85 research outputs found
Mitochondrial DNA content in embryo culture medium is significantly associated with human embryo fragmentation
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Mitochondrial DNA in Day 3 embryo culture medium is a novel, non-invasive biomarker of blastocyst potential and implantation outcome.
No full textIn assisted reproduction technology, embryo competence is routinely evaluated on morphological criteria. Over the last decade, efforts in improving non-invasive embryo assessment have looked into the secretome of embryos. Human embryos release genomic DNA (gDNA) and mitochondrial DNA (mtDNA) into the culture medium, and the mtDNA/gDNA ratio is significantly correlated with embryo fragmentation. Here, we investigate whether mtDNA/gDNA ratio in embryo spent medium is correlated with blastulation potential and implantation. The mtDNA/gDNA ratio was assessed in 699 Day 3 culture media by quantitative polymerase chain reaction (qPCR) to investigate its correlation with embryo morphology, blastocyst development and implantation. A logistic regression model evaluated whether mtDNA/gDNA ratio in the secretome may improve the prediction of blastulation. We found that embryos that successfully developed into blastocysts exhibited a significantly higher mtDNA/gDNA ratio in the culture medium compared with those that arrest (P = 0.0251), and mtDNA/gDNA, combined with morphological grading, has the potential to predict blastulation better than morphology alone (P = 0.02). Moreover, mtDNA/gDNA ratio was higher in the media from good-quality embryos that reached the full blastocyst stage on Day 5 compared with those that developed more slowly (P < 0.0001). With respect to blastocyst morphology, higher trophectoderm quality was associated with a higher mtDNA/gDNA ratio in the culture medium. Finally, a high mtDNA/gDNA ratio in spent medium was associated with successful implantation outcome (P = 0.0452) of good-quality embryos. In summary, the mtDNA/gDNA ratio in the Day 3 embryo secretome, in combination with morphological grading, may be a novel, non-invasive, early biomarker to improve identification of viable embryos with high developmental potential
Influence of age on response to controlled ovarian stimulation in women with low levels of serum anti-Müllerian hormone
No full textThis study aims at detecting and evaluating differences in quantitative response to controlled ovarian stimulation (COS) with high doses of gonadotropins in women with low serum anti-Müllerian hormone (AMH). About 369 first cycles in a real-life scenario in women between 21 and 43 years old and with AMH ≤0.9 ng/ml were analyzed. Older women had a significantly worse outcome with respect to young women, not only qualitatively, but also in terms of quantitative ovarian response to COS [odd ratio (OR) to obtain at least three MII oocytes with each increasing year of female age: 0.89, 95% CI: 0.85 − 0.94; p <.001]. This study endorses that age is a significant factor when counseling patients with low AMH. AMH levels per se are not a reason to exclude patients from a COS treatment, since pregnancy and live birth can be achieved, especially in younger patients. However, with an AMH equally low, the ovarian response worsens with age, making questionable the effectiveness of a stimulation with high-dose gonadotropins in the older subgroup
Pronuclear score improves prediction of implantation rate in ICSI cycles
No full textBackground: In assisted reproduction technology embryo competence is routinely evaluated on morphological
criteria but efficacy remains relatively low. Additional information could be obtained by evaluating pronuclear (PN)
morphology. Up to now controversial results have been reported about the prognostic value of PN score. One of
the main limitations of literature data is the use of different PN classification methods. In this regard, in 2011 the
ESHRE and Alpha Scientists in Reproductive Medicine defined three PN categories to standardize zygote
assessment. In this study we evaluated whether the consensus ESHRE-Alpha system for the pronuclear scoring
could be an useful additional criterion to improve prediction of embryo implantation potential.
Methods: This is a retrospective, longitudinal, observational, cohort study. We included 3004 zygotes from 555
women who underwent ICSI treatment at our Center between January 2014 and June 2019. The PN were
categorized as score 1: symmetrical, 2: non-symmetrical, 3: abnormal. A subset of 110 zygotes did not cleaved. On
day 2–3 1163 embryos were transferred, 232 arrested, and 9 were cryopreserved. Among the 1490 embryos
cultured up to day 5–7, 516 became blastocysts: 123 were transferred on day 5 and 393 were cryopreserved.
Comparisons of age, cleavage and blastocyst rate, quality of embryos, implantation success among PN score groups
were evaluated by chi-square test or Kruskal-Wallis test as appropriate. Potential predictors of embryo implantation
were first tested in univariable analysis using generalized estimating equations taking into account
correlation between embryos originated from the same patient. Then, variables potentially associated with
implantation success (P<0.05) were included in a multivariable analysis for calculating the adjusted odds ratio (OR)
and 95% confidence interval (CI).
