Aim
This study aimed to assess the efficacy of the endometrial receptivity array (ERA) as a diagnostic tool and the impact of personalized embryo transfer (pET) for the treatment of patients with ...recurrent implantation failure (RIF) in Japan.
Methods
Fifty patients with a history of RIF with frozen‐thawed blastocyst transfers were recruited from July, 2015 to April, 2016. Endometrial sampling for the ERA and histological dating and a pET according to the ERA were performed. The receptive (R) or non‐receptive (NR) status of the endometrium as a result of the first ERA, endometrial dating, and pregnancy rates after the pET were analyzed.
Results
Of the patients with RIF, 12 (24%) were NR. Among them, eight (66.7%) were prereceptive. A clinical follow‐up was possible in 44 patients who underwent the pET. The pregnancy rates were 58.8% per patient and 35.3% per first pET in the R patients and 50.0% per patient and 50.0% per first pET in the NR patients. Discrepancies between the ERA results and histological dating were seen more in the NR patients than in the R patients.
Conclusions
For patients with unexplained RIF, there is a significance in searching for their personal window of implantation (WOI) using the ERA, considering the percentage of those who were NR and the pregnancy rates that resulted from the pET. By transferring euploid embryos in a personal WOI, much better pregnancy rates are expected.
Purpose
To investigate whether progestin‐primed ovarian stimulation (PPOS) with chlormadinone acetate (CMA) adversely affects clinical results and neonatal outcomes, or causes congenital deformities.
...Methods
This retrospective study was conducted at private IVF clinic from November 2018 to November 2021. Women underwent oocyte retrieval using gonadotropin‐releasing hormone (GnRH) antagonist protocol (n = 835) or PPOS protocol (n = 57) were included. Eligible patients were normal ovarian responders (aged <40, AMH ≧1.0 ng/mL) with freeze‐all cycle. Embryo developments, clinical results, or neonatal outcomes of singletons derived from transfer of frozen single blastocysts were compared within each group.
Results
Patient characteristics were similar in both groups. The median LH level (mIU/mL) at trigger in the GnRH antagonist group 2.0 (1.2–3.7) was significantly higher than in the PPOS group 0.9 (0.3–1.7). There was no cycle with premature LH surge in the PPOS group. Fertilization and blastocyst formation rates did not differ significantly between groups. Furthermore, clinical outcomes were also similar in the two groups. Congenital abnormality rates did not differ significantly 0.9% (3/329), 0.0% (0/17).
Conclusions
CMA using ovarian stimulation did not negatively affect clinical results. Our data suggest that PPOS with CMA is an appropriate ovarian stimulation method for normal ovarian responders.
Previously, using the Keratin5-Cre transgenic mouse model we reported that female Lgr4-conditional KO mice (Lgr4(K5 KO)) showed subfertility with defective stromal decidualization due to abnormal ...development of the uterine gland. However, the impact of the LGR4 defect on luminal epithelial cells was not investigated in the previous report. Here, we focused on the receptive state of the luminal epithelium in Lgr4(K5 KO) mice that received ovarian hormone treatment. In Lgr4(K5 KO) mice, progesterone failed to inhibit the luminal epithelial cell proliferation. Immunohistochemical and qRT-PCR analyses revealed down-regulated progesterone signaling in the uterus of Lgr4(K5 KO) mice. These results demonstrated that LGR4 is essential for the acquisition of endometrial receptivity through ovarian hormone signaling.
Background: To evaluate obstetrical and neonatal outcomes of singletons conceived after advanced assisted reproductive technology (ART) techniques: conventional IVF pregnancies (C-IVF), ejaculated ...sperm intracytoplasmic sperm injection (ICSI), assisted oocyte activation (AOA), in vitro maturation (IVM), and testicular sperm extraction (TESE). Methods: The subjects were 3,028 singletons who were born after fresh or frozen embryo transfer. The subjects were separated into five groups: C-IVF (Formula: see text), ICSI (Formula: see text), AOA (Formula: see text), IVM (Formula: see text), and TESE (Formula: see text). We evaluated obstetrical and neonatal outcomes calculating the adjusted odds ratio (AOR) using multivariable logistic regression analyses for fresh and frozen embryos and for cleavage and blastocyst transfer. The C-IVF group was used as a background control for the ICSI group. Moreover, the TESE, AOA, and IVM groups were compared to the ICSI group to evaluate the effects of the ICSI procedure itself. Results: The incidence of perinatal complications was significantly lower in the ICSI-fresh group (Formula: see text, 95% CI: 0.10–0.83, Formula: see text). Regarding sex ratio, the IVM was significantly associated with sex ratio imbalance toward female in both fresh and frozen groups (Formula: see text, 95% CI: 0.10–0.96, Formula: see text, 95% CI: 0.07–0.98, Formula: see text). On the other hand, there were no significant differences in preterm birth rate, low birth weight rate and congenital abnormalities rate between conventional IVF, ICSI, and the other groups. Conclusions: There were no negative effects on obstetrical and neonatal outcomes between conventional IVF and ICSI. Although this was a limited sample size study, advanced ART technologies such as AOA, IVM, and TESE also seem to have a low risk of adverse impact on obstetrical and neonatal outcomes but may have a slight impact on sex ratio.
