Correlation between Morphologic Grading and Euploidy Rates of Blastocysts, and Clinical Outcomes in In Vitro Fertilization Preimplantation Genetic Screening

BACKGROUND: The standard morphological evaluation has been widely used for embryo selection, but it has limitations. This study aimed to investigate the correlation between morphologic grading and euploidy rate of in vitro fertilization (IVF) preimplantation genetic screening (PGS) and compare the pregnancy rates in young and old ages. METHODS: This is a retrospective study using the medical records of patients who underwent IVF procedures with PGS between January 2016 and February 2017 in a single center. The embryo grades were categorized into 4 groups: excellent, good, fair, and poor. Basic characteristics, euploidy rates, clinical pregnancy (CP) rates and ongoing pregnancy rates were analyzed. RESULTS: The excellent group had significantly higher rate of euploid embryos than fair group (47.82% vs. 29.33%; P = 0.023) and poor group (47.82% vs. 29.60%; P = 0.005). When the four groups were recategorized into two groups (excellent and good vs. fair and poor), they also showed significant difference in euploidy rates (44.52% vs. 29.53%; P = 0.002). When the patients were divided into two groups by age 35, the CP rates for those under and over 35 years old were 44.74% and 47.83%, respectively, which showed no significant difference. CONCLUSION: The significant differences among the euploidy rates of different morphologic embryo grades demonstrated the positive correlations between the morphologic grading of the embryo and the euploidy rate of PGS. Additionally, there was no significant difference between the younger and older patients' CP rates. These findings emphasize the fact that old age patients might benefit from PGS whatever the indication of PGS is.

Effect of Antifreeze Protein on Mouse Ovarian Tissue Cryopreservation and Transplantation

PURPOSE: To investigate the effect of antifreeze protein (AFP) supplementation on ovarian vitrification and transplantation. MATERIALS AND METHODS: In this experimental study, we researched a total of 182 ovaries from 4-week-old ICR mice. The equilibration solution included 20% ethylene glycol (EG), and the vitrification solution included 40% EG, 18% Ficoll, and 0.3 M sucrose. Intact ovaries were first suspended in 1 mL of equilibration solution for 10 min, and then mixed with 0.5 mL of vitrification solution for 5 min. Ovaries were randomly assigned to 3 groups and 0, 5, or 20 mg/mL of type III AFP was added into the vitrification solution (control, AFP5, and AFP20 groups, respectively). The vitrified ovaries were evaluated after warming and 2 weeks after autotransplantation. The main outcome measurements are follicular morphology and apoptosis assessed by histology and the TUNEL assay. RESULTS: A significantly higher intact follicle ratio was shown in the AFP treated groups (control, 28.9%; AFP5, 42.3%; and AFP20, 44.7%). The rate of apoptotic follicles was significantly lower in the AFP treated groups (control, 26.6%; AFP5, 18.7%; and AFP20, 12.6%). After transplantation of the vitrified-warmed ovaries, a significantly higher intact follicle ratio was shown in the AFP20 group. The rate of apoptotic follicles was similar among the groups. CONCLUSION: The results of the present study suggest that supplementing AFP in the vitrification solution has beneficial effects on the survival of ovarian tissue during cryopreservation and transplantation.

Efficacy of Random-start Controlled Ovarian Stimulation in Cancer Patients

This study aimed to evaluate the efficacy of random-start controlled ovarian stimulation (COS) in cancer patients for emergency fertility preservation. In this retrospective comparative study, 22 patients diagnosed with cancer and 44 infertile women undergoing conventional in vitro fertilization (IVF) were included. In cancer patients, ovarian stimulation was started on the day of referral, irrespective of their menstrual cycle date. The control group was selected by age matching among women undergoing conventional IVF. COS outcomes were compared between groups. The number of total and mature oocytes retrieved and the oocyte maturity rate were higher in the random-start group than in the conventional-start group. However, duration of ovarian stimulation was longer in the random-start group (11.4 vs. 10.3 days, P = 0.004). The addition of letrozole to lower the estradiol level during COS did not adversely affect total oocytes retrieved. However, oocyte maturity rate was lower in cycles with letrozole than in cycles without letrozole (71.6% vs. 58.2%, P = 0.019). Our study confirms the feasibility and effectiveness of random-start COS in cancer patients.

