Ginny Mounce

Randomized, controlled pilot trial of natural versus hormone replacement therapy cycles in frozen embryo replacement in vitro fertilization

OBJECTIVE To determine whether there is any difference between the outcomes of two standard treatment protocols for frozen embryo replacement (FER): natural and down-regulated hormone replacement treatment (HRT). DESIGN Open, single-center, randomized, controlled pilot trial. SETTING Private fertility clinic. PATIENT(S) Women (n = 159) planning an FER cycle at the Oxford Fertility Unit, aged <40 years at the time their embryos were frozen; with at least one blastocyst or two cleavage-stage embryos in storage; regular ovulatory cycles; and at most two previous FER cycles. INTERVENTION(S) Eligible participants were recruited and randomized between March 2010 and July 2012 into one of two standard FER treatment groups: natural (n = 80) menstrual (Natural) or GnRH agonist/HRT (n = 79) cycles. MAIN OUTCOME MEASURE(S) Live birth rate after replacement of frozen-thawed embryos, clinical pregnancy rate, implantation rate, and cycle cancellations. RESULT(S) A total of 159 women were randomized (80 Natural; 79 HRT), and 145 had ET and completed the study (72 Natural; 73 HRT). Pregnancy outcomes were not significantly different between the two groups. The live birth rates were 26.3% (Natural) and 31.7% (HRT) per randomized patient. Per ET/protocol the live birth rates were 29.2% and 34.2%. The implantation rates were 24.3% and 26.0%, and there were three twin births in the Natural and five in the HRT arms. CONCLUSION(S) The findings of this pilot study support the suggestion that for women with ovulatory cycles undergoing FER, the outcomes are similar between natural and HRT protocols. CLINICAL TRIAL REGISTRATION NUMBER NCT00843570. Registered at www.clinicaltrials.gov.

Does advancing male age influence the expression levels and localisation patterns of phospholipase C zeta (PLCζ) in human sperm

Socio-economic factors have led to an increasing trend for couples to delay parenthood. However, advancing age exerts detrimental effects upon gametes which can have serious consequences upon embryo viability. While such effects are well documented for the oocyte, relatively little is known with regard to the sperm. One fundamental role of sperm is to activate the oocyte at fertilisation, a process initiated by phospholipase C zeta (PLCζ), a sperm-specific protein. While PLCζ deficiency can lead to oocyte activation deficiency and infertility, it is currently unknown whether the expression or function of PLCζ is compromised by advancing male age. Here, we evaluate sperm motility and the proportion of sperm expressing PLCζ in 71 males (22–54 years; 44 fertile controls and 27 infertile patients), along with total levels and localisation patterns of PLCζ within the sperm head. Three different statistical approaches were deployed with male age considered both as a categorical and a continuous factor. While progressive motility was negatively correlated with male age, all three statistical models concurred that no PLCζ–related parameter was associated with male age, suggesting that advancing male age is unlikely to cause problems in terms of the sperm’s fundamental ability to activate an oocyte.

An altered endometrial CD8 tissue resident memory T cell population in recurrent miscarriage

When trying to conceive 1% of couples have recurrent miscarriages, defined as three or more consecutive pregnancy losses. This is not accounted for by the known incidence of chromosomal aneuploidy in miscarriage, and it has been suggested that there is an immunological aetiology. The endometrial mucosa is populated by a variety of immune cells which in addition to providing host pathogen immunity must facilitate pregnancy. Here we characterise the endometrial CD8-T cell population during the embryonic window of implantation and find that the majority of cells are tissue resident memory T cells with high levels of CD69 and CD103 expression, proteins that prevent cells egress. We demonstrate that unexplained recurrent miscarriage is associated with significantly decreased expression of the T-cell co-receptor CD8 and tissue residency marker CD69. These cells differ from those found in control women, with less expression of CD127 indicating a lack of homeostatic cell control through IL-7 signalling. Nevertheless this population is resident in the endometrium of women who have RM, more than three months after the last miscarriage, indicating that the memory CD8-T cell population is altered in RM patients. This is the first evidence of a differing pre-pregnancy phenotype in endometrial immune cells in RM.

An overview of information giving in fertility clinics

Abstract Information giving is a key aspect of the provision of high-quality patient-centred health care, resulting in patients who are well-informed, better adjusted to their circumstances and are compliant with their treatment. Fertility patients generally appear to be satisfied with the information they are given but a significant minority are not. Giving information to infertile patients is complicated by the nature of their condition, desire for a child and complexity of treatment options. Patients need detailed, well-timed information to support difficult decision-making, such as when to end treatment. The experiences of some individual patients and particular sub-groups in receiving and understanding information suggest that the quality of information or the way it is communicated could be improved. It is suggested that this may be achieved by reviewing the format and timing of the information provided, ensuring adequate staff training and facilitating flexibility in clinic organisation.

Emotion Work in Ethnography

The tensions and emotion work inherent in longitudinal ethnographic work are discussed in this chapter, using empirical evidence from the authors Ph.D. The sustained involvement with research participants, characteristic of this approach, is not only advantageous in terms of data collection and insider viewpoint, but also challenging because of the extended duration of the research relationship. The studys themes, concerning the experiences of infertile couples starting fertility treatments, are of a highly emotional and intimate nature raising questions of privacy and threatening negative feelings in both researcher and participants. These issues, and that of reactivity, are discussed in terms of researcher experiences in the field, and she examines how reflexivity contributes to methodological and practical effect in this setting. The author suggests strategies for researchers working with similarly emotional topics.

Pulling it All Together: Emotional Reflexivity in Health and Social Care Field Research

All the contributors to this book recommend taking a self-conscious decision to use emotional reflexivity as part of their research practice. In practice, much thought has gone in to what it means to do reflexivity and what it means to be transparent about the goings-on in the field. This is important as dual roles such as researcher practitioner can have an impact on the research, especially where practice and research roles collide and influence the data we collect. Having ways to step back and to reflect on subjectivities and practice and research identities enables an analytic eye on our own reactions as practitioner researchers.