Part Of Assisted Reproductive Technologies Research Articles

Cryopreservation, cryoprotectants, and potential risk of epigenetic alteration.

The cryopreservation of gametes and embryos has increased notably over the past 20years and is now an essential part of assisted reproductive technologies (ARTs). However, because the cryopreservationprocess is un-physiological for human cells, gametes, and embryos, cryobiologists have suggested diverse methods to successfully cryopreserve human gametes and embryos in order to maintain their viability and assure successful pregnancy. During the first period of early development, major waves of epigenetic reprogramming-crucial for the fate of the embryo-occur. Recently, concerns relating to the increased incidence of epigenetic anomalies and genomic-imprinting disorders have been reported after ARTs and cryopreservation. Epigenetic reprogramming is particularly susceptible to environmental and un-physiological conditions such as ovarian stimulation, embryo culture, and cryopreservation that might collectively affect epigenetics dysregulation. Additionally, recent literature suggests that epigenetic and transcriptomic profiles are sensitive to the stress induced by vitrification, osmotic shock, oxidative stress, rapid temperature and pH changes, and cryoprotectants; it is therefore critical to have a more comprehensive understanding of the potential induced perturbations of epigenetic modifications that may be associated with vitrification. The aim of this paper is to present a critical evaluation of the association of gamete and embryo cryopreservation, use of cryoprotectants, and epigenetic dysregulations with potential long-term consequences for offspring health.

Sambucus Nigra: black fruits that makes sperms come out ahead in in vitro fertilization

Freezing is a non-physiological method that includes a series of processes such as dilution, incubation, cooling, freezing and thawing, which affect the structure, biochemistry and function of sperm. Human sperm freezing has overcome many spatial and temporal limitations and is now an integral part of assisted reproductive technologies (ART). Freezing causes biochemical, functional and structural changes in sperm. These changes include plasma and sperm acrosome membranes, which increase their permeability and leads to disruption of morphology, motility and chromatin structure. Therefore, freezing causes irreversible damage to sperm, which leads to the loss of movement and biological function of most sperm. Sperm health is one of the important factors in the fertility of couples. Therefore, reducing the harmful effects caused by freezing and properly performing the in vitro Fertilization (IVF) process, the development of useful solutions is inevitable. The extract from black fruits of Elderberry (Sambucus nigra) has potent in vitro effect on the sperm motility, vitality and oxidative profile. This extract can largely improve the sperms parameters and stereological parameters (spermatogonia, primary spermatocyte, round spermatid, and Leydig cells), decrease of TNF-a and caspase-3 expression, increase of the serum testosterone, increase of mitochondrial activity, and reduction of reactive oxygen species. So, it can also be used as in vivo status. We suggested that black fruits of Sambucus nigra makes sperms come out ahead in IVF techniques.

ARTIFICIAL INSEMINATION IN GOAT: A NEW PROSPECT FOR SCIENTIFIC GOAT BREEDING

In India major portion of goat farming is extensive and breeding system follows uncontrolled natural mating. For better breeding management there should be sufficient good quality stud bucks. But it is very unfortunate that due to lack of breeding buck more than 30% estrus does remain without service. In order to check the negative selection and for proper management of breeding policy, cryopreservation of superior native buck semen and artificial insemination is the only way. Artificial insemination (AI) is a part of assisted reproductive technology (ART) providing augmentation of genetic make-up in individuals. Artificial insemination in sheep and goat was first described detail in 1987. Globally 0.5 million AIs are performed annually in case of goat which is very less than other animals. Research in the area of cryopreservation of goat semen and artificial insemination has been limited to few research institutes and AI is least practiced in field condition. Intra-cervical insemination is widely practiced in case of does with successful results.

Follicular flushing during oocyte retrieval in assisted reproductive techniques.

