Fresh Donor Research Articles

Efficacy of Fecal Microbiota Transplantation for Clostridium difficile Infection in Children

Fecal microbiota transplantation (FMT) is commonly used to treat Clostridium difficile infection (CDI). CDI is an increasing cause of diarrheal illness in pediatric patients, but the effects of FMT have not been well studied in children. We performed a multi-center retrospective cohort study of pediatric and young adult patients to evaluate the efficacy, safety, and factors associated with a successful FMT for the treatment of CDI. We performed a retrospective study of 372 patients, 11 months to 23 years old, who underwent FMT at 18 pediatric centers, from February 1, 2004, to February 28, 2017; 2-month outcome data were available from 335 patients. Successful FMT was defined as no recurrence of CDI in the 2 months following FMT. We performed stepwise logistic regression to identify factors associated with successful FMT. Of 335 patients who underwent FMT and were followed for 2 months or more, 271 (81%) had a successful outcome following a single FMT and 86.6% had a successful outcome following a first or repeated FMT. Patients who received FMT with fresh donor stool (odds ratio [OR], 2.66; 95% CI, 1.39-5.08), underwent FMT via colonoscopy (OR, 2.41; 95% CI, 1.26-4.61), did not have a feeding tube (OR, 2.08; 95% CI, 1.05-4.11), or had 1 less episode of CDI before FMT (OR, 1.20; 95% CI, 1.04-1.39) had increased odds for successful FMT. Seventeen patients (4.7%) had a severe adverse event during the 3-month follow-up period, including 10 hospitalizations. Based on the findings from a large multi-center retrospective cohort, FMT is effective and safe for the treatment of CDI in children and young adults. Further studies are required to optimize the timing and method of FMT for pediatric patients-factors associated with success differ from those of adult patients.

Mesenchymal stem cells may ameliorate inflammation in an ex vivo model of extracorporeal membrane oxygenation.

Mesenchymal stem cells exhibit immunomodulatory properties which are currently being investigated as a novel treatment option for Acute Respiratory Distress Syndrome. However, the feasibility and efficacy of mesenchymal stem cell therapy in the setting of extracorporeal membrane oxygenation is poorly understood. This study aimed to characterise markers of innate immune activation in response to mesenchymal stem cells during an ex vivo simulation of extracorporeal membrane oxygenation. Ex vivo extracorporeal membrane oxygenation simulations (n = 10) were conducted using a commercial extracorporeal circuit with a CO2-enhanced fresh gas supply and donor human whole blood. Heparinised circuits (n = 4) were injected with 40 × 106-induced pluripotent stem cell-derived human mesenchymal stem cells, while the remainder (n = 6) acted as controls. Simulations were maintained, under physiological conditions, for 240 minutes. Circuits were sampled at 15, 30, 60, 120 and 240 minutes and assessed for levels of interleukin-1β, interleukin-6, interleukin-8, interleukin-10, tumour necrosis factor-α, transforming growth factor-β1, myeloperoxidase and α-Defensin-1. In addition, haemoglobin, platelet and leukocyte counts were performed. There was a trend towards reduced levels of pro-inflammatory cytokines in mesenchymal stem cell-treated circuits and a significant increase in transforming growth factor-β1. Blood cells and markers of neutrophil activation were reduced in mesenchymal stem cell circuits during the length of the simulation. As previously reported, the addition of mesenchymal stem cells resulted in a reduction of flow and increased trans-oxygenator pressures in comparison to controls. The addition of mesenchymal stem cells during extracorporeal membrane oxygenation may cause an increase in transforming growth factor-β1. This is despite their ability to adhere to the membrane oxygenator. Further studies are required to confirm these findings.

