生殖医学杂志最新文献

OBJECTIVE: To evaluate the correlation between em-bryo morphology and antepartum biomarker levels and obstetric outcomes following single embryo transfers (SETs).STUDY DESIGN: In vitro fertilization patients who delivered at the study site’s partnering hospital were included. Embryo morphology was compared to antepartum biomarkers and pregnancy outcomes.RESULTS: At a single academic reproductive endocrinology/infertility center, 2,882 SETs (day 3, 5, or 6) were performed from July 1, 2001, to June 30, 2013. Embryologic, serologic, and obstetric outcomes were available for 78 patients (cleavage [n=23]; blastocyst [n=55]). Embryos with a lower quality inner cell mass (ICM) demonstrated higher second trimester maternal serum alpha-fetoprotein (AFP) (p=0.0241) and AFP multiple of median (MoM) (p= 0.0036). After adjusting for age, body mass index, parity, and smoking status, this statistical significance remained (p=0.0319 for AFP; p=0.0026 for AFP MoM).CONCLUSION: Embryo morphokinetics did not correlate with perinatal outcome or a majority of placental biomarkers. A low ICM score was associated with higher second trimester maternal serum AFP values. This warrants further investigation, especially due to the risks of potential adverse obstetric outcomes associated with high AFP levels. Despite these findings, no difference in obstetric outcomes between low and high ICM scores was observed after controlling for maternal confounding variables. Patients should be reassured that embryo implantation, regardless of morphological score, results in similar obstetric outcomes.

OBJECTIVE: To determine if autologous endometrial cell coculture improves embryo development and clinical outcomes.STUDY DESIGN: Patients who met the inclusion criteria were randomized to either traditional in vitro fertilization (IVF) (control, n=73) or autologous endometrial cell coculture (AECC) (n=61). All patients underwent endometrial biopsy on cycle day 5–10 post luteinizing hormone surge. A total of 129 patients underwent embryo transfer (69 control, 60 AECC). Clinical outcomes as well as embryonic quality measures were then compared between the 2 groups.RESULTS: The mean age, day 3 follicle-stimulating hormone, number of oocytes collected, and clinical outcomes were similar between the 2 groups. Embryo development was overall similar, with the exception that embryonic grade was significantly better with AECC than with control: 1.5 (0.04) vs. 2.6 (0.03), p<0.0001. There was no difference in implantation, live birth or multiple gestation rates.CONCLUSION: This is one of the largest prospective randomized controlled trials of AECC versus traditional IVF. There was significant improvement in embryo morphology in the coculture group, although clinical outcomes were similar between the groups. Further studies are necessary to achieve enough power to fully delineate the effects of coculture on IVF outcome.

BACKGROUND: Homologous Robertsonian translocation carriers have been considered to have no chance, theoretically, of having a normal embryo. For these carriers, traditional genetic counseling would suggest using donated sperm or oocyte rather than using their own gametes.CASE: This study reports the case of a 45,XY,t(21;21)(q10;q10) homologous Robertsonian translocation carrier who had an approximately normal offspring with a mosaic karyotype: 46,XX,[86]/46, XX,t(21;21)[14].CONCLUSION: Carriers of homologous Robertsonian translocations might have a chance of having normal offspring. For these carriers, besides traditional assisted reproductive technology such as using gametes from a donor, preimplantation genetic diagnosis might have clinical value.

OBJECTIVE: To evaluate the effect of obesity on clinical parameters and pregnancy rates in infertile women with polycystic ovary syndrome (PCOS), who have undergone ovulation induction.STUDY DESIGN: This retrospective study included 177 women with PCOS who presented to our gynecological endocrinology outpatient clinic for diagnosed infertility. All of the patients initially received clomiphene citrate (CC), and if CC resistance was noted, gonadotropins were used. The patients were classified into 2 groups according to BMI (<30 kg/m2=control group and ≥30 kg/m2=study group). Pregnancy was assessed by β-hCG levels and a visible gestational sac in the endometrium.RESULTS: The demographic and hormonal parameters were similar between the groups. The mean duration of infertility was longer in the study group (p<0.05). In the study group, cycle cancellation due to CC resistance (p=0.039) and mean baseline LH levels (p=0.026) was statistically more likely than in the control group. On follow-up, 4 (9.3%) patients in the study group had conceived and 26 (19.4%) patients in the control group had conceived (p=0.041).CONCLUSION: Obesity adversely affects pregnancy rates in women with PCOS who undergo ovulation induction cycles. Clinicians should recommend weight loss in these patients before ovulation induction.

BACKGROUND: Birth-related injuries are a well-known complication of vaginal breech deliveries but are not anticipated during cesarean breech deliveries. However, long bone fractures in the neonate can result from delivery of the breech presentation by cesarean section. CASES: We report 2 cases of long bone fractures that occurred during cesarean section for breech presentation. No underlying bone pathology or systemic illness could be identified in either case. There were no other predisposing risk factors for fractures except breech presentation. Both infants were managed with cast application and outpatient physical therapy and recovered without any residual deformity.CONCLUSION: Obstetricians should be aware of the possibility of long bone fractures with abdominal breech deliveries. Their prompt recognition and conservative management, including physical therapy, can prevent bone deformities.

