Naoki Takeshita

Effects of bipolar electrocoagulation versus suture after laparoscopic excision of ovarian endometrioma on the ovarian reserve and outcome of in vitro fertilization

The aim of this study was to assess the effect of coagulation versus suture used for hemostasis during laparoscopic excision of a unilateral endometrioma for outcome of in vitro fertilization (IVF).

An innovative LC-MS/MS-based method for determining CYP 17 and CYP 19 activity in the adipose tissue of pre- and postmenopausal and ovariectomized women using 13C-labeled steroid substrates.

CONTEXT Does adipose tissue produce steroid hormones like an endocrine organ? OBJECT To clarify whether adipose tissue produces sex steroid hormone like an endocrine organ, we estimated several key steroid hormone levels, as well as CYP17 and CYP19 activity, in ovariectomized, pre- and postmenopausal women by liquid chromatography-tandem mass spectrometry (LC-MS/MS). SUBJECTS AND METHODS The subjects were 19 premenopausal (n = 12), postmenopausal (n = 4), and ovariectomized women (n = 3) aged 27-68 years. Serum, visceral adipose and sc adipose samples were taken from these subjects and stored at -70°C. The levels of cortisol, cortisone, progesterone (Prog), androstenedione, dehydroepiandrosterone, estrone, estradiol (E2), and T in serum and adipose tissue were estimated simultaneously by LC-MS/MS. CYP17 and CYP19 activity in tissues were assayed with the use of (13)C-labeled steroid precursors and LC-MS/MS-based estimation of the metabolites. RESULTS E2 and Prog levels in the sera of postmenopausal or ovariectomized women were less than 10% of those in premenopausal women. No marked variations were seen in other hormones. Estrone, androstenedione, dehydroepiandrosterone, and Prog levels in the visceral and sc tissues of postmenopausal and ovariectomized women were 9-60 times higher than those in serum, whereas E2 and T levels were 3- to 7-fold higher than those in serum, and cortisol and cortisone levels were 20% of those found for serum. CYP17 in adipose tissue was found to have 17-hydroxylase and 20,17-lyase activity, with each catalytic activity being essentially equal. Therefore, CYP17 in adipose tissue is of the testicular/ovarian type but not adrenal type, which has 17-hydroxylase activity dominant. The presence of CYP19 activity in adipose tissue was approximately 3% of CYP17. CONCLUSION Our findings suggest that adipose tissue acts as an endocrine organ, with CYP17 and CYP19 activity playing an essential role in sex steroid hormone biosynthesis.

Deletion detection for diagnosis of Duchenne muscular dystrophy in the Japanese population—Comparisom between the polymerase chain reaction and the Southern blot analysis

SummaryWe compared the efficacy of the multiplex PCR with that of the cDNA analysis for detection of deletions of the DMD gene in the Japanese patients. Thirty males with DMD from 27 Japanese families were studied by the multiplex PCR, and 24 of them were also investigated by Southern blot analysis. We used five dystrophin cDNA probes for deletion analysis. A total of 19 regions were amplified by the PCR to detect deletions, 9 regions by the method of Chamberlain et al. and another 10 regions by the method of Beggs et al. Deletions were detected in 14 (52%) out of 27 DMD families by the PCR. Southern blot analysis detected deletions in 14 (64%) out of 22 families. Thirteen (93%) of the 14 DMD families with deletions detected by Southern blotting were also confirmed by the multiplex PCR. Provided care is taken in cases where the deletion is limited to a single exon, the multiplex PCR appears to be an efficient and useful alternative to conventional Southern blot analysis for detecting deletions during the prenatal and postnatal diagnosis of DMD.

Current status of non‐invasive prenatal testing in Japan

The purpose of this study was to report the 3‐year experience of a nationwide demonstration project to introduce non‐invasive prenatal testing (NIPT) of maternal plasma for aneuploidy, and review the current status of NIPT in Japan.

Regulating assisted reproductive technologies in Japan.

Japan’s first in vitro fertilization preembryo transfer (IVF-ET) baby was born in 1983 some 5 years behind Louise Brown, the world’s first IVF-ET child (1). Subsequent technological advances have been remarkable, and assisted reproductive technology (ART) has now become firmly established in the treatment of infertility. In 1999, 69,019 cycles of IVF-ET had been performed in Japan, with 11,929 babies born as a result; this equates to 1 in 100 live births. The number of facilities performing IVF-ET has increased annually, reaching 423 in 1999 (2). There are few large-scale IVF facilities in Japan handling in excess of 200 cases a year; instead the country is characterized by its numerous small clinics. To date, however, no legal regulations covering ART have been promulgated in Japan. Since the Japan Society of Obstetrics and Gynecology (JSOG) issued its “Announcements on IVF-ET” in 1983, new statements and revisions have been made in line with the emergence of new technologies. Nevertheless, it is necessary to point out that the development of practical legal regulations has moved slowly in this country. For example, although artificial insemination by donor (AID) was first performed in 1949, for some reason, this date is cited as 1996 in JSOG statements (3). Some couples now travel to countries where IVF is unregulated in order to reap the benefits of ART, including preimplantation genetic diagnosis (PGD),

Prenatal Diagnosis of Duchenne Muscular Dystrophy by Polymerase Chain Reaction Analysis

The efficacy of the polymerase chain reaction (PCR) in the first-trimester prenatal diagnosis of Duchenne muscular dystrophy (DMD) was examined. Twenty-seven fetuses from 26 Japanese pedigrees at risk for DMD were analyzed. PCR-restriction fragment length polymorphism analysis, multiplex PCR, and dinucleotide repeat polymorphism analysis were used. Of 16 males, 11 were determined to be unaffected, 4 were affected, and the remaining 1 was undetermined. Of the 11 female fetuses, 1 was diagnosed as a noncarrier, 4 were carriers, and the carrier status of the remaining 6 was not determined at the option of the patients, although DNA polymorphisms could be detected in those patients. Prenatal diagnosis by PCR analysis was possible in 96% of the fetuses tested (26 of 27).