Cadaveric study of extensor retinaculum of the wrist

Introduction: The function of the wrist extensor retinaculum is to prevent the extensor tendon bowstringing. Because the retinaculum is damaged by hand trauma and surgical exposure during the wrist surgery, the knowledge of anatomy of the retinaculum helps surgeons to restore the normal function of the extensor retinaculum. Material and Methods: The morphological variation of the retinaculum and average length and width of both septal attachment of the retinaculum were examined using 50 fresh donor cadavers. Results: Our finding found that the extensor retinaculum was white thickening fascia which arranged in transverse direction across over the wrist extensor group. The original retinaculum was defined as the part inserted from the radius to the pisiform and triquetrum. The mean length was ranging 10–35 mm and the mean width of proximal and distal end was 62–93 mm and 64–89 mm, respectively. There were supplemental retinaculums where was located on the proximal and distal to the original retinaculum. These retinaculums were thinner and more translucent. We found four patterns of attachment sites of the proximal retinaculum and five patterns for the distal extensor retinaculum. In addition, the average septal attachment size was varied from 1.24 to 27.81 mm in length and width was 0.33–20.50 mm for the real retinaculum. W also found the 84% present of the septal attachment beside the 6th compartment in ulnar side. Discussion and Conclusion: The knowledge of anatomical characteristic of the extensor retinaculum includes morphology, dimensions, and septal attachment is benefit for surgery.

A Rabbit Corneal Endothelial Dysfunction Model Using Endothelial-Mesenchymal Transformed Cells

Unlike humans, rabbit corneal endothelial wounds are known to spontaneously heal. The current study was aimed to develop a new rabbit bullous keratopathy model using corneal endothelial cells that were induced to undergo endothelial-mesenchymal transformation (EMT). EMT was induced in rabbit corneal endothelial cells (RCECs) by culturing with TGFβ and basic FGF Supplemented Medium. The corneal endothelia in recipient rabbits were mechanically scraped from the corneal endothelial surface inside an 8 mm mark. Then, a suspension of EMT-induced RCECs (EMT-RCECs) was injected into the anterior chamber. Eyes injected with freshly isolated RCECs (Fresh RCECs group) and eyes that were scraped without injection of cells (Scrape group) were used as controls. Immediately following operation, subepithelial and stromal edema was observed with increased central corneal thickness and corneal opacity in all groups. In the EMT-RCECs group, bullous keratopathy persisted for 42 days up to the end of the study. In the Fresh-RCECs and Scrape groups, corneal transparency and thickness recovered by 7 days after treatment and was maintained up to 42 days. The activated fibroblast marker, α-SMA, was observed spanning from corneal endothelium to corneal stroma in the EMT-RCECs group. Interestingly, α-SMA was upregulated in the Scrape-group as well. In all groups, there was no damage to other intraocular structures, and intraocular pressure was normal throughout the observation period. Transplanting a fresh donor cornea effectively treated corneal edema due to bullous keratopathy. This model is a promising tool for pre-clinical trials in the development of new therapies against corneal endothelial dysfunction.

Detection and Quantification of Plasmodium falciparum in Aqueous Red Blood Cells by Attenuated Total Reflection Infrared Spectroscopy and Multivariate Data Analysis.

We demonstrate a method of quantification and detection of parasites in aqueous red blood cells (RBCs) by using a simple benchtop Attenuated Total Reflection Fourier Transform Infrared (ATR-FTIR) spectrometer in conjunction with Multivariate Data Analysis (MVDA). 3D7 P. falciparum were cultured to 10% parasitemia ring stage parasites and used to spike fresh donor isolated RBCs to create a dilution series between 0-1%. 10 µL of each sample were placed onto the center of the ATR diamond window to acquire the spectrum. The sample data was treated to improve the signal to noise ratio and to remove the contribution of water, and then the second derivative was applied to resolve spectral features. The data were then analyzed using two types of MVDA: first Principal Component Analysis (PCA) to determine any outliers and then Partial Least Squares Regression (PLS-R) to build the quantification model.

