Serum Anti-Mullerian hormone and embryo morphokinetics detecting by time-lapse imaging: a comparison between the polycystic ovarian syndrome and tubal factor infertility

Background: Anti-Mullerian hormone [AMH] is considered as a good marker for quantitative evaluation of ovarian response to the stimulation during assisted reproductive technology cycles

Objective: to evaluate the association between serum AMH level and embryo morphokinetics using time-lapse imaging and intracytoplasmic sperm injection [ICSI] outcomes in women with polycystic ovarian syndrome [PCOS]

Materials and Methods: we evaluated a total of 547 embryos from 100 women underwent ICSI cycles; 50 women with PCOS and 50 women with tubal factor infertility. Serum AMH level was measured in all participants. Time-laps records were annotated for time to pronuclear fading [tPNf], time to 2-8 cells [t2-t8], reverse cleavage, direct cleavage, and also for the presence of multinucleation

Results: AMH was negatively correlated with t5, t8, and the third cell cycle [p=0.02, p=0.02, and p=0.01; respectively] in PCOS group. AMH had no correlation with embryo kinetics in infertile women with tubal factor infertility. Moreover, AMH level is similar between embryos with and without direct cleavage as well as reverse cleavage and Multinucleation in both groups. The Receiver operating characteristic curves analyses indicated that AMH was not an accurate predictor of clinical pregnancy as well as a live birth [AUC=0.59 [95% CI, 0.42-0.76]] in PCOS women. However, in the women with tubal factor infertility AMH showed a fair prediction value for clinical pregnancy [AUC=0.64 [95% CI, 0.48-0.82]] along with the live birth [AUC=0.70 [95% CI, 0.55-0.85]]

Conclusion: some of the time-lapse embryo parameters may be related to the AMH concentration. However, AMH is not an accurate tool to predict the ICSI outcomes in PCOS women

Fresh versus frozen embryo transfer after gonadotropin-releasing hormone agonist trigger in gonadotropin-releasing hormone antagonist cycles among high responder women: a randomized, multi-center study

Background: The use of embryo cryopreservation excludes the possible detrimental effects of ovarian stimulation on the endometrium, and higher reproductive outcomes following this policy have been reported. Moreover, gonadotropin-releasing hormone agonist trigger in gonadotropin-releasing hormone [GnRH] antagonist cycles as a substitute for standard human chorionic gonadotropin trigger, minimizes the risk of ovarian hyperstimulation syndrome [OHSS] in fresh as well as frozen embryo transfer cycles [FET]

Objective: To compare the reproductive outcomes and risk of OHSS in fresh vs frozen embryo transfer in high responder patients, undergoing in vitro fertilization triggered with a bolus of GnRH agonist

Materials and Methods: In this randomized, multi-centre study, 121 women undergoing FET and 119 women undergoing fresh ET were investigated as regards clinical pregnancy as the primary outcome and the chemical pregnancy, live birth, OHSS development, and perinatal data as secondary outcomes

Results: There were no significant differences between FET and fresh groups regarding chemical [46.4% vs. 40.2%, p=0.352], clinical [35.8% vs. 38.3%, p=0.699], and ongoing [30.3% vs. 32.7%, p=0.700] pregnancy rates, also live birth [30.3% vs. 29.9%, p=0.953], perinatal outcomes, and OHSS development [35.6% vs. 42.9%, p=0.337]. No woman developed severe OHSS and no one required admission to hospital

Conclusion: Our findings suggest that GnRHa trigger followed by fresh transfer with modified luteal phase support in terms of a small human chorionic gonadotropin bolus is a good strategy to secure good live birth rates and a low risk of clinically relevant OHSS development in in vitro fertilization patients at risk of OHSS

Perinatal outcome in fresh versus frozen embryo transfer in ART cycles

Background: Despite of higher pregnancy rate after frozen embryo transfer [FET] which is accepted by the majority of researches, the safety of this method and its effect on neonatal outcome is still under debate

Objective: The aim of this study was to evaluate pregnancy and neonatal outcome of FET compare to fresh cycles

