Can anti-ovarian antibody testing be useful in an IVF-ET clinic?

OBJECTIVE: To establish importance of anti-ovarian antibodies (AOA) testing in infertile women. DESIGN: A clinical reproductive outcome comparative study between two groups of women undergoing IVF-ET. Group 1 consists of women tested positive for AOA, put on corticosteroid therapy, reverted to AOA negative and then taken up for IVF-ET. Group 2 were seronegative for AOA. SETTING: Major urban infertility reference centre and National research institute. PATIENT(S): Five hundred seventy infertile women enrolled for IVF-ET. INTERVENTION(S): AOA testing, corticosteroid therapy and IVF-ET/ICSI. MAIN OUTCOME MEASURE(S): Comparable clinical outcome and significance of AOA testing established. RESULTS: AOA positive serum samples were sent periodically to re-investigate presence of AOA after corticosteroid therapy and women turned AOA negative were taken up for IVF-ET. Of the 70/138 women in group 1 who were treated with corticosteroids and turned seronegative for AOA, 22/70 were poor responders and needed donor oocyte-recipient cycles. Results demonstrated that fertilization and clinical pregnancy rates between both groups are comparable. Nevertheless, it is also observed that there is poor response to stimulation protocol, smaller number of oocytes retrieved and more spontaneous abortions in group 1 women. Hence not all outcomes following the treatment are comparable between the two groups. Usefulness of the test was established in two case studies. CONCLUSIONS: AOA testing could be included in the battery of tests investigating and treating infertility.

A case-control study identifying chromosomal polymorphic variations as forms of epigenetic alterations associated with the infertility phenotype.

OBJECTIVE: To study the association of chromosomal polymorphic variations with infertility and subfertility. DESIGN: A comparative case-controlled association study using cytogenetic techniques to compare the frequency of chromosomal variations in infertile individuals versus fertile controls. SETTING: Department of Infertility Management and Assisted Reproduction, Jaslok Hospital and Research Centre, Mumbai, India. PATIENT(S): 760 infertile individuals and 555 fertile controls. INTERVENTION(S): ICSI, IUI, karyotyping, inverted 4',6-diamidino-2-phenylindole (DAPI), CBG banding. MAIN OUTCOME MEASURE(S): Frequency of chromosomal polymorphic variations in infertile individuals undergoing infertility treatment versus fertile individuals. RESULT(S): A highly statistically significant increase in the frequency of total chromosomal variants in infertile women (28.31% vs. 15.16%) and infertile men (58.68% vs. 32.55%) was observed. The frequency of 9qh+ was statistically significantly increased in women with primary infertility (16.22% vs. 6.41%) and in men with severe male factor infertility (14.69% vs. 4.25%). A highly statistically significant increase in the frequency of Yqh+ was observed in men whose wives had a bad obstetric history (30.20% vs. 12.74%). CONCLUSION(S): The statistically significantly higher incidence of heterochromatic variations found in infertile individuals stresses on the need to evaluate their role in infertility and subfertility. Potential epigenetic, genetic, and chromosomal modifications could be associated with certain complex disorders such as infertility and bad obstetric history.

Cumulus coculture and cumulus-aided embryo transfer increases pregnancy rates in patients undergoing in vitro fertilization.

OBJECTIVE: To evaluate the effect of the use of cumulus-aided embryo transfer on pregnancy rates. To study the proximity of expanded cumulus cells to the developing embryo. To document by light microscopy the anchoring of day 3 to day 4 embryos by the expanded cumulus cells. To demonstrate by transmission electron microscopy the cellular activity of the expanded cumulus cells. To evaluate the expression of growth factors (vascular endothelial growth factor, interleukin-6, insulin-like growth factor I) that are secreted by the cumulus cells. DESIGN: A comparative study of a group of women undergoing cumulus coculture and cumulus-aided embryo transfer, with those who underwent cumulus coculture but did not undergo cumulus-aided embryo transfer. The endpoint was the achievement of pregnancy. SETTING: Department of Infertility Management and Assisted Reproduction, Jaslok Hospital and Research Centre, Mumbai, India. PATIENT(S): Five hundred seventeen women undergoing treatment for infertility using intracytoplasmic sperm injection and embryo transfer and fulfilling set criteria. To validate our initial results, we conducted a similar study on 208 women where randomization was performed. INTERVENTION(S): Embryos were cocultured with the patient's own cumulus cells and were transferred into the uterus with approximately 30 microL of the expanded cumulus cells. MAIN OUTCOME MEASURE(S): Pregnancy, implantation, and multiple gestation rates. RESULT(S): Our study demonstrated a significant increase in the implantation rate in the study group (group A) of 25.6% versus 14.5% in the control group (group B) and a significant increase in the pregnancy rate in the study group (group A) of 47.6% versus 34% achieved in the control group (group B). Although the incidence of multiple gestation was similar (38.6% in the study group and 32.9% in the control group), the higher-order multiple gestation rate was significantly more in the study group as compared with the control group (18.1% vs. 2.4%). Similar pregnancy and implantation rates were observed in the randomized study. CONCLUSION(S): This study demonstrates the efficacy of cumulus-aided embryo transfer, using autologous cumulus cells. It indicates a significant increase in implantation and pregnancy rates. The results suggest that cumulus cells play an important role in embryonic development, and that they may provide a mechanism to improve embryo-uterine adhesion by physical proximity, and by secreting cytokines and growth factors required to aid the implantation process.