Shan Luo

Needle immersed vitrification can lower the concentration of cryoprotectant in human ovarian tissue cryopreservation

OBJECTIVEnTo investigate whether needle immersed vitrification (NIV) can further lower the concentration of cryoprotective agent (CPA).nnnDESIGNnExperimental cross-sectional controlled in vitro study.nnnSETTINGnUniversity teaching hospital.nnnPATIENT(S)nHuman ovarian biopsy tissues were obtained from ten women undergoing gynecology operations.nnnINTERVENTION(S)nOvarian cortical tissues were cryopreserved using slow freezing or vitrification. The vitrification solutions used were as follows: group A: 2.69 mol/L ethylene glycol (EG)+2.11 mol/L dimethylsulfoxide (DMSO)+0.5 mol/L sucrose; group B: 2.42 mol/L EG+1.90 mol/L DMSO+0.5 mol/L sucrose; group C: 2.15 mol/L EG+1.69 mol/L DMSO+0.5 mol/L sucrose; and group D: 1.88 mol/L EG+1.48 mol/L DMSO+0.5 mol/L sucrose.nnnMAIN OUTCOME MEASURE(S)nHistologic evaluations were performed using light and electron microscopy. Apoptosis was assessed by TUNEL staining. Tissue damage after cryopreservation was measured by the levels of lactate dehydrogenase (LDH) in culture.nnnRESULT(S)nThe proportion of normal ultrastructure of granulosa cells and stromal cells in groups B and C was higher than that in group A. The proportion of TUNEL-positive primordial follicles and stromal cells in the NIV groups decreased with reduction of concentration. Additionally, LDH levels in groups B and C were lower than in group A.nnnCONCLUSION(S)nThe NIV method could further lower the concentration of CPA. Therefore, we can use the CPA of group C as an optimal concentration for NIV.

Gonadotropin-releasing hormone for preservation of ovarian function during chemotherapy in lymphoma patients of reproductive age: a summary based on 434 patients.

Background Gonadotropin-releasing hormone agonists (GnRHa) might play a role in preserving ovarian function in lymphoma patients by inhibiting chemotherapy-induced ovarian follicular damage. However, studies of its clinical efficacy have reported conflicting results. Method We conducted a meta-analysis to determine the effect of the preservation of ovarian function by administering GnRHa in young patients with lymphoma undergoing chemotherapy. Seven studies were identified that met inclusion criteria and comprised 434 patients assigned to GnRHa combined chemotherapy or chemotherapy alone. Results The incidence of women with premature ovarian failure (POF) demonstrated a statistically significant difference in favor of the use of GnRHa (OR=0.32, 95% CI 0.13-0.77). In addition, the final level of FSH in the GnRH group was significantly lower than control group. (MD= -11.73, 95% CI,-22.25- -1.20), and the final level of AMH in the GnRH group was significantly higher than control group (MD=0.80; 95% CI, 0.61–0.98). However, there was no statistically significant difference between treatment and the control groups in the incidence of a spontaneous pregnancy (OR=1.11; 95% CI, 0.55–2.26). Conclusion This meta-analysis suggests that GnRHa may be effective in protecting ovarian function during chemotherapy in lymphoma patients. More well-designed prospective studies are needed to carry out for further understanding of this topic.

Fertility assistance program following the Sichuan earthquake in China

On May 12, 2008 an earthquake measuring 8.0 on the Richter scale hit Wenchuan in Sichuan province, a mountainous region in western China, and rendered many parents childless. Doctors from the Womens Fertility Program of the Second West China Hospital in Sichuan carried out a post earthquake fertility assistance program in the following 3 months. The program included 3 parts: sociomedical fertility health support; psychological counseling and intervention in reproductive health; and an assisted reproductive technology (ART) service. Couples whose children had died or were disabled in the earthquake were entitled to free fertility counseling and ART, if required. Some women are currently pregnant as a result of the program, which has been successful in helping some surviving couples achieve their reproductive desires.

Polymorphism T → C of gene CYP17 promoter and polycystic ovary syndrome risk: A meta-analysis