PGT in fresh and frozen donor oocyte cycles

To compare pre-implantation genetic testing (PGT) for anonymous fresh and frozen donor oocytes. Retrospective cohort study of PGT for fresh and frozen anonymous donor oocytes. Frozen thawed oocytes were treated with intracytoplasmic sperm injection (ICSI) two hours post thaw. Fresh oocytes were treated with ICSI 40 to 42 hours post ovulation trigger for retrieval. Fertilization confirmation occurred 18 to 20 hours post ICSI and placed in a single step culture media through day 6 of embryo development. Embryos were evaluated on day 3 and assisted hatched for via laser ablation. When multiple cells herniating from the zona pellucida on day 5 and day 6, embryos were biopsied for aneuploidy testing. Embryo biopsy consisted of laser removal of 5 to 7 cells from the trophectoderm juxtaposed to the inner cell mass. The biopsied cells were treated according to the reference laboratory protocol for off site Next-generation sequencing for aneuploidy screening. Embryos available for testing were vitrified and stored under liquid nitrogen until results were obtained from the reference laboratory. A total of 147 frozen donor oocytes were thawed in 24 patients and 807 oocytes in the 38 fresh donor cycles. There was a significantly more oocytes per patient in the fresh subgroup as compared to the frozen thawed. Where the fresh subgroup had and average of 21 oocytes per patient compared to 6.12 oocytes per patient in the frozen-thawed subgroup. In the frozen-thawed subgroup, a total of 107 (72%) oocytes fertilized normally resulting in 15/20 (75%) euploid day 5 and 24/36 (67%) euploid day 6 embryos. In the fresh donor oocyte subgroup there were 532 (66%) normally fertilized oocytes. Yielding 95/137 (69%) day 5 euploid and 76/104 (73%) day 6 euploid embryos (Not Significant). There were 15 frozen embryo transfers in the Frozen-Thawed subgroup, where 10 (67%) patients resulted in ongoing pregnancy with an average of 1.0 embryos transferred per patient. There was no significant difference for the 33 frozen embryo transfers from fresh oocyte cycles where 19 (57%) resulted in ongoing pregnancies with an average of 1.12 embryos transferred per patient (Not Significant). (Table 1). This study shows that cryopreserved oocytes do not result in higher rates of aneuploidy as compared to fresh oocytes. Anonymous donors are an excellent control for comparing the efficacy of frozen-thawed oocytes. Fresh and frozen oocytes resulted in excellent pregnancy outcomes with the utilization of PGT evaluation for aneuploidy testing.Tabled 1PGD with Fresh vs Frozen-thawed Donor OocytesFrozen-ThawedFreshP-Value# Patients2438Oocytes147807# Fertilized (%)107 (72)531 (66)N.S.Day 5 Euploidy (%)15/20 (75)95/137 (69)N.S.Day 6 Euploidy (%)24/36 (67)76/104 (73)N.S.# FET's1533# Ongoing (%)10 (67)19 (57)N.S.Avg ET1.01.12N.S. Open table in a new tab

Fresh vs. frozen donor oocytes (DO) - looking at the big picture, is one superior?

