The Onco Fertility Journal最新文献

{"title":"Is embryogenesis and ART outcome different in polycystic ovary syndrome?","authors":"M. Patil, P. Reddy, Chinmayie Chandrashekar, M. Patil","doi":"10.4103/tofj.tofj_20_19","DOIUrl":"https://doi.org/10.4103/tofj.tofj_20_19","url":null,"abstract":"Introduction: As oogenesis is a continuum of months, oocyte quality will be dictated by events that occur during both the growth and maturation stages of development. Morphological variation of the oocyte and embryo result from intrinsic factors such as age and genetic defects or extrinsic factors such as stimulation protocol, culture condition, and nutrition. Controlled ovarian stimulation (COH) interferes with the balance of forces within the ovary and overrides their endogenous pattern of control to optimize normal selection process. Aim: 1. To compare the embryogenesis and outcome of assisted reproductive technology (ART) in polycystic ovary syndrome (PCOS) and non-PCOS women. 2. To determine whether embryo quality, implantation rate (IR) and clinical pregnancy rate (CPR) are related to estradiol (E2) or progesterone (P4) levels on the day of human chorionic gonadotropin (hCG). Materials and Methods: This was a retrospective case–control study of 425 women at a Tertiary Care Center from January 2017 to December 2018. Of these 183 were PCOS and 242 non-PCOS matched for body mass index and age. We compared the follicle stimulating hormone, antral follicle count (AFC), anti-Mullerian hormone, thyroid-stimulating hormone, total gonadotropin utilized, total days of stimulation, estradiol (E2), and progesterone (P4) on the day of hCG trigger between both groups. Before entering the in vitro fertilization program, patients were classified into PCOS and non-PCOS depending on the AFC at the baseline scan done on day 2/3 of the menstrual cycle. We calculated the fertilization, cleavage, blastocyst formation rate, and utilization rate of the embryos from the total oocytes retrieved and fertilized in four different groups classified according to the E2 levels on the day of the hCG (≤1000, 1001–2000, 2001–3000, >3000 pg/ml) in both PCOS and non-PCOS women. We also looked at the IR and CPR in the above four groups in fresh cycle and included the frozen embryo transfer cycles to calculate the utilization rate. Statistical comparison was done using the Mann–Whitney U test. Results: There was no statistically significant difference in the fertilization rate (P = 0.803), cleavage rate was higher in PCOS group (P = 0.001) and blastocyst formation rate was higher in non-PCOS group (P < 0.001). There was no statistical difference seen in the grade of the embryos on day 3 and day 5 across the E2 groups in the PCOS women. The quality of embryos on D3 and D5 was much better in non-PCOS group with E2 levels more than 2000 pg/ml. The IR was similar in both PCOS and non-PCOS group when E2 values were <2000 pg/ml and >3000 pg/ml. The IR was higher in the PCOS group as compared to non-PCOS in women with E2 between 2000 and 3000 (P = 0.020). No difference in the CPR across the E2 groups. The utilization rate of the embryos per egg retrieved and per 2PN was statistically higher in patients with an E2 < 1000 pg/ml in PCOS women. The utilization rate of the embryos per egg r","PeriodicalId":425762,"journal":{"name":"The Onco Fertility Journal","volume":"32 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124545944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Resetting the “biological clock”","authors":"Nalini Mahajan","doi":"10.4103/tofj.tofj_19_19","DOIUrl":"https://doi.org/10.4103/tofj.tofj_19_19","url":null,"abstract":"Biologically speaking, the dice is loaded against women. While it is possible for men to be fathers’ way into old age, for women, reproductive capacity has already started waning when they cross the age of 35 and is severely limited after the age of 40. The reason for this phenomenon lies in the ability of the male germ cells to develop throughout adult life. Women, on the other hand, are thought to have a finite pool of oocytes at birth, which diminishes with age. This view was put forth by Waldeyer in 1870 and reaffirmed by other authors. It gained wide acceptance in the scientific community after a paper by Zuckerman in 1951,[1] which stated that neo‐oogenesis did not occur postnatally in mammals.[2] This view remained unopposed till Johnson et al.