A survey on awareness of genetic counseling for non-invasive prenatal testing: The first year experience in Japan

The purpose of this study is to summarize the results from a survey on awareness of genetic counseling for pregnant women who wish to receive non-invasive prenatal testing (NIPT) in Japan. As a component of a clinical study by the Japan NIPT Consortium, genetic counseling was conducted for women who wished to receive NIPT, and a questionnaire concerning both NIPT and genetic counseling was given twice: once after pre-test counseling and again when test results were reported. The responses of 7292 women were analyzed. They expressed high satisfaction with the genetic counseling system of the NIPT Consortium (94%). The number of respondents who indicated that genetic counseling is necessary for NIPT increased over time. Furthermore, they highly valued genetic counseling provided by skilled clinicians, such as clinical geneticists or genetic counselors. The vast majority (90%) responded that there was sufficient opportunity to consider the test ahead of time. Meanwhile, women who received positive test results had a poor opinion and expressed a low-degree satisfaction. We confirmed that the pre-test genetic counseling that we conducted creates an opportunity for pregnant women to sufficiently consider prenatal testing, promotes its understanding and has possibilities to effectively facilitate informed decision making after adequate consideration. A more careful and thorough approach is considered to be necessary for women who received positive test results.

Effect of oocyte transportation time on the clinical results of transport in vitro fertilization/intracytoplasmic sperm injection-embryo transfer

Background and AimsIn transport assisted reproductive technology (ART), the time taken to transport oocytes to the main center differs greatly among the satellite facilities and may influence the clinical results.MethodsFor the conventional in vitro fertilization (IVF) groups in which oocytes were collected at the satellite facilities and transported to the main ART center for insemination and embryo transfer, there were 29 cycles in 27 patients with a transportation time within 60 min (short time transport IVF (ST-IVF)), 78 cycles in 62 patients with a time between 60 and 120 min (long time transport IVF (LT-IVF)), and there were 141 cycles in 110 patients at the main ART center (center IVF (C-IVF)). For the intracytoplasmic sperm injection (ICSI) group, there were 65 ST-ICSI cycles in 42 patients, 146 LT-ICSI cycles in 97 patients, and 326 cycles in 238 patients at the main ART center (C-ICSI).ResultsThe morphologically favorable embryo rate was lower in the ST-ICSI group (33.8%, P < 0.05) than in the C-ICSI group (38.1%), and the morphologically poor embryo rate in the LT-IVF group (38.6%, P < 0.0001) was higher than in the C-IVF group (26.7%). The rate of embryo transfers resulting in pregnancies was 16.7% in the ST-ICSI group (P < 0.01) and 17.3% in the LT-ICSI group (P < 0.001), both less than that of 35.2% for the C-ICSI group.ConclusionsTo improve both the morphologically favorable embryo rate and the pregnancy rate in transport ART, it is essential to improve the total quality control at the satellite facilities.

Fetal cell-free DNA fraction in maternal plasma for the prediction of hypertensive disorders of pregnancy

OBJECTIVE The purpose of this study is to compare the fetal fractions during non-invasive prenatal testing (NIPT) in singleton pregnancies according to gestational age and maternal characteristics to evaluate the utility of this parameter for the prediction of pregnancy complications including gestational diabetes mellitus (GDM) and hypertensive disorders of pregnancy (HDP). STUDY DESIGN This study was a multicenter prospective cohort study. The present data were collected from women whose NIPT results were negative. The relationships between the fetal fractions and the gestational age, maternal weight and height, and incidences of miscarriage, preterm delivery, and pregnancy complications including GDM, HDP and placental abruption were assessed. RESULTS A total of 5582 pregnant women with verified NIPT negative results were registered in the study. The demographic characteristics of the study populations were statistically analyzed, and the women with HDP tended to have a low fetal fraction in samples taken during early gestation. The area under the curve (AUC) in a receiver operating characteristic curve (ROC) analysis was 0.608 for women with HDP. CONCLUSION A low fetal fraction on NIPT might be correlated with future HDP. However, predicting HDP during early pregnancy in women with a low fetal fraction might be difficult.

Pyoderma gangrenosum in a pregnant patient: A case report and literature review

Pyoderma gangrenosum (PG) is a rare ulcerative skin disease that usually starts as a pustular lesion and rapidly progresses to a painful ulcer with undermined violaceous borders. The occurrence of PG during pregnancy is uncommon. We describe a case of a pregnant patient with PG who was diagnosed as having ulcerative colitis after delivery. Obstetricians need to understand the pathogenesis of PG and its associated conditions because it is important to make a proper diagnosis and provide targeted therapy.