Blastocyst euploidy and implantation rates in a young (<35 years) and old (≥35 years) presumed fertile and infertile patient population.

OBJECTIVE: To examine the relationship between blastocyst euploidy and implantation rates in a presumed fertile patient population. DESIGN: Retrospective analysis. SETTING: Private IVF clinic. PATIENT(S): IVF patients undergoing comprehensive chromosome screening (CCS). INTERVENTION(S): Embryo biopsy at the blastocyst stage with preimplantation genetic screening using CCS. MAIN OUTCOME MEASURE(S): Euploidy, chemical pregnancy, and implantation rates. RESULT(S): There was no significant difference in the number of euploid blastocysts between presumed fertile (68/118, 57.6%) and infertile (75/132, 56.8%) patients<35 years old. Likewise, there was no significant difference in the number of euploid blastocysts between presumed fertile (42/86, 48.8%) and infertile (97/206, 47.1%) patients≥35 years old. When those same patients underwent a corresponding frozen embryo transfer cycle, presumed fertile patients demonstrated a significantly higher chemical pregnancy rate when compared with infertile patients, 28/33 (84.8%) and 50/81 (61.7%), respectively. Moreover, presumed fertile patients exhibited significantly higher implantation rates compared with infertile patients, 36/42 (85.7%) and 54/109 (66.7%), respectively. CONCLUSION(S): When subdivided by maternal age, no significant difference was seen in blastocyst euploidy rates between presumed fertile and infertile patients; however, chemical pregnancy and implantation rates were significantly higher in a presumed fertile patient population even when transferring only euploid blastocysts. This would indicate that infertility, as a disease, may encompass other aspects such as uterine or other unknown embryological factors that can influence outcomes.

Comparison of aneuploidy, pregnancy and live birth rates between day 5 and day 6 blastocysts.

Comprehensive chromosome screening is typically used for aneuploidy analysis of blastocysts. It is believed that either day of blastocyst development is acceptable. Euploidy rates and outcomes were examined between day 5 and day 6 blastocysts in two studies. First, euploidy rates of day 5 and day 6 blastocysts were examined on a per-embryo and per-patient basis. Second, outcomes were compared when only euploid day 5 or day 6 blastocysts were transferred in a cryopreserved embryo transfer cycle. In cycles (n = 70) that had blastocysts biopsied on both day 5 and day 6, day 5 blastocysts had a higher chance of being euploid than day 6 blastocysts (125/229 [54.6%]) and (77/180 [42.8%]), respectively (P = 0.0231). Similarly, euploid rates in blastocysts from patients (n = 193) with day 5 biopsy, day 6 biopsy, or both, were significantly higher in day 5 (235/421 [55.8%]) compared with day 6 (184/413 [44.6%]) blastocysts (P = 0.0014). In the second study, 50 women (36.1 ± 4.3 years) and 39 women (35.1 ± 3.8 years) with only euploid day 5 or euploid day 6 blastocysts transferred during a cryopreserved embryo transfer had similar cycle outcomes. Although underpowered, these data suggest that euploid day 6 blastocysts are as capable of positive outcomes as their euploid day 5 counterparts.

The origin, mechanisms, incidence and clinical consequences of chromosomal mosaicism in humans.

BACKGROUND: Chromosomal mosaicism, the presence of two or more distinct cell lines, is prevalent throughout human pre- and post-implantation development and can lead to genetic abnormalities, miscarriages, stillbirths or live births. Due to the prevalence and significance of mosaicism in the human species, it is important to understand the origins, mechanisms and incidence of mosaicism throughout development. METHODS: Literature searches were conducted utilizing Pubmed, with emphasis on human pre- and post-implantation mosaicism. RESULTS: Mosaicism persists in two separate forms: general and confined. General mosaicism is routine during human embryonic growth as detected by preimplantation genetic screening at either the cleavage or blastocyst stage, leading to mosaicism within both the placenta and fetus proper. Confined mosaicism has been reported in the brain, gonads and placenta, amongst other places. Mosaicism is derived from a variety of mechanisms including chromosome non-disjunction, anaphase lagging or endoreplication. Anaphase lagging has been implicated as the main process by which mosaicism arises in the preimplantation embryo. Furthermore, mosaicism can be caused by any one of numerous factors from paternal, maternal or exogenous factors such as culture media or possibly controlled ovarian hyperstimulation during in vitro fertilization (IVF). Mosaicism has been reported in as high as 70 and 90% of cleavage- and blastocyst-stage embryos derived from IVF, respectively. CONCLUSIONS: The clinical consequences of mosaicism depend on which chromosome is involved, and when and where an error occurs. Mitotic rescue of a meiotic error or a very early mitotic error will typically lead to general mosaicism while a mitotic error at a specific cell lineage point typically leads to confined mosaicism. The clinical consequences of mosaicism are dependent on numerous aspects, with the consequences being unique for each event.

Laser deposited coatings of Co-Cr-Mo onto Ti-6Al-4V and SS316L substrates for biomedical applications.

Functionally gradient bio-coating material was built by laser deposition. Co-Cr-Mo material was deposited on a Ti-6Al-4V substrate transitioning from 0% to 100%. Control over the cooling rate is shown to be a key to reduce the effects of thermal expansion differences of the materials. The microstructures and composition of the functionally gradient material (FGM) were characterized using an optical microscope, SEM, EDS, and XRD. EDS results showed a gradual transition to 50% Co-Cr-Mo and ∼100% Co-Cr-Mo on the top layer. XRD analysis showed the absence of a brittle intermetallic phase that forms between Titanium and Cobalt. As the amount of Co-Cr-Mo increased, the microhardness of the FGM samples significantly increased. A comparison was made between Co-Cr-Mo deposited on SS316L substrates as well as Ti-6Al-4V. The bonding strength of the coatings on both substrates was tested and found to meet the ASTM standard requirement.

Cardiac resynchronization therapy may improve symptoms of congestive heart failure in patients without electrical or mechanical dyssynchrony.

AIMS: Cardiac resynchronization therapy (CRT) has reportedly not been effective in the absence of electrical or mechanical dyssynchrony. We present six patients with severe left ventricular (LV) dilation, mitral regurgitation (MR), and non-ischaemic cardiomyopathy who underwent CRT. We assessed the effects of CRT on LV ejection fraction (EF), LV dimensions, mitral valve regurgitant fraction (RF), pulmonary arterial pressures (PAP), and serum levels of B-natriuretic peptide (BNP). METHODS AND RESULTS: All patients had severe LV dilation (>/=6.8 cm) and no electrical or mechanical dyssynchrony. All patients underwent CRT-D (with defibrillator) without complications. Average echocardiographic follow-up was 4.6 months. Mean LVEF increased significantly from 20.8 +/- 3.4 to 28.3 +/- 2.9% after CRT (P < 0.01). Mean LV end-diastolic dimension decreased significantly from 6.9 +/- 0.15 to 6.45 +/- 0.33 cm after CRT (P = 0.03); mean BNP serum level decreased from 1738 +/- 526 to 1040 +/- 768 pg/mL (P = 0.07). Baseline RF decreased from 45 +/- 12.2 to 20 +/- 10.9% after CRT-D (P = 0.009). Mean PAP decreased from 48.5 +/- 5.8 to 42.6 +/- 5.2 (P = 0.03). In five patients, New York Heart Association class symptoms improved by at least one level. No patients required assist devices or transplantation. One patient was hospitalized during follow-up. CONCLUSION: We describe six patients with severe LV dilation without evidence of electrical or mechanical dyssynchrony who improved with CRT, possibly due to improvement in MR.

Successful in vitro fertilization with anonymous donor oocytes in a patient with recurrent massive hemoperitoneum following spontaneous and induced ovulation.

OBJECTIVE: To report a case of severe von Willebrand's disease treated with in vitro fertilization using donor oocytes. DESIGN: Case report and literature review. SETTING: Private practice infertility center. PATIENT(S): Infertility patient with recurrent massive hemoperitoneum following spontaneous and induced ovulation. INTERVENTION(S): In vitro fertilization using donor oocytes. MAIN OUTCOME MEASURE(S): Successful term delivery. RESULTS(S): Delivery of healthy term singleton infant without maternal complication. CONCLUSION(S): The indications for in vitro fertilization using donor oocytes, while primarily for patients with medical/surgical menopause or genetic disorders, can be expanded to patients with contraindications for spontaneous or induced ovulation.