[3] demonstrated oocyte‐stem cells (OSCs) capable of generating new eggs, in adult mouse ovaries. These eggs underwent fertilization and produced viable offspring. These findings, though heavily debated, sparked extensive research because of their value in the fertility treatment of women with premature ovarian insufficiency (POI). White et al., 2012[4] demonstrated oocyte formation by active germ cells purified from ovaries of reproductive age women. In recent years, other authors[5] have provided convincing evidence of the presence of OSCs and their capability of developing into fertilizable oocytes and producing viable offspring in mice.","PeriodicalId":425762,"journal":{"name":"The Onco Fertility Journal","volume":"137 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127343936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Oocyte embryo and ovarian tissue freezing in endometriosis: Food for thought","authors":"U. Jindal, S. Verma","doi":"10.4103/tofj.tofj_17_19","DOIUrl":"https://doi.org/10.4103/tofj.tofj_17_19","url":null,"abstract":"Fertility preservation by oocyte, embryo, or ovarian tissue in females is an established technique now. In addition to oncology patients, the indications have been extended to other benign diseases such as endometriosis which carry a significant risk of decrease in ovarian reserve due to disease or therapy instituted. Fertility preservation is not without its pros and cons. All young women need to be counseled regarding the decrease in ovarian reserve with endometriosis, age and/or surgery. Fertility preservation options need to be discussed whenever immediate childbearing is not possible or desired.","PeriodicalId":425762,"journal":{"name":"The Onco Fertility Journal","volume":"5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126004847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tubal choriocarcinoma presenting as an ectopic pregnancy","authors":"A. Kant, Grishma Dhanesha, U. Gupta, A. Kaul, Divya M. Kant","doi":"10.4103/tofj.tofj_10_19","DOIUrl":"https://doi.org/10.4103/tofj.tofj_10_19","url":null,"abstract":"Choriocarcinoma, a subtype of gestational trophoblastic disease, is a rare and aggressive neoplasm. It occurs due to neoplastic changes in the chorionic villi epithelium. Primary fallopian tube choriocarcinoma is extremely rare and commonly mistaken as ectopic pregnancy. We present a case of a 37-year-old female who presented with complaints of prolonged spotting per vaginum following an induced abortion. Ultrasound was suggestive of the right tubal ectopic pregnancy, and beta-human chorionic gonadotropin (BHCG) levels were remarkably high. The patient was taken for laparoscopy suspecting tubal ectopic pregnancy and right salpingectomy was done. Histopathology was suggestive choriocarcinoma of fallopian tube. Contrast enhanced CT scan of brain MRI pelvis, and chest X-ray showed no evidence of metastasis. Hence, the patient was managed with single-agent chemotherapy with injection methotrexate with leucovorin. The case highlights the importance of histopathological examination of tubal specimen in all patients presenting with tubal ectopic pregnancy and also the need to suspect a tubal choriocarcinoma in any patient presenting as ectopic pregnancy with high BHCG levels.","PeriodicalId":425762,"journal":{"name":"The Onco Fertility Journal","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125031039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fertility preservation for female cancer patients by manipulating ovarian stem cells that survive oncotherapy","authors":"D. Bhartiya","doi":"10.4103/tofj.tofj_12_19","DOIUrl":"https://doi.org/10.4103/tofj.tofj_12_19","url":null,"abstract":"Infertility and premature ovarian failure are unwanted side effects of oncotherapy in females; however, a large number of patients survive cancer due to recent advances in their management. One of the available options to restore fertility in cancer survivors is to transplant ovarian cortical tissue slices at orthotopic sites which has resulted in the birth of 130 babies. Spontaneous pregnancies have also been reported after heterotopic transplantation of cortical tissue slices which can only be explained by the presence of stem cells and paracrine support provided by transplanted ovarian slices to the nonfunctional ovary. The ovary harbors two populations of stem cells, including very small embryonic-like stem cells (VSELs) and slightly bigger ovarian stem cells (OSCs) that divide and undergo clonal expansion to form germ cell nests in adult ovary before undergoing neo-oogenesis and primordial follicle assembly. Being relatively quiescent, VSELs survive oncotherapy and can regenerate the nonfunctional ovary. Stem cells niche gets affected by oncotherapy and transplanting autologous bone marrow mesenchymal stem cells (MSCs, which provide paracrine support) have shown to normalize ovarian function in rodents with the birth of healthy pups. Similarly, transplanting of autologous MSCs in human ovary with premature ovarian failure resulted in the birth of a baby. These advances in the field of OSCs need to be put in proper context before considering making