Follicular aspiration under transvaginal ultrasound guidance is routinely performed as part of assisted reproductive technology (ART) to retrieve oocytes for in vitro fertilisation (IVF). The process involves aspiration of the follicular fluid followed by the introduction of flush, typically culture media, back into the follicle followed by re-aspiration. However, there is a degree of controversy as to whether this intervention yields a larger number of oocytes and is hence associated with greater potential for pregnancy than aspiration only. To assess the safety and efficacy of follicular flushing as compared with aspiration only performed in women undergoing ART. We searched the following electronic databases up to 13 July 2021: the Cochrane Gynaecology and Fertility Specialised Register of Controlled Trials, CENTRAL (containing output from two trial registries and CINAHL), MEDLINE, Embase, and PsycINFO. We also searched LILACS, Google Scholar, and Epistemonikos. We reviewed the reference lists of relevant papers and contacted experts in the field to identify further relevant studies. We included randomised controlled trials (RCTs) that compared follicular aspiration and flushing with aspiration alone in women undergoing ART using their own gametes. Primary outcomes were live birth rate and miscarriage rate per woman randomised. Two review authors independently assessed studies identified by search against the inclusion criteria, extracted data, and assessed risk of bias. A third review author was consulted if required. We contacted study authors as needed. We analysed dichotomous outcomes using Mantel-Haenszel odds ratios (ORs), 95% confidence intervals (CIs), and a fixed-effect model, and we analysed continuous outcomes using mean differences (MDs) between groups presented with 95% CIs. We examined the heterogeneity of studies via the I2 statistic. We assessed the certainty of evidence using the GRADE approach. We included 15 studies with a total of 1643 women. Fourteen studies reported outcomes per woman randomised, and one study reported outcomes per ovary. No studies were at low risk of bias across all domains; the main limitation was lack of blinding. The certainty of the evidence ranged from moderate to very low, and was downgraded for risk of bias, imprecision, and inconsistency. We are uncertain of the effect of follicular flushing on live birth rate compared to aspiration alone (OR 0.93, 95% CI 0.59 to 1.46; 4 RCTs; n = 467; I2 = 0%; moderate-certainty evidence). This suggests that with a live birth rate of approximately 30% with aspiration alone, the equivalent live birth rate with follicular flushing lies between 20% and 39%. We are uncertain of the effect of follicular flushing on miscarriage rate compared to aspiration alone (OR 1.98, 95% CI 0.18 to 22.22; 1 RCT; n = 164; low-certainty evidence). This suggests that with a miscarriage rate of approximately 1% with aspiration alone, the equivalent miscarriage rate with follicular flushing lies between 0% and 22%. We are uncertain of the effect of follicular flushing on oocyte yield (MD -0.47 oocytes, 95% CI -0.72 to -0.22; 9 RCTs; n = 1239; I2 = 61%; very low-certainty evidence); total number of embryos (MD -0.10 embryos, 95% CI -0.34 to 0.15; 2 RCTs; n = 160; I2 = 58%; low-certainty evidence); and clinical pregnancy rate (OR 1.12, 95% CI 0.85 to 1.51; 7 RCTs; n = 939; I2 = 46%; low-certainty evidence). The duration of the retrieval process may be longer with flushing (MD 175.44 seconds, 95% CI 152.57 to 198.30; 7 RCTs; n = 785; I2 = 87%; low-certainty evidence). It was not possible to perform a meta-analysis for adverse events, although individual studies reported on outcomes ranging from depression and anxiety to pain and pelvic organ injury. The effect of follicular flushing on both live birth and miscarriage rates compared with aspiration alone is uncertain. Although the evidence does not permit any firm conclusions on the impact of follicular flushing on oocyte yield, total number of embryos, number of cryopreserved embryos, or clinical pregnancy rate, it may be that the procedure itself takes longer than aspiration alone. The evidence was insufficient to permit any firm conclusions with respect to adverse events or safety.