Results: There was no significant difference in patients’age, cleavage and blastulation rates, and embryo
morphology among the three PNscore groups. The PN score 1-embryos had a greater implantation success
respect to score 2-3-ones (OR 1.83; 95% CI 1.34-2.50, P=0.0001). Consistently, the pronuclear score remained
predictive of implantation in top quality embryos (OR 1.68; 95%CI 1.17-2.42, P= 0.005).
Conclusions: The consensus pronuclear score may be routinely included among criteria for embryo evaluation to
increase patients’ chance of becoming pregnant
Telehealth for infertile patients during SARS-CoV-2 pandemic: far and yet close
No full textBackground: In Italy during the first pandemic wave of SARS-CoV-2 the activity of fertility centers was stopped, with the exception of fertility preservation in oncological patients. We adopted telehealth and we evaluated whether it could help in the management of infertile couples at a fertility center. Methods: A longitudinal study performed at a public fertility center. Telehealth was offered to 72 couples referred to our center for a first consultation from March 17th to May 31st, 2020. Percentage of patients who performed the first assisted reproduction technology (ART) cycle or intrauterine insemination (IUI) within 6 months from the first visit and drop-out rate were analyzed during COVID-19 pandemic and compared to historical controls (couples admitted to our center in 2017-2019). Results: Eighty-five (61/72) percent of couples accepted telehealth. Time to first treatment after online consultation in telehealth group (4.5 (1.8) months) was significantly shorter (p = 0.033) respect to time to first treatment after face-to-face visit of historical controls (7.5 (6.9) months). After telehealth consultation, we observed a significant reduction (p = 0.002) of drop-out rate from 39% in historical controls to 17% of telehealth group. Telehealth significantly diminished the drop-out rate also during the COVID-19 pandemic respect to 73% after traditional face-to-face visits (p = 0.0005), with a time to first treatment of 3.7 (2.1) months in couples who refused telehealth. Conclusions: Telehealth could be a useful tool to facilitate the path of patients in a fertility center
State of the art on oocyte cryopreservation in female cancer patients: A critical review of the literature
No full textDuring the last decades, important advances in therapeutic options have led to increased survival rates in cancer patients; however, cancer treatments are associated with several potential adverse effects including infertility in those diagnosed during their reproductive years. A proper discussion about fertility preservation options before the use of therapies with potential gonadotoxicity (i.e. oncofertility counseling) is standard of care and should be offered to all patients of childbearing age. Temporary ovarian suppression with LH-RH analogs, oocyte and embryo cryopreservation are standard strategies for fertility preservation in female cancer patients. Oocyte cryopreservation should be preferred to embryo cryopreservation when this latter is prohibited by law, avoided for ethical or religious issues and in single women refusing sperm donation. Despite the increasing use of this strategy, data are still lacking about the efficacy and safety of the procedure in female cancer patients, with most of the evidence on this regard deriving from infertile non-oncologic women. This article aims at critically review the available evidence about the success of oocyte cryopreservation in female cancer patients with the final goal to further improve the oncofertility counseling of these women.SCOPUS: re.jinfo:eu-repo/semantics/publishe
Lack of p73 expression in mature B All and identification of three new splicing variants restricted to pre-B and C-ALL indicate a role of p73 in B cell ALL
No full textA two-step approach in using hyaluronic acid for selection of spermatozoa improves implantation rate in ICSI cycle
No full textContraception in cancer survivors: insights from oncofertility follow-up visits
No full textObjective: Current literature suggests that cancer survivors are less likely to receive adequate contraception counseling. However, limited data existed on barriers to contraception usage in this population and on the efficacy of dedicated consultations. This study aims to describe how contraception is perceived by cancer survivors after counseling and acceptance rates of highly effective contraceptives. Methods: We retrospectively analyzed clinical records from 313 consecutive cancer survivors at their first follow-up visit at the Oncofertility Unit of a tertiary hospital, from 2014 to 2019. Contraception acceptance and choice were examined stratified for the type of malignancy (hormone-sensible or not). A multivariate logistic regression model was used to evaluate possible predictors of acceptance. Results: Thity-three women were excluded from the analysis because trying to conceive or already pregnant. Out of the remaining 280, only 9 (3.2%) asked spontaneously for contraception, in all the other visits the issue was brought up by the physician. After counseling 44.3% of the women without contraindications still opted out effective methods for fear of hormones or refusal of more medications. Age < 33 years and being in a relationship were correlated with acceptance. Conclusions: Even after a complete counseling in a dedicated service, fears of hormones and refusal of more medications remain strong issues for these patients. Family planning needs to be discussed with cancer survivors, preferably in the context of a long-term healthcare relationship. The Oncofertility Unit should become a privileged place for this type of counseling
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