The T→C polymorphism of CYP17 gene has been inconsistently associated with polycystic ovary syndrome (PCOS) risk. We examined the association by performing a meta-analysis. Two investigators independently searched the Medline, Embase, CNKI, and Chinese Biomedicine Databases. Summary odds ratios (ORs) and 95% confidence intervals (95% CIs) for CYP17 polymorphism and PCOS were calculated in a fixed-effects model and a random-effects model when appropriate. The pooled ORs were performed for co-dominant model (CC vs. TT, TC vs. TT), dominant model (CC+TC vs. TT), and recessive model (CC vs. TC+TT). Subgroup analyses were performed by ethnicity, country, Hardy-Weinberg equilibrium (HWE) in controls and study sample size. This meta-analysis included 10 case-control studies, which included 1321 PCOS cases and 1017 controls. Overall, the variant genotypes (CC and TC) were not associated with PCOS risk, compared with the wild-type TT homozygote. Similarly, no associations were found in the dominant and recessive models. Stratified analyses by ethnicity/country also detected no significant association. However, limiting the analysis to the studies within HWE, a significantly increased risk was observed (TC vs. TT, OR=1.44, 95% CI=1.10-1.88; dominant model, OR=1.41, 95% CI=1.10-1.81). Moreover, when stratifying by study sample size, a significantly elevated risk was found among small sample studies (≤200 subjects), but not among large sample studies (> 200 subjects). This meta-analysis suggests that the CYP17 T/C polymorphism may be not associated with PCOS risk, while the observed increase in risk of PCOS may be due to small-study bias.

Effectiveness of GnRH Antagonist in the Management of Subfertile Couples Undergoing Controlled Ovarian Stimulation and Intrauterine Insemination: A Meta-Analysis

Background Recent studies have indicated the use of gonadotropin-releasing hormone antagonists (GnRH-ant) as an adjuvant treatment to prevent premature luteinization (PL) and improve the clinical outcomes in patients undergoing controlled ovarian stimulation (COS) with intrauterine insemination (IUI). However, the results of these studies are conflicting. Methods We conducted a systematic review and meta-analysis of randomized trials aiming to compare the clinical efficacy of GnRH-ant in COS/IUI cycles. Twelve studies were identified that met inclusion criteria and comprised 2,577 cycles assigned to COS/IUI combined GnRH-ant or COS/IUI alone. Results Meta-analysis results suggested that GnRH-ant can significantly increase the clinical pregnancy rate (CPR) (ORu200a=u200a1.42; 95% CI, 1.13–1.78) and decrease the PL rate (ORu200a=u200a0.22, 95% CI, 0.16–0.30) in COS/IUI cycles. Subgroup analysis results suggested statistically significant improvement in the CPR in non-PCOS patients (ORu200a=u200a1.54; 95% CI, 1.03–2.31) but not in the PCOS population (ORu200a=u200a1.65; 95% CI, 0.93–2.94) and multiple mature follicle cycles (ORu200a=u200a1.87; 95% CI, 0.27–12.66). There were no difference in the miscarriage and multiple pregnancy rates between the groups. Conclusion This meta-analysis suggested that GnRH-ant can reduce the incidence of PL and increase the CPR when used in COS/IUI cycles, and it was especially useful for non-PCOS patients. However, evidence to support its use in PCOS patients is still insufficient

Impact of obesity on endometrial blood flow in women without polycystic ovarian syndrome during intracytoplasmic sperm injection

BackgroundObesity may exert a negative effect on in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) treatment. However, the effect of obesity on the endometrium remains unknown. This study was designed to assess the effect of isolated body mass index (BMI) on endometrial blood supply in non-polycystic ovary syndrome (PCOS) women during ICSI by power Doppler Ultrasound.MethodsAn observational prospective study was carried out. A total of 206 patients without PCOS were divided into 4 groups based on Chinese BMI classification (kg/m(2): underweight (BMIu2009<u200918.5), normal weight (18.5 less than or equal to BMIu2009<u200924), overweight (24 less than or equal to BMIu2009<u200928), and obese (BMI greater than or equal to 28). Endometrial thickness, endometrial pattern, endometrial spiral arterial resistance index (RI) and pulsatility index (PI) values and systolic/diastolic ratio (S/D) were assessed on the day of human chorionic gonadotropin administration.ResultsObese patients required more doses of gonadotrophin and longer stimulation duration than the normal weight patients (Pu2009<u20090.05). Endometrial thickness and pattern were not statistically different between the 4 BMI subgroups (Pu2009>u20090.05). Subendometrial blood flow was detected in 165 (80.1%) patients and spiral arterial PI was significantly higher in the obese group than in the normal weight and underweight groups (Pu2009<u20090.05). All parameters of ICSI outcome were comparable, including pregnancy and miscarriage rates.ConclusionsObesity (BMI greater than or equal to 28xa0kg/m(2)) appears to exert a negative effect on endometrial and subendometrial blood flow based on the Chinese standard of obesity; however, it seems to have no significant effect on ICSI outcomes in non-PCOS women.