The far-reaching impact of abortion bans: reproductive care and beyond

On 24 June 2022, the US Supreme Court overturned Roe v. Wade, a 49-year-old precedent that provided federal constitutional protection for abortions up to the point of foetal viability, returning jurisdiction to the individual states. Restrictions that came into effect automatically in several states, and are anticipated in others, will severely limit access to abortions in approximately half of the US. Even though every state allows for exceptions to the abortion bans, in some instances these exceptions can be used to preserve the health of a pregnant patient, while in other instances, only to preserve their life. The vague and confusing nature of the abortion ban exceptions threatens to compromise the standard of care for patients with pregnancy complications that are distinct from abortions, such as nonviable pregnancies, miscarriages, and ectopic pregnancies. Additionally, we envision challenges for the treatment of women with certain autoimmune conditions, pregnant cancer patients, and patients contemplating preimplantation genetic diagnosis as part of assisted reproductive technologies. The abortion ban exceptions will impact and interfere with the medical care of pregnant and non-pregnant patient populations alike and are poised to create a medical and public health crisis unlike any other one from the recent past.

Effects of Repeated Cryopreservation of Cleavage-Stage Embryos on Pregnancy and Perinatal Outcomes of Single Embryo Transfer

Background: Embryo cryopreservation is an important part of assisted reproductive technologies to increase cumulative pregnancy rate in clients. However, in clinical settings, embryos can be subjected to repeated cryopreservation-warming cycles due to certain clinical circumstances. There are limited data on the effect such cycles may have on the success of embryo transfer procedures. In this study, we investigated the effect of repeated cryopreservation of cleavage-stage embryos on the pregnancy and perinatal outcomes of frozen embryo transfer (FET). Methods: We retrospectively collected data on single cleavage-stage embryo transfer (ET) cycles performed in our center from January 2017 to August 2021 and identified 98 cycles of repeated cryopreservation-warming in cleavage-stage ET cycles. Propensity score matching was conducted according to the age of the patients, body mass index, endometrial thickness, type of oocyte retrial cycle, and quality of the transplanted embryos to match once-cryopreserved cleavage-stage ET cycles in our center at a ratio of 1:3 (caliper value 0.01). Finally, 294 once-cryopreserved cleavage-stage ET cycles were set as controls. Clinical pregnancy, early miscarriage, live birth rates, and other pregnancy and perinatal outcomes were compared between the two groups. Results: Similar success rates were obtained with twice-cryopreserved embryo transfers (n = 98) and with once-cryopreserved embryo transfers (n = 294). Importantly, there was no significant difference in the clinical pregnancy, early miscarriage, and live birth rates as well as perinatal outcomes such as preterm birth and pregnancy complication rates between the two groups. There were no birth defects in the two groups. Conclusions: Repeated cryopreservation may not negatively affect pregnancy and perinatal outcomes of single cleavage-stage ET and may present a safe option for resuscitated cleavage-stage embryos that have been canceled for transfer.

Novelties in Ovine Assisted Reproductive Technologies – A Review

Abstract Artificial insemination (AI) as a part of assisted reproductive technologies represents the oldest and most widespread method used to accelerate genetic progress in all domestic animals. After its first implementation in ovine reproduction and almost 80 years afterward, AI is continuously used for improving the genetic merit, utilizing either fresh or short-time chilled semen. Nevertheless, regardless of the semen used for insemination, the conception rate (CR) is still lower in comparison to natural service. At least two factors are commonly thought to limit the success of the AI and reduce the CR: (1) failure of placing the semen directly into the uterus due to the specific anatomic structure of the ewe’s cervix; (2) lower viability of ram spermatozoa during cryopreservation (<30% progressively motile spermatozoa after thawing). This review elaborates on recent studies that aimed to achieve acceptable CR through the implementation of cervical or intrauterine insemination: deep intracervical, intrauterine trans-cervical, and intracornual. Several hormonal treatments (oxytocin, estrogen, or prostaglandin) were evaluated on inducing cervical dilation that facilitates insemination. A comprehensive analysis was given to the effects of several antioxidants (GSSG, GSH, and cysteine) supplemented in ram semen-freezing media. Sex-sorted ram semen fertility rate results were presented from our studies.

