Blastulation of a zygote to a hatched blastocyst without any clear cell division: an observational finding in a time-lapse system after in vitro fertilization.

PURPOSE: To describe an interesting not previously described morphokinetic finding. METHODS: Retrospective case report of a couple undergoing controlled ovarian stimulation (COS) followed by in vitro fertilization and blastocyst transfer. RESULTS: We identified a unique finding of blastulation of a fertilized human zygote after conventional in vitro fertilization. The fertilized zygote did not show any clear cytokinesis until approximately 107 h post insemination, when it started dividing into a blastocyst. By 113 h post insemination, inner cell mass and trophectoderm cells could be clearly distinguished and the blastocyst was completely hatched by 136 h post insemination. CONCLUSION: Time-lapse systems offer more detailed observations of embryonic development. Here, we report an atypical development of an embryo that was not described previously. We hope to become an insightful discussion among peers and incentive the publication of such findings in the future.

[ENZIAN-score, a classification of deep infiltrating endometriosis]. / ENZIAN-Score, eine Klassifikation der tief infiltrierenden Endometriose.

The ENZIAN-Score is presented as a new instrument to classify the deep infiltrating endometriosis. Especially the retroperitoneal part of the severe endometriosis is focussed on. In analogy to an oncological staging four different stages are pronounced. The localisation and the expansion of the endometriosis nodule was indicated to different subgroups. The still used rAFS-score is of no clinical evidence, as we pointed out in a retrospective study of our patients with severe intestinal endometriosis.

Presence of transforming growth factor alpha and epidermal growth factor in human ovarian tissue and follicular fluid.

Intra-ovarian regulation of follicular maturation is modulated by various factors. Among these, growth factors are important local actors. We examined the immunohistochemical localization of transforming growth factor alpha (TGF-alpha), epidermal growth factor (EGF) and epidermal growth factor receptor (EGF-R) in 18 human ovaries. The concentration of TGF-alpha and EGF in follicular fluid was measured by ELISA. TGF-alpha was detected in oocytes of primordial and early preantral follicles. Furthermore, staining was observed in granulosa cells of preantral follicles and in theca cells of preantral, antral and preovulatory follicles. EGF showed a similar distribution as TGF-alpha. Atretic follicles were strongly positive for TGF-alpha and EGF. In the corpus luteum, theca lutein cells were strongly positive for TGF-alpha and EGF. Immunoreactivity for EGF-R was observed only in the granulosa cells of antral follicles. Follicular fluids from patients undergoing in-vitro fertilization (IVF) were examined for their content of TGF-alpha and EGF. TGF-alpha was detected in 37% of the samples. The concentration ranged from 43 pg/ml to 602 pg/ml. EGF was not detected in any of the follicular fluids tested. These observations support the participation of EGF/TGF-alpha in follicular maturation. Furthermore, the presence of TGF-alpha in follicular fluid and the simultaneous absence of EGF suggests that TGF-alpha plays a more pronounced role than EGF in oocyte maturation during late follicular phase.