Thai in vitro Whittaker, Andrea
2015., 20150601, 2015, 2015-08-11, Letnik:
30
eBook
In Thailand, infertility remains a source of stigma for those couples that combine a range of religious, traditional and high-tech interventions in their quest for a child. This book explores this ...experience of infertility and the pursuit and use of assisted reproductive technologies by Thai couples. Though using assisted reproductive technologies is becoming more acceptable in Thai society, access to and choices about such technologies are mediated by differences in class position. These stories of women and men in private and public infertility clinics reveal how local social and moral sensitivities influence the practices and meanings of treatment.
In vitro maturation has become a significant component of modern assisted reproductive techniques. Published data have been supported for the safety and effectiveness of in vitro maturation ...treatment. In recent years, potential indications for in vitro maturation (IVM) have been a topic of interest and investigation.
Significant improvements in technique enhancement and data publication for evaluating the efficacy of IVM have been achieved. Recent studies have shown that IVM could offer several advantages over in vitro fertilization. Currently, there are growing indications for IVM beyond the commonly mentioned indication of infertile women with polycystic ovary syndrome. Additionally, some potential candidates might have significant advantages for IVM, such as women diagnosed with gonadotropin resistance ovary syndrome or those seeking fertility preservation. With a better understanding of IVM, from basic science to clinical practice, it can be applied safely, effectively, and affordably to a broader range of patients, making it a more accessible and patient-friendly option.
Despite the possibly acknowledged limitations, the potential of in vitro maturation cannot be denied. As this technique becomes increasingly accessible to patients and more continuous efforts are dedicated to advancing this technique, the impact of in vitro maturation is expected.
ObjectiveTo compare success rates, associated risks and cost-effectiveness between intrauterine insemination (IUI) and in vitro fertilisation (IVF).DesignRetrospective observational study.SettingThe ...UK from 2012 to 2016.ParticipantsData from Human Fertilisation and Embryology Authority’s freedom of information request for 2012–2016 for IVF/ICSI (intracytoplasmic sperm injection)and IUI as practiced in 319 105 IVF/ICSI and 30 669 IUI cycles. Direct-cost calculations for maternal and neonatal expenditure per live birth (LB) was constructed using the cost of multiple birth model, with inflation-adjusted Bank of England index-linked data. A second direct-cost analysis evaluating the incremental cost-effective ratio (ICER) was modelled using the 2016 national mean (baseline) IVF and IUI success rates.Outcome measuresLB, risks from IVF and IUI, and costs to gain 1 LB.ResultsThis largest comprehensive analysis integrating success, risks and costs at a national level shows IUI is safer and more cost-effective than IVF treatment.IVF LB/cycle success was significantly better than IUI at 26.96% versus 11.49% (p<0.001) but the IUI success is much closer to IVF at 2.35:1, than previously considered. IVF remains a significant source of multiple gestation pregnancy (MGP) compared with IUI (RR (Relative Risk): 1.45 (1.31 to 1.60), p<0.001) as was the rate of twins (RR: 1.58, p<0.001).In 2016, IVF maternal and neonatal cost was £115 082 017 compared with £2 940 196 for IUI and this MGP-related perinatal cost is absorbed by the National Health Services. At baseline tariffs and success rates IUI was £42 558 cheaper than IVF to deliver 1LB with enhanced benefits with small improvements in IUI. Reliable levels of IVF-related MGP, OHSS (ovarian hyperstimulation syndrome), fetal reductions and terminations are revealed.ConclusionIUI success rates are much closer to IVF than previously reported, more cost-effective in delivering 1 LB, and associated with lower risk of complications for maternal and neonatal complications. It is prudent to offer IUI before IVF nationally.
In vitro maturation (IVM) refers to maturation in culture of immature oocytes at different stages that may or may not have been exposed to short courses of gonadotropins. The source of immature ...oocytes is an important feature for subsequent embryonic development, pregnancy, and healthy live births. IVM is an effective treatment that has already achieved significant outcomes of acceptable pregnancy and implantation rates and has led to the births of several thousand healthy babies. As the development of IVM treatment continues, an attractive possibility for improving the already successful outcome is to combine a natural-cycle in vitro fertilization (IVF) treatment with immature-oocyte retrieval followed by IVM of those immature oocytes. If the treatment processes can be simplified for immature-oocyte retrieval, different types of infertile women may be able to take advantage of these treatments. Mild-stimulation IVF combined with IVM treatment may represent a viable alternative to the standard treatment. Although IVM treatment is still considered to be experimental, it is now time to reconsider the IVM technology and its development. Mild-stimulation IVF combined with IVM may prove to be not just alternatives to standard treatments, but potentially first-line treatment choices.
Is one cycle of IVM non-inferior to one cycle of conventional in IVF with respect to live birth rates in women with high antral follicle counts (AFCs)?