Alterations of miR-16, miR-let-7a and their target genes expression in human blastocysts following vitrification and re-vitrification

Embryo cryopreservation is a widely used technique in infertility management and today is an essential part of assisted reproductive technology (ART). In some cases, re-vitrification can be applied to good quality supernumerary warmed embryos that have not been transferred in the present cycle. However, there is no study about re-vitrification impact on microRNA and gene expression in human embryos. The purpose of this study is to evaluate miR-16, miR-let7a and target genes expression in in vitro produced human blastocysts following re-vitrification.Day3 embryos obtained from ICSI cycles of fertile couples referring for family balancing program were biopsied and cultured individually. On the fourth day (post-ICSI) male ones (choices of their parents) were transferred and the females (good quality embryos) were donated for research. Donated embryos were cultured to blastocyst stage and assigned to three groups: fresh, vitrified and re-vitrification. Embryos were vitrified on Cryotech carriers. Then blastocysts of three groups were individually assessed for expression of miR-16, miR-let7a and target genes.The results showed that re-vitrification of human blastocysts did not affect the ability to re-expand in culture. In addition, significant decrease was observed in miR-16 and miR-let7a expression in re-vitrified group compared to fresh (p < 0.05). A significant upregulation of the target genes ITGβ3 and BCL-2 in re-vitrified and vitrified embryos was observed compared to the fresh group (p < 0.05). The expression of BAX as a pro-apoptotic gene showed a significant decrease in re-vitrification group comparing with the fresh one (P < 0.05).The results of this research indicated that re-vitrification of embryos changes the expression of miR-16, miR-let-7a and their target genes. These alterations include increased expression of BCl-2 and ITGβ3 genes which play important roles in embryo survival and implantation, respectively. Clinical proof of these effects requires further research.

The Association Between High Birth Weight and Long-Term Outcomes—Implications for Assisted Reproductive Technologies: A Systematic Review and Meta-Analysis

Background: Studies have shown that the prevalence of children born with high birth weight or large for gestational age (LGA) is increasing. This is true for spontaneous pregnancies; however, children born after frozen embryo transfer (FET) as part of assisted reproductive technology (ART) also have an elevated risk. In recent years, the practice of FET has increased rapidly and while the perinatal and obstetric risks are well-studied, less is known about the long-term health consequences.Objective: The aim of this systematic review was to describe the association between high birth weight and LGA on long-term child outcomes.Data Sources: PubMed, Scopus, and Web of Science were searched up to January 2021. Exposure included high birth weight and LGA. Long-term outcome variables included malignancies, psychiatric disorders, cardiovascular disease, and diabetes.Study Selection: Original studies published in English or Scandinavian languages were included. Studies with a control group were included while studies published as abstracts and case reports were excluded.Data Extraction: The methodological quality, in terms of risk of bias, was assessed by pairs of reviewers. Robins-I (www.methods.cochrane.org) was used for risk of bias assessment in original articles. For systematic reviews, AMSTAR (www.amstar.ca) was used. For certainty of evidence, we used the GRADE system. The systematic review followed PRISMA guidelines. When possible, meta-analyses were performed.Results: The search included 11,767 articles out of which 173 met the inclusion criteria and were included in the qualitative analysis, while 63 were included in quantitative synthesis (meta-analyses). High birth weight and/or LGA was associated with low to moderately elevated risks for certain malignancies in childhood, breast cancer, several psychiatric disorders, hypertension in childhood, and type 1 and 2 diabetes.Conclusions: Although the increased risks for adverse outcome in offspring associated with high birth weight and LGA represent serious health effects in childhood and in adulthood, the size of these effects seems moderate. The identified risk association should, however, be taken into account in decisions concerning fresh and frozen ART cycles and is of general importance in view of the increasing prevalence in high birthweight babies.

Oocyte recovery rates in flushing versus nonflushing during oocyte retrieval in assisted reproductive techniques