Since the first reported birth in 1983, many children have been born using DO. Donated sperm is mostly frozen, quarantined and purchased from banks; however, using FRESH female gametes has long been viewed as the gold standard in DO. As FROZEN DO banks have emerged in recent years, using FROZEN DO has become common, changing the treatment-process model. The use of FROZEN DO may simplify logistics and allow recipients more choices as well as lower infection risk, time pressures and/or cost. Thus, we aimed to compare outcomes and processes using FRESH vs commercially-banked FROZEN DOs at our program. Retrospective cohort at a single large university program. We reviewed all FRESH and FROZEN DO cycles from 1/1/2015 - 12/31/2017. Cycles with and without preimplantation genetic testing for aneuploidy (PGT-A) were included. Primary outcomes were clinical pregnancy rate (CPR) and ongoing pregnancy (>12 weeks gestation) / live birth rate (LBR). See Table. 164 FRESH (126 w ET) + 67 FROZEN (64 w ET) DO cycles were evaluated. Notably, significantly more oocytes were available for use in FRESH vs. FROZEN cycles (21 vs. 7, p<.0001). 2PN fertilization was similar (p=.9), whereas Blastocyst Utility (BUR; transferred + frozen) was greater in FRESH (p=.002). PGT-A was performed in 119/164 (73%; 93 w ET) FRESH, but only 6/67 (9%; 5 w ET) FROZEN. In non-PGT-A cycles, CPR and LBR for FIRST embryo transfer (ET) were similar. In PGT-A cycles, CPR was not different, but LBR was higher for FRESH than FROZEN (p=0.01). When comparing non-PGT-A to PGT-A FRESH, CPR and LBR were not different (p=1). Total annual program costs for recruiting, screening, stimulating and retrieving 65 FRESH DO cycles was $644,645, (thus, single usable donor cost was $9900: Meds $4200, Staffing $2331, Cycle Treatment $1954, Labs $1415). In contrast, one batch (6) of banked FROZEN DOs costs ∼$15,000. FRESH DO cycles have the advantage of more oocytes, fresh fertilization and higher BUR. Disadvantages include recipient coordination, lower donor availability and production of more supernumerary blastocysts that may never be used. FROZEN DOs are more readily available albeit at lower oocyte numbers and have an 8% no-ET rate due to poor embryo development. PGT-A does not offer improvement in LB outcomes in DO while adding cost (as well as a second freeze and potentially lower outcome when using few FROZEN DOs). Perhaps FRESH donor “splitting” between recipients with fresh fertilization, then blastocyst freeze with subsequent frozen ET makes the most sense from a logistical, cost and efficiency standpoint. DO banks remain a viable option.Tabled 1FRESH vs. Commercially-Banked FROZEN DO. Mean no. of blastocysts (BL) transferred/cycle=1 for both.FRESH DO (n=174; mean no. oocytes used/cycle=21)FROZEN DO (n=67; mean no. oocytes used/cycle=7)P Value (mean no. oocytes used/cycle: <0.0001)2PN Fertilization Rate2295/2939 (78%)327/420 (78%)0.90BUR/2PN1485/2317 (64%)180/327 (55%)0.002Non-PGT-A Cycles n (n with ET)**In these cycles, 0/33 (0%) FRESH vs. 5/60 (8%) FROZEN were cancelled for poor embryo development33 (33)60 (59)CPR for FIRST ET22/33 (67%)36/59 (61%)0.66LBR for FIRST ET20/33 (61%)31/59 (53%)0.52No. cycles with supernumerary BL - Mean no. BL frozen32/33 (97%) - 741/59 (70%) - 20.001PGT-A Cycles n (n with ET)119 (93)7 (5)No. Cycles with at Least 1 Euploid BL115/119 (97%)6/7 (86%)0.25Euploid BL / Biopsied BL534/1050 (51%)12/22 (55%)0.83CPR for FIRST ET62/93 (67%)1/5 (20%)0.053LBR for FIRST ET56/93 (60%)0/5 (0%)0.01 Open table in a new tab

Are outcomes from fresh donor oocytes still superior to frozen donor oocytes?

Are outcomes from fresh donor oocytes still superior to frozen donor oocytes?

The posterior temporal supraSMAS minimally invasive lifting technique using soft-tissue fillers.

To investigate the effectiveness of the posterior temporal supraSMAS minimally invasive lifting technique and compared it to experiments performed in fresh human body donors by applying skin vector displacement measurement technology. A total of 15 patients (14 females/1 male) with a mean age of 37.1±9.4years and a mean body mass index of 21.4±3.3kg/m2 were included into this observational analysis. The injection procedure was additionally performed in 2 male and 1 female fresh body donors with a mean age of 85.67±9.7years and a mean body mass index of 23.83±4.7kg/m2 . Different grades of skin laxity, variable amounts of product, and the application with and without subcision were tested and measured via three-dimensional reconstructions and surface displacement vectors using Vectra software with VAM module. Esthetic outcome was rated by an independent professional observer and by the patient immediately after the treatment (76.67%±17.6% vs 66.67%±18.1%) (P=0.001) and after 1month (80.00%±14.0% vs 75.00%±21.1%) (P=0.19). Skin laxity, subcision, and the application of more than 1.0cc per side resulted in our experimental setting in a smaller magnitude of skin displacement vectors indicating a reduced lifting effect. The posterior temporal supraSMAS minimally invasive lifting procedure seems to be a valid technique to treat temporal volume loss and to reduce the signs of age-related changes in the middle and lower face, ie "marionett line" and jowl deformity.

Comparison of multiple thawing techniques on thaw time and stability of hemostatic proteins in canine plasma products.

