Hsuan-Wei Huang

Human oocyte maturity in vivo determines the outcome of blastocyst development in vitro

AbstractPurpose: To date, the impact of oocyte maturity at aspiration on the blastocyst formation in vitro has not been fully evaluated. This study was undertaken to assess the influence of oocyte maturity in patients undergoing in vitro fertilization and blastocyst transfer program. Methods: A total of 1278 oocytes derived from 147-IVF cycles were retrospectivly analyzed. Oocyte maturity was graded on a scale from 1 to 5 based on the morphology of the ooplasm, cumulus mass, corona radiata, and membrana granulosa cells. Results: Mature oocytes yielded the highest fertilization rates. Although the cleavage rates were similar in both groups, the percentage of poor morphology, day-3 embryos from the nonmature-oocyte group was significantly higher than from the mature-oocyte group (54.7% vs. 15.5%, P < 0.001). Although good morphology, day-3 embryos were collected from nonmature oocytes, the incidence of these embryos developing to the blastocyst stage was significantly less than from mature oocytes (33.3% vs. 71.2%, P < 0.001). Although blastocyst stage embryos were collected from nonmature oocytes, the incidence of these embryos developing to the top-scoring blastocysts was significantly less than from mature oocytes (58.3% vs. 89.5%, P < 0.001). Conclusions: These phenomena suggest that oocyte maturity produced in vivo determine the fertilization potential and subsequent blastocyst quality in vitro.

Laparoscopic-Assisted Vaginal Hysterectomy in Women of all Weights and the Effects of Weight on Complications

STUDY OBJECTIVE To compare intraoperative and postoperative complication rates for laparoscopic-assisted vaginal hysterectomy (LAVH) between women classified as obese, normal weight, or very thin based on body mass index (BMI). DESIGN Retrospective cohort study (Canadian Task Force classification II-3). SETTING University hospital. PATIENTS Six hundred seventy women (162 with BMI >25, 34 with BMI <18.5, 474 with BMI 18.5-25 kg/m(2)). INTERVENTION LAVH. MEASUREMENTS AND MAIN RESULTS For women with high BMIs, 34 procedures (21.0%) were converted to laparotomy, compared with 48 (10.1%) for women of normal body weight and 3 (8.8%) for those with low BMI (p = 0.001). Average blood loss was 299.3 +/- 87.8, 219.1 +/- 57.5, and 231.8 +/- 65.9 ml, respectively (p <0.001). Very thin women had similar intraoperative and postoperative complication rates (8.8 %) as women of normal body weight (8.6%) and obese women (11.1%). CONCLUSION Obese women had increased likelihood of conversion to laparotomy and greater blood loss after LAVH than nonobese women. Very thin women had similar intraoperative and postoperative complication rates as women of normal body weight and obese women.

The Maturity of Human Cumulus-Free Oocytes Is Positively Related to Blastocyst Development and Viability

AbstractPurpose: We investigated whether the human oocyte maturity at the removal of cumulus/corona cells affects the embryo outcome in vitro. Methods: A total of 620 oocytes, which subsequently underwent blastocyst culture, were included in this analysis. Oocytes that were in prophase or Metaphase I of meiosis at the removal of cumulus/corona cells were in Group II. Oocytes that were in Metaphase II at the removal of cumulus/corona cells were in Group I. Results: Group I oocytes yielded the highest fertilization rates (96.3% vs. 77.1%, P < 0.001). The incidence of Group II oocytes developing to the blastocyst stage was significantly less than from Group I oocytes (38.1% vs. 86.1%, P < 0.001). The percentage of top-scoring blastocysts from Group I oocytes was higher than that of Group II oocytes (95.4% vs. 76.2%, P < 0.001). Conclusions: Oocyte maturity at the removal of cumulus/corona cells needs to be considered in selecting good quality blastocysts for embryo transfer.

Coculture of Human Spermatozoa with Reproductive Tract Cell Monolayers Can Enhance Sperm Functions Better than Coculture with Vero Cell Monolayers

AbstractPurpose: In order to develop a better system for support of human sperm function in vitro, we conducted studies to evaluate whether reproductive tract cells are better than non-reproductive tract cells as an adjunt in that regard. Methods: Human spermatozoa were cocultured with Vero cells, with human oviduct cells and endometrial cells, and without cells (control) for either 1, 4, or 24 hr. Sperm motility was then analyzed with a computer-aided sperm analyzer (CASA-Hamiliton Thron, HTM IVOS Motility Analyzer). Aliquots of spermatozoa incubated for 24 hr were also stained with Hoechst 33258 and FITC-PNA to evaluate the status of acrosome in live cells. Results: Significant differences (P<0.05) between the oviduct cell and the control groups after 24 hr were evident in the curvilinear velocity (VCL) (81.4±13.4 vs 60.0±14.1 µm/sec) and amplitude of lateral head displacement (ALH) (5.2±0.6 vs 4.1±0.5 µm). The incidence of acrosome reaction of live sperm was significantly higher in the endometrial cell group than in the controls (25.4±9.9 vs 6.6±2.4%;P<0.001). Conclusions: Coculture with human reproductive tract cells seems to improve some functional parameters of human spermatozoa. Coincubation with such cell lines, especially oviduct cells, might be a feasible approach to optimization of human spermatozoa for assisted fertilization using subfertile or frozen-thawed samples. We think coincubating human spermatozoa with a human reproductive tract cell line, especially oviduct cells, might be a feasible approach in preparing human spermatozoa for assisted fertilization in subfertile and frozen-thawed semen samples.

Non-Surgical Treatment of Pelvic Actinomycosis Associated with a Pelvic Abscess: A Case Report

Objective: Most cases of pelvic actinomycosis undergo surgical extirpation, usually by means of a hysterectomy and a bilateral salpingo-oophorectomy. We report a case of pelvic actinomycosis associated with a pelvic abscess 15 cm in diameter which was completely resolved after medical treatment alone. Case Report(s): A 47-year-old woman was transferred to our hospital due to intermittent fever and progressive abdominal distention for 2 weeks. Removal of the IUD and an endometrial curettage were pertormed by a private practician. The pathological report of the endometrium from the private practician revealed suppurative inflammation with actinomycosis. Computerized tomography showed a huge pelvic abdominal cystic mass 15 cm in diameter extending to the bilateral paracolic gutter. A staphylococcus infection was documented from the blood culture result. So, antibiotics were shifted to intravenous gentamycin (60 mg q8h) and chloramphenical (1 g/day). The fever then subsided, and the mass shrunk. The patient was discharged, and oral antibiotic therapy was maintained for 1 more month. She was free of symptoms and with no complications in the follow-up visits. A pelvic ultrasonographic examination 3 months later showed complete resolution of the pelvic mass. Conclusions(s): Pelvic actinomycosis is a rare pelvic inflammatory disease. Co-infection with other microorganisms should always be taken into consideration and may provide additional information for treatment.