Follicular aspiration under transvaginal ultrasound guidance is performed as part of assisted reproductive technology (ART) to retrieve oocytes for in vitro fertilization (IVF). However, controversy as to whether follicular flushing following aspiration yields a larger number of oocytes than aspiration only is ongoing. The aim of this study was to assess the safety and efficacy (oocyte recovery rates) of follicular flushing when compared with aspiration only performed in women undergoing ART. The study was conducted at Sir Gangaram Hospital, New Delhi. Retrospective data of 100 females undergoing ART was taken from September 2019 to September 2020. Patients were divided into two groups of 50 each. In first group, patients underwent oocyte retrieval using double lumen needle (flushing technique) and in the second group, single lumen needle (no flushing) were used. Females with age ≤37 years who were having ≤9 follicles, size ≥14 mm during oocyte retrieval when undergoing ARTs. Categorical variables were presented in number and percentage (%) and continuous variables, as mean ± standard deviation and median. Normality of data was tested by Kolmogorov–Smirnov test. If the normality was rejected, then nonparametric test was used. Quantitative variables were compared using Mann–Whitney test. Follicular flushing had significantly better oocyte recovery rates when compared with no flushing (P 0.05) in M2 rates in patients undergoing intracytoplasmic sperm injection (ICSI) when compared in both the groups. There was no significant difference (P > 0.05) in fertilization rates in patients undergoing IVF and ICSI, respectively, in both the groups. Double lumen needle with flushing technique gives better oocyte recovery rates in low responder women undergoing ARTs. Hence, follicular flushing may be considered in such patients for oocyte retrieval.

Long-term consequences of prenatal progesterone exposure.

Progesterone is extensively used in clinical practice: during the first trimester of pregnancy as part of assisted reproductive technologies and for the prevention of preterm birth. Knowledge regarding potential benefits and harms of this treatment is therefore crucial in order to effectively counsel women with regards to their management (Di Renzo GC, et al, Gynecol Endocrinol. 2012 Nov;28(11):925-32). In this issue of BJOG, Simons et al present the results of a thorough systematic review and meta-analysis on the long-term consequences of prenatally administered progesterone (BJOG 2020 xxxx).

Pregnancy outcomes following oocyte donation.

The use of oocyte donation (OD) has increased continuously over the last three decades, and it is now an indispensable part of assisted reproductive technology (ART). With OD, it has become possible to overcome the biological barrier of ovarian follicle pool depletion and the general age-related decline in fertility. This review contains a thorough appraisal of the safety of OD with an analysis of short-term pregnancy outcomes. Salient up-to-date evidence was evaluated, which revealed that in comparison with both IVF with autologous oocytes, and naturally conceived pregnancies, there is: (i) an increased risk of hypertensive disorders of pregnancy and preeclampsia; (ii) an increased risk of low birth weight and preterm birth and (iii) an increased risks of obstetric emergencies, following OD treatment. As a precaution, it is therefore highly encouraged to perform only single embryo transfer (SET) and to prescribe prophylactic low-dose aspirin during OD pregnancies.

Does human oocyte cryopreservation affect equally on embryo chromosome aneuploidy?

Oocytes cryopreservation as an important part of assisted reproductive technologies, which should ensure after warming not only intact oocyte morphological characteristics, but also their genetic apparatus stability. However, the meiotic spindle is very sensitive to the temperature fluctuations that can lead to unequal chromosome segregation during meiosis and as a consequence can cause embryo aneuploidy after oocyte fertilization. The aim of the study was to estimate the oocytes cryopreservation impact on human embryo chromosome aneuploidy. It has been shown that fertilization rate of the cryopreserved oocytes did not differ from fresh ones (83.1% vs 84% respectively). The number of blastocysts obtained from cryopreserved oocytes was less than that obtained from fresh oocytes, however, their morphological characteristics were better if compared the fresh oocytes. Our results showed different cryopreservation impact on aneuploidy rates of certain chromosomes in embryos obtained from cryopreserved oocytes. They had an increased aneuploidy of chromosome 13 and a decreased nondisjunction of chromosome 18 and sex chromosomes.

Mitochondrial DNA as a Factor of Glaucomous Optic Neuropathy’s Development Mechanism

Currently, the mitochondrial component is becoming increasingly significant in the development and progression of glaucoma optic neuropathy. Since mitochondria have their own genetic apparatus, the study of qualitative and quantitative changes in mitochondrial DNA (mtDNA) becomes part of the disease diagnosis, in addition to studying the functional characteristics of the organelles alone. Moreover, the inability to explain the nature of the disease by known mutations of nuclear DNA contributes to the the study of mtDNA. In this review, we briefly discuss the mitochondrial genetics and the role of mitochondrial haplogroups in the diseases manifestation. We summarize the accumulated data on the qualitative and quantitative changes in mtDNA in patients with glaucoma. We discuss the approach to prevent the inheritance of mutant mtDNA as a part of assisted reproductive technologies, as well as the first steps towards the mtDNA heteroplasmy level manipulation and direct mtDNA editing.

