Can we modify assisted reproductive technology practice to broaden reproductive care access

Capsule:
Access to care may be enhanced by modifying standard assisted reproductive technology practice to make fertility treatment cheaper, simpler, and better tolerated by patients.

Authors:
Richard J. Paulson, M.D., Bart C.J.M. Fauser, M.D., Ph.D., Lan T.N. Vuong, M.D., Kevin Doody, M.D., H.C.L.D.

Volume 105, Issue 5, Pages 1138-1143

Abstract:

One of the barriers to access to fertility care is the relative complexity of fertility treatments. If these can be simplified, more patients may be able to take advantage of these treatments. In this overview, we review the potential benefits of simplifying ovarian stimulation by the means of four distinct methods: 1) using mild stimulation for IVF cycles; 2) using in vitro maturation to allow for the retrieval of oocytes that are not yet fully mature yet have the potential to result in live births; 3) conducting IVF in modified natural cycles which use no exogenous FSH stimulation; and 4) allowing embryo culture to take place in a novel intravaginal incubation system. These methods are considered to be somewhat unconventional, yet they have all been shown to lead to live births. In the era of individualized patient care, these techniques present viable alternatives to standard treatment. As experience and outcome data accumulate, they may prove to be not just alternatives to standard treatment, but potentially first-line treatment choices.

Potential role of circulating microRNAs as a biomarker for unexplained recurrent spontaneous abortion

Capsule:
Four circulating miRNAs (miR-320b, miR-146b-5p, miR-221-3p, miR-559) were up-regulated and one miRNA (miR-101-3p) was down-regulaed in unexplained recurrent spontaneous abortion (URSA). These circulating microRNAs may be involved in URSA pathogenesis and provide a promising new diagnostic biomarker for URSA.

Authors:
Weibing Qin, M.D., Yunge Tang, M.D., Ning Yang, M.D., Xiangcai Wei, M.D., Jiehua Wu

Volume 105, Issue 5, Pages 1247-1254

Abstract:

Objective:
To compare circulating microRNA (miRNA) profiles between unexplained recurrent spontaneous abortion (URSA) and normal early pregnancies (NEP) and to evaluate the potential role of circulating miRNA as a biomarker for URSA.

Design:
Laboratory study using human plasma samples.

Setting:
Special hospital and research institutes.

Patient(s):
From September 2012 to April 2013, samples of plasma were obtained from 27 URSA patients and 28 NEP patients at 6–10 weeks of gestation at the Department of Reproductive Immunology in Family Planning Special Hospital of Guangdong Province.

Intervention(s):
Differential miRNA profiling analysis of plasma collected from URSA and NEP patients was performed with the use of microarray.

Main Outcome Measure(s):
The circulating miRNA expression profile was assessed by means of microarray and real-time quantitative reverse-transcription polymerase chain reaction (qRT-PCR) analysis.

Result(s):
Twenty-five circulating miRNAs were expressed differentially in URSA compared with NEP. Of these, nine were overexpressed and 16 down-regulated. Six differentially expressed circulating miRNAs were selected to validate the microarray results, and qRT-PCR data confirmed the reliability of the microarray results. Further analysis showed that four circulating miRNAs (miR-320b, miR-146b-5p, miR-221-3p, miR-559) were up-regulated. In URSA, one circulating miRNA (miR-101-3p) was down-regulated in other larger scale samples according to qRT-PCR. Based on target gene analysis, we speculate that these circulating miRNAs regulate URSA by targeting immune, apoptosis, and angiogenic gene functions.

Conclusion(s):
Circulating microRNAs may be involved in URSA pathogenesis and provide a promising new diagnostic biomarker for URSA.

Number of biopsied trophectoderm cells is likely to affect the implantation potential of blastocysts with poor trophectoderm quality

Capsule:
We found that the implantation potential is negatively affected by the biopsied cell number in blastocysts with poor trophectoderm morphological score.

Authors:
Shuoping Zhang, M.Sc., Keli Luo, M.D., Ph.D., Dehua Cheng, M.Sc., Yueqiu Tan, Ph.D., Changfu Lu, Ph.D., Hui He, M.Sc., Yifan Gu, Ph.D., Guangxiu Lu, M.D., Fei Gong, M.D., Ph.D., Ge Lin, M.D., Ph.D.

Volume 105, Issue 5, Pages 1222-1227

Abstract:

Objective:
To evaluate whether the developmental potential of the blastocyst is affected by the number of trophectoderm (TE) cells biopsied in preimplantation genetic diagnosis (PGD) cycles.

Design:
Retrospective study.

Setting:
University-affiliated center.

Patient(s):
Women underwent PGD cycles of blastocyst biopsy and fluorescence in situ hybridization analysis.

Intervention(s):
Not applicable.

Main Outcome Measure(s):
Biopsied TE cell number of blastocysts, survival, and implantation rates.

Result(s):
The biopsied TE cell number was affected by the TE quality and experience of different embryologists. The diagnostic efficiency increased when from one to five cells were biopsied (86.7%, 91.7%%, 96.0%, 96.8%, to 98.7%) and was maximized when more than six cells were biopsied. To compare the clinical efficiencies, blastocysts were divided into four groups according to biopsied TE cell number: 1–5, 6–10, 11–15, and 16–41. For the blastocysts with grade A TE score, no significant difference was observed in the survival and implantation rates among the four groups. For the blastocysts with grades B and C TE scores, the survival rates showed no significant differences among the four groups, but a significant decreasing trend in implantation rates was observed with increasing biopsied TE cell number.

Conclusion(s):
The implantation potential is negatively affected by the biopsied TE cell number in blastocysts with poor TE morphological score.

Articles of Special Interest

Potential role of circulating microRNAs as a biomarker for unexplained recurrent spontaneous abortion

Sunday, May 1, 2016
Four circulating miRNAs (miR-320b, miR-146b-5p, miR-221-3p, miR-559) were up-regulated and one miRNA (miR-101-3p) was down-regulaed in unexplained recurrent spontaneous abortion (URSA). These circulating microRNAs may be involved in URSA pathogenesis and provide a promising new diagnostic biomarker for URSA.

Number of biopsied trophectoderm cells is likely to affect the implantation potential of blastocysts with poor trophectoderm quality

Sunday, May 1, 2016
We found that the implantation potential is negatively affected by the biopsied cell number in blastocysts with poor trophectoderm morphological score.

Mosaicism Survival of the fittest versus no embryo left behind

Sunday, May 1, 2016

Authors:
Santiago Munné, Ph.D., James Grifo, M.D., Ph.D., Dagan Wells, Ph.D.…

The challenge of embryonic mosaicism in preimplantation genetic screening

Sunday, May 1, 2016

Authors:
Richard T. Scott Jr., M.D., Daniela Galliano, M.D.…

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