Improvement In Pregnancy Research Articles

Application of antioxidants in extender on bull sperm cryopreservation to reduce the male effect in dairy fertility

Because male and female effects on fertility must be considered, it may be difficult to achieve accurate and repeatable fertility predictions using only sperm characteristics given differences in breed, health, and season. Improving sperm quality after cryopreservation may be a method to reduce the male effect on the fertility outcome. This study was conducted using 2 different Certified Semen Service approved extenders, one containing plant-derived antioxidants, to assess cryopreserved sperm quality and determine pregnancy per AI (P/AI) in a commercial dairy farm. Beef bull ejaculates (n = 24 ejaculates, n = 4 bulls) were split and frozen in egg-yolk-TRIS (EYT) or GameteGuard-FB cryopreservation extenders. Frozen-thawed sperm was evaluated for sperm quality and used for insemination in dairy cows (n = 4,856). Improvement was shown in total and progressive motility, acrosome integrity, and reduction of DNA fragmentation at 0 and 3 h after thawing in sperm frozen in GameteGuard-FB when compared with the EYT extender. An overall 12.7% improvement in pregnancy per AI (P/AI) was observed when GameteGuard-FB (40.8%) was used for cryopreservation when compared with EYT (36.2%). More importantly, GameteGuard-FB frozen semen increased P/AI for first service by 19.5% (35.9% EYT and 42.9% GameteGuard-FB) and 45.0% was also observed at third service (31.3% EYT and 45.4% GameteGuard-FB). The use of GameteGuard-FB resulted in an average 40% P/AI among bulls. Taken together, the increase in cryopreserved sperm quality using GameteGuard-FB can be used to minimize the male effects on pregnancy outcomes in commercial dairy farms.

Patient-reported outcome and experience measures for quality improvement in pregnancy and childbirth care: a retrospective cohort study

BackgroundPatient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) can highlight issues that remain unnoticed when using standard clinical quality indicators. However, estimations of the potential power of measuring PROMs...

Comparison of the Effectiveness of Endometrial Receptivity Analysis (ERA) to Guide Personalized Embryo Transfer with Conventional Frozen Embryo Transfer in 281 Chinese Women with Recurrent Implantation Failure.

BackgroundThis study aimed to compare the effectiveness of endometrial receptivity analysis (ERA)-guided personalized embryo transfer (pET) with conventional frozen embryo transfer (FET) in 281 Chinese women with recurrent implantation failure (RIF).Material/MethodsA total of 281 eligible patients with RIF were recruited and assigned to ERA (ERA followed by pET) and FET groups. The clinical pregnancy outcomes were compared between the 2 groups.ResultsThere were no significant differences between the ERA and FET groups in terms of endometrial thickness on the day of embryo transfer, mean attempts of assisted reproductive technology (ART) treatment, anti-Mullerian hormone, follicle-stimulating hormone, or antral follicle count in the fresh cycle (P>0.05). The ERA test identified 35% of samples as receptive and 65% as nonreceptive, and comparable pregnancy outcomes were observed between receptive and nonreceptive patients (P>0.05). Higher pregnancy and implantation rates were found in the ERA group than in the FET group (P<0.01), while no significant differences were detected between the 2 groups in terms of miscarriage rates (P>0.05).ConclusionsIn this study of Chinese women with RIF undergoing in vitro fertilization and embryo transfer, ERA-guided pET resulted in a significant improvement in pregnancy and implantation rates when compared with FET.

Opioid misuse in pregnancy

Key content The UK has one of the highest rates of opioid misuse in Europe, with dramatic escalation over the last decade. Much of this drug use in women coincides with childbearing age and continues into pregnancy. Opioid misuse in pregnancy is associated with considerable obstetric and neonatal complications. Management of women with opioid misuse in pregnancy requires a multidisciplinary approach with specialist input from drug services. Opioid substitution regimes with methadone or buprenorphine during pregnancy have been shown to improve perinatal outcomes and the woman’s compliance with care. Learning objectives To be familiar with the obstetric and neonatal complications that can arise from opioid misuse in pregnancy; in particular, neonatal abstinence syndrome. To appreciate the wider needs of women who misuse opioid medication and how we can support them during the antenatal, intrapartum and postpartum periods. To understand how opioid substitution regimes with methadone or buprenorphine can lead to an improvement in pregnancy and infant outcomes. Ethical issues While opioid substitution regimes reduce illicit drug use, improve compliance with obstetric care and improve neonatal birthweight, women should be counselled that they do not eliminate the risk of neonatal abstinence syndrome. Should we be commencing opioid‐dependent women on long‐term contraception prior to discharge to avoid potential future unplanned pregnancies? What safeguarding issues need to be addressed for the pregnant mother, unborn child and other existing children?

