Horng-Der Tsai

Laser-assisted hatching of embryos is better than the chemical method for enhancing the pregnancy rate in women with advanced age

OBJECTIVEnAssisted hatching may enhance embryo implantation. This study was conducted to examine the efficacy of the laser- and chemical-assisted hatching for promotion of implantation (IR), pregnancy (PR), and delivery rate (DR) in older women undergoing IVF cycles.nnnDESIGNnProspective study.nnnSETTINGnAn IVF unit of a medical center.nnnPATIENT(S)nA total of 601 embryos from 141 women aged > or =38 years underwent controlled ovarian hyperstimulation (COH) and assisted hatching.nnnINTERVENTION(S)nThe study population was divided into two groups: group 1 had laser-assisted hatching (n = 85) and group 2 had chemical-assisted hatching (n = 56). Before the transfer, the day 3 embryos were hatched by using a 1.48-microm noncontact diode laser or acid Tyrodes solution.nnnMAIN OUTCOME MEASUREMENT(S)nThe IR, PR, and DR between the groups were compared.nnnRESULT(S)nThere were no statistical differences between groups in age, E2 concentrations during hCG administration, gonadotrophin dosage, embryo grade, the numbers of oocytes retrieved, oocytes fertilized, and embryos transferred. Higher IR, PR, and DR were noted in the laser-assisted hatching group. The IR, PR, and DR were: group 1, 8.2%/31.8%/24.7% and group 2, 3.8%/16.1%/10.7%, respectively.nnnCONCLUSION(S)nLaser-assisted hatching of embryos is more effective than the chemical method in enhancing the IR and PR of women with advanced age. The laser system allows an easier, faster, and safer micromanipulation of the zona pellucida, which provided a better method in zona drilling.

Gynecology: Low-Dose Aspirin for Infertile Women with Thin Endometrium Receiving Intraeuterine Insemination: A Prospective, Randomized Study

AbstractPurpose: The objective was to evaluate the effect of aspirinon infertile women with thin endometrium.nMethods: Patients who had thin endometrium (≤ 8 mm)and intrauterine insemination were divided into the aspirinand nonaspirin groups. Endometrial pattern (trilaminar andnontrilaminar) and thickness, the pulsatility index (PI) andresistance index (RI) of the uterine artery, spiral artery, andovarian dominant follicles, and pregnancy rates of bothgroups were measured.nResults: A total of 114 and 122 women were included inthe aspirin and nonaspirin groups, respectively. There weresignificantly higher percentages of trilaminar endometrium(46.5% vs. 26.2%) and pregnancy rate (18.4% vs. 9.0%)after aspirin therapy. There was nonsignificant differencein the endometrial thickness, and PI/RI values of the uterineartery, spiral artery, and ovarian dominant follicle betweenboth groups.nConclusions: Higher pregnancy rate and better endometrialpattern were achieved in patients with thin endometriumafter aspirin administration. Aspirin therapy could notsignificantly increase the endometrial thickness and theresistance of uterine and ovarian flow.

Antral follicle counting in predicting the retrieved oocyte number after ovarian hyperstimulation.

Purpose: To evaluate the antral follicle (AF) counting in predicting the outcome after controlled ovarian hyperstimulation (COH) and IVF-ET.Methods: Infertile women who accepted the COH and IVF-ET were included prospectively. Day-3 AF number was determined by transvaginal sonography. They were divided into three groups: Group 1: ≤3 AF; Group 2: 4–10 AF; Group 3: ≥11 AF. Retrieval oocyte number, embryo number, pregnancy rate (PR), and implantation rate (IR) of the three groups were compared.Results: A total of 372 cycles were included. Patients in Groups 1, 2, and 3 were statistically different in age (35.3 vs. 31.9 vs. 28.5), Day-3 FSH (14.3 vs. 5.9 vs. 4.1), cancellation (34.4% vs. 2.7% vs. 0.9%), gonadotropin dosage, retrieval oocyte number (2.9 vs. 8.2 vs. 14.5), embryo number (2.2 vs. 6.5 vs. 11.7), PR (11.1% vs. 34.6% vs. 35.0%), and IR (3.0% vs. 8.2% vs. 8.9%).Conclusions: Patients with ≤3 AF have a significantly higher cancellation rate, fewer retrieved oocyte number, and lower PR. Combination of AF counting and basal FSH level increased the sensitivity in predicting the ovarian reserve. Retrieved oocyte number could be predicted by the formula: oocyte = 0.802 × AF + 2.01.