Efficacy of Random-start Controlled Ovarian Stimulation in Cancer Patients

This study aimed to evaluate the efficacy of random-start controlled ovarian stimulation (COS) in cancer patients for emergency fertility preservation. In this retrospective comparative study, 22 patients diagnosed with cancer and 44 infertile women undergoing conventional in vitro fertilization (IVF) were included. In cancer patients, ovarian stimulation was started on the day of referral, irrespective of their menstrual cycle date. The control group was selected by age matching among women undergoing conventional IVF. COS outcomes were compared between groups. The number of total and mature oocytes retrieved and the oocyte maturity rate were higher in the random-start group than in the conventional-start group. However, duration of ovarian stimulation was longer in the random-start group (11.4 vs. 10.3 days, P = 0.004). The addition of letrozole to lower the estradiol level during COS did not adversely affect total oocytes retrieved. However, oocyte maturity rate was lower in cycles with letrozole than in cycles without letrozole (71.6% vs. 58.2%, P = 0.019). Our study confirms the feasibility and effectiveness of random-start COS in cancer patients.

Feasibility of Oxaliplatin, Leucovorin, and 5-Fluorouracil (FOLFOX-4) Chemotherapy in Heavily Pretreated Patients with Recurrent Epithelial Ovarian Cancer / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The purpose of this study is to evaluate the efficacy and toxicity of oxaliplatin, leucovorin, and 5-fluorouracil (FOLFOX-4) chemotherapy in heavily pretreated patients with recurrent epithelial ovarian cancer (EOC). MATERIALS AND METHODS: Clinical data were reviewed in 28 patients who received FOLFOX-4 as more than the second-line chemotherapy, consisting of 85 mg/m2 of oxaliplatin as a 2-hour infusion, 200 mg/m2 of leucovorin as a 2-hour infusion, and bolus 400 mg/m2 on day 1, followed by a 22-hour infusion of 600 mg/m2 of 5-fluorouracil for two consecutive days every three weeks. In addition, its efficacy and toxicity were compared with those reported in in three previous relevant studies. RESULTS: A total of 128 cycles of FOLFOX-4 were administered with the median number of five cycles (range, 1 to 10 cycles). In nine patients with measurable disease, complete response (CR) and partial response (PR) were observed in 0 (0%) and two (22.2%) patients, whereas in 19 patients with non-measurable disease, CR and PR were observed in 0 (0%) and five (26.3%) patients. Among all patients, grade 3 anemia, neutropenia, and thrombocytopenia were observed in two (7.1%), three (10.7%), and one (3.6%) patient, and grade 3 fatigue, nausea and vomiting, and peripheral neuropathy were observed in one (3.6%), two (7.1%), and three (10.7%) patients. In addition, median values of time to progressive disease and chemotherapy-specific survival were three months (range, 0 to 10 months) and nine months (range, 4 to 24 months). CONCLUSION: FOLFOX-4 is feasible as salvage chemotherapy with acceptable toxicity for heavily pretreated patients with recurrent EOC.

The Association among Serum Leptin System, Bone Biochemical Markers and Bone Mineral Density Before and After Hormone Therapy / 대한골다공증학회지

OBJECTIVES: To investigate the relationships between serum leptin, soluble leptin receptor (sLR) and bone mineral density (BMD) and bone biochemical markers and to evaluate association among these factors after hormone therapy (HT) in postmenopausal Korean women. METHODS: Serum leptin, sLR, biochemical markers, osteoprotegerin (OPG) and soluble receptor activator of NF-kB ligand (sRANKL) were measured by enzyme linked immunosorbent assay in 159 postmenopausal Korean women. The BMD at the lumbar spine (LS) and femoral neck (FN) was determined by dual energy X-ray absorptiometry, and changes of these factors were also measured in 70 postmenopausal women receiving HT. RESULTS: After adjustment for age and year since menopause, body mass index (BMI) was found to be significantly correlated with leptin (r=0.42, P25 kg/m2) were significantly higher than those in women with normal weight, whereas sLR levels were lower in the former women than in the latter women. After HT, serum leptin levels (P<0.005) and FLI (P<0.05) decreased significantly and decreased serum sLR levels (P<0.05) was found only in obese women. The percent changes in BMD at FN after HT were negatively correlated with the changes of sLR after HT. CONCLUSIONS: Circulating leptin system is not associated with BMD but BMI. Leptin and FLI decrease after HT and the changes of sLR reflects changes in BMD at FN after HT.

