Measurement of endometrial and uterine vascularity by transvaginal ultrasonography in predicting pregnancy outcome during frozen-thawed embryo transfer cycles.

AIM: An appropriate endometrial condition and vascular supply are usually considered essential for implantation of an embryo. This study was performed to assess the role of endometrial and uterine vascularity status measurement in predicting pregnancy outcome during frozen-thawed embryo transfer cycles. MATERIAL AND METHODS: A total of 70 infertile women were recruited with controlled ovarian stimulation followed by oocyte retrieval. After in vitro fertilization or intracytoplasmic sperm injection, embryos were cultured to blastocysts and blastocysts with good quality were selected for cryopreservation. After endometrial preparation, vitrified blastocysts were thawed and assisted hatching by zona dissection was performed. On the day of embryo transfer, endometrial thickness (EMT), resistance index (RI) and pulsatility index (PI) of sub-endometrial artery (SEA) and uterine artery (UA) were obtained by transvaginal sonography. The women were divided into the pregnant and non-pregnant groups, and these variables were compared between the two groups. RESULTS: Patients' general demographic characteristics were not statistically different between the pregnant and non-pregnant groups. The overall implantation rate, clinical pregnancy rate, and ongoing pregnancy rate were 31.1%, 41.4% and 28.6%, respectively. Twenty-nine patients who conceived had average EMT, RI of SEA, PI of SEA, RI of UA, and PI of UA values of 9.15 mm, 0.91, 2.42, 0.95, and 3.37, respectively. Forty-one patients who did not conceive had average EMT, RI of SEA, PI of SEA, RI of UA, and PI of UA values of 9.31 mm, 1.01, 2.56, 0.94, and 3.00, respectively. In the two groups, none of the variables was statistically different (P > 0.05). CONCLUSIONS: EMT and blood flow index of endometrium and uterus measured by transvaginal sonography are not an effective predictor of pregnancy outcome in frozen-thawed embryo transfer cycles.

Identification of biomarkers for endometriosis in plasma from patients with endometriosis using a proteomics approach.

The present study aimed to examine potential biomarkers for the diagnosis of endometriosis. A plasma-based proteomic approach, including 2-dimentional electrophoresis and mass spectrometry, was used. Samples were obtained from patients with (n=15) and without (n=15) endometriosis, or from mice with surgically induced endometriosis. Seven spots corresponding to six differentially expressed proteins were identified in the human plasma samples. However, only haptoglobin (Hp) was identified to be significantly decreased in the plasma levels of patients with endometriosis (P<0.05) and in mice with surgically induced endometriosis (P<0.05). The results demonstrated that Hp was downregulated in females with endometriosis, and it therefore, may be a useful diagnostic tool as a biomarker of endometriosis.

The effect of long zona dissection using ICSI pipettes for mechanical assisted hatching in vitrified-thawed blastocyst transfers.

OBJECTIVE: To investigate the effect of long zona dissection (LZD) compared with partial zona dissection (PZD) using ICSI pipettes for mechanical assisted hatching (AH) in vitrified-thawed blastocyst transfers. DESIGN: Prospective study. SETTING: University IVF clinic. PATIENT(S): A total of 120 women ≦ 38 years old undergone vitrified-thawed blastocyst transfers with LZD or PZD. INTERVENTION(S): The culture of all pronucleate embryos to the blastocyst stage and the selection of blastocysts ≧ grade 3BB (Gardner and Schoolcraft score), followed by vitrified-thawed blastocyst transfers with LZD (n = 60) or with PZD (n = 60) MAIN OUTCOME MEASURE(S): Complete hatching rates, implantation rates, pregnancy rates. RESULT(S): At 5 h after thawing, complete hatching rates of blastocysts were significantly higher in LZD group compared with PZD group, 52.4 % vs. 31.8 % (P = 0.001). Implantation and clinical pregnancy rates were significantly higher in LZD group compared with PZD group, 40.9 % vs. 25.7 % and 63.0 % vs. 40.0 %, respectively (P = 0.010, P = 0.011). CONCLUSION(S): LZD using ICSI pipettes for mechanical AH improves significantly complete hatching, implantation and pregnancy rates in vitrified-thawed blastocyst transfers.