We could not demonstrate non-inferiority of IVM ...compared with IVF.
IVF with ovarian hyperstimulation has limitations in some subgroups of women at high risk of ovarian stimulation, such as those with polycystic ovary syndrome. IVM is an alternative ART for these women. IVM may be a feasible alternative to IVF in women with a high AFC, but there is a lack of data from randomized clinical trials comparing IVM with IVF in women at high risk of ovarian hyperstimulation syndrome.
This single-center, randomized, controlled non-inferiority trial was conducted at an academic infertility center in Vietnam from January 2018 to April 2019.
In total, 546 women with an indication for ART and a high AFC (≥24 follicles in both ovaries) were randomized to the IVM (n = 273) group or the IVF (n = 273) group; each underwent one cycle of IVM with a prematuration step versus one cycle of IVF using a standard gonadotropin-releasing hormone antagonist protocol with gonadotropin-releasing hormone agonist triggering. The primary endpoint was live birth rate after the first embryo transfer. The non-inferiority margin for IVM versus IVF was -10%.
Live birth after the first embryo transfer occurred in 96 women (35.2%) in the IVM group and 118 women (43.2%) in the IVF group (absolute risk difference -8.1%; 95% confidence interval (CI) -16.6%, 0.5%). Cumulative ongoing pregnancy rates at 12 months after randomization were 44.0% in the IVM group and 62.6% in the IVF group (absolute risk difference -18.7%; 95% CI -27.3%, -10.1%). Ovarian hyperstimulation syndrome did not occur in the IVM group, versus two cases in the IVF group. There were no statistically significant differences between the IVM and IVF groups with respect to the occurrence of pregnancy complications, obstetric and perinatal complications, preterm delivery, birth weight and neonatal complications.
The main limitation of the study was its open-label design. In addition, the findings are only applicable to IVM conducted using the prematuration step protocol used in this study. Finally, the single ethnicity population limits the external generalizability of the findings.
Our randomized clinical trial compares live birth rates after IVM and IVF. Although IVM is a viable and safe alternative to IVF that may be suitable for some women seeking a mild ART approach, the current study findings approach inferiority for IVM compared with IVF when cumulative outcomes are considered. Future research should incorporate multiple cycles of IVM in the study design to estimate cumulative fertility outcomes and better inform clinical decision-making.
This work was partly supported by Ferring grant number 000323 and funded by the Vietnam National Foundation for Science and Technology Development (NAFOSTED) and by the Fund for Research Flanders (FWO). LNV has received speaker and conference fees from Merck, grant, speaker and conference fees from Merck Sharpe and Dohme, and speaker, conference and scientific board fees from Ferring; TMH has received speaker fees from Merck, Merck Sharp and Dohme, and Ferring; RJN has received conference and scientific board fees from Ferring, is a minor shareholder in an IVF company, and receives grant funding from the National Health and Medical Research Council (NHMRC) of Australia; BWM has acted as a paid consultant to Merck, ObsEva and Guerbet, and is the recipient of grant money from an NHMRC Investigator Grant; RBG reports grants and fellowships from the NHMRC of Australia; JS reports lecture fees from Ferring Pharmaceuticals, Biomérieux, Besins Female Healthcare and Merck, grants from Fund for Research Flanders (FWO), and is co-inventor on granted patents on CAPA-IVM methodology in the US (US10392601B2) and Europe (EP3234112B1); TDP, VQD, VNAH, NHG, AHL, THP and RW have no financial relationships with any organizations that might have an interest in the submitted work in the previous three years, and no other relationships or activities that could appear to have influenced the submitted work.
NCT03405701 (www.clinicaltrials.gov).
16 January 2018.
25 January 2018.
Despite significant progress in vitro maturation (IVM) and in vitro culture (IVC) of oocytes and embryos, their developmental competence remains low. To address this issue, we used buffalo oocytes as ...a model system to investigate the effects and mechanisms of oxygen concentration on IVM and IVC. Our findings demonstrated that culturing buffalo oocytes with 5% oxygen significantly enhanced the efficiency of IVM and developmental competence of early embryos. Immunofluorescence results suggested that HIF1α played a critical role in these progresses. RT-qPCR results showed that maintaining a stable expression of HIF1α in cumulus cells with 5% oxygen concentration enhanced glycolysis, expansion, and proliferation abilities, up-regulated the expression of development-related genes, and suppressed apoptosis level. Consequently, it improved the maturation efficiency and quality of oocytes, leading to improve developmental capacity of buffalo early embryos. Similar outcomes were also observed when embryos were cultured with 5% oxygen. Collectively, our study provided insights into the role of oxygen regulation during oocytes maturation and early embryo development, and could potentially improve the efficiency of human assisted-reproduction technology.
