scholarly journals Effectiveness of Cryopreservation in Patients of Young Reproductive Age with the Risk of Ovarian Hyperstimulation, "Thin" Endometrium and Previous IVF Failures

2021 ◽  
Vol 11 (4) ◽  
pp. 538-542
Author(s):  
Natalia Protopopova ◽  
Kseniia Krylova ◽  
Elena Druzhinina ◽  
N Boldonova ◽  
Albina Labygina ◽  
...  

The article provides an analysis of clinical, anamnestic and laboratory parameters for patients of young reproductive age who participated in IVF programs and have cryopreserved embryos. The main reasons for embryo cryopreservation were prevention of OHSS, "thin" endometrium and "previous IVF failures." It has been found that the patients from the group of transfer cancellation due to prevention of ovarian hyperstimulation had a higher ovarian reserve, a larger number of eggs, fresh and frozen embryos, and shorter shelf life of frozen embryos. All embryos were of the best quality (corresponding to the day of cultivation); the “post-thaw cultivation” technique was applied. During stimulation, lower amounts of gonadotropins were used. Patients with thin endometrium and previous IVF failures demonstrated slow growth of follicles, which required a higher course dose of gonadotropins with the addition of LH-containing preparations. Regardless of the group, in most cases, frozen/thawed embryos were transferred at the blastocyst stage (Day 5). The pregnancy rate was high in patients at risk of OHSS and with thin endometrium (48.6%, 48.0%). Patients with IVF failures had a lower pregnancy rate; this is due to endometrial pathology in the medical history, a smaller number of antral follicles, oocytes, fresh and frozen embryos, and longer shelf life of frozen embryos.

2018 ◽  
Vol 30 (1) ◽  
pp. 181
Author(s):  
S. Khunmanee ◽  
J. Suwimonteerabutr ◽  
M. Techakumphu ◽  
T. Swangchan-Uthai

Assisted reproductive technologies including superovulation, laparoscopic AI (LAI), and embryo transfer (ET) are important tools for genetic improvement in the sheep industry. The present study aimed to determine the effects of embryo stage and cryopreservation method on field trial outcomes of embryo transfer on small-scale farms in Thailand. Black Dorper ewes (n = 16) were used as donors and mixed breed ewes (n = 21) were used as recipients. Donors were superovulated as previously described (Tríbulo et al. 2012 Theriogenology 77, 1679-1685, 10.1016/j.theriogenology.2011.12.013) and inseminated by LAI within 22 to 24 h after standing heat (Day 0). Donors females were flushed on Day 2 to recover 2- to 8-cell embryos (n = 8) or on Day 6 to recover blastocyst-stage embryos (n = 8). Recovered embryos were randomly cryopreserved by either slow freezing or vitrification methods. Into 21 recipients was inserted an intravaginal device impregnated with CIDR® that was left in place for 10 days. Those received 300 IU of pregnant mare serum gonadotropin (PMSG) on Day 9 and randomly assigned to receive embryos on either Day 2 or 6 after oestrus. Two- to 8-cell embryos were thawed and transferred into the ipsilateral oviduct (n = 1-5 embryos/recipient) on Day 2. Five recipients received 15 slow-frozen embryos and 5 received 13 vitrified embryos. Blastocyst stage embryos were thawed and transferred into the ipsilateral uterine horn (n = 1-4 embryos/recipient) on Day 6. Five recipients received 11 slow-frozen embryos and 4 received 7 embryos. Pregnancy diagnosis was determined by ultrasonography 45 days after embryo transfer. Pregnancy rate was calculated as the proportion of ewes with at least one pregnancy out of the total number of ewes that received embryos. Chi-squared analysis was used to determine the effects of embryo freezing technique and embryo stage on pregnancy rate (SAS 9.2, SAS Institute Inc., Cary, NC, USA). All donor ewes responded to the superovulation program (donor had 3 to 6 corpora lutea). The mean number of viable embryos recovered was 4.3 ± 2.4 and 3.1 ± 3.7 for Day 2 and Day 6, respectively. Nineteen of the 21 recipient ewes responded to the synchronization program and received embryos in the study. There was no effect (P > 0.05) of embryo stage (5/10 = 50% v. 3/9 = 33.3% for 2- to 8-cell v. blastocyst, respectively) or cryopreservation method (4/10 = 40% v. 4/9 = 44.4% for slow-freezing and vitrification, respectively) on pregnancy rate following embryo transfer. Results of the present study suggest that similar pregnancy rates following embryo transfer in sheep under tropical conditions in Thailand can be obtained using either 2- to 8-cell embryos or blastocyst-stage embryos and with embryos that have been cryopreserved by slow-freezing or vitrification. Further research with larger numbers of animals is necessary to confirm the preliminary results of the present study.