Leukemia Inhibitory Factor Expression in Different Endometrial Locations Between Fertile and Infertile Women Throughout Different Menstrual Phases

AbstractPurpose: The purpose was to demonstrate the leukemiainhibitory factor (LIF) expression in different endometriallocations between fertile and infertile women throughoutdifferent menstrual phases. The relationship betweenprogesterone level and LIF expression were evaluated.nMethods: Endometrial biopsies were performed onidiopathic infertile and normal fertile women accepted theinfollicular, periovulatory, and luteal phases. The lutealprogesterone level was measured. Endometrial LIFimmunostaining of luminal epithelium, glandular epithelium, andstroma were detected. The relationship between luteal LIFexpression and progesterone level was evaluated.nResults: Significant LIF expression was noted in theendometrium of fertile women rather than that of infertile women.The LIF expression was highest in the luminal epithelium,moderate in the glandular epithelium, and lowest in thestroma. The luminal and glandular epithelial staining werelowest in follicular phase, moderate in periovulatory phase,and strongest in luteal phase. The stromal LIF presentedwith a noncyclical manner. The LIF expression is not relatedwith the progesterone level.nConclusions: Endometrial LIF expression is related tohuman fertility. Endometrial LIF expression is dependenton cellular localizations and menstrual stages. Stronger LIFexpression presents in the endometrial epithelium duringluteal phase.

Fetal renal volume assessment by three-dimensional ultrasonography

OBJECTIVEnThis study was undertaken to measure fetal renal volume by means of three-dimensional ultrasonography and to use those data to establish the accurate constant and formula for fetal renal volume assessment with two-dimensional ultrasonography.nnnSTUDY DESIGNnSingleton fetuses between 15 and 40 weeks gestation were included. The volumes of both fetal kidneys were measured with three-dimensional ultrasonography. Three fetal renal diameters (largest anteroposterior, transverse, and longitudinal diameters) were measured, and the constant of the fetal renal volume formula was calculated. Linear regression curves were made for each kidney from the fetal renal volume, the three diameters, and the constant.nnnRESULTSnA total of 112 fetuses were included. The following fetal renal volume formula was established: Fetal renal volume = Constant (R) x Largest anteroposterior diameter (x) x Largest transverse diameter (y) x Largest longitudinal diameter (z). The volumes, the three diameters, and the constants appeared different between the right and left kidneys but not statistically significantly so.nnnCONCLUSIONnThree-dimensional ultrasonography is useful in assessing fetal renal volume. The fetal renal volume formula makes possible accurate measurements of fetal renal volume by two-dimensional ultrasonography.

Recombinant human leukemia inhibitory factor enhances the development of preimplantation mouse embryo in vitro.

OBJECTIVEnTo assess the effect of recombinant human leukemia inhibitory factor (rhLIF) on mouse embryos in vitro.nnnDESIGNnControlled prospective study.nnnSETTINGnAcademic research environment.nnnANIMAL(S)nFemale CB6F1 mice between 6 and 8 weeks old.nnnINTERVENTION(S)nMice were divided randomly into three groups, which included a control group in an in vivo study (group I) and two groups in an in vitro study (groups II and III). Mice were killed at 116-120 hours (group I) and 44-48 hours (groups II and III) after hCG injection. Two-cell embryos (groups II and III) and blastocysts (group I) were obtained. Embryos in group II were cocultured with human tubal fluid (HTF) + 0.5% human serum albumin and in group III with HTF + rhLIF (1,000 U/mL) under paraffin oil.nnnMAIN OUTCOME MEASURE(S)nThe embryonic numbers in different stages were recorded and compared.nnnRESULT(S)nSimilar early embryo development to the four- to eight-cell and morula stages was noted between groups II and III (87.3% versus 91.0% and 74.6% versus 87.1%, respectively). However, further embryo development to the blastocyst, expanded blastocyst, and hatching blastocyst in group II (48.1%, 31.7%, and 18.5%, respectively) was lower than that in group III (83.6%, 53.7%, and 37.8%).nnnCONCLUSION(S)nRhLIF does not provide obvious stimulation in the early mouse embryo. However, rhLIF has positive effects on preimplantation blastocyst growth, differentiation, and hatching.