Sperm nuclear maturity and chromatin stability in subfertile patients: Density gradient centrifugation is fair but non-discriminative in selecting the right population

Multiple technologies exploring chromatin structure anomalies have been applied during the last decade to evaluate fertility disorders and to increase the predictive value of sperm analysis for procreation in vivo and in vitro. Our aim was to implement sperm nuclear maturity and nuclear chromatin stability as a functional test for male infertility diagnosis and to compare it with a fertile group. As semen processing is an integral part of assisted reproductive technologies the impact of density gradient centrifugation in selecting sperm based on nuclear maturity and stability was also analyzed. Flow cytometry combined with fluorescent dyes exhibiting affinity for DNA was implemented. Both nuclear parameters correlated significantly with semen parameters. The control fertile group had significantly higher mean condensed population and a significantly lower hypocondensed and hypercondensed fractions as compared to the subfertile study group. Density gradient centrifugation succeeded in selecting the condensed population in both the control and study groups, while reducing the hypocondensed percentage. The hypercondensed population which was ten-fold higher in the study group remained unchanged after selection, in both the control and the study groups. Sperm nuclear maturity and chromatin stability appears to be homogenous in the fertile sperm donors and heterogeneous in subfertile patients. Sperm preparation for assisted reproduction should aim to minimize the risk of abnormal spermatozoa being used for fertilization.

Overexpression of Mitochondrial Genes (Mitochondrial Transcription Factor A and Cytochrome c Oxidase Subunit 1) in Mouse Metaphase II Oocytes following Vitrification via Cryotop.

Background: Gamete cryopreservation is an inseparable part of assisted reproductive technology, and vitrification is an effective approach to the cryopreservation of oocytes. The aim of this study was to investigate vitrification effects on the expression levels of mitochondrial transcription factor A (Tfam) and mitochondrial-encoded cytochrome c oxidase subunit 1 (Cox1) in mouse metaphase II oocytes. Methods:Oocytes were selected by simple random sampling and distributed amongst five experimental groups (control [n=126], docetaxel [n=132], docetaxel+cryoprotectant agent [CPA] [n=134], docetaxel+vitrification [n=132], and vitrification [n=123]). After the warming process, the oocytes were fertilized and cultured into a 2-cell stage. Then, the effects of vitrification on the expression of the Tfam and Cox1 genes were determined via real-time reverse transcriptase polymerase chain reaction. Each group was compared with the control group. The data were analyzed with ANOVA using GraphPad and SPSS, version 21. Results:A significant decrease was observed in the fertilization rate of each group in comparison with the control group (P=0.001). The rate of 2-cell formation after in vitro fertilization was significantly lower in both vitrification groups (docetaxel+vitrification and vitrification) than in the non-vitrification groups (fresh control and docetaxel) and control group (P=0.001 and P=0.004). The expression level of Cox1 was significantly higher in the vitrification group than in the control group (P=0.01), while it was lower in the docetaxel group than that in the control group (P=0.04). The expression level of the Tfam gene was significantly high in the vitrification group (vitrification+docetaxel) and the non-vitrified group (docetaxel+CPA) in comparison with the control group (P=0.01). Conclusion:This study indicated that the vitrification of mouse MII oocytes increased the expression of the Tfam and Cox1 genes.

