Katarzyna Litwicka

Significance of metaphase II human oocyte morphology on ICSI outcome

OBJECTIVE To evaluate the influence of specific oocyte morphologic features (morphotypes) on intracytoplasmic sperm injection (ICSI) outcome. The identification of oocyte quality markers is particularly important when a low number of oocytes can be used for IVF. DESIGN Retrospective analysis. SETTING Medical center. PATIENT(S) Five hundred sixteen consecutive ICSI cycles. Only couples affected by severe male factor infertility were excluded. INTERVENTION(S) A total of 1,191 metaphase II (MII) oocytes (1-3 per patient) were randomly selected from the cohort of oocytes obtained from each patient and evaluated for morphologic appearance. MAIN OUTCOME MEASURE(S) Fertilization, pronuclear morphology, embryo quality, pregnancy rate. RESULT(S) There was a presence of vacuoles, abnormal I polar body, and large perivitelline space related to a lower fertilization rate. Pronuclear morphology was effected by the presence of a large perivitelline space, diffused cytoplasmic granularity, and/or centrally located granular area. The latter characteristic also negatively related to day 2 embryo quality. According to the odds ratios obtained for each oocyte morphotype to reach at least one outcome, an MII oocyte morphologic score (MOMS) was calculated. A significant relationship was found between MOMS and female age, female basal FSH, and clinical outcome. CONCLUSION(S) Morphologic evaluation before ICSI helps to identify MII oocytes with higher developmental potential.

Permanent amenorrhea associated with endometrial atrophy after uterine artery embolization for symptomatic uterine fibroids

OBJECTIVE To report a case of permanent amenorrhea associated with endometrial atrophy after uterine artery embolization for symptomatic uterine fibroids. DESIGN Case report. SETTING Gynecologic clinic of a university hospital. PATIENT(S) A 44-year-old woman with menorrhagia and anemia caused by multiple fibroids. INTERVENTION(S) Transcatheter bilateral uterine artery embolization with polyvinyl alcohol particles, with hormonal, sonographic, and hysteroscopic follow-up procedures. MAIN OUTCOME MEASURE(S) Serum follicle-stimulating hormone (FSH) and estradiol levels were measured, and sonographic appearance of the ovaries and the endometrium at baseline and 1, 3, 6, and 12 months after treatment were recorded. Hysteroscopy was performed with endometrial biopsy at baseline and 6 months after embolization. RESULT(S) The patient remained amenorrheic from the procedure. Serial posttreatment measurements of FSH and estradiol levels and repeated ovarian imaging showed no change in ovarian function as compared with baseline. A reduction in endometrial thickness (<or=5 mm), as compared with the endometrial thickness measured at baseline (7.2 mm), was sonographically documented 1, 3, 6, and 12 months after treatment. Postprocedure hysteroscopy showed an atrophic endometrium, and endometrial biopsy confirmed endometrial atrophy. CONCLUSION(S) Permanent amenorrhea associated with endometrial atrophy may occur following uterine artery embolization for fibroids and, to the best of our knowledge, this is the first time this complication has been reported. Patients should be appropriately counseled about the risk of reduced fertility after embolization.

Caesarean scar pregnancy: a review of management options.

Purpose of review The current review aims to provide an overview of the already available and emerging treatment modalities for caesarean scar pregnancy (CSP). Recent findings CSP is a type of ectopic gestation associated with a high risk of serious complications. The cause of this condition and the best management are still unclear. However, some medical and surgical treatment modalities have been suggested. The main objectives in the clinical management of CSP should be the prevention of massive blood loss and the conservation of the uterus to maintain further fertility, womens health and quality of life. Current data suggest that expectant management should not be recommended, whereas there are accumulating data suggesting that early diagnosis offers single or combined medical and surgical treatment options avoiding uterine rupture and haemorrhage, thus preserving the uterus and fertility. Summary No universal treatment guidelines for management of CSP have been published up to now. The lack of data on the best evidence should encourage any individual case report and further multicentre studies for recommendation establishment.

Efficiency of slush nitrogen vitrification of human oocytes vitrified with or without cumulus cells in relation to survival rate and meiotic spindle competence

OBJECTIVE To evaluate the efficiency of slush nitrogen vitrification of human oocytes with or without cumulus cells in terms of survival rate and maintenance of meiotic spindle. DESIGN Randomized, comparative study. SETTING Medical center. PATIENT(S) A total of 274 oocytes obtained from 46 couples undergoing infertility treatment. INTERVENTION(S) Metaphase II oocytes were divided into groups A and B, vitrified with and without cumulus cells, respectively. MAIN OUTCOMES MEASURE(S) Survival rates and maintenance of meiotic spindle observed immediately after warming and 3 hours after incubation. RESULT(S) No statistically significant difference was detected between the two groups in terms of survival rate, but a significantly higher percentage of detectable spindle was observed in group B (completely denuded oocytes), either immediately after warming or 3 hours after incubation. CONCLUSION(S) Complete denudation of oocytes before slush nitrogen vitrification does not influence survival rates but positively affects oocyte meiotic spindle competence. These data support the hypothesis that cumulus cells during vitrification represent an obstacle to cryoprotectant penetration more than having a protective role for the oocyte.