Intraduction: Ovarian hyperstimulation syndrome (OHSS) is very serius complication of in vitro fertilisation (IVF) treatments. Human chorionic gonadotrophine (hCG) is the trigger factor of the syndrome. Gonadotrophine releasing hormone agonist (GnRHa) can use instead of hCG for triggering the ovulation. Matherial and Methods: This study aims to evaluate the effects of ovulation triggering with Gonadotrophine Releasing Hormone Agonists (GnRHa) on ovarian hyperstimulation syndrome (OHSS) rates and pregnancy success in patients at risk of OHSS. 51 cycles were evaluated in 50 women. Gonadotrophine (Gn) was applied to all patients with a flexible GnRHa protocol. To trigger ovulation, 0.2 mg triptorelin was applied when the estradiol level was 3500-7000 pg/mL and/or when at least 18 follicles were determined at ≥10mm. Oocyte Pick-Up (OPU) was performed 35 hours after the triptorelin injection. Within 1 hour of OPU, luteal support with 1500 IU hCG was administered to the patients and on the night of OPU, vaginal progesterone and oral estrogen were started. Results: OHSS was determined in 5 cycles (9.8%), and 4 of them (7.8%) were early OHSS. Embryo transfer was applied in 49 cycles. The pregnancy rate was determined as 44.9%, clinical pregnancy rate as 26.5%, continuing pregnancy rate as 24.4% and the abortus rate as 2%. Conclusion: GnRHa triggering applied before treatment to patients at risk of early OHSS does not completely eliminate the risk of OHSS. Nevertheless, this protocol improved treatment results without increasing the rates of severe OHSS.


2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
M. Cenariu ◽  
E. Pall ◽  
C. Cernea ◽  
I. Groza

The purpose of this research was to evaluate three embryo biopsy techniques used for preimplantation genetic diagnosis (PGD) in cattle and to recommend the least invasive one for current use, especially when PGD is followed by embryo cryopreservation. Three hundred bovine embryos were biopsied by either one of the needle, aspiration or microblade method, and then checked for viability by freezing/thawing and transplantation to recipient cows. The number of pregnancies obtained after the transfer of biopsied frozen/thawed embryos was assessed 30 days later using ultrasounds. The results were significantly different between the three biopsy methods: the pregnancy rate was of 57% in cows that received embryos biopsied by needle, 43% in cows that received embryos biopsied by aspiration, and 31% in cows that received embryos biopsied by microblade. Choosing an adequate biopsy method is therefore of great importance in embryos that will undergo subsequent cryopreservation, as it significantly influences their viability after thawing.


2019 ◽  
Vol 16 (1) ◽  
Author(s):  
Zahra Dehbashi ◽  
Shaheen Khazali ◽  
Fateme Davari Tanha ◽  
Farnaz Mottahedian ◽  
Mahsa Ghajarzadeh ◽  
...  