The role of progesterone/estradiol ratio in exploring the mechanism of late follicular progesterone elevation in low ovarian reserve women

Late follicular progesterone (P) elevation continues to complicate a significant part of assisted reproductive technologies (ART) cycles, despite the ardent employment of gonadotropin releasing hormone (GnRH) analogues. In women with good ovarian reserve, late follicular P elevation is believed to be the result of the controlled ovarian stimulation (COS) itself, multiple follicular development and excessive ovarian steroidogenic activity. These mechanisms do not seem to be plausible in women with low ovarian reserve. In these women, excessive COS achieve a small number of pre-ovulatory follicles, which is not coupled to considerable ovarian steroidogenic activity. Therefore, other mechanisms should be pursued and explored.Delicate paracrine and autocrine mechanisms within the oocyte-cumulus complex were suggested to preserve the integrity of the pre-ovulatory follicle, including inhibition of P increase and follicular luteinization. However, clinical studies to demonstrate the disruption of these mechanisms in cases with low ovarian reserve and ageing oocytes are still lacking. Late follicular progesterone/estradiol (P/E2) ratio was introduced into clinical practice as a more appropriate way to analyze P rise in women undergoing COS to control for the E2 increase. The current hypothesis claims that in a follicular environment were the mechanism that prevent premature luteinization is disrupted, independent to LH surge; P rise at the late follicular phase may relatively bypass normal E2 production, at the pre-ovulatory stage of steroidogenesis, causing a rise in the P/E2 ratio. Therefore, in women with low ovarian reserve and few pre-ovulatory follicles, undergoing conventional COS, a negative (reverse) correlation between number of maturing follicles and P/E2 ratio may support the existence of such a mechanism as its disruption, while a no or a positive correlation may disapprove it.

Follicular flushing during oocyte retrieval in assisted reproductive techniques.

Follicular aspiration under transvaginal ultrasound guidance is routinely performed as part of assisted reproductive technology (ART) to retrieve oocytes for in vitro fertilisation (IVF). However, controversy as to whether follicular flushing following aspiration yields a larger number of oocytes and hence is associated with greater potential for pregnancy than aspiration only is ongoing. To assess the safety and efficacy of follicular flushing as compared with aspiration only performed in women undergoing ART. We searched the following electronic databases up to 18 July 2017: Cochrane Gynaecology and Fertility Group (CGF) Specialised Register of Controlled Trials, the CENTRAL Register of Studies Online (CRSO), MEDLINE, Embase, PsycINFO, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL). We also searched the trial registries ClinicalTrials.gov and the World Health Organization (WHO) International Clinical Trials Registry Platform to identify ongoing and registered trials up to 4 July 2017. We reviewed the reference lists of reviews and retrieved studies to identify further potentially relevant studies. We included randomised controlled trials (RCTs) that compared follicular aspiration and flushing with aspiration alone in women undergoing ART using their own gametes. Primary outcomes were live birth rate and miscarriage rate per woman randomised. Two independent review authors assessed studies against the inclusion criteria, extracted data, and assessed risk of bias. A third review author was consulted if required. We contacted study authors as required. We analysed dichotomous outcomes using Mantel-Haenszel odds ratios (ORs), 95% confidence intervals (CIs), and a fixed-effect model, and we analysed continuous outcomes using mean differences (MDs) between groups presented with 95% CIs. We examined the heterogeneity of studies via the I2 statistic. We assessed the quality of evidence by using GRADE (Grades of Recommendation, Assessment, Development and Evaluation) criteria. We included ten studies, with a total of 928 women. All included studies reported outcomes per woman randomised. We assessed no studies as being at low risk of bias across all domains and found that the main limitation was lack of blinding. Using the GRADE method, we determined that the quality of the evidence ranged from moderate to very low, and we identified issues arising from risk of bias, imprecision, and inconsistency.Comparing follicular flushing to aspiration alone revealed probably little or no difference in the live birth rate (OR 0.95, 95% CI 0.58 to 1.56; three RCTs; n = 303; I2 = 30%; moderate-quality evidence). This suggests that with a live birth rate of approximately 41% with aspiration alone, the equivalent live birth rate with follicular flushing is likely to lie between 29% and 52%. None of the included studies reported on the primary outcome of miscarriage rate.Data show probably little or no difference in oocyte yield (MD -0.28 oocytes, 95% CI -0.64 to 0.09; six RCTs; n = 708; I2 = 0%; moderate-quality evidence). Very low-quality evidence suggests that the duration of oocyte retrieval was longer in the follicular flushing group than in the aspiration only group (MD 166.01 seconds, 95% CI 141.96 to 190.06; six RCTs; n = 714; I2 = 88%). We found no evidence of a difference in the total number of embryos per woman randomised (MD -0.10 embryos, 95% CI -0.34 to 0.15; two RCTs; n = 160; I2 = 58%; low-quality evidence) and no evidence of a difference in the number of embryos cryopreserved (meta-analysis not possible). Data show probably little or no difference in the clinical pregnancy rate (OR 1.07, 95% CI 0.78 to 1.46; five RCTs; n = 704; I2 = 49%; moderate-quality evidence). Only two studies reported on adverse outcomes: One reported no differences in patient-reported adverse outcomes (depression, anxiety, and stress), and the other reported no differences in needle blockage, vomiting, and hypotension. No studies reported on safety. This review suggests that follicular flushing probably has little or no effect on live birth rates compared with aspiration alone. None of the included trials reported on effects of follicular aspiration and flushing on the miscarriage rate. Data suggest little or no difference between follicular flushing and aspiration alone with respect to oocyte yield, total embryo number, or number of cryopreserved embryos. In addition, follicular flushing probably makes little or no difference in the clinical pregnancy rate. Evidence was insufficient to allow any firm conclusions with respect to adverse events or safety.