Successful management of a triplet heterotopic caesarean scar pregnancy after in vitro fertilization-embryo transfer

OBJECTIVE To report a case of a triplet heterotopic caesarean scar pregnancy (CSP) with two gestational sacs implanted in the caesarean scar after in vitro fertilization-embryo transfer. DESIGN Case report. SETTINGS Private reproductive medicine center and obstetric department of a university hospital. PATIENT(S) A 31-year-old woman with previous caesarean section affected by secondary infertility related to male azoospermia. INTERVENTION(S) In vitro fertilization-embryo transfer followed by early ultrasound diagnosis of heterotopic CSP and selective embryo reduction performed by transvaginal ultrasound-guided potassium chloride and methotrexate injection in the ectopic gestational sacs. MAIN OUTCOME MEASURE(S) Successful pregnancy outcome. RESULT(S) An ongoing intrauterine pregnancy with a live birth after successful management of ectopic gestational sacs. CONCLUSION(S) Triplet heterotopic CSP with two ectopic gestational sacs may occur after IVF-ET and, to our knowledge, this is the first time such a complication has been reported. Ultrasound is the main tool allowing early diagnosis of this condition, and the injection of potassium chloride and methotrexate is a safe and efficacious treatment method. The gynecologist managing early pregnancy should be aware of the possibility of CSP, and patients must be appropriately counseled about the different treatment options.

In women with thyroid autoimmunity, does low‐dose prednisolone administration, compared with no adjuvant therapy, improve in vitro fertilization clinical results?

The objective of the study was to verify if prednisolone treatment may influence the in vitro fertilization (IVF) outcome in euthyroid women affected by thyroid autoimmunity.

The endometrial preparation for frozen-thawed euploid blastocyst transfer: a prospective randomized trial comparing clinical results from natural modified cycle and exogenous hormone stimulation with GnRH agonist

PurposeThe aim of the study was to evaluate two methods of endometrial preparation for frozen-thawed single euploid blastocyst transfer: modified natural and artificial cycle with GnRH-agonist pituitary suppression.MethodsIn this prospective, controlled randomized trial, a total of 236 patients undergoing infertility treatment were randomized in 1:1 ratio; 118 received a frozen-thawed single euploid blastocyst transfer in a modified natural cycle and 118 in an artificial cycle with GnRH-agonist pituitary suppression. In the artificial protocol, GnRH-agonist combined with estradiol valerate was administered. In the natural protocol, only final oocyte maturation was induced using human chorionic gonadotropin administration. The primary end-points were the clinical pregnancy and implantation rates; the secondary end-points were the cost-benefit in terms of drug cost and the number of visits and the woman psychological distress caused by the treatment.ResultsNo significant differences were found in clinical pregnancy, implantation, and miscarriage rates between protocols. The number of clinical and ultrasound controls and the number of laboratory dosages and venous samplings were similar in both study groups. No significant differences were found between the groups in the anxiety and depression values before the start of treatment, on the days of progesterone administration, the blastocyst transfer, and pregnancy test.ConclusionsThe findings of this study evidence that in case of frozen-thawed single euploid blastocyst transfer, both protocols are equally effective in terms of clinical outcomes, cost-benefit, and patient compliance. The choice of endometrial preparation protocol should be based on women menstrual and ovulatory characteristics or otherwise on patient need for cycle planning.Trial registrationwww.clinicaltrials.gov with number NCT02378584

Co-transfer of embryos derived from cryopreserved and fresh natural cycle oocytes: a pilot study

Italian legislation regarding reproductive medicine prohibits embryo storage while allowing cryopreservation of supernumerary oocytes. This study evaluated the effect of fresh oocytes obtained from natural unstimulated cycles on the clinical success rates derived from the use of frozen-thawed (FR-TH) oocytes obtained following ovarian stimulation. For 36 women, intracytoplasmic sperm injection was performed on FR-TH oocytes supplemented by a fresh oocyte, if available, derived from a natural cycle in which gonadotrophin-releasing hormone-antagonist was used for premature LH surge control. The retrieval rate of fresh oocytes was 61.1% and survival rate of FR-TH oocytes was 43.6%. The fertilization rate of fresh and FR-TH oocytes was 70% and 52.5%, respectively. Fifty embryos were transferred, 14 of them developed from fresh oocytes and 36 from FR-TH oocytes. Six pregnancies occurred in 10 cycles in which the embryos developed from fresh and FR-TH oocytes (pregnancy rate 60.0%) and two in 12 patients in whom the embryos were obtained from only FR-TH oocytes (pregnancy rate 16.7%) (P < 0.05). In summary, the data demonstrate that the transfer of embryos derived from oocytes cryopreserved following a previous ovarian stimulation and an embryo developed from a fresh one retrieved in natural cycle ensures an excellent clinical outcome.