To compare thawing times of fresh frozen canine plasma between a 37 °C warm water bath, running water bath and dry plasma thawer and compare haemostatic protein stability after thawing in a warm water bath or dry plasma thawer. To measure thawing times, a 240-mL bag of frozen plasma was thawed in warm water bath, running water bath or dry plasma thawer-10 times for each method. To evaluate stability ofhaemostatic proteins, fresh canine donor plasma samples were split into 120-mL bags and 3-mL control aliquots before freezing. Bags were thawed by warm water bath or dry plasma thawer and aliquots equilibrated to room temperature. Concentrations of haemostatic proteins, albumin, D-dimers, prothrombin time and partial thromboplastin time were obtained. The running water bath had the shortest thaw time: median thaw time of 15 minutes versus 18 minutes for both the dry plasma thawer and warm water bath. Statistically significant differences in partial thromboplastin time, factor VII, factor X, von Willebrand factor, and von Willebrand factor collagen binding assay were detected among groups but were unlikely to be clinically relevant. A traditional running water bath provided the fastest thawing time but the dry plasma thawer resulted in the most stable haemostatic proteins.

Analysis of IL-6 and IL-1β release in cryopreserved pooled human whole blood stimulated with endotoxin.

To overcome the lack of availability of fresh human whole blood for pyrogen detection, we explored the feasibility of utilizing cryopreserved pooled human blood to detect the responses of the pro-inflammatory cytokines IL-6 and IL-1β to LPS. Whole blood was obtained from five donors and incubated with LPS. The quantities of pro-inflammatory cytokines were measured using ELISA, and the results were compared among the samples. After the blood was cryopreserved with Dimethyl sulfoxide (DMSO) (10% v/v) and stored for 4 mo at –196℃, the detection limits of the IL-6/IL-1β responses to LPS were 0.2/0.4 endotoxin units (EU)/ml, respectively, and IL-6/IL-1β release increased in response to LPS in a dose-dependent manner. When these experiments were performed in three separate laboratories, the within-laboratory reproducibility of the IL-6/IL-1β responses was 100%/86.7%, 93.3%/100%, and 86.7%/80%, and the inter-laboratory reproducibility was 92.9%/85.7%, 64.3%/63.6%, and 57.1%/66.7%, respectively. The sensitivity (the probability of correctly classifying positive samples) and specificity (the probability of correctly classifying negative samples) of the IL-6/IL-1β tests were 81.7%/82.5% and 100%/100%, respectively. The results of this study suggest that cryopreserved pooled blood is a convenient and viable alternative for evaluating in vitro pyrogenicity. Additionally, maintaining cryopreserved pooled blood promotes safety for the user because it is released only after pretesting for infection parameters and has lower variation than fresh donations from a variety of donors.

Registro Nacional de Actividad-Registro de la Sociedad Española de Fertilidad de fecundación in vitro e inyección espermática intracitoplasmática. Años 2014 y 2015

IntroductionThis document presents the IVF/ICSI activity records of the National Activity Register-Spanish Fertility Society Register for the years 2014-2015. These were the first two years of mandatory participation in this Register for assisted reproduction centres in Spain. Material and methodsThe data analysed corresponded to the cycles carried out in 225 Spanish centres in 2014, and in 231 in 2015. The following IVF/ICSI cycles were studied: with own fresh oocytes, 51,591 in 2014 and 53,679 in 2015; with fresh donor oocytes, 16,630 in 2014 and 14,655 in 2015. Cycles with embryo cryopreservation totalled 21,007 in 2014 and 23,692 in 2015. PGD/PGS cycles totalled 5,242 in 2014 and 7,045 in 2015, and cycles with cryopreserved oocytes, 6,692 in 2014 and 8,138 in 2015. ResultsIn IVF/ICSI with own fresh oocytes, a total of 12,576 clinical gestations were obtained in 2014 and 12,041 in 2015, representing pregnancy rates by fresh embryo transfer of 36.6% and 36.4%, respectively. Of these pregnancies, 21.3% were multiple in 2014 and 20.8% in 2015. In IVF/ICSI with fresh donor oocytes, 13,083 fresh transfers were performed in 2014 and 12,211 in 2015, which in 2014 resulted in 7,275 clinical gestations (55.6%) of which 28.1% were multiple, and in 2015 resulted in 6,653 (54.5%) of which 25.7% were multiple. In 2014, of the 1,689 transfers for PGD, 776 gestations were obtained (45.9%) and in 2015, of the 1,935 transfers, 917 gestations were obtained (47.4%). In 2014, 641 transfers were made with embryos from vitrified own oocytes and 5,372 with vitrified donated oocytes. In 2015, the corresponding figures were 712 and 6,416. ConclusionsThe number of cycles recorded has increased significantly, due to legislative changes that make participation in this Register mandatory. Particularly notable is the increase in donor cycles with vitrified oocytes. The rate of multiple gestation remains high.

