The impact of semen parameters on ICSI and pregnancy outcomes in egg recipient cycles with PGT-A.

BACKGROUND: The egg donation model offers an opportunity to isolate the male factor and evaluate its impact on IVF-intracytoplasmic sperm injection and pregnancy outcomes. OBJECTIVE: To study the effect of non-obstructive azoospermia on intracytoplasmic sperm injection and pregnancy outcomes compared with severe oligozoospermia and mild-to-moderate oligozoospermia in egg recipient cycles. MATERIALS AND METHODS: This is a retrospective longitudinal cohort study, including 1594 patients who underwent intracytoplasmic sperm injection in egg recipient cycles with preimplantation genetic testing for aneuploidies. The cohort was divided into three groups: couples with non-obstructive azoospermia accounting for 479 patients (30%); couples with severe oligozoospermia (sperm number <5 × 106 /mL), accounting for 442 patients (27.8%); couples with mild-to-moderate oligozoospermia, with sperm number >5 × 106 and <15 × 106 /mL, accounting for 673 patients (42.2%). RESULTS: The fertilisation rate was significantly reduced in the non-obstructive azoospermia group as compared with the severe oligozoospermia and the mild-to-moderate oligozoospermia group: 30.3% versus 63% and 77.3% (p < 0.05). Logistic regression analysis adjusted for confounders highlighted non-obstructive azoospermia as a negative predictor of obtaining a euploid blastocyst both per injected oocyte and per obtained blastocyst. The miscarriage rate in the non-obstructive azoospermia group was 11.8%; higher than the severe oligozoospermia and mild-to-moderate oligozoospermia groups (7% and 2.7%) (p < 0.05). The live birth rate per embryo transfer (ET) was significantly lower in the non-obstructive azoospermia group compared with the severe oligozoospermia and the mild-to-moderate oligozoospermia group (20.4% vs. 30.3% and 35.4%, p < 0.05). The risk of preterm labour was significantly higher in the non-obstructive azoospermia group, compared with the severe oligozoospermia and mild-to-moderate oligozoospermia group (55.1% vs. 46.8% and 16.1%, p < 0.001), and this difference was observed in both singleton and twin pregnancies. DISCUSSION AND CONCLUSION: In our retrospective comparative study, non-obstructive azoospermia significantly affects early embryonic potential and live birth rates per cycle and per embryo transfer. It is also associated with higher risk of preterm birth. Future prospective multi-centre studies are needed to highlight the effect of sperm quality on ART and pregnancy outcomes.

Safety and tolerability of regadenoson compared with dipyridamole in myocardial perfusion imaging in patients scheduled to undergo medium to high-risk noncardiac surgery: a randomized controlled study.

OBJECTIVE: Regadenoson is the first Food and Drug Administration-approved selective A2A adenosine receptor agonist used in myocardial perfusion imaging. Its main benefits are its simplified and brief protocol, along with the ability to be administered safely in patients with asthma or chronic obstructive pulmonary disease of moderate severity. This study aims to identify any potential benefits of regadenoson, regarding the frequency of adverse reactions and its tolerability, over dipyridamole. METHODS: This is a randomized controlled study of 200 patients scheduled for medium to high-risk noncardiac surgery, of whom 100 were stressed with regadenoson (study group) and the rest with dipyridamole (control group). RESULTS: A greater proportion of adverse reactions was recorded in the regadenoson group as compared to the dipyridamole group (53 vs. 36%; P = 0.023), though the duration of most adverse reactions was shorter in the regadenoson group. Dyspnea (P < 0.001) and gastrointestinal disturbances (P = 0.001) were significantly more frequent in the regadenoson group. The use of aminophylline in patients who developed any adverse events was similar in the two groups (P > 0.05). When multiple regression analyses were performed, differences in adverse reactions between the two groups were no longer significant (odds ratio = 1.96; 95% confidence interval, 0.88-3.25; P = 0.11). CONCLUSION: In our group of patients scheduled for myocardial perfusion imaging for preoperative assessment, the two agents, regadenoson and dipyridamole, have no significant differences in the frequency of mild adverse reactions and in aminophylline use, with regadenoson also having the advantage of faster symptom resolution. Nevertheless, dipyridamole can be considered as a well-tolerated and low-cost alternative.

Retrotransposon RNA expression and evidence for retrotransposition events in human oocytes.