•5% oxygen concentration could enhance buffalo oocyte IVM and early embryonic developmental competence.•The mechanism of oxygen concentration on buffalo oocyte maturation is accomplished through the regulations of HIF1α.•HIF1α regulation could affect glycolysis ability, expansion, apoptosis and proliferation of buffalo cumulus cells.
Nano-emulsion (NE) composed of MCT oil, Tween 80 and lecithin was fabricated by ultrasonication method to encapsulate curcumin. Loading ability and efficiency of curcumin were 0.548 mg/mL and 95.10% ...respectively which indicated its water dispersibility was increased by 1400 fold. Chitosan with low, middle and high molecular weight (3 kDa, 30 kDa and 190–310 kDa respectively) was applied for coating the prepared NE. After chitosan coating, zeta potential value of NE was changed from negative to positive. At the same time, chitosan coating prevented NE phase separation in ionic strength test and inhibited degradation of curcumin during thermal and UV irradiation treatment. Using pH-stat method, it was found that middle and high molecular weight chitosan coating may interfere with lipolysis of NE during the in vitro digestion which also slightly decreased curcumin bio-accessibility. Therefore, NE coated with chitosan is a promising delivery system to promote the applications of curcumin in functional food and beverage system.
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•Nano-emulsion loaded with curcumin increased its water dispersibility.•Chitosan with various molecular weight was used to coat nano-emulsion.•Chitosan coating increased physical and chemical stability of curcumin.•Chitosan coating slightly decreased the bio-accessibility of curcumin.
Abstract
Infertility affects one in six of the population and increasingly couples require treatment with assisted reproductive techniques. In vitro fertilization (IVF) treatment is most commonly ...conducted using exogenous FSH to induce follicular growth and human chorionic gonadotropin (hCG) to induce final oocyte maturation. However, hCG may cause the potentially life-threatening iatrogenic complication "ovarian hyperstimulation syndrome" (OHSS), which can cause considerable morbidity and, rarely, even mortality in otherwise healthy women. The use of GnRH agonists (GnRHas) has been pioneered during the last two decades to provide a safer option to induce final oocyte maturation. More recently, the neuropeptide kisspeptin, a hypothalamic regulator of GnRH release, has been investigated as a novel inductor of oocyte maturation. The hormonal stimulus used to induce oocyte maturation has a major impact on the success (retrieval of oocytes and chance of implantation) and safety (risk of OHSS) of IVF treatment. This review aims to appraise experimental and clinical data of hormonal approaches used to induce final oocyte maturation by hCG, GnRHa, both GnRHa and hCG administered in combination, recombinant LH, or kisspeptin. We also examine evidence for the timing of administration of the inductor of final oocyte maturation in relationship to parameters of follicular growth and the subsequent interval to oocyte retrieval. In summary, we review data on the efficacy and safety of the major hormonal approaches used to induce final oocyte maturation in clinical practice, as well as some novel approaches that may offer fresh alternatives in future.
Producing high-competent oocytes during the in vitro maturation (IVM) is considered a key step for the success of the in vitro production (IVP) of embryos. One of the known disruptors of oocyte ...developmental competence on IVP is oxidative stress (OS), which appears due to the imbalance between the production and neutralization of reactive oxygen species (ROS). The in vitro conditions induce supraphysiological ROS levels due to the exposure to an oxidative environment and the isolation of the oocyte from the follicle protective antioxidant milieu. In juvenile in vitro embryo transfer (JIVET), which aims to produce embryos from prepubertal females, the oocytes are more sensitive to OS as they have inherent lower quality. Therefore, the IVM strategies that aim to prevent OS have great interest for both IVP and JIVET programs. The focus of this review is on the effects of ROS on oocyte IVM and the main antioxidants that have been tested for protecting the oocyte from OS. Considering the importance that OS has on oocyte competence, it is crucial to create standardized antioxidant IVM systems for improving the overall IVP success.
•In vitro embryo production programs expose oocytes to supraphysiological ROS levels•Oxidative stress affects oocyte developmental competence•Oocytes from juvenile animals are more susceptible to oxidative stress•The use of antioxidants on oocyte in vitro maturation improves blastocyst development
Production and Culture of the Bovine Embryo Tríbulo, Paula; Rivera, Rocío Melissa; Ortega Obando, Martha Sofia ...
Methods in molecular biology (Clifton, N.J.),
2019, Letnik:
2006
Journal Article
A protocol for production of bovine embryos from oocytes collected from ovaries obtained from an abattoir is described. The protocol includes methods for in vitro maturation of oocytes, capacitation ...of sperm, fertilization, and development of the resultant embryos to the blastocyst stage. The protocol can be easily modified to use oocytes collected by ultrasound-guided follicular aspiration.
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