Geographical Variability in the Outcome of Donor egg IVF - Analysis of SART Data on 71,182 Donor egg IVF Cycles

An earlier analysis of abbreviated SART (Society for Reproductive Technology) data for 2007 (n=443) had identified geographical heterogeneity in live birth (LB) rates in the United States resulting from donor egg IVF (In- Vitro Fertilization), and these observations allowed for positing on ecological underpinnings to IVF success. We herein aimed to determine the validity of geographical differences in LB following donor egg IVF through use of a larger study sample of both fresh and frozen embryo transfer donor egg IVF cycles (n=71, 182), after adjusting for a number of variables that are recognized to impact cycle success. Consistent with the earlier observations, geographical location of the IVF clinic emerged as an independent predictor of LB following donor egg IVF; also, highest LB rates with donor egg IVF following both fresh ET and with FET were noted at clinics located in the W compared to centers located in NE of United States (on analyses adjusting for recipient’s age, body mass index (BMI), race, number of embryos transferred (ET), and use of assisted hatching (AH) the likelihood for donor egg IVF related LB for clinics in W compared to the NE:OR 1.28, 95% CI 1.20-1.37 for fresh ET and OR: 1.18, 95% CI: 1.06 -1.30 for FET). This study reaffirms that success of donor egg IVF is susceptible to ecological influences that merit further investigation.

Euploidy rate is indpendently associated with the number of ova retrieved in a fresh donor cycles

Studies have demonstrated that > 50% of human embryos are aneuploid following ovarian stimulation and IVF. Embryonic aneuploidy is correlated with maternal age. The reported aneuploidy rates range from 30% in women <30 years of age to >70% in women >40 years old (Munne et al., 2007). Experimental evidence also suggests that other treatment-related factors, including culture conditions, gamete manipulation, gamete aging and ovarian stimulation protocols may influence aneuploidy rates in human embryos. A recent study also reported that euploid blastocyst rates in cycles using donor eggs varied greatly between infertility clinics ranging from 39.5% to 82.5% (Munne et al., 2017). We examined the impact of the length of the ovarian stimulation, the number of ova retrieved, and the influence of the treating physician in fresh donor egg cycles from a single fertility center on: 1) the percentage of euploid blastocysts and 2) the frequency of blastocyst formation. A total of 161 consecutive fresh donor oocyte cycles performed between 2015 and 2016 were included in the study. The donors had a mean age of 25.1 +/- 3.5 years. A total of 1352 blastocysts were biopsied. The biopsies were analyzed in a single PGS laboratory using either high density oligonucleotide aCGH or NGS. The euploid and overall blastocyst rates were examined as a function of a) the length of the ovarian stimulation (stratified into three groups: < 8 =days (n=23), 9-11 days (n=117) and >12 days (n=21)); b) number of ova retrieved (stratified into three groups: < 20 eggs (n=35), 21-40 eggs (n=100), >41 eggs (n=26)); and c) between the four treating physicians. The euploid rate was calculated by dividing the number of euploid embryos by the number of biopsied blastocysts. Embryos with no diagnosis and/or degraded DNA (<2%) were excluded from this analysis. The percentage data were transformed by arcsine transformation and then analyzed using ANOVA and Tukey test. Differences with p<0.05 were considered significant in all comparisons. The euploid rates were 78.7%, 78.4% and 80.0% respectively when comparing by the length of ovarian stimulation, with no observed statistical differences (p=0.94). When analysed by the number of eggs retrieved, the euploid rates were: 73.2%, 79.9%, and 82.1%, respectively. A significant higher euploidy rate was observed in the group retrieved > 40 eggs (82.1%) compared to the group had < 20 eggs retrieved (p= 0.039). Four physicians managed the egg donor cycles with similar euploid rates of 74.6%, 79.7%, 81.2% and 78.4% (p=0.18). There were no significant differences observed in the percentage of blastocyst formation as a function of the length of ovarian stimulation (61.8%, 61.3%, and 61.8%, p=0.95), number of ova retrieved (61.5%, 61.2%, and, 63.3%, p=0.88) or treating physicians (57.6%, 66.5%, 62.3% and 67.0%, p=0.25). In donor ova cycles, the rate of euploid blastocysts was independently associated with the number of ova retrieved. The blasocysts formation frequency was not affected by the length of the ovarian stimulation, number of ova retrieved, or the treating physician.

