying potential but rarely implemented biomarkers of successful implantation. Differences between the findings of published omics studies, and perhaps because embryonic and endometrial molecular signatures were often not investigated jointly, have prevented firm conclusions being reached. A timely review summarizing omics studies on the molecular determinants of human implantation in both the embryo and the endometrium will help facilitate integrative and reliable omics approaches to enhance ART outcomes. In order to provide a comprehensive review of the literature published up to September 2019, Medline databases were searched using keywords pertaining to omics, including 'transcriptome', 'proteome', 'secretome', 'metabolome' and 'expression profiles', combined with terms related to implantation, such as 'endometrial receptivity', 'embryo viability' and 'embryo implantation'. No language restrictions were imposed. References from articles were also used for additional literature. Here we provide a complete summary of the major achievements in human implantation research supplied by omics approaches, highlighting their potential to improve reproductive outcomes while fully elucidating the implantation mechanism. The review highlights the existence of discrepancies among the postulated biomarkers from studies on embryo viability or endometrial receptivity, even using the same omic analysis. Despite the huge amount of biomarker information provided by omics, we still do not have enough evidence to link data from all omics with an implantation outcome. However, in the foreseeable future, application of minimally or non-invasive omics tools, together with a more integrative interpretation of uniformly collected data, will help to overcome the difficulties for clinical implementation of omics tools. Omics assays of the embryo and endometrium are being proposed or already being used as diagnostic tools for personalised single-embryo transfer in the most favourable endometrial environment, avoiding the risk of multiple pregnancies and ensuring better pregnancy rates.

Intercultural Effectiveness and Leadership: Exploring the Intersection of Two College Student Outcomes

This qualitative study drew data from the Wabash National Study of Liberal Arts Education, examining how two liberal arts outcomes, intercultural effectiveness and leadership, functioned together in the context of students’ experiences. Our findings illuminated three patterns of interactions among these outcomes: (a) intercultural effectiveness learning was foregrounded, (b) leadership learning was foregrounded, and (c) intercultural effectiveness and leadership emerged simultaneously. These findings can inform educators’ efforts to cultivate culturally competent and critically conscious citizens.

Effect of Switching from a Progestin-Primed Ovarian Stimulation Protocol to a Modified Ultra-Long Protocol Among Women Who Had 1 Progestin-Primed Ovarian Stimulation (PPOS) Failure Verses Those Who Had 2 PPOS Failures.

BackgroundThere is little research on whether normoresponsive patients who produced poor-quality embryos once verses those who produced poor-quality embryos twice when using a single COH protocol should change to a different controlled ovarian hyperstimulation (COH) protocol.Material/MethodsIn this retrospective study, we enrolled 108 patients with 1 PPOS failure who chose to continue receiving the progestin-primed ovarian stimulation (PPOS) protocol (n=61) versus those who decided to switch to the modified ultra-long protocol (n=47). We also enrolled 131 normoresponsive patients with 2 PPOS failures who chose to continue receiving the PPOS protocol (n=60) versus those who decided to switch to the modified ultra-long protocol (n=71) in the third cycle.ResultsWe found no significant difference in clinical outcomes of patients with 1 PPOS failure who continued using the PPOS protocol verses those who switched to the modified ultra-long protocol in the second cycle, expect for a lower cancelation rate (4.3% vs. 16.4%). However, the patients with 2 PPOS failures had significantly more good-quality embryos (0.9 vs. 0.4), more viable embryos (1.8 vs. 0.9), lower cancelation rates (18.3% vs. 53.3%), and higher pregnancy rates per aspirated cycle (26.8% vs. 10.0%) when switching to the modified ultra-long protocol compared to those who decided to continue receiving the PPOS protocol (P<0.05). Furthermore, the odds of clinical pregnancy (odds ratio [OR] 5.997, 95% confidence interval [CI] 1.476–24.361, P=0.01) were positively associated with switching to the COH protocol in the third cycle.ConclusionsFor normoresponsive patients with poor-quality embryos when using the PPOS protocol, switching to the modified ultra-long protocol after having 2 PPOS failures was associated with better ART outcomes.

Screening assessment of thyroid-stimulating hormone and prolactin levels and their effect on ART outcomes in women of young reproductive age

Screening assessment of thyroid-stimulating hormone and prolactin levels and their effect on ART outcomes in women of young reproductive age

FoxO1 is a cell-specific core transcription factor for endometrial remodeling and homeostasis during menstrual cycle and early pregnancy.

Endometrium is a vital multicellular tissue for progression of pregnancy. Forkhead box O1 (FoxO1) transcription factor plays an important role in the endometrium as it regulates various cellular processes with its unique expression in different cell types. This review focuses on the role of FoxO1 in endometrium with a particular emphasis on FoxO1 signaling in individual endometrial cell types during the menstrual cycle and early pregnancy. A literature search was conducted in PubMed, Web of Science and Scopus to select studies reporting the role of FoxO1 in endometrium using the keywords: FoxO1, endometrium, menstrual cycle, early pregnancy, endometrial receptivity, implantation, decidualization, angiogenesis and neoplasia. Papers published before October 2020 were selected. Drawing on advances in laboratory science and preclinical studies, we performed a narrative review of the scientific literature to provide a timely update on the roles of FoxO1 during the menstrual cycle and early pregnancy. FoxO1 is considered to be a decidualization marker in endometrial stromal cells, mainly because it regulates the transcription of decidual prolactin and insulin-like growth factor-binding protein 1 genes. Importantly, 507 of 3405 genes that are specifically regulated during decidualization of human endometrial stromal cells are expressed abnormally as a result of FOXO1 reduction. Epithelial FoxO1 is currently accepted as a novel endometrial receptivity marker for humans and mice owing to its timely and specific expression at the window of implantation. On the other hand, FOXO1 is essential in endometrial epithelial cell proliferation and differentiation to achieve endometrial homeostasis since loss of function of FOXO1 causes endometrial neoplasia. Last but not least, FoxO1 seems to act like a navigator molecule for embryo homing owing to its notably decreased nuclear expression in endometrial luminal epithelial cells, specifically at the blastocyst attachment region, which results in differentiation, entosis and apoptosis of endometrial epithelial cells during the peri-implantation period. In endothelium, FoxO1 expression coincides with the timing of increased vascular permeabilization during early pregnancy. There are limited data regarding the importance of FoxO1 upregulation in endometrial endothelial cells, therefore, it is time to investigate the role of endothelial FoxO1, which is the missing piece in the puzzle of the enigmatic endometrium. Another missing piece in the puzzle for the role of FoxO1 is on embryo development. FoxO1 is a cell-specific core transcription factor involved in efficient endometrial remodeling during the menstrual cycle and early pregnancy. A better understanding of the role of FoxO1 as a decidualization marker, as an emerging marker of endometrial receptivity, and as a therapeutic target to prevent endometrial neoplasia could help us to make sense of endometrial biology and thus to improve the outcomes of ART in the clinic.