The prenatal diagnosis of Pierre-Robin sequence

The purpose of this study was to evaluate the spectrum of prenatal sonographic and chromosomal findings, associated anomalies and perinatal and neonatal outcomes in cases with Pierre–Robin sequence. All cases (20) with Pierre–Robin sequence, who were born at China Medical College Hospital between 1990 and 1997, were included and analysed in this series. 12 pregnancies (60 per cent) were complicated by polyhydramnios and 9 (45 per cent) were combined with cleft palate. Four cases (20 per cent) with cardiac anomalies were also observed. Two fetuses (10 per cent) had abnormal karyotyping (one trisomy 21, one trisomy 18). All fetuses were delivered at or near term. Male deviation was observed in cases with isolated Pierre–Robin sequence or combined mild anomalies (male–female ratio: 13:3). Two neonatal mortalities and three with mental retardation were observed. This investigation provides a basis for counselling patients with fetal micrognathia or neonatal Pierre–Robin sequence. The main prenatal sonographic findings of Pierre–Robin sequence are micrognathia, polyhydramnios and cleft palate. In cases of polyhydramnios, sonographic examination of the facial profile and palate are recommended. After the finding of polyhydramnios, micrognathia, and even cleft palate, clinicians should be aware of the possibility of neonatal Pierre–Robin sequence. Cardiac evaluation and karyotyping is also recommended. Copyright

Cryopreservation of human spermatozoa within human or mouse empty zona pellucidae

OBJECTIVEnTo compare the empty zona pellucidae (ZP) of different species for use in the cryopreservation of spermatozoa.nnnDESIGNnProspective study.nnnSETTINGnAn IVF unit of a medical center.nnnPATIENT(S)nPatients with azoospermia, oligoasthenozoospermia, or normal spermatozoa.nnnINTERVENTION(S)nHuman and mouse ZP were prepared by evacuating the cytoplasm of oocytes or embryos. The evacuated ZP were injected with spermatozoa from patients with severe oligoasthenozoospermia and from healthy, fertile men. After the freezing and thawing procedure, the spermatozoa were aspirated outside the ZP.nnnMAIN OUTCOME MEASURE(S)nThe number of spermatozoa per ZP, the number of motile sperm before freezing and after thawing, the number of sperm lost per ZP after freezing, and the sperm recovery rate were compared according to the different origins of the ZP and the sperm.nnnRESULT(S)nThe number of spermatozoa, number of motile sperm before freezing and after thawing, number of sperm lost per ZP, and sperm recovery rate were comparable in all groups. The total mean number of motile sperm before freezing and after thawing, the mean number of nonmotile sperm after thawing, the mean number of sperm lost after thawing, and the sperm recovery rate were 14.5%, 11. 8%, 1.0%, 1.5%, and 82%, respectively.nnnCONCLUSION(S)nZona pellucidae are an ideal vehicle for the cryopreservation of sperm collected by testicular sperm extraction or microsurgical epididymal sperm aspiration or from patients with severe oligoasthenozoospermia. There were no differences when human and mouse ZP were used for sperm storage.

Prenatal sonographic diagnosis of Cantrell's pentalogy with cystic hygroma in the first trimester.

We report 2 cases of Cantrells pentalogy with cystic hygroma diagnosed in the first trimester of pregnancy. Both fetuses had ectopia cordis, omphalocele, a sternal defect, and cystic hygroma detected by sonography. Cystic hygroma may be another characteristic of Cantrells pentalogy in the first trimester.

Comparison of a single half-dose, long-acting form of gonadotropin-releasing hormone analog (GnRH-a) and a short-acting form of GnRH-a for pituitary suppression in a controlled ovarian hyperstimulation program

OBJECTIVEnTo compare the effect of a single low-dose leuprolide acetate depot (LA depot) and leuprolide acetate (LA) on pituitary down-regulation in women undergoing controlled ovarian hyperstimulation (COH).nnnDESIGNnRetrospective study.nnnSETTINGnAn IVF unit of an academic medical center.nnnPATIENT(S)nWomen who underwent COH and IVF-ET.nnnINTERVENTION(S)nPituitary down-regulation with half-dose LA depot (1.88 mg sc, group 1) or LA (0.5 mg/d sc, group 2) was started on menstrual days 21-23.nnnMAIN OUTCOME MEASURE(S)nThe concentrations of estradiol (E(2)), FSH, LH, gonadotropin dosages, the numbers of oocytes retrieved, oocytes fertilized and embryos transferred, and pregnancy rates of the two groups were compared.nnnRESULT(S)nA total of 289 patients in group 1 and 158 in group 2 were included. There were no statistically significant differences between the two groups in baseline concentrations of E(2) and FSH, concentrations of E(2), FSH, and LH during hCG administration, gonadotropin dosage, the number of oocytes retrieved, the number of oocytes fertilized and embryos transferred, and pregnancy rates.nnnCONCLUSION(S)nSingle half-dose LA depot offers a useful alternative for pituitary suppression in ovarian stimulation for IVF.