Although human diseases of retrotransposition-derived etiology have been documented, retrotransposon RNA expression and the occurrence of retrotransposition events in the human oocyte are not studied. We investigated the RNA expression of L1 and HERV-K10 retrotransposons in human oocytes by RT-PCR analysis with designed primers. Using denucleated germinal vesicles (GVs), we detected RT-PCR products of expressed L1, HERV-K10 and, unexpectedly, SINE-R, VNTR and Alu (SVA) retrotransposons. Their transcript specificities were identified as such following RNA-FISH and their origin by cloning and sequence alignment analyses. Assessing the expression level in comparison with somatic cells by densitometry analysis, we found that although in normal lymphocytes and transformed HeLa cells their profile was in an order of L1 > HERV-K10 > SVA, remarkably this was reversed in oocytes. To investigate whether de novo retrotransposition events occur and reverse transcriptases are expressed in the human oocyte, we introduced in GVs either a retrotransposition active human L1 or mouse reverse transcriptase deficient-VL30 retrotransposon tagged with an EGFP-based retrotransposition cassette. Interestingly, in both the cases, we observed EGFP-positive oocytes, associated with an abnormal morphology for L1 and granulation for VL30, and the retrotransposition events were confirmed by PCR. Our results: (i) show that L1, HERV-K10 and SVA retrotransposons are transcriptionally expressed and (ii) provide evidence, for the first time, for retrotransposition events occurring in the human oocyte. These findings suggest that both, network of retrotransposon transcripts and controlled retrotranspositions, might serve important functions required for oocyte development and fertilization while the uncontrolled ones might explain the onset of genetic disorders.

Conception and pregnancy outcome in a patient with 11-bp deletion of the steroidogenic acute regulatory protein gene.

OBJECTIVE: To report the pregnancy outcome of a patient with congenital lipoid adrenal hyperplasia (CLAH) due to an 11-bp deletion of the steroidogenic acute regulatory protein (StAR) gene. DESIGN: Case report. SETTING: University-based pediatric endocrinology unit and private IVF clinic. PATIENT(S): A 24-year-old woman homozygous for a StAR gene deletion, married to a man heterozygous for the same molecular defect. INTERVENTION(S): Ovarian stimulation, oocyte retrieval followed by IVF, blastomere biopsy, preimplantation genetic diagnosis, and additional estrogen support until placental function initiation. MAIN OUTCOME MEASURE(S): Normal pregnancy outcome and delivery of a healthy newborn. RESULT(S): A female patient with CLAH gave birth to a normal newborn after IVF and preimplantation genetic diagnosis. CONCLUSION(S): Pregnancy is feasible in patients with StAR gene mutations, provided that extra estrogens are offered until placental function ensues.

Novel strategy with potential to identify developmentally competent IVF blastocysts.

BACKGROUND: Currently there are no markers fully predictive of developmental competence of human IVF embryos. The present study investigated a novel strategy involving blastocyst biopsy and DNA fingerprinting to link developmental competence with gene expression patterns. METHODS: Patient's blastocysts were biopsied to remove 8-20 trophectoderm (TE) cells for molecular analysis prior to transfer. Biopsy samples were amplified and gene expression was evaluated using microarrays. Sibling TE biopsies and cells from resulting offspring were subjected to DNA fingerprinting to identify which blastocyst(s) in the transfer cohort developed to term. RESULTS: Blastocyst biopsy did not appear to impair developmental competence. Comparative microarray analysis of cDNA from pooled 'viable' and 'non-viable' TE samples identified over 7000 transcripts expressed exclusively in 'viable' blastocysts. The most significant of these included transcripts involved in cell adhesion and cell communication, key processes that have been associated with mammalian implantation. DNA fingerprinting of three cohorts of sibling blastocysts identified those blastocyst(s) that produced term pregnancies. CONCLUSIONS: The combination of blastocyst biopsy, microarray gene expression profiling and DNA fingerprinting is a powerful tool to identify diagnostic markers of competence to develop to term. This strategy may be used to develop a rapid diagnostic assay or for refining existing criteria for the selection of the single most viable blastocyst among a cohort developing in vitro.

Empty follicle syndrome associated with ovarian torsion in an in vitro fertilization program.

We report a very rare case of ovarian torsion following controlled ovarian stimulation for in vitro fertilization in which no oocytes were obtained at the time of ovum retrieval from the left torsed ovary. The patient was a 33-year-old nulligravida female undergoing controlled ovarian stimulation. On day 14, the patient complained of lower left abdominal pain with nausea. Transvaginal oocyte retrieval from the right ovary was performed. The patient subsequently underwent laparoscopy 6 hours following oocyte retrieval. A portion of the left ovary was observed. The ovary was detorsed at the time of laparoscopy followed by peritoneal lavage.