Abstract Background Endometriosis can exert obvious negative effects on women’s quality of life. Excisional surgery is among the most effective treatments for severe pelvic endometriosis. The prevalence of severe pelvic adhesions following a laparoscopic examination of severe endometriosis varies between 50 and 100%. Temporary intraoperative ovarian suspension is a method for the reduction of adhesions is in the treatment of severe pelvic endometriosis. Given the importance and the prevalence of endometriosis and its complications, we conducted the present study to determine more effective adhesion-reducing methods with a view to improving the quality of the treatments provided. Methods The present prospective double-blind randomized clinical trial was conducted on 50 women of reproductive age (≥ 19 years) diagnosed with severe pelvic endometriosis on transvaginal ultrasound scans and vaginal examinations at Yas Hospital between 2014 and 2017. Women with severe endometriosis (stage III, stage IV, and deep infiltrating endometriosis) requiring an extensive bilateral dissection of the pelvic walls and the rectovaginal space, with preserved uterus and ovaries, were included in the study. The preoperative severity of ovarian adhesions was assessed in terms of ovarian motility, measured through a combination of gentle pressures applied with the vaginal probe and abdominal pressures applied with the examiner’s free hand. A table of random numbers was used to choose which ovary to suspend. The entire study population received standard general anesthesia. In the laparoscopic examination of the cases with severe endometriosis, both ovaries were routinely suspended to the anterior abdominal wall with PROLENE sutures. At the end of the surgery, one of the ovaries was kept suspended for 7 days, whereas the other ovarian suspension suture was cut. At 3 months postoperatively, all the patients underwent ultrasound scans for the assessment of ovarian motility and adhesions. The severity of pelvic pain was defined according to a visual analog score. After surgery, infertile women were followed for 2-4 years, and were contacted regarding the infertility treatment. Chemical and clinical pregnancy rates was compered between the two groups. Results Three months after laparoscopy, the adhesions were mild in 41 (82%) patients and moderate in 9 (18%) on the suspended side, and mild in 12 (24%) patients and moderate in 38 (76%) on the control side (P < 0.001). The mean dysmenorrhea score was 6.8 ± 1.5 before surgery and 4.5 ± 1.4 after surgery (P < 0.001). The chemical pregnancy rate and clinical pregnancy rate were not different in the suspended and control groups (P = 0. 62, P = 0.64). Conclusions The reduction in adhesions via ovarian suspension surgery promises reductions in the complications of endometriosis.


2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
S Ojosnegros ◽  
A Seriola ◽  
E Aroca ◽  
A Godeau ◽  
D Denkova ◽  
...  

Abstract Study question Can globulin-rich compared to albumin (HSA) supplements improve blastulation and support embryo development towards post implantation? Summary answer Yes, globulin supplements with clinical-grade quality increase blastulation efficiency by 20% (50% in older mothers) and support the transition of embryos towards post-implantation development. What is known already During embryonic development at the morula stage there is a metabolic transition towards glycolysis as demand from outsourced energy increases. Therefore as cleavage proceeds, the demand for nutrients in the embryo increases accordingly. With few exceptions, HSA from human plasma or recombinant origin has been the main an only protein supplement used in almost all IVF-procedures. Globulin rich supplements are available but their use is not widespread and little is known about their efficiency in post-implantation development. Study design, size, duration We have cultured more than 600 mouse embryos in continuous media containing a protein supplement#1 (PS#1), from 1-cell up to blastocyst stage. At blastocyst stage embryos were replaced into fresh media containing protein supplement#2 (PS#2). The embryos were allowed to hatch naturally and then transferred into a proprietary matrix for further development and implantation for an additional 48h. Participants/materials, setting, methods: The blastulation rate, measured for HSA-supplemented embryo cohort was compared with embryos cultured in PS#1. Hatching efficiency was reported for embryos cultured in transfer media including PS#2. Once embedded in the matrix, advanced label-free imaging techniques and custom algorithms to measure matrix implantation strength were used. Key molecular markers (i.e. OCT4, CDX2) for correct post-implantation lineage patterning were documented by conventional 3D confocal immunofluorescence imaging. Main results and the role of chance Embryos supplemented with PS#1 reached blastocyst with overall 21% higher efficiency than embryos supplemented by HSA. When separated by age cohorts, embryos obtained from older females (ex-colony breeders, &gt;14 weeks old) reached blastocyst stage with 55% higher efficiency than the same type of embryos cultured in the presence of HSA. Embryos obtained from females at optimal reproductive age reached blastocyst stage 10% more efficiently under PS#1 supplementation than with HSA. Hatching efficiency was 45% higher for embryos cultured with PS#2 than embryos supplemented with HSA. For every variable tested (e.g.% of arrested or degenerated embryos) or condition implemented (e.g. mouse basal media, human basal media from different brands, etc.) PS#1 and PS#2 outperformed, without exception, the supplementation with HSA. When embedded in the implantation matrix, the embryos cultured with PS#1 (cleavage) and transferred to PS#2 at blastocyst stage showed a remarkable implantation ability as measured by trophoblast outgrowth and matrix deformations. The embryos in PS#2 medium exerted stronger force into the matrix and also survived longer times than the embryos in HSA. PS#2 supported the transition of blastocyst towards post-implantation stages of development showing the correct lineage patterning of embryonic and extraembryonic molecular markers, including Oct4, CDx2, EOMES or GATA4. Limitations, reasons for caution This is a study based on an animal model. These observations need to be confirmed by ongoing experiments with human embryos. Wider implications of the findings: This work constitutes a proof-of-concept for the use of globulin-rich supplements as higher performance substitute of albumin in the culture of IVF embryos, both as (i) a standard protein source for culture media and (ii) as a supplement for transfer media to capacitate the embryo for implantation. Trial registration number Not applicable