Pregnancy planning in women with diabetes mellitus type 2

BACKGROUND: The increase in the incidence of type 2 diabetes mellitus worldwide and the improvement in the quality of diabetic and obstetric care lead to an increase in the number of pregnant women with type 2 diabetes mellitus. The incidence of obstetric and perinatal adverse outcomes in women with type 2 diabetes mellitus is often higher than in women with type 1 diabetes. In the world literature, there are few works on the effect of pregnancy planning on the course and outcome of pregnancy in women with type 2 diabetes mellitus.&#x0D; AIM: The aim of this study was to evaluate the role of pregnancy planning in patients with type 2 diabetes mellitus in improvement of pregnancy and birth outcomes.&#x0D; MATERIALS AND METHODS: We retro- and prospectively analyzed the course and outcome of pregnancy in 124 women with type 2 diabetes mellitus, who were observed in the Diabetes Mellitus and Pregnancy Center of the Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott for the period from 2010 to 2019. The study included 34 women with type 2 diabetes mellitus at the stage of pregnancy planning and 90 women during pregnancy. All patients underwent a general clinical examination, carbohydrate metabolism correction, training at the School of Diabetes Mellitus in the principles of rational nutrition, self-control of glycemia and insulin therapy. Diabetes compensation was assessed by the level of glycated hemoglobin, determined using a method certified in accordance with the National Glycogemoglobin Standartization Program and standardized in accordance with the reference values adopted in the Diabetes Control and Complications Trial, as well as by the level of glycemia (self-control at least four times a day). We also assessed the severity of vascular complications of type 2 diabetes mellitus before and during pregnancy, and identified and treated comorbidities. To assess the degree of obesity, the criteria of the World Health Organization and the pregravid body mass index calculated by the Quetelet formula were used. The severity of preeclampsia was assessed in accordance with federal clinical guidelines. Ultrasound examination of the fetus with Doppler blood flow in the vessels of the fetoplacental complex was performed using a Voluson E6 ultrasound system (GE Healthcare, USA). For the timely diagnosis of diabetic fetopathy and fetal cardiomyopathy, dynamic fetometry and echocardiography were conducted. In addition, cardiotocography was performed for antenatal assessment of the fetus from the 30th week of pregnancy. After delivery, a neonatologist assessed the condition of the newborn using the Apgar scale at the first and fifth minutes of life, and then the assessment was carried out in the early neonatal period.&#x0D; RESULTS: In the group of women who received pregravid training, the course and outcomes of pregnancy were significantly better: the frequency of preeclampsia was lower (14.7%) compared to the group of women with an unplanned pregnancy (40.0%); there was no severe preeclampsia compared to the same women (13.3%). The number of preterm births was significantly lower (14.7%) in the group of women with planned pregnancy compared to the group of women without pregravid preparation (37.8%). In addition, in the group of women planning pregnancy, there were no fetal congenital malformations, neonatal hypoglycemic conditions, hypertrophic cardiomyopathy; in the group of women with an unplanned pregnancy, these parameters being found to amount to 6.7%, 24.4% and 6.7%, respectively. There was no perinatal mortality in the group of women with a planned pregnancy; however, this parameter was shown to be 3.3% in the group of women with an unplanned pregnancy.&#x0D; CONCLUSIONS: Pregnancy planning in patients with type 2 diabetes mellitus can significantly improve the course of pregnancy and childbirth outcomes.

Analysis of Improvement of Pregnancy During Pandemic at Pondok Gede Health Centre Bekasi City in 2021

Pregnant women at Pondok Gede Health Center experienced an increase in visits to pregnancies of at-risk mothers in 2019 which consisted of 23 people, while in 2020 there were 103 people. The main cause of pregnancy at risk age is the non- compliance of family planning, the work of WFH during the pandemic. Efforts to reduce risky age pregnancies, BKKBN urges couples of reproductive age to plan pregnancy, using contraception (condoms). The analysis of the causes of increased pregnancy at risk is a large picture of pregnant women with maternal age ≤ 20 years and ≥ 35 years. This research aimed to determine the analysis of the causes of increased pregnancies at risky ages during the pandemic at Pondok Gede Health Center, Bekasi City in 2021. Research analytic by using the method cross-sectional. Sample were 82 respondents with accidental sampling technique. The instrument research was a questionnaire. Data analyzed using univariat and bivariat by test statistic chi square. The result is pregnant women with age ≥ 35 years were 75.6%, who had good knowledge was 54.9%. who have access to family planning services was 53.7%, who were planned was 56.1%, anxiety was 54.9%, who have unmet need pregnancy was 51.2%, and who work WFH was 72,0%. There was no significant relationship between knowledge, access to family planning services, planned pregnancy, anxiety, unmet need pregnancy, work during the pandemic and pregnancy at the age of mothers at risk at Pondok Gede Health Center, Bekasi City with a p value &lt;0.05.

A 5-year multicentre randomized controlled trial comparing personalized, frozen and fresh blastocyst transfer in IVF

Research questionDoes clinical performance of personalized embryo transfer (PET) guided by endometrial receptivity analysis (ERA) differ from frozen embryo transfer (FET) or fresh embryo transfer in infertile patients undergoing IVF? DesignMulticentre, open-label randomized controlled trial; 458 patients aged 37 years or younger undergoing IVF with blastocyst transfer at first appointment were randomized to PET guided by ERA, FET or fresh embryo transfer in 16 reproductive clinics. ResultsClinical outcomes by intention-to-treat analysis were comparable, but cumulative pregnancy rate was significantly higher in the PET (93.6%) compared with FET (79.7%) (P = 0.0005) and fresh embryo transfer groups (80.7%) (P = 0.0013). Analysis per protocol demonstrates that live birth rates at first embryo transfer were 56.2% in PET versus 42.4% in FET (P = 0.09), and 45.7% in fresh embryo transfer groups (P = 0.17). Cumulative live birth rates after 12 months were 71.2% in PET versus 55.4% in FET (P = 0.04), and 48.9% in fresh embryo transfer (P = 0.003). Pregnancy rates at the first embryo transfer in PET, FET and fresh embryo transfer arms were 72.5% versus 54.3% (P = 0.01) and 58.5% (P = 0.05), respectively. Implantation rates at first embryo transfer were 57.3% versus 43.2% (P = 0.03), and 38.6% (P = 0.004), respectively. Obstetrical outcomes, type of delivery and neonatal outcomes were similar in all groups. ConclusionsDespite 50% of patients dropping out compared with 30% initially planned, per protocol analysis demonstrates statistically significant improvement in pregnancy, implantation and cumulative live birth rates in PET compared with FET and fresh embryo transfer arms, indicating the potential utility of PET guided by the ERA test at the first appointment.

Relationship between Islamic Lifestyle and Mental Health in Pregnant Women : A Cross-Sectional Study

Objective: Mental health problems in women during pregnancy are widely associated with the negative consequences of pregnancy. Various factors can affect the mental health improvement in pregnancy. The effects of lifestyle and especially the Islamic lifestyle on mental health are unknown. Therefore, the researcher determined to examine the correlation between the Islamic lifestyle and women’s mental health in pregnancy.&#x0D; Materials and Methods: The study on 300 pregnant women referred to the clinics affiliated to Shahid Beheshti University of Medical Sciences was carried out as descriptive cross-sectional. The research tools included the Islamic lifestyle questionnaire and DASS-21.&#x0D; Results: The results showed that there is a significant negative relationship between mental health and the Islamic lifestyle. (r = -0.310). The regression test results show that the mean score of the mental health problems decreases 0.09 per unit by increasing an Islamic lifestyle score.&#x0D; Conclusion: Since the results show that there is a significant negative relationship between Islamic lifestyle and the women’s mental health, interventional studies are suggested to increase awareness and change lifestyle in order to improve the mental health.&#x0D; Bangladesh Journal of Medical Science Vol.19(3) 2020 p.394-400

Randomized Controlled Trials of Headache Treatments in Pregnancy: A Systematic Review.

Headaches affect 88% of reproductive-aged women. Yet data are limited addressing treatment of headache in pregnancy. While many women experience improvement in pregnancy, primary and secondary headaches can develop. Consequently, pregnancy is a time when headache diagnosis can influence maternal and fetal interventions. This study was aimed to summarize existing randomized control trials (RCTs) addressing headache treatment in pregnancy. We searched PubMed, CINAHL, EMBASE, ClinicalTrials.gov, Cochrane Library, CINAHL, and SCOPUS from January 1, 1970 through June 31, 2019. Studies were eligible if they were English-language RCTs addressing treatment of headache in pregnancy. Conference abstracts and studies investigating postpartum headache were excluded. Three authors reviewed English-language RCTs addressing treatment of antepartum headache. To be included, all authors agreed each article to meet the following criteria: predefined control group, participants underwent randomization, and treatment of headache occurred in the antepartum period. If inclusion criteria were met no exclusions were made. Our systematic review registration number was CRD42019135874. A total of 193 studies were reviewed. Of the three that met inclusion criteria all were small, with follow-up designed to measure pain reduction and showed statistical significance. Our systematic review of RCTs evaluating treatment of headache in pregnancy revealed only three studies. This paucity of data limits treatment, puts women at risk for worsening headache disorders, and delays diagnosis placing both the mother and fetus at risk for complications.

Useful impacts of royal jelly on reproductive sides, fertility rate and sperm traits of animals.

Royal jelly (RJ) is one of the furthermost valuable curative products mentioned by natural medicine scientists due to its promising medical and nutritional purposes. It possesses many impacts, including antioxidants, antimicrobial, antitumor, anti-inflammatory and immunomodulatory functions in human and animal that benefit their health and welfare, resulting in its widespread use in medical and commercial products and healthy food. Recently, favourable functions of RJ on male fertility have been reported in different animals. According to earlier literatures, the level of RJ supplementation in animal diet ranged from 100 to 200mg/kg. Oral exposure to RJ has been reported to have oestrogenic influences in the adult female rats. Also, RJ may be influential in improvement of pregnancy and lambing rates of ewes. Oral administration of RJ at 100mg/kg diet before sexual maturity enhanced sexual behaviour and semen quality of male rabbits. Moreover, RJ administration (up to 400mg/kg diet once weekly) for male rabbits exposed to heat stress can counteract "summer infertility" and improve physiological responses. Furthermore, supplementation of freezing extender media with 0.1 or 3% RJ had a protective influence on cryopreserved and chilled spermatozoa of buffalo and ram respectively. However, the high dose of RJ oral administration (800mg/kg) by pubescent male rats for 1month had an undesirable effect on the reproductive system; however, the somewhat unfavourable influences were mitigated by the discontinuation of the administration. This review shows the chemical composition, favourable applications and health benefits of RJ and its effects on reproductive aspects, semen quality and in vitro fertilization outcomes which are advantageous for scientists, researchers, nutritionists, physiologists, embryologists, pharmacists, veterinarians, pharmaceutical industries and animal's breeders.

Do the risks of preimplantation genetic testing for aneuploidy outbalance the benefits?

Much has been achieved in the field of preimplantation genetic testing for aneuploidy (PGT-A; previously preimplantation genetic screening, PGS) in recent years, particularly with the novel and more precise methods for analyzing biopsied cells such as comparative genomic hybridization (CGH) and single-nucleotide polymorphism (SNP) arrays. Although these methods have been used in individual studies and shown an improvement in pregnancy and birth rates in some cases, the final results from prospective randomized studies are still awaited. Until these are available, the promising results from individual studies remain experimental. We also owe it to our patients to apply promising novel methods outside of studies, if a positive effect has been demonstrated. The same applies to the polar body diagnosis (PBD) practiced in Germany for aneuploidy screening. Thus, one can conclude that neither PGT-A by means of analyzing blastomeres nor polar body screening to indirectly investigate oocytes currently have a positive effect on pregnancy and birth rates. The large specialist societies, the American Society for Reproductive Medicine (ASRM) and the European Society of Human Reproduction and Embryology (ESHRE), also advise against routine use of these methods.

Pregnancy planning in women with diabetes mellitus type 2

The aim of the study: to evaluate the role of pregnancy planning in patients with diabetes mellitus type 2 in improvement of pregnancy and birth outcomes.&#x0D; Material and methods. 80 women with type 2 diabetes mellitus who were referred to the centre “Diabetes mellitus and pregnancy” in Ott’s Research Institute of Obstetrics and Gynecology were examined.&#x0D; Results. In the group of women who underwent pre-pregnancy counseling, the course and outcome of pregnancy were significantly better. Since the frequency of gestosis was lower (60%) than in the group without pregnancy planning (86.7%), there was no gestosis of severe degree in the group of women who underwent pre-pregnancy counseling (in the group without pregnancy planning the rate of gestosis of moderate and severe degree was 25%). Frequency of preterm delivery was lower (15%) in the group of women who underwent pre-pregnancy counseling than in the group without pregnancy planning (38.3%). Also in the group of women who underwent pre-pregnancy counseling there were no fetal congenital malformations, neonatal hypoglycemic events and hypertrophic cardiomyopathy (in the group without pregnancy planning these indicators were respectively - 3.4; 28.8; 3.4%. Also in the group of women who underwent pre-pregnancy counseling there were no perinatal mortality (in the group without pregnancy planning this indicator was 3.4%.&#x0D; Conclusion: pregnancy planning in patients with diabetes mellitus significantly improves the course and outcome of pregnancy.

MP29-13 HISTAMINE INTOLERANCE AND MICROBIOTA CHANGES IN PATIENTS WITH PAINFUL BLADDER SYNDROME / INTERSTITIAL CYSTITIS

You have accessJournal of UrologyInfections/Inflammation/Cystic Disease of the Genitourinary Tract: Interstitial Cystitis II1 Apr 2017MP29-13 HISTAMINE INTOLERANCE AND MICROBIOTA CHANGES IN PATIENTS WITH PAINFUL BLADDER SYNDROME / INTERSTITIAL CYSTITIS Elke Hessdorfer Elke HessdorferElke Hessdorfer More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.925AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The cause of Painful Bladder Syndrome / Interstitial Cystitis is currently unknown. Histamine seems to play a major role in IC as neurogenic inflammation is one of the hypothesis of IC. Antihistamines are part of the guideline recommendations, foods high in histamine (e.g. Shorter-Moldwin Food Sensitivity Questionnaire) aggravate IC symptoms. Objective: Within this retrospective study the role of histamine overload in the gut and vagina is highlighted. METHODS Between September 2012 and October 2016 a total of 80 women (range 19 to 75 years, mean age 47) were surveyed. Histamine in fecal samples was measured with a commercially available ELISA kit (LDN Labor Diagnostika Nord GmbH &Co. KG, Nordhorn, Germany). The results were compared to an age-matched cohort of 57 healthy women.Additionally, vaginal swabs were analysed for histamine producing bacteria of the Enterococcus and Enterobacteriaceae family. Furthermore a complete gut microbiota analysis was done in all women. RESULTS Stool results: In 55 of the 80 analysed women elevated histamine levels were found in fecal samples compared to a control-group of 57 healthy women.Moreover in most of the patients the protective anaerobic indicator microbiota (mainly lactobacilli and bifidobacteria) was also diminished. Vaginal swab results: In 39 out of the 55 women with the elevated histamine level the presence of Enterococcus ssp. and / or Enterobacteriaceae in vaginal swabs was also detected. In 12 women only the presence of Enterococcus ssp. and / or Enterobacteriaceae was found. 4 women did neither show elevated histamine levels nor the presence of histamine producing bacteria in vaginal swabs. CONCLUSIONS There are paralleles between IC and histamine intolerance: 1% of the population affected, 80% female and middle aged, symptom improvement in pregnancy because of a 500 fold higher level of the diamine oxidase (histamine eliminating enzyme). Histamine intolerance is a poorly described disease which can present with a variety of symptoms also found as comorbidities in IC patients like e.g. migraine, irritable bowel syndrome and urticaria. Histamine can increase intestinal permeability causing a leaky gut which prompts the body to initiate immune reactions causing autoimmune diseases and can also lead to pain through a toll-like receptor (TLR)-4 inflammatory response. That TLR-4 plays a role in pain has recently been demonstrated in IC patients by the MAPP research group. Moreover histamine alone as shown in mice can also cause pelvic pain. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e385 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Elke Hessdorfer More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Maximum basal FSH predicts reproductive outcome better than cycle-specific basal FSH levels: waiting for a "better" month conveys limited retrieval benefits.

BackgroundElevated follicle stimulating hormone (FSH) is associated with poor vaginal oocyte retrieval (VOR) outcomes and cycle cancellations but intercycle variability in basal FSH reportedly does not predict ovarian response.MethodsWe conducted a retrospective cohort study of basal FSH (n = 15573 cycles) in couples (n = 9132) who initiated IVF cycle(s) with basal estradiol (E2) <100 pg/mL between 2002 and 2014 to reevaluate this hypothesis.The most recent (current) FSH, maximum FSH (Max FSH) and prior cycle maximum basal FSH (PMax FSH) were computed for each cycle. Metaphase II (MII) oocyte counts were modeled by age, stimulation type, prior peak E2 level, prior MII count, Max FSH, PMax FSH and current FSH. Antral follicle counts, pregnancy, clinical pregnancy and live birth rates were modeled as secondary outcomes.ResultsMax FSH level distinguished completed cycles from cancelled cycles better than PMax FSH or current FSH (AUC of 0.72, 0.71 and 0.61, respectively, p < 0.001). Fewer MIIs were retrieved (5.7 ± 3.8) in cycles with Max FSH >13 mIU/mL (n = 1475) than those with ≤13 mIU/mL (n = 11978) (11.6 ± 7.1) (p < 0.001). Max FSH was a better predictor of MII count than PMax FSH or current FSH after controlling for age, stimulation type, prior peak E2 level and prior MII count.Additional MIIs were retrieved on average in cycles with PMax FSH >13 mIU/mL (n = 1930) whose current FSH was ≤13 mIU/ml rather than >13 mIU/ml (p < 0.01) after controlling for age, cycle number and stimulation type. However, no improvement in pregnancy or live birth rate was detected.ConclusionsMax FSH is the best FSH-based predictor of ovarian reserve. Retrieval benefits from waiting for a "better" month appear to exist but are limited.Electronic supplementary materialThe online version of this article (doi:10.1186/s12958-015-0078-0) contains supplementary material, which is available to authorized users.

N-acetylcysteine for polycystic ovary syndrome: a systematic review and meta-analysis of randomized controlled clinical trials.

Objective. To review the benefits and harms of N-acetylcysteine (NAC) in women with polycystic ovary syndrome (PCOS). Method. Literature search was conducted using the bibliographic databases, MEDLINE (Ovid), CINAHL, EMBASE, Scopus, PsyInfo, and PROQUEST (from inception to September 2013) for the studies on women with PCOS receiving NAC. Results. Eight studies with a total of 910 women with PCOS were randomized to NAC or other treatments/placebo. There were high risk of selection, performance, and attrition bias in two studies and high risk of reporting bias in four studies. Women with NAC had higher odds of having a live birth, getting pregnant, and ovulation as compared to placebo. However, women with NAC were less likely to have pregnancy or ovulation as compared to metformin. There was no significant difference in rates of the miscarriage, menstrual regulation, acne, hirsutism, and adverse events, or change in body mass index, testosterone, and insulin levels with NAC as compared to placebo. Conclusions. NAC showed significant improvement in pregnancy and ovulation rate as compared to placebo. The findings need further confirmation in well-designed randomized controlled trials to examine clinical outcomes such as live birth rate in longer follow-up periods. Systematic review registration number is CRD42012001902.

Significant Improvement in Pregnancy Rates Following Frozen Embryo Transfers When Combined with Microarray-Comparative Genomic Hybridization (aCGH)

There is a growing body of evidence that embryo transfer (ET) of vitrified blastocysts in an unstimulated cycle improves implantation rates due to a more receptive uterine environment. Evidence is also growing that 24-chromosome screening to select euploid embryos improves implantation rates. This study looks at the effect of combining these two procedures on pregnancy rates by comparing outcomes of fresh versus warmed transfers of blastocysts that were screened by aCGH and those that were not.

Significant improvement in pregnancy rates following frozen embryo transfers when combined with microarray-comparative genomic hybridization (aCGH)

ObjectiveThere is a growing body of evidence that embryo transfer (ET) of vitrified blastocysts in an unstimulated cycle improves implantation rates due to a more receptive uterine environment. Evidence is also growing that 24-chromosome screening to select euploid embryos improves implantation rates. This study looks at the effect of combining these two procedures on pregnancy rates by comparing outcomes of fresh versus warmed transfers of blastocysts that were screened by aCGH and those that were not.DesignRetrospective data analysis at a private fertility clinic.Materials and Methods827 sequential, non-randomized, ET's performed over 11-months during 2012 – 2013 were evaluated. Fresh ET was performed at the blastocyst stage on patients with a mean age of 34.8 years. Warmed ET was performed in unstimulated cycles after blastocysts were vitrified then individually warmed using the Cryotop® method (Kitazato). Trophectoderm biopsy followed by aCGH testing (Reprogenetics) was performed on Day 5 or 6 on patients with a mean age of 38.6 years.ResultsSignificant improvement in clinical pregnancy (CP) was demonstrated in all warmed ETs following aCGH testing (∗p<0.0216). A trend in CP increase was found for both: warmed ET vs. fresh ET without testing (^p<0.0858) and for warmed ET vs. fresh ET following aCGH testing (#p<0.0520).ConclusionSignificant improvement in clinical pregnancy rates may be obtained by taking advantage of the ability of A) blastocysts to survive trophectoderm biopsy for aCGH testing, B) vitrification/warming methodology being successfully applied to biopsied blastocysts, and C) for warmed, euploid embryos to be transferred into an unstimulated uterine environment that is more receptive to embryo implantation. ObjectiveThere is a growing body of evidence that embryo transfer (ET) of vitrified blastocysts in an unstimulated cycle improves implantation rates due to a more receptive uterine environment. Evidence is also growing that 24-chromosome screening to select euploid embryos improves implantation rates. This study looks at the effect of combining these two procedures on pregnancy rates by comparing outcomes of fresh versus warmed transfers of blastocysts that were screened by aCGH and those that were not. There is a growing body of evidence that embryo transfer (ET) of vitrified blastocysts in an unstimulated cycle improves implantation rates due to a more receptive uterine environment. Evidence is also growing that 24-chromosome screening to select euploid embryos improves implantation rates. This study looks at the effect of combining these two procedures on pregnancy rates by comparing outcomes of fresh versus warmed transfers of blastocysts that were screened by aCGH and those that were not. DesignRetrospective data analysis at a private fertility clinic. Retrospective data analysis at a private fertility clinic. Materials and Methods827 sequential, non-randomized, ET's performed over 11-months during 2012 – 2013 were evaluated. Fresh ET was performed at the blastocyst stage on patients with a mean age of 34.8 years. Warmed ET was performed in unstimulated cycles after blastocysts were vitrified then individually warmed using the Cryotop® method (Kitazato). Trophectoderm biopsy followed by aCGH testing (Reprogenetics) was performed on Day 5 or 6 on patients with a mean age of 38.6 years. 827 sequential, non-randomized, ET's performed over 11-months during 2012 – 2013 were evaluated. Fresh ET was performed at the blastocyst stage on patients with a mean age of 34.8 years. Warmed ET was performed in unstimulated cycles after blastocysts were vitrified then individually warmed using the Cryotop® method (Kitazato). Trophectoderm biopsy followed by aCGH testing (Reprogenetics) was performed on Day 5 or 6 on patients with a mean age of 38.6 years. ResultsSignificant improvement in clinical pregnancy (CP) was demonstrated in all warmed ETs following aCGH testing (∗p<0.0216). A trend in CP increase was found for both: warmed ET vs. fresh ET without testing (^p<0.0858) and for warmed ET vs. fresh ET following aCGH testing (#p<0.0520). Significant improvement in clinical pregnancy (CP) was demonstrated in all warmed ETs following aCGH testing (∗p<0.0216). A trend in CP increase was found for both: warmed ET vs. fresh ET without testing (^p<0.0858) and for warmed ET vs. fresh ET following aCGH testing (#p<0.0520). ConclusionSignificant improvement in clinical pregnancy rates may be obtained by taking advantage of the ability of A) blastocysts to survive trophectoderm biopsy for aCGH testing, B) vitrification/warming methodology being successfully applied to biopsied blastocysts, and C) for warmed, euploid embryos to be transferred into an unstimulated uterine environment that is more receptive to embryo implantation. Significant improvement in clinical pregnancy rates may be obtained by taking advantage of the ability of A) blastocysts to survive trophectoderm biopsy for aCGH testing, B) vitrification/warming methodology being successfully applied to biopsied blastocysts, and C) for warmed, euploid embryos to be transferred into an unstimulated uterine environment that is more receptive to embryo implantation.

Evaluation of laser assisted hatching (LAH) in cryotransfer according to the thickness of the zona pellucida: preliminary data from a randomised study

The aim of this study is to evaluate if an improvement in pregnancy and implantation rates is possible by using Laser Assisted Hatching (LAH) to thin two different thinning areas(quarter or half) of the zona pellucida in vitrified-devitrified embryonic cycles.