Materials and Methods: In this study,1134 patients using fresh ET and 285 women underwent FET were investigated regarding live birth as primary outcome and gestational age, birth weight, gender, multiple status, ectopic pregnancy, still birth and pregnancy loss as secondary outcomes

Results: Our results showed that there is no difference between FET and fresh cycles regarding live birth [65.6% vs. 70.4% respectively]. Ectopic pregnancy, still birth and abortion were similar in both groups. The mean gestational age was significantly lower among singletons in FET group compared to fresh cycles [p=0.047]. Prematurity was significantly elevated among singleton infants in FET group [19.6%] in comparison to neonates born after fresh ET [12.8%] [p=0.037]

Conclusion: It seems that there is no major difference regarding perinatal outcome between fresh and frozen embryo transfer. Although, live birth is slightly increased in fresh cycles and prematurity was significantly increased among singleton infants in FET group

First successful pregnancies following embryo selection using time-lapse technology in Iran: case report

Embryo selection is a vital part of in vitro fertilization [IVF] programs, with morphology-based grading systems having been widely used for decades. Time-lapse imaging combined with embryo morph kinetics may proffer a non-invasive means for improving embryo selection. We report the first ongoing and chemical pregnancies using Time-lapse embryo scope to select best embryos for transfer in Iran. A case with tubal factor infertility was admitted to IVF program with normozoospermia. After ovarian hyper stimulation, 6 COCs were retrieved and inseminated with 25,000 progressive sperms/oocyte. Five zygotes were placed individually into the micro wells of equilibrated embryo scope dish for Time-lapse observation, and incubated at 37 [Degree sign] C, 5% CO2. On day 3, single embryo transfer [SET] took place based on kinetic parameters of the embryos. Clinical pregnancy was confirmed 7 weeks after SET. The second case with history of previous ICSI failure was admitted with azoospermia. Nine MII oocytes underwent ICSI, and incubated in Time-lapse facilities. The rest of procedures were followed as described for case 1. Chemical pregnancy was confirmed 15 days after SET. This approach opens a way to select best embryo non-invasively for SET; thus, increasing implantation, while reducing multiple pregnancy complications

Characterization of mesenchymal stem cells from human dental pulp, preapical follicle and periodontal ligament

Human dental stem cells have high proliferative potential for self-renewal that is important to the regenerative capacity of the tissue. The aim was to isolate human dental pulp stem cells [DPSC], periodontal ligament stem cells [PDLSC] and periapical follicle stem cells [PAFSC] for their potential role in tissue regeneration. In this experimental study, the postnatal stem cells were isolated from dental pulp, preapical follicle and periodontal ligament .The cells were stained for different stem cell markers by immunocytochemistry. To investigate the mesenchymal nature of cells, differentiation potential along osteoblastic and adipogenic lineages and gene expression profile were performed. For proliferation potential assay, Brdu staining and growth curve tests were performed. Finally, all three cell types were compared together regarding their proliferation, differentiation and displaying phenotype. The isolated cell populations have similar fibroblastic like morphology and expressed all examined cell surface molecule markers. These cells were capable of differentiating into osteocyte with different capability and adipocyte with the same rate. PAFSCs showed more significant proliferation rate than others. Reverse transcriptase PCR [RT-PCR] for nanog, oct4, Alkaline phosphatase [ALP] and glyceraldehydes-3-phosphate dehydrogenease [GADPH] as control gene showed strong positive expression of these genes in all three isolated cell types. PDLSCs, DPSCs and PAFSCs exist in various tissues of the teeth and can use as a source of mesenchymal stem cells for developing bioengineered organs and also in craniomaxillofacial reconstruction with varying efficiency in differentiation and proliferation

Staged repair of giant recurrent omphalocele and gastroschesis "camel-litter method"-A new technique