The Association between Single Nucleotide Polymorphisms of Sclerostin (SOST) Gene, Bone Mineral Density and Circulating Osteoprotegerin (OPG) / 대한골다공증학회지

OBJECTIVES: To investigate the relationship between polymorphisms of sclerostin (SOST) gene and bone mineral density (BMD) in postmenopausal Korean women. MATERIALS AND METHODS: The SOST rs865429 (g.5942C>T), rs17882143 (c.28G>A), rs10534024 (-1396TCC/Del) polymorphisms were analyzed by Taqman assay and direct DNA sequencing in 399 postmenopausal Korean women. Serum CrossLaps (CTX), bone alkaline phosphatase (BAP), osteocalcin, osteoprotegerin (OPG) and soluble receptor activator of NF-kB ligand (sRANKL) were measured by enzyme linked immunosorbent assay. The BMD at the lumbar spine (LS) and femoral neck (FN) were determined by dual energy X-ray absorptiometry, and in 311 postmenopausal women receiving hormone therapy (HT) BMD was also measured after HT of 1 year.

Oocyte Maturity in Relation to Woman's Age in In Vitro Fertilization Cycles Stimulated by Single Regimen

PURPOSE: During stimulated in vitro fertilization (IVF) cycle, up to 30% of the recovered oocytes are immature ones which have poor fertilization capacity; however, the precise influencing factors are largely unknown. Here, we analyzed the association of oocyte immaturity with woman's age in IVF cycles stimulated by single regimen. MATERIALS AND METHODS: A total of one-hundred ninety five IVF cycles stimulated by recombinant FSH and GnRH antagonist protocol between 2003 and 2009 were analyzed retrospectively. The mean age of women was 34.2+/-4.0 (26-45 years). After triggering by exogenous hCG, an ultrasound-guided retrieval of oocytes was performed 35-36 hours later. All clinical data were stratified by woman's age; group I: or =41 (n=19). RESULTS: The total retrieved oocytes, as well as immature oocytes, were significantly lower in group IV, however, the mean % of immature oocytes was significantly higher in group IV than other age groups. Oocyte immaturity tended to decrease as increasing age in women aged 40 years or less. CONCLUSION: In stimulated IVF cycle, much higher oocyte immaturity was noted in women aged 41 years or more.

Sperm nuclear DNA fragmentation and chromatin structure in one-day-old ejaculated sperm / 대한생식의학회지

OBJECTIVE: To evaluate sperm nuclear DNA fragmentation and chromatin structure after 18 hours'incubation at room temperature. METHODS: Twenty-eight male partners who participating IVF treatment were prospectively included in this study. Ejaculated sperm count and motility were assessed. The sperm was then immediately processed by the conventional swim-up method. After utilization of some of the sample for routine clinical use, the remainder of each of the samples was divided into two aliquots. One aliquot was immediately assessed for sperm nuclear DNA fragmentation (TUNEL assay) and chromatin structure (toluidine blue [TB] staining). The other aliquot was incubated at room temperature for 18 hours and then assessed by two methods. Only dark-TB sperms were considered as having abnormal chromatin structure. Data before and after extended incubation were compared using a paired Student's t-test. RESULTS: Before and after extended culture, nuclear DNA fragmentation assessed by TUNEL was 4.9+/-4.7% and 7.0+/-6.4%, respectively (p=0.008). The proportion of abnormal chromatin structure (dark-TB sperm) was 8.2+/-5.6% and 10.3+/-6.5% (p<0.001), before and after incubation, respectively. CONCLUSION: After 18 hours' incubation at room temperature, sperm nuclear DNA and chromatin structure were significantly affected. The IVF practitioner should bear this information in mind when performing delayed insemination, especially for in vitro maturation cycles.