Cetrorelix lowers premature luteinization rate in gonadotropin ovulation induction–intrauterine insemination cycles: a randomized-controlled clinical trial

Attempting to compare the rates of premature luteinization (PL), clinical pregnancy, and cycle cancellation in ovulation induction-intrauterine insemination (OI-IUI) cycles with and without the GnRH antagonist, cetrorelix, a randomized-controlled trial was undertaken in which patients were randomized to one of two OI-IUI protocols. Those in the cetrorelix arm showed a significantly reduced rate of PL and no change in clinical pregnancy or cycle cancellation rate, leading to the conclusion that GnRH antagonists can decrease the rate of PL, but appear to have no effect on pregnancy or cycle cancellation in gonadotropin OI-IUI cycles.

Zona thinning: ‘Laying it on thick’

The zona pellucida is a multi-layered glycoprotein coat surrounding the mammalian egg and embryo. To implant successfully in the uterine wall, the embryo must shed this coat. During human IVF, two approaches have been used to facilitate this event in order to enhance implantation: (I) breaching the zona pellucida entirely (assisted hatching) and (II) removing a limited stretch of the outermost layer (zona thinning). It is important to distinguish between these two approaches since the outermost layer of the human zona pellucida appears less hardened than the inner layers. In this issue of Reproductive BioMedicine Online, Valojerdi and co-workers from Tehran (Iran) report on detrimental effects of a rather vigorous method of zona pellucida thinning using a laser along one quarter of the embryo’s circumference. This is the first report showing a detrimental effect after zona manipulation without blastomere biopsy. There are over 400 papers on assisted hatching and zona thinning in the literature with the majority having reported clinical results. Generally speaking, two types of outcomes have been reported: (I) an improvement in pregnancy and/or implantation rate, or (II) no effect of the intervention. The paper by Valojerdi et al. adds a new category to this list: a discernible detrimental effect of the intervention. In general, it is not surprising that outcomes have been so varied following zona pellucida manipulation, particularly considering the many different approaches used and the varied circumstances under which the investigations have been conducted. It is a considerable task to sort through all the studies and clinical trials. The latest Cochrane Review of the assisted hatching literature was published earlier this year (Das et al., 2009Das S. Blake D. Farquhar C. Seif M.M.W. Assisted hatching on assisted conception (IVF and ICSI).Cochrane Database System. Rev. 2009; https://doi.org/10.1002/14651858.CD001894.pub4Crossref PubMed Scopus (63) Google Scholar). The abstract of this study does not detail the long list of its findings and conclusions and anyone interested enough in this technique should perhaps read the entire document (which is nearly 80 pages long). The conclusion of this review is that in certain embryos assisted hatching has some clinical benefit, including those that were thawed or devitrified. Assisted hatching in the largest acceptable cohort of papers increased the chance of pregnancy, but not that of miscarriage. Yet, in the paper by Valojerdi et al., zona thinning appears detrimental in devitrified embryos. The authors provide a concise analysis of what could have caused this outcome, noting that similar studies do not confirm their findings. The message from this important work is that circumstances under which clinical trials involving methodology are conducted may not be comparable. Operator skill and experience and an understanding of the complexities of tools such as lasers play a critical role and, if compromised, can undermine a perfectly acceptable randomization protocol in a clinical trial. In the case of lasers, responsible manufacturers of certified instruments have made a significant effort to make their instruments sensitive and apparently fullproof for the inexperienced user. However, following manufacturer’s instructions carefully may not be enough. For instance embryologists usually calibrate the laser using ink painted on one side of a regular glass slide, but the Petri dish is not made of glass and the embryo is much nearer to the lens in a dish than the ink on a slide. Thinning the zona pellucida over one quarter of the embryo’s circumference involves a relatively large amount of energy, which may penetrate beyond the zona and into the embryo proper. Calibration errors may result in extensive release of energy into the embryo since the laser will not be properly focused. This is just one possible explanation for the observations in the study of Valojerdi et al. Although assisted hatching was introduced into clinical practice some 20 years ago, the method has not yet been standardized. This is unfortunate since it contributes to variability in results. Relying on publications and manufacturer guidelines alone is not always sufficient for proper application of complex technologies. Therefore careful (small) pilot studies should be conducted prior to large-scale trials in order to avoid unintended and unexpected detrimental effects in large numbers of cases.