There is no difference in clinical miscarriage rates between vitrified blastocysts developed from fresh donor oocytes vs vitrified banked donor oocytes

Vitrification has revolutionized IVF, and when applied to cryopreservation of the female gametes it allows for increased availability, efficiency, and lower costs. Whether vitrification of donor eggs can be accomplished without an increase in miscarriage rate has not been widely described.

Geographical Variability in the Outcome of Donor egg IVF - Analysis of SART Data on 71,182 Donor egg IVF Cycles

An earlier analysis of abbreviated SART (Society for Reproductive Technology) data for 2007 (n=443) had identified geographical heterogeneity in live birth (LB) rates in the United States resulting from donor egg IVF (In- Vitro Fertilization), and these observations allowed for positing on ecological underpinnings to IVF success. We herein aimed to determine the validity of geographical differences in LB following donor egg IVF through use of a larger study sample of both fresh and frozen embryo transfer donor egg IVF cycles (n=71, 182), after adjusting for a number of variables that are recognized to impact cycle success. Consistent with the earlier observations, geographical location of the IVF clinic emerged as an independent predictor of LB following donor egg IVF; also, highest LB rates with donor egg IVF following both fresh ET and with FET were noted at clinics located in the W compared to centers located in NE of United States (on analyses adjusting for recipient’s age, body mass index (BMI), race, number of embryos transferred (ET), and use of assisted hatching (AH) the likelihood for donor egg IVF related LB for clinics in W compared to the NE:OR 1.28, 95% CI 1.20-1.37 for fresh ET and OR: 1.18, 95% CI: 1.06 -1.30 for FET). This study reaffirms that success of donor egg IVF is susceptible to ecological influences that merit further investigation.

Platelet sequestration with a new-generation autotransfusion device.

Autologous platelet-rich plasma (PRP) can be used either to prevent platelets (PLTs) from lesions during extracorporeal circulation or for wound therapy, when processed into PLT gel. The aim of this study was to evaluate the PLT sequestration abilities of a new-generation autotransfusion device. In this experimental study the discontinuous, new-generation autotransfusion device XTRA was evaluated using fresh donor blood. The blood was processed in four different size bowls (X55, X125, X175, X225 [bowls' size in mL]) using the device's built-in "PLT sequestration program." PLT functionality was tested using aggregometry; for PLT activation, β-thromboglobulin (β-TG) and soluble P-selectin levels were determined. Cell damage was assessed by a morphology score and hypotonic shock response. Additionally, PLTs were tested after 6 hours to identify storage lesions. Platelet recovery in the PRP ranged from 39% to 64% and averaged 6.2-fold PLT enrichment as defined by the increase in PLT concentration. The preparation caused minimal cell damage and a decrease in cell function by only 10%, but a slight activation was observed amounting to 9% of the maximal β-TG release. The efficiency of the preparation, represented by the PLT recovery rate, increased in a linear fashion with the increasing bowl sizes being tested. After 6 hours of storage the prepared PLTs showed an additional 9% loss in function, but only 4% decrease in viability. The autotransfusion device XTRA was capable of high-quality perioperative PRP preparation, and the bowl size was found to have an influence on the efficiency of the preparation.