Differential Expression Profile of Immunological Cytokines in Local Ovary in Patients with Polycystic Ovarian Syndrome: analysis by Flow Cytometry

OBJECTIVEnImmune dysregulation may play an important role in the pathogenesis of polycystic ovary syndrome (PCOS). The purpose of this study was to investigate the Th1 and Th2-related cytokine profile in local ovary of women with PCOS.nnnSTUDY DESIGNnThe T lymphocytes of follicular fluid (FF) were obtained at the time of oocyte retrieval before in-vitro fertilization (IVF) in woman with or without PCOS. After culturing with PMA, Ionomycin and Golgi stop agent, cells were detected for the intracellular cytokine production by flow cytometry. The profile of Th1 (IFN-γ, IL-2) and Th2 (IL-4, IL-10) cytokines of CD3(+) CD4(+)T lymphocyte subsets were analyzed through invert gating. These cytokines in FF were also evaluated by ELISA.nnnRESULTSnFlow cytometry analysis showed that the production of Th1 (IFN-γ, IL-2) cytokines in FF lymphocytes in PCOS patients were significantly higher than those in controls; ELISA result also demonstrated that the concentration of Th1 cytokines (IFN-γ, IL-2) in FF in PCOS patients is significantly increased compared with those in controls.nnnCONCLUSIONnIt is concluded that the immune dominance of Th1 may be the immunological feature of the ovary in PCOS patients. It might participate in the immune pathogenesis in the ovary of PCOS patients. These results suggest that chronic inflammation maybe one of the underlying mechanism for the pathogenesis of PCOS.

Effect of pretreatment with transdermal testosterone on poor ovarian responders undergoing IVF/ICSI: A meta-analysis.

In order to identify and describe the effectiveness of transdermal testosterone pretreatment on poor ovarian responders, MEDLINE, EMBASE, the Cochrane library and the Chinese biomedical database were searched for randomized controlled trials (RCTs). Three RCTs, which compared the outcomes of female pretreatment with transdermal testosterone prior to in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) with those of control groups, were included in the present review. The three RCTs enrolled a total of 221 randomized subjects. The meta-analysis revealed that females who received transdermal testosterone treatment prior to their IVF/ICSI cycle had a two-fold increase in live birth rate [risk ratio (RR)=2.01, 95% confidence interval (CI) 1.03–3.91], clinical pregnancy rate (RR=2.09, 95% CI 1.14–3.81) and a significantly more oocyte retrieved [mean difference (MD)=1.36, 95% CI 0.82–1.90]. The current findings provide evidence that pretreatment with transdermal testosterone may improve the clinical outcomes for poor ovarian responders undergoing IVF/ICSI. However, the results should be interpreted with caution due to the small sample size of the studies used and the heterogeneities. Further good quality RCTs would be needed to reach further conclusions.

Influence of the Wenchuan earthquake on self-reported irregular menstrual cycles in surviving women

Objective.u2003To explore the influence of stress induced by the Wenchuan earthquake on the menstrual cycles of surviving women. Methods.u2003Self-reports of the menstrual cycles of 473 women that survived the Wenchuan earthquake were analyzed. Menstrual regularity was defined as menses between 21 and 35 days long. The death of a child or the loss of property and social resources was verified for all surviving women. The severity of these losses was assessed and graded as high, little, and none. Results.u2003About 21% of the study participants reported that their menstrual cycles became irregular after the Wenchuan earthquake, and this percentage was significantly higher than before the earthquake (6%, pu200a<u200a0.05). About 30% of the surviving women with a high degree of loss in the earthquake reported menstrual irregularity after the earthquake. Association analyses showed that some stressors of the Wenchuan earthquake were strongly associated with self-reports of menstrual irregularity, including the loss of children (RR: 1.58; 95% CI: 1.09, 2.28), large amounts of property (RR: 1.49; 95% CI: 1.03, 2.15), social resources (RR: 1.34; 95% CI: 1.00, 1.80) and the hormonal contraception use (RR: 1.62; 95% CI: 1.21, 1.83). Conclusions.u2003Self-reported menstrual irregularity is common in women that survived the Wenchuan earthquake, especially in those who lost children, large amounts of property and social resources.

Effect of gonadotropin-releasing hormone antagonists on intrauterine insemination cycles in women with polycystic ovary syndrome: a meta-analysis

Abstract Polycystic ovary syndrome (PCOS) patients undergoing controlled ovarian stimulation and intrauterine insemination (COS/IUI) often face the risk of premature luteinization, which may result in lower pregnancy rate and higher miscarriage rate. This review was performed to identify if adjuvant treatment with GnRH antagonist (GnRH-ant) could effectively improve the clinical outcome of patients with PCOS undergoing COS/IUI. A literature search was conducted on the PubMed, EMBASE and Cochrane library databases. Two randomized controlled trials were included in this review, enrolling a total of 333 cycles. The patients who received GnRH-ant treatment had lower progesterone levels on the hCG day and a reduced premature luteinization rate. However, the rates of live birth, clinical pregnancy and miscarriage did not significantly differ between the GnRH-ant supplementation group and control group. In conclusion, although the existing randomized controlled trials indicate that GnRH-ant can effectively decrease the premature luteinizaton rate, evidence to support its use to improve clinical pregnancy outcomes in PCOS patients undergoing COS/IUI treatment is insufficient.