Preliminary clinical outcome of novel strategy for the maximization of cumulative pregnancy rates per retrieval in normal responders.

OBJECTIVE: We devised a novel strategy, a GnRH antagonist protocol with a GnRH agonist trigger followed by frozen-thawed blastocyst transfers with long zona dissection (LZD). The purpose of this study was to investigate the clinical outcomes of this new strategy according to age. METHODS: Ninety women aged less than 35 (group A) and 32 women aged 35 to 39 (group B) underwent the GnRH antagonist protocol with a GnRH agonist trigger in order to obtain many oocytes and prevent early-onset ovarian hyperstimulation syndrome (OHSS). All oocytes were cultured to the blastocyst stage and all blastocysts grade 3BB or better were cryopreserved. Embryo transfers were only performed in freeze-thaw cycles to prevent late-onset OHSS and to overcome embryo-endometrium dyssynchrony. LZD was performed just after thawing to improve hatching and implantation rates. RESULTS: The average numbers of retrieved oocytes and blastocysts grade 3BB or better were 12.8±5.5 and 4.4±2.6 in group A and 10.9±7.4 and 2.5±2.2 in group B, respectively, and OHSS did not occur in any of the women. Implantation rates were 46.7% in group A and 39.3% in group B. Cumulative clinical pregnancy rates per retrieval were 77.8% in group A and 62.5% in group B. Cumulative ongoing pregnancy rates per retrieval were 71.1% in group A and 53.1% in group B. CONCLUSION: GnRH antagonist protocol with GnRH agonist trigger followed by frozen-thawed blastocyst transfers with LZD can generate many blastocysts without OHSS and maximize cumulative pregnancy rates per retrieval. This strategy is more effective in young women aged less than 35 than in women aged 35 to 39.

Administration of visfatin during superovulation improves developmental competency of oocytes and fertility potential in aged female mice.

OBJECTIVE: To examine whether visfatin administration during superovulation improves ovarian response, developmental competence of oocytes, and fertility in aged female mice. DESIGN: Controlled experimental study. SETTING: University hospital. ANIMAL(S): Two groups of differently aged C57BL female mice (6-11 and 26-31 weeks). INTERVENTION(S): Female mice were coinjected intraperitoneally with 5 IU pregnant mare's serum gonadotropin (PMSG) and visfatin of various doses (0-500 ng/mL), followed by 5 IU human chorionic gonadotropin (hCG) injection 48 hours later. Then the mice were immediately mated with an individual male. After 18 hours zygotes were cultured, and expression of ovarian visfatin and vascular endothelial growth factor (VEGF) was examined. Potential pregnancies of visfatin-administered aged female mice were monitored for delivery of offspring. MAIN OUTCOME MEASURE(S): Number of zygotes retrieved, embryo developmental competency, fertility potential, ovarian visfatin and VEGF expression. RESULT(S): Ovarian visfatin expression was significantly decreased in the aged mice group compared with the young. Visfatin administration significantly increased embryo developmental rate and ovarian visfatin and VEGF expressions in the aged mice. Visfatin-administered aged mice delivered significantly higher numbers of offspring than controls. CONCLUSION(S): This study suggests that visfatin administration during superovulation plays an important role in regulating oocyte quality and can improve oocyte quality and fertility of aged female mice.

Case series of mycobacterium abscessus infections associated with a trigger point injection and epidural block at a rural clinic.

OBJECTIVES: The aim of this report is to investigate Mycobacterium abscessus infections at a rural clinic and carry out a surveillance program to determine the extent and source of these infections. METHODS: The authors conducted an active surveillance investigation of 36 patients who had visited the clinic since 1 July 2008. Clinical specimens were collected from the patients and an envirnmental investigation. Pulsed-field gel elctrophoresis (PFGE) was performed for comparing with M. abscessus isolates from the patients. RESULTS: Six specimens were obtained from the 6 patients respectively and 22 environmental samples were obtained. M. abscessus was isolated from the wounds of two patients, and various nosocomial pathogens, but not M. abscessus, were isolated from the surrounding environment. Two strains of M. abscessus from patients were identical as a result of PFGE. CONCLUSION: Infection control education including proper hand hygiene should be emphasized for physicians performing invasive procedures. There also needs to be more attention for invasive procedures management, including trigger point injection and epidural block in rural clinics.