Purpose
To find the best methods to achieve the highest pregnancy and birth rates for couples needing testicular sperm extraction (TESE)‐intracytoplasmic sperm injection (ICSI).
Methods
...Retrospectively studied were 801 patients with male factor infertility who had undergone TESE‐ICSI between April, 1996 and July, 2016 and who had been categorized into four groups: obstructive azoospermia (OA); non‐obstructive azoospermia (NOA); Klinefelter syndrome (KS); and cryptozoospermia (Crypt). The sperm retrieval rate, hormone levels, fertilization rate (FR), pregnancy rate (PR), and birth rate (BR) after ICSI among three groups were compared: fresh testicular sperm (FS)‐fresh oocytes (FO) (Group I); frozen‐thawed testicular sperm‐FO (Group II); and FS‐vitrified‐warmed oocytes (Group III).
Results
The testicular sperm recovery rate was 57.8% (463/801): 89.6% in the Crypt, 97.1% in the OA, 28.9% in the NOA, and 42.2% in the KS groups. The follicle‐stimulating hormone levels were significantly higher in the NOA and KS groups and the testosterone levels were significantly lower in the KS group. The FR, PR, and BR were: 65.2%, 43.2%, and 28.5% in group I; 59.2%, 33.4%, and 18.7% in group II; and 56.4%, 33.8%, and 22.1% in group III.
Conclusion
Intracytoplasmic sperm injection with FS‐FO achieved the best PR and BR. It should be considered what to do in cases with no testicular sperm by TESE. The authors hope that ICSI with donor sperm will be allowed in Japan in the near future.
Leucine-rich repeat-containing G protein-coupled receptor 4 (Lgr4) is a type of membrane receptor with a seven-transmembrane structure. LGR4 is homologous to gonadotropin receptors, such as ...follicle-stimulating hormone receptor (Fshr) and luteinizing hormone/choriogonadotropin receptor (Lhcgr). Recently, it has been reported that Lgr4 is a membrane receptor for R-spondin ligands, which mediate Wnt/beta-catenin signaling. Defects of R-spondin homolog (Rspo1) and wingless-type MMTV integration site family, member 4 (Wnt4) cause masculinization of female gonads. We observed that Lgr4−/− female mice show abnormal development of the Wolffian ducts and somatic cells similar to that in the male gonads. Lgr4−/− female mice exhibited masculinization similar to that observed in Rspo1-deficient mice. In Lgr4−/− ovarian somatic cells, the expression levels of lymphoid enhancer-binding factor 1 (Lefl) and Axin2 (Axin2), which are target genes of Wnt/beta-catenin signaling, were lower than they were in wild-type mice. This study suggests that Lgr4 is critical for ovarian somatic cell specialization via the cooperative signaling of Rspo1 and Wnt/beta-catenin.
Oocyte vitrification is one of the methods for preserving fertility of cancer patients. In 2013, we reported a successful live birth using cryopreserved oocytes from a patient who contracted ...Ph-positive acute lymphoid leukemia at the retrieval age of 20. In this report, we described a second live birth from the same patient. The patient visited our clinic in November 2018 hoping to utilize vitrified oocytes cryopreserved in 2007. As a result, a day 3 single eight-cell stage embryo was transferred in a hormone replacement therapy cycle. She became pregnant and gave birth to a healthy girl (2,740 g) in September 2019. This is a case report of two live births from 10 matured oocytes that had been preserved for 12 years.
Background: It is important to select blastocysts based on their likelihood of leading to pregnancy. The purpose of this study was to focus on expansion time and blastocyst diameter as simple factors ...to assess blastocysts relative to clinical outcomes. Methods: This study is based on 1,514 cycles in women Formula: see text years who underwent frozen-thawed blastocyst transfer (FBT) between November 2017 and February 2021. Blastocysts were classified according to the time they reached Formula: see textm inner diameter (116, 120, and 140Formula: see texth). Furthermore, blastocyst diameter at freezing was classified into three groups: groups S (under 167Formula: see textFormula: see textm), M (167–181Formula: see textFormula: see textm), and L (over 181Formula: see textFormula: see textm), based on tertile values. We compared the clinical outcomes (including the clinical pregnancy rate CPR) of FBT. Results: CPR was significantly higher in groups M and L than in group S at 116Formula: see texth (Formula: see text). At 120Formula: see texth, CPR in group L was significantly higher than in group S (Formula: see text). However, at 140Formula: see texth, there were no significant differences among the three groups. There were no significant differences in miscarriage rates at 116, 120, and 140Formula: see texth. When only good quality embryos were compared, group L resulted in a significantly higher CPR than group S at 116Formula: see texth (Formula: see text). At 120Formula: see texth, both groups M and L had significantly higher CPR than group S (Formula: see text). There were no significant differences at 140Formula: see texth. Conclusion: These results suggest that when multiple embryos are frozen at the same time on day 5 of culture, a higher pregnancy rate can be obtained by selecting embryos with larger blastocyst diameters. In addition, it is important to confirm sufficient blastocyst expansion before cryopreservation.
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