transplantation of ovarian cortical tissue at orthotopic sites as method of standard care. Transplanting autologous MSCs is safe, and efficacy to regenerate nonfunctional ovaries needs to be evaluated in clinical settings.","PeriodicalId":425762,"journal":{"name":"The Onco Fertility Journal","volume":"111 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116173462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preimplantation genetic testing for aneuploidy and subsequent blastocyst transfer improves pregnancy outcome in advanced maternal age patients","authors":"B. Rawat, Surleen Kaur","doi":"10.4103/tofj.tofj_14_19","DOIUrl":"https://doi.org/10.4103/tofj.tofj_14_19","url":null,"abstract":"Context: Advanced maternal age (AMA) is an important parameter that negatively influences the pregnancy rate in assisted reproductive technology because the rate of aneuploidy in the embryos increases with the patient age. Aims: The aim of this study is to evaluate whether the transfer of an euploid embryo selected by preimplantation genetic testing for aneuploidy (PGT-A) would improve the pregnancy outcome in AMA patients. Settings and Design: This was a retrospective controlled study. Materials and Methods: A total of 250 patients who had undergone frozen transfers of day 5/6 blastocysts were recruited. Patients who had morphologically selected euploid blastocyst transfer were grouped under PGT-A (n = 47) and patients who had only morphologically selected blastocyst transfer were grouped under non-PGT-A (n = 203). The patients were further grouped as test group (AMA patients, ≥35 years of age) and control group (young patients, <35 years of age) in PGT-A and non-PGT-A arm. The comparison was performed between all of the groups. The primary outcome measure was serum beta-human chorionic gonadotropin level for pregnancy confirmation after 14 days of embryo transfer. Statistical Analysis Used: The Chi-square test was used to analyze pregnancy outcomes. Results: Overall pregnancy rate was found to be significantly increased in the PGT-A group in comparison to the non-PGT-A group irrespective of the age (78.5% vs. 59.7%, P = 0.00001). No significant difference were observed in Young versus AMA group of PGT-A arm (79.2% vs. 77.8%, P = 0.62). Interestingly, the study showed a significant increase in the pregnancy outcome of the AMA patients of PGT-A group (77.8% vs. 57.8%, P = 0.002) as compared to the non-PGT-A group. Conclusions:> The present study demonstrates that the transfer of PGT-A-selected euploid embryo significantly improves the pregnancy outcome in AMA patients.","PeriodicalId":425762,"journal":{"name":"The Onco Fertility Journal","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127552051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The use of preimplantation genetic testing for aneuploidy and mitochondrial DNA scoring helps in improving assisted reproductive techniques outcome","authors":"Nalini Mahajan, J. Kaur","doi":"10.4103/tofj.tofj_13_19","DOIUrl":"https://doi.org/10.4103/tofj.tofj_13_19","url":null,"abstract":"Background: Aneuploidy is a leading cause of implantation failure and miscarriage. Preimplantation genetic testing for aneuploidy (PGT-A) with mitoscore enables screening of viable euploid embryos, thereby improving in vitro fertilization (IVF) outcome. Aim of the study: The aim of this study is to determine if the use of PGT-A in patients with valid indications can help improve assisted reproductive techniques outcome. Materials and Methodology: All patients undergoing IVF-PGT-A cycles between April 2016 and March 2018 were included (n = 42) in the study. Patients were compared with a control group consisting of fresh or frozen blastocyst transfers selected by morphology, during the same period (n = 226). Trophectoderm samples were subjected to chromosome analysis and mitoscore assessment using next-generation sequencing. Single-embryo transfer was done according to transfer priority determined by mitoscore. Statistical Analysis: The Chi-square test was used for comparisons between the study groups with respect to percentages. A value of P <0.05 was considered as statistically significant. Results: The indications for PGT-A in our patients were advanced maternal age 33%, followed by recurrent pregnancy loss 25%, recurrent implantation failure 19%, previous history of aneuploidy 16%, and severe male factor 6%. An ongoing pregnancy rate (OPR) of 61% versus 48% (P = 0.0049) was achieved with PGT-A versus controls, respectively. Thirty-two percent of patients did not have any euploid embryos for transfer. Conclusion: Offering PGT-A with mitoscore for valid indications seems to be an impressive tool to increase implantation and OPRs and helps in counseling patients for further course of treatