Embryonic development in human oocytes fertilized by split insemination

OBJECTIVE: To compare the laboratory outcomes of intracytoplasmic sperm injection (ICSI) and conventional insemination using sibling oocytes in poor prognosis IVF cycles where ICSI is not indicated. METHODS: Couples undergoing IVF with following conditions were enrolled: history of more than 3 years of unexplained infertility, history of > or =3 failed intrauterine insemination, leukocytospermia or wide variation in semen analysis, poor oocyte quality, or > or =50% of embryos had poor quality in previous IVF cycle(s). Couples with severe male factor requiring ICSI were excluded. Oocytes were randomly assigned to the conventional insemination (conventional group) or ICSI (ICSI group). Fertilization rate (FR), total fertilization failure, and embryonic development at day 3 and day 5 were assessed. RESULTS: A total of 309 mature oocytes from 37 IVF cycles (32 couples) were obtained: 161 were assigned to conventional group and 148 to ICSI group. FR was significantly higher in the ICSI group compared to the conventional group (90.5% vs. 72.7%, P<0.001). Total fertilization failure occurred in only one cycle in conventional group. On day 3, the percentage of cleavage stage embryos was higher in ICSI group however the difference was marginally significant (P=0.055). In 11 cycles in which day 5 culture was attempted, the percentage of blastocyst (per cleaved embryo) was significantly higher in the ICSI group than the conventional group (55.9% vs. 25.9%, P=0.029). CONCLUSION: Higher FR and more blastocyst could be achieved by ICSI in specific circumstances. Fertilization method can be tailored accordingly to improve IVF outcomes.

Mature oocyte retrieval during laparotomic debulking surgery following random-start controlled ovarian stimulation for fertility preservation in a patient with suspected ovarian cancer

Herein, we report a case of successful mature oocyte retrieval during laparotomy after random-start controlled ovarian stimulation (COS) in a 21-year-old nulliparous woman with suspected recurrent ovarian immature teratoma. The patient had been diagnosed with stage IIIC immature teratoma two years earlier following a staging operation, including right oophorectomy and left ovarian cystectomy. And she had subsequently undergone four rounds of postoperative adjuvant chemotherapy with bleomycin, etoposide, and cisplatin. Approximately two years after the initial surgery, she was strongly suspected of having recurrent ovarian immature teratoma on radiologic follow-up. We performed random-start COS and in vivo oocyte retrieval during laparotomic debulking surgery including left oophorectomy. Eight mature oocytes were successfully retrieved and vitrified for fertility preservation. The final pathologic diagnosis was mature cystic teratoma of the ovary and peritoneal implants consistent with gliomatosis peritonei. This is the first case report in which random-start COS and in vivo oocyte retrieval were performed.

Obstetric outcomes after uterine myomectomy: Laparoscopic versus laparotomic approach

OBJECTIVE: To compare the pregnancy-related complications after laparoscopic and laparotomic uterine myomectomy. METHODS: A retrospective study of 415 women who received laparoscopic (n = 340) or laparotomic (n = 75) resection of uterine leiomyomas in one center. The mean follow-up period was 26.5 months in laparoscopic group and 23.9 months in laparotomic group. RESULTS: Fifty-four and 12 pregnancies occurred in laparoscopic and laparotomic myomectomy group, respectively. The major obstetric outcomes were similar between two groups. There was no ectopic pregnancy or preterm birth. There were two cases of obstetric complication in laparoscopic group only; one experienced neonatal death and postpartum hemorrhage due to placental abruption and the other underwent subtotal hysterectomy due to uterine dehiscence identified during Cesarean section. CONCLUSION: Uterine rupture or dehiscence after laparoscopic myomectomy occurred in 3.7% (2/54) which lead to unfavorable outcome. Appropriate selection of patients and secure suture techniques appears to be important for laparotomic myomectomy in reproductive-aged women.

The Effects of Platelet-Derived Growth Factor-BB on the Expression of Bone Matrix Protein in the MC3T3-E1 Cells / 대한치주과학회지

Bone remodeling results from the combined process of bone resorption and new bone formation which is regulated in part by some of the polypeptide growth factors such as platelet derived growth factor(PDGF), which has been known to be an important local regulator of bone cell activity and participate in normal bone remodeling. This process includes strictly regulated gene expression of several bone matrix proteins such as type I collagen and osteopontin, a 44 kDa phosphorylated glycoprotein, which has important roles in bone formation. The purpose of this study is to evaluate the effecs of PDGF-BB on the mRNA expression of bone matrix protein, type I collagen and osteopontin, in MC3T3-E1 cell culture. Cells were seeded at 5x10(5) cells in 10 ml of minimum essential medium alpha(alpha-MEM) containig 10% fetal bovine serum, 10 mM beta glycerophosphate. 0.1, 1, 10 ng/ml PDGF-BB were added to the cells for the day 3, 7, 14, 21, 28 and cultured for 24 hours. Type I collagen cDNA, Hf677, and osteopontin cDNA were used as probes for northern blot analysis. Total cellular RNA was purified at indicated day and northern blot analysis was performed. The results were as follows: Type I collagen mRNA expressions were higher at the day 3 and 7, and lower in the day 14, 21 in the control groups. In the experimental groups, mRNA expressions were increased when 0.1 ng/ml PDGF-BB were added on the day 3, 7, 21, and decreased in dose-dependent manner on the day 14, decreased at all added dose on the day 28. Osteopontin mRNA expressions were highest in the day 21 groups and lowest in the day 14 groups in the control groups. Interesting results were shown in the day 14 and 21 groups. We found that osteopontin mRNA level was increased in dose dependent manner in the day 14 groups, and decreased dose dependent manner in the day 21 groups. In conclusion, PDGF-BB may have various control effects on type I mRNA expression in the growth and differentiation process of MC3T3-E1 cells and may have contrary regulatory effects on osteopontin mRNA expression. For examples, when the baseline level of osteopontin mRNA was low, as in the day 14, PDGF-BB up-regulated osteopontin mRNA expression in dose dependent manner, and when the baseline level was high as in the day 21, PDGF-BB down-regulated dose dependent manner. Thus, it may be useful for clinical application in periodontal regeneration procedure if further study were performed.