New national outcome data on fresh versus cryopreserved donor oocytes

BackgroundImprovements in oocyte cryopreservation techniques and establishment of cryopreserved donor oocyte banks have led to improved access to and lower cost of donor oocytes, upending the traditional practice of fresh oocyte donation. The objective of this study was to examine national trends in utilization and live birth rates with fresh versus cryopreserved donor oocytes.MethodsA retrospective analysis of 2013 through 2015 aggregate U.S. national data reported by the Society for Assisted Reproductive Technology which included 30,160 IVF cycles with either fresh or cryopreserved donor oocytes was performed.ResultsDuring the study period utilization of fresh oocyte donations rapidly declined by 32.9%, while cryopreserved oocyte donation increased by 44.4%. Fresh donor oocytes produced significantly higher live birth rates per recipient cycle start than cryopreserved donor oocytes (51.1% vs. 39.7%). Over the three-year study period fresh donor oocytes produced stable live birth rates per recipient cycle start while those with cryopreserved oocytes significantly declined year-by-year.ConclusionDespite rising popularity of cryopreserved donor oocytes, prospective patients should be counselled that fresh donor oocytes still represent standard of care due to higher live birth rates.

Assisted reproductive technology with donor sperm: national trends and perinatal outcomes

Information regarding the use of donor sperm in assisted reproductive technology, as well as subsequent treatment and perinatal outcomes, remains limited. Outcome data would aid patient counseling and clinical decision making. The objectives of the study were to report national trends in donor sperm utilization and live birth rates of donor sperm-assisted reproductive technology cycles in the United States and to compare assisted reproductive technology treatment and perinatal outcomes between cycles using donor and nondonor sperm. We hypothesize these outcomes to be comparable between donor and nondonor sperm cycles. This was a retrospective cohort study using data from all US fertility centers reporting to the Centers for Disease Control and Prevention's National Assisted Reproductive Technology Surveillance System, accounting for ∼98% of assisted reproductive technology cycles (definition excludes intrauterine insemination). The number and percentage of assisted reproductive technology cycles using donor sperm and rates of pregnancy, live birth, preterm birth (<37 weeks), and low birthweight (<2500 g) were the primary outcomes measured. Treatments assessed include use of donor vs nondonor sperm. The trends analysis included all banking and fresh assisted reproductive technology cycles using donor and autologous oocytes performed between 1996 and 2014 (n= 1,710,034). The outcomes analysis was restricted to include only fresh autologous cycles performed between 2010 and 2014 (n= 437,569) to focus on cycles with a potential outcome and cycles reflective of current practice, thereby improving the clinical relevance. Cycles canceled prior to retrieval were excluded. Statistical analysis included linear regression to explore polynomial trends and log-binomial regression to estimate relative risk for outcomes among cycles using donor and nondonor sperm. Of all banking and fresh donor and autologous oocyte assisted reproductive technology cycles performed between 1996 and 2014, 74,892 (4.4%) used donor sperm. In 2014, 7351 assisted reproductive technology cycles using donor sperm were performed, as compared with 1763 in 1996 (6.2% vs 3.8% of all cycles). Among all autologous oocyte cycles performed between 2010 and 2014, the live birth rate was lower for donor sperm (27.9%) than nondonor sperm cycles (32.5%); however, after adjustment for maternal age, donor sperm use was associated with an increased likelihood of live birth (adjusted relative risk, 1.06, 95% confidence interval, 1.01-1.10). Per transfer, there was no significant difference in live birth rates for donor vs nondonor sperm (31.9% vs 36.8%; adjusted relative risk, 1.04, 95% confidence interval, 0.998-1.09). Per singleton live birth, there was no significant difference in preterm birth (11.5% vs 11.8%; adjusted relative risk, 0.98, 95% confidence interval, 0.90-1.06); however, low birthweight delivery was slightly lower in donor sperm cycles (8.8% vs 9.4%; adjusted relative risk, 0.91, 95% confidence interval, 0.83-0.99). Donor sperm use in assisted reproductive technology has increased in the United States, accounting for approximately 6% of all assisted reproductive technology cycles in 2014. Assisted reproductive technology treatment and perinatal outcomes were clinically similar in donor and nondonor sperm cycles.

Nerve terminals at the human corneoscleral limbus

AimsTo demonstrate and characterise distinct subepithelial compact nerve endings (CNE) at the human corneoscleral limbus.MethodsTen fresh human donor corneoscleral discs (mean age, 67 years) and 26 organ-cultured corneoscleral rims (mean...