Kadar Hormon LH Basal sebagai Prediktor Kebrhasilan Stimulasi Ovarium pada Program Bayi Tabung

Background: Ovarian stimulation is part of assisted reproductive technology (ART) process, which aims to spur the growth of follicles to be developed, so that it will increase the chance of getting pregnant. LH surge cause the final follicular maturation, ovulation and becoming corpus luteum. So that an increase in LH may adversely affect the development of the follicle and eventually affect in-vitro fertilization.Objective To determine the effect of basal LH hormone to follicles on the stimulation of ovarian.Method: Cohort Retrospective. Research Location: Permata Hati Clinic of Sardjito Hospital, YogyakartaResult dan Discussion: The study included 70 cycles of 70 women who underwent ovarian stimulation for in-vitro fertilization and fulfill inclusion and exclusion criterias. The subjects were divided into 2 groups based on basal LH hormone levels i.e. LH ≤ 3 mIU/ml as the test group and LH &gt;3 mIU/ml as the control group. From analysis, response to ovarian stimulation in group with LH ≤3 mIU/ml was significantly different than LH &gt;3 mIU/ml (RR 1,875; 95% CI 1,275–2,757; p=0,00*).Conclusion: Low level of basal LH (≤ 3 mIU/ml) generating fewer number of mature follicles in patients who performed ovarian stimulation in in-vitro fertilization program.Keyword: basal LH, ovarian stimulation, in-vitro fertilization.

Percepciones y creencias sobre criopreservación embrionaria en mujeres y hombres que se realizan técnicas de reproducción asistida en Santiago, Chile.

Although embryo cryopreservation is frequently used as part of assisted reproductive technology, quantitave information addressing how infertile couples live the experience of having cryopreserved embryos is lacking in Chile. The aim of this study is to examine men and women's perception and beliefs regarding their cryopreserved embryos, as well as their perspective on embryo donation and disposition. Methods: 153 women and men with frozen embryos from a public hospital, Instituto de Investigactiones Materno Infantil, and a private clinic, Clínica Las Condes, in Santiago, Chile, responded between May 2015 and May 2016 to an anonymous online survey addressing their perceptions and beliefs concerning their cryopreserved embryos. Respondents considered their frozen embryos to be equivalent to a child (53.2%) or a potential child (40.7%). Only 8% regard them as an organized group of cells. Over 60% of respondents disagree with destroying surplus embryos or using them for research. Participants from the public hospital are more willing to donate their embryos to another couple than those from the private center (61% vs 40%; P=0.016); 34% of respondents agreed to donate surplus embryos to same sex couples. This study reveals that Chilean couples are emotionally bound to their frozen embryos, and that discarding them is not an option. The results from this survey will help strengthen counseling for couples to enable them to make informed decisions regarding their surplus embryos.