2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
K Banerjee ◽  
B Singla

Abstract Study question To assess the role of subcutaneous granulocyte colony-stimulating factor (G-CSF) in thin endometrium cases. Summary answer G CSF has beneficial role to improve the endometrium thickness in thin endometrium. What is known already Endometrium is very important for embryo implantation and the endometrial thickness is the marker of receptivity of the endometrium. Study design, size, duration Study design - Retrospective analysis Size - 88 infertile females with thin endometrium (&lt; 7 mm) in the age group of 23 to 40 years Duration - one year. Participants/materials, setting, methods In the group 1 of 44 females, subcutaneous infusion of G CSF (300 mcg/ml) was added along with other supplements and if lining was not more than 7 mm in 72 hours, then second infusion was given. In the group 2 of 44 females, only estradiol valerate and sildenafil were given.The efficacy of G CSF was evaluated by assessing the endometrium thickness before embryo transfer, pregnancy rates and clinical pregnancy rates. Main results and the role of chance There was no difference between the two groups regarding demographic variables, egg reserve, sperm parameters, number of embryos transferred and embryo quality. . The pregnancy rate was 60% (24 out of 40 cases) in the group 1 that was significantly higher than in-group 2 that was 31% (9 out of 29 cases) with p value &lt; 0.0001. The clinical pregnancy rate was also significantly higher in-group 1 (55%) as compared to group 2 (24%) with p value &lt; 0.0001. Limitations, reasons for caution Further larger cohort studies are required to explore the subcutaneous role of G CSF in thin endometrium. Wider implications of the findings: Granulocyte colony-stimulating factor has beneficial role to improve the endometrium thickness in thin endometrium. In most of previous studies, the intrauterine infusion of G CSF was given to improve the uterine lining. This is one of the few studies done that showed subcutaneous role of G CSF in thin endometrium. Trial registration number Not applicable


QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Ahmed Mohamed Nour El-Din Hashaad ◽  
Reda Mokhtar Kamal Ghanem ◽  
Sara Abouelfath Abouelasrar Gad Dawoud

Abstract Background Polycystic ovary syndrome (PCOS) is considered one of the most common endocrine disorders affecting females in their reproductive age. In PCOS, an imbalance between androgens, anti-Müllerian hormone (AMH) and follicle stimulating hormone (FSH), cause a halt of follicular growth. Insulin resistance (IR) is another important component of PCOS. There is increasing evidence that vitamin D affects insulin and glucose metabolism, Vitamin D plays a vital role in the regulation of glucose-insulin homeostasis. Objectives to assess the efficacy of vitamin D supplementation in improving ovulation induction in PCOS women (1ry outcome) and increasing pregnancy rate (secondary outcome). Patients and Methods 120 women diagnosed PCOS according to Rotterdam criteria and were resistant to CC treatment were randomly allocated into equal two groups: Group V: number of 60 patients received cholecalciferol + Metformin for 2 months. Group C: 60 patients received Metformin 2 months. After two months from the start:Both study groups started induction with Clomiphene Citrate added every month starting from the 3rd month to the 5th month (3 cycles of ovulation induction) in addition to previous drugs mentioned. Results In our study results, regulation of menstrual cycle occured in 63.6% of women who recieved vitamin D + metformin (group V) and ovulation was confirmed in 34.5% of the total number (55 women). Later, 18% of them got pregnant after 3 months of treatment. Added to that 16 women out of 39 (41%) got pregnant by the end of the follow up period with cumulative pregnancy rate (53%). On the other hand menstrual regularity in (group C: metformin) recorded 61% with ovulation percentage of 26.9% (n = 54). Followed by 14.8% pregnancy rate at the 3rd month., which increased to 27.5% by the end of the study out of 47.5% ovulated women (n = 40). Cumulative pregnancy rate 40%. Conclusion From the current study we can conclude that there is no significant difference of adding vitamin D to CC resistant PCOS regarding ovulation and pregnancy rates. However, it can augment metformin action and improves its outcome.


2004 ◽  
Vol 16 (2) ◽  
pp. 213 ◽  
Author(s):  
J. Small ◽  
M. Colazo ◽  
D. Ambrose ◽  
R. Mapletoft ◽  
J. Reeb ◽  
...  

The objective was to evaluate the effect of pLH treatment on pregnancy rates in recipients receiving in vivo- or in vitro-produced bovine embryos. Heifers (n=37) and lactating (n=28) and non-lactating (n=150) beef cows were treated at random stages of the cycle with 100μg GnRH i.m. (Cystorelin, Merial Canada Inc., Victoriaville, Quebec, Canada) on Day −9, 500μg cloprostenol i.m. (PGF; Estrumate, Schering Plough Animal Health, Pointe-Claire, Quebec, Canada) on Day —2 and GnRH on Day 0 (66h post-PGF; without estrus detection). Cattle were placed at random, by class, into three groups: no further treatment (Control; n=71), or 12.5mg pLH (Lutropin-V, Bioniche Animal Health, Belleville, Ontario, Canada) on Day 5 (n=72) or on Day 7 (n=72) after the second GnRH. On Day 7, cattle with a CL &gt;10mm in diameter (determined ultrasonically) received in vivo-produced, fresh (Simmental) or frozen (Holstein), or in vitro-produced frozen (Holstein) embryos (embryo type balanced among groups). Embryos were cryopreserved in 10% ethylene glycol; in vivo-produced frozen embryos were thawed 5 to 10s in air, 15s in a water-bath at 30°C and then “direct-transferred” nonsurgically. In vitro-produced frozen embryos (donated by IND Lifetech Inc., Delta, British Columbia, Canada) were thawed in a water-bath at 27°C for 10s and placed in ViGro Holding Plus medium (AB Technology, Pullman, WA, USA) at room temperature, evaluated and then transferred nonsurgically. Pregnancy was determined by ultrasonography on Day 35. Data were analyzed with CATMOD, chi-square and GLM procedures (SAS Institute, Cary, NC, USA.). Twenty cattle (9.3%) did not receive embryos; five heifers had cervical problems, and five heifers and 10 cows did not have a CL &gt;10mm. Overall, 7.1% of the recipients had two CL on the day of embryo transfer. There was no effect (P&gt;0.05) of treatment, embryo type (or interaction) or class of recipient on pregnancy rate (overall, 44.1%, 86/195; Table 1). Similarly, mean (±SD) CL diameter and luteal area did not differ (P&gt;0.05) among groups or between pregnant and open recipients (overall, 22.0±3.4mm and 352.0±108.7mm, respectively). However, recipients with a CL diameter ≥18mm tended (P&lt;0.1) to have a higher pregnancy rate (45.8 vs 25.0%). In a subset of 40 recipients examined ultrasonically on Day 12, 50% of those treated on Day 5 and 70% of those treated with pLH on Day 7 had two CL. In summary, overall pregnancy rate in GnRH-synchronized recipients receiving in vitro- or in vivo-produced embryos by nonsurgical transfer was 44.1%. Embryo survival to Day 35 was not affected by type of embryo or treatment with pLH 5 or 7 days after ovulation. Table 1 Pregnancy rate in recipients on Day 35 based on pLH treatment and embryo-type


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