Is there an optimal timing interval between hCG trigger and oocyte vitrification?

OBJECTIVE: Oocyte vitrification has been developed as a promising alternative to slow freezing; however, the clinical outcome is highly operator dependent. From the past study, we know the timing of cryoprotectant exposure and understand that the intervals between the application of liquid nitrogen and thawing solution are crucial factors in the vitrification process. However, the optimal time intervals between hCG trigger and oocyte vitrification and equilibration remain unknown. This study aimed to evaluate the optimal intervals before and during modified vitrification. MATERIALS AND METHODS: This retrospective study included 66 patients undergoing vitrified-thawed oocyte cycles from June 2018 to May 2019. Oocyte in vitro maturation (IVM) is defined as the maturation in vitro of an immature oocyte collected using a standard pick up procedure. Oocytes were grouped into the following intervals: (1) human chorionic gonadotropin (hCG) trigger to oocyte vitrification (<38 h; 38-39 h; >39 h; IVM) (2) oocyte equilibration time (<10 min; 10-12 min; 12-15 min). The vitrification and warming procedures were performed following the steps as shown in the Cryotec method. RESULTS: A total of 390 mature oocytes were vitrified with the Cryotec method. The survival rates were not significantly different among the various intervals after the hCG trigger (97.59%; 95.54%; 100%); however, there was a trend of decreased survival rate in IVM group (66.67%). The oocyte survival rates were not significantly different among the various times of oocyte equilibration (96.77%; 97.33%; 95.42%). CONCLUSIONS: This was the first study to demonstrate no correlation between oocyte survival rate and the time intervals between hCG trigger and oocyte vitrification. Nor did the oocyte survival rate correlate with the various equilibration times during vitrification, as long as the oocyte was mature. In the future, large, prospective, randomized controlled studies will be required to confirm the clinical outcomes.

Detection of paternal origin of fetal de novo rea(21q;21q) down syndrome in a pregnancy of a young woman associated with an abnormal first-trimester maternal serum screening result.

OBJECTIVE: We present detection of paternal origin of fetal de novo rea(21q;21q) Down syndrome in a pregnancy of a young woman associated with an abnormal first-trimester maternal serum screening result. CASE REPORT: A 26-year-old, gravida 2, para 1, woman underwent amniocentesis at 17 weeks of gestation because of an abnormal first-trimester screening result of 1/139 risk of Down syndrome calculated by 3.109 multiples of the median (MoM) of maternal serum free ß-hCG and 0.454 MoM of pregnancy associated plasma protein-A (PAPP-A). Her husband was 29 years old, and the couple had a 1-year-old healthy daughter. Amniocentesis revealed a karyotype of 46,XX,+21,der(21;21)(q10;q10). The pregnancy was terminated at 19 weeks of gestation, and a malformed fetus was delivered. The parental karyotypes were normal. Postnatal analysis of the umbilical cord showed a karyotype of 46,XX,+21,der(21;21) (q10;q10). Polymorphic DNA marker analysis on the DNA extracted from parental bloods and umbilical cord confirmed a paternal origin of the de novo rea(21q;21q) Down syndrome. CONCLUSION: Prenatal diagnosis of de novo rea(21q;21q) Down syndrome should include a polymorphic DNA marker analysis of the parental origin, and the acquired information is useful for genetic counseling of the recurrence of unbalanced rea(21q;21q) offspring and the determination of low-level tissue mosaicism or gonadal mosaicism in one of the parents.

Amniotic Membrane Graft in the Management of Complex Vaginal Mesh Erosion.

Vaginal mesh erosion is a devastating complication after pelvic floor mesh surgery and it can be treated conservatively or with surgical revision. However, the management options following a failed primary revision or complex vaginal erosions are very limited. The aim of this study is to describe a novel treatment using an amniotic membrane as an inlay graft for such patients. Eight patients who failed conservative or primary surgical revision were enrolled. The complex erosions included vaginal agglutination, multiple vaginal erosions, recurrent erosions, and mesh cutting through the urethra. We used an amniotic membrane as a graft to cover the vaginal defect after partial excision of the mesh erosion and we describe the technique in this study. There were no intraoperative complications and none of the patients reported any further symptoms at a mean of 27 months follow-up. Only one patient had recurrent erosion, however, the erosion size was narrower and was subsequently successfully repaired. No further vaginal mesh erosions were noted in the other patients who all had good functional recovery. The use of an amniotic graft can be an economic and alternative method in the management of complex vaginal mesh erosions.