The aim of this article is to present a new Technique of giant omphaloceles repair in neonatal period and also later in life in patients that the primary repair has been failed. From 1999 to 2006, seven consecutive children [male/female ratio 0.4] with giant omphalocele [n=6] and Gastroschesis [n=2] were underwent this new operation in our center. In this technique, there were two operations. The mean of hospital stay was 38 days [range, 23-42 days], and full enteral feeding was achieved on the 8 to 25 postoperative day [Mean, 14 day]. The final closure, in all patients was achieved between the 14 to 32 days after the first operation [Mean, 21 day]. Mechanical ventilation was necessary for the mean of 5 days [range, 2-8 days]. All patients are alive and have no complication due to the operation [1 month-7 years]. Giant omphalocele and Gastroschesis can be safely repaired. The placement of an intraperitoneal tissue expander and traction of abdominal muscles can create the needed space for closure in several weeks in patients with giant omphalocele/ Gastroschesis

Evaluating the role of first polar body morphology on rates of fertilization and embryo development in ICSI cycles

Recent studies have demonstrated that morphology of the first polar body [1st PB] is related to oocyte viability, which can be used as a prognostic tool to predict oocyte performance and pregnancy outcomes in an intracytoplasmic sperm injection [ICSI] program. According to some studies, there is a correlation between oocyte performance and 1st PB morphology, while others have not reported any correlation. The objective of this study is to evaluate the role of 1st PB morphology on rates of fertilization and embryo development in ICSI cases. In this prospective study morphological characteristics of 470 metaphase II [MII] oocytes were assessed in 80 ICSI cycles. The women were ages 21-42 years [mean 32.6 +/- 0.2]. Their oocytes were retrieved after a hyperstimulation protocol. After denudation, all oocytes were evaluated for 1st PB morphology. The oocytes were divided into two groups of A [normal 1st PB] and B [abnormal fragmented 1st PB]. In addition, other abnormalities, such as refractile bodies [RF], wide previtelline space [wPVS], central and general granulation, bull's eye, vacuole, smooth endoplasmic reticulum cluster [SERc], debris in PVS, shape and dark oocyte were checked. For verifying of fertilization, about 18-19 hours post-ICSI, oocytes were checked for two-pronuclear. Assessments of embryo quality, development and embryo transfer were done at day two. Chisquare, Fisher's exact and independent sample t tests were chosen for statistical analysis. Twenty-seven percent of oocytes had fragmented 1st PB, while the remainder was associated with other morphological abnormalities. A total of 46.1% and 26.9% of oocytes showed double and multiple defects, respectively. RF was the most common abnormality observed in group B. No significant differences in women's' ages between groups A and B were noted [p=0.3]. A total of 179 and 107 oocytes [61.5% vs. 59.8%] were fertilized in groups A and B, respectively [p=0.7]. The rates of good embryo formation for A and B groups were 66. 5% and 55. 6% [p=0.07], and cleavage rates were 77. 7% and 68.5%, respectively [p=0.09]. The data demonstrated that 1st PB morphology does not appear to be a prognostic factor for rates of fertilization and embryo development in ICSI cycles

relationship between seasonal variability and pregnancy rates in women undergoing assisted reproductive technique

Backgrownd: Studies in regions with seasonal climatic variations have revealed a correlation between human natural conception and birth rates. Holidays and other cultural activities probably have influence on conception, but the ambient temperature and emotional influences on the female hormones related to fertility may play an important part in the seasonal variation in conception

Objectives: The aim of study was to determine the relationship between the success rate of Assisted Reproductive Technique [ART] treatment cycles and temperature in different seasons

Materials and Methods: A retrospective study on all individuals undergoing assisted ART at our institution was performed during June 2000 to June 2001. The study population represented 258 IVF-ET cycles and 821 ICSI treatment cycles. Different variables were analyzed using jj test

Results: In IVF treatment cycles, conception was more common from early spring [March to June]. This decreased from spring, with the minimum in fall, 22% and 14%, respectably. A significant seasonal variability in the number of eggs, embryo transferred and sperm motility was not demonstrated [p>0.05], but sperm count was significantly higher in spring than any other season [72 +/- 4 xl0[6] and 52 +/- 7xl0[6], respectively]

Conclusion: The seasonal changes should be taken into account together with other factors when evaluating infertility data