Live birth after frozen-thawed embryo transfer: which endometrial preparation protocol is better?

OBJECTIVE: To compare the clinical outcomes of modified natural cycle (mNC) and artificial cycle (AC) protocols for frozen embryo transfers. MATERIAL AND METHODS: A total of 490 frozen-thawed autologous embryo transfer cycles, performed in a single tertiary IVF center, between January 2015 and September 2017, were retrospectively analyzed. Of these, 214 cycles were performed after mNC and 276 cycles were performed after gonadotrophin-releasing hormone (GnRH) agonist plus sequential estrogen and progestin priming protocol. The primary outcome was live birth and secondary outcomes were clinical pregnancy, implantation and miscarriage rates. Multivariate regression analysis was used to adjust covariates on clinical outcome. RESULTS: The rates of live birth (33.6 % vs. 29.3 %, respectively), clinical pregnancy (40.2 % vs. 36.6 %, respectively), implantation (32.3 % vs. 28.5 %, respectively), and miscarriage (5.1 % vs. 6.9 %, respectively) were not different between the mNC and AC groups. Multivariate analysis also showed that the method for endometrial preparation had no significant effect on clinical pregnancy and live birth. The adjusted odds ratios (OR) of live births and clinical pregnancies were 0.97 (95 % CI 0.64-1.48) and 0.98 (95 % CI 0.65-1.46) for the AC compared to mNC group. However, there was a significant difference between mNC and AC in cycles in which double embryo transfer was performed. The live birth (48 % vs. 31.4 %P= 0.01) and clinical pregnancy rates (53.9 % vs. 38.8 %, P= 0.02) were significantly higher in the mNC group than the AC group for double embryo transfers. CONCLUSION: The live birth and clinical pregnancy rates are comparable between mNC and AC with GnRH agonists in frozen thawed embryo transfer cycles. In ovulatory patients with planned double embryo transfer, mNC can be considered. Further well-designed prospective studies are needed to confirm our results.

Differential gene expression analysis of human cumulus cells.

OBJECTIVE: This study was performed to explore the possibility that each oocyte and its surrounding cumulus cells might have different genetic expression patterns that could affect human reproduction. METHODS: Differential gene expression analysis was performed for 10 clusters of cumulus cells obtained from 10 cumulus-oocyte complexes from 10 patients. Same procedures related to oocyte maturation, microinjection, and microarray analyses were performed for each group of cumulus cells. Two differential gene expression analyses were performed: one for the outcome of clinical pregnancy and one for the outcome of live birth. RESULTS: Significant genes resulting from these analyses were selected and the top 20 affected pathways in each group were analyzed. Circadian entrainment is determined to be the most affected pathway for clinical pregnancy, and proteoglycans in cancer pathway is the most affected pathway for live birth. Circadian entrainment is also amongst the 12 pathways that are found to be in top 20 affected pathways for both outcomes, and has both lowest p-value and highest number of times found count. CONCLUSION: Although further confirmatory studies are necessary, findings of this study suggest that these pathways, especially circadian entrainment in cumulus cells, may be essential for embryo development and pregnancy.

Expression of the Bone Morphogenetic Protein-2 (BMP2) in the Human Cumulus Cells as a Biomarker of Oocytes and Embryo Quality.

BACKGROUND: The members of the transforming growth factor-B superfamily, as the bone morphogenetic proteins (BMPs) subfamily and anti-Müllerian hormone (AMH), play a role during follicular development, and the bone morphogenetic protein-2 (BMP2), AMH, and THY1 are expressed in ovaries. AIM: This study was designed to define whether or not the expressions of these proteins in human cumulus cells (CCs) can be used as predictors of the oocyte and embryo competence. SETTINGS AND DESIGN: The study included nine female patients who were diagnosed as idiopathic infertility, aged 25-33 years (median 30 years) and underwent Assisted Reproductive Technologies. MATERIALS AND METHODS: The CCs from 60 oocyte-cumulus complexes obtained from the nine patients were evaluated with immunofluorescence staining in respect of BMPs, AMH and THY1 markers. The CCs surrounding the same oocytes were evaluated separately according to the oocyte and embryo quality. STATISTICAL ANALYSIS: Quantitative data were statistically analyzed for differences using the two-sided Mann-Whitney U test (P < 0.05). RESULTS AND CONCLUSIONS: Significant differences in immunofluorescence staining were observed in oocyte quality and embryo quality for the BMP2 only (P < 0.05). No significant differences were observed for AMH or CD90/THY1. CONCLUSION: These results demonstrated that there is a significant difference in the expression of BMP2 in the CCs of good quality oocytes and subsequently a good embryo.