OBJECTIVE: To evaluate whether magnetic resonance imaging (MRI) contributes to ultrasound for the evaluation of fetal central nervous system (CNS) anomalies. The secondary objective was to investigate whether MRI adds more information regarding the evaluation of specific pathologies or conditions.STUDY DESIGN: We retrospectively compared fetal MRI findings with ultrasound findings in CNS anomalies with respect to certain pathologic groups. Additionally, we evaluated diagnostic accuracy by comparing fetal MRI and ultrasound findings with postnatal findings.RESULTS: A total of 34 patients had 40 provisional diagnoses by fetal ultrasound, and of those patients 14 had a provisional diagnosis of ventriculomegaly and 14 had a provisional diagnosis of cerebellar or posterior fossa anomalies. MRI added to or changed the diagnosis in 52.5% of the patients with CNS abnormalities. The contribution rate in ventriculomegaly was 71.4%, and MRI changed the diagnosis in all indefinite diagnoses by ultrasound. Additionally, of the 15 patients with postnatal findings, there were no cases in which only the ultrasound findings were correct, but the MRI findings were incorrect.CONCLUSION: MRI contributes to ultrasound in the diagnosis of CNS anomalies. Cases of indefinite diagnosis and ventriculomegaly by ultrasound had greater benefit from MRI.

OBJECTIVE: To evaluate the efficacy of varicocele repair in patients with nonobstructive azoospermia.STUDY DESIGN: Ten patients with nonobstructive azoospermia and clinical varicoceles who underwent varicocele repair were retrospectively investigated. According to the postoperative appearance of motile spermatozoa in the ejaculate, the patients were divided into 2 groups: Responder and Nonresponder. The outcomes of each group were investigated.RESULTS: There were 4 (40%) patients in the Responder group. Serum follicle-stimulating hormone levels were significantly higher in the Nonresponder group than in the Responder group (19.9±6.4 IU/mL vs. 10.8± 4.0 IU/mL, p<0.05). Mean sperm concentration was 5.4 million spermatozoa/mL in the Responder group. One patient achieved a spontaneous pregnancy, and another achieved an assisted pregnancy. In the Nonresponder group 5 patients underwent microdissection testicular sperm extraction (micro-TESE) postoperatively. In 1 patient, motile spermatozoa were successfully retrieved. Histopathological findings in the other 4 patients were Sertoli-cell-only.CONCLUSION: The present study suggested that varicocele repair could be considered in men with nonobstructive azoospermia who have clinical varicoceles. Moreover, varicocele repair seemed to improve sperm retrieval rate during micro-TESE for those in the Nonresponder group.

OBJECTIVE: To uncover potential genes and biological processes that contribute to breast cancer development.STUDY DESIGN: We studied gene expression profiles, which are publicly available from the Gene Expression Omnibus database, for the 2 most prevailing subtypes of breast cancer: lobular and ductal invasive breast carcinomas.RESULTS: We identified a total of 98 genes that shared regulation pattern in both subtypes of breast carcinoma. Further functional annotations indicated that 124 biological processes and 8 Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways were over-represented, such as cell surface receptor signaling pathway. We also identified unique gene expression profiles in each subtype of breast cancer. A total of 460 genes were solely differentially expressed between ductal cancer cells and normal cells, and 75 biological processes and 10 KEGG pathways were enriched by these 460 differential genes, including cell proliferation and regulation of cell death. Meanwhile, 308 genes were found to be differentially expressed between lobular cancer cells and normal cells. Intriguingly, only 11 biological processes and 8 KEGG pathways showed overrepresentation among these 308 genes, such as collagen metabolic process.CONCLUSION: Cumulatively, our results indicate that the invasive lobular and ductal carcinomas share a similar profile of gene expression and pathway alteration but also harbor subtype-specific mechanisms of tumorigenesis.

OBJECTIVE: To investigate the trend of cesarean section (CS) delivery rate and CS indications between January 2009 and December 2013 at Hassan II Hospital, Settat, Morocco.STUDY DESIGN: The demographic characteristics of women who gave birth at the hospital during the study period were collected. A total of 36,965 puerperal patients (aged 14–52 years at 33–42 weeks’ gestation) were enrolled. Delivery outcomes and the indication for CS delivery were studied.RESULTS: The CS rate increased from 11.48% in 2009 to 14.76% in 2013 (p<0.05), and the perinatal mortality rate decreased from 3.34% in 2009 to 2.24% in 2013 (p<0.05). The 3 most common indications for CS delivery were previous lower segment CS, cephalopelvic disproportion, and intrauterine growth restriction.CONCLUSION: There is a trend of increasing CS rate at Hassan II Hospital. Previous lower segment CS, cephalopelvic disproportion, and intrauterine growth restriction are the 3 most common CS indications.

Background: Renal angiomyolipomas are uncommon during pregnancy, but it is important to consider them in the differential diagnosis, for the increased risk of complications such as bleeding, renal artery compression, and renovascular hypertension.

Case: A 42-year-old woman was admitted at 34 weeks of gestation for severe abdominal pain in the right flank associated with severe hypertension. During the postadmission immediate cesarean section for fetal compromise, abdominal exploration revealed a massive retroperitoneal hematoma (around 30 cm) up to the cecal region until the lower edge of the liver. The diagnosis was the rupture of a renal angiomyolipoma causing renovascular hypertension.

Conclusion: Renovascular hypertension should be considered in patients who present with accelerated hypertension, particularly if the hypertension is resistant to medical therapy and not associated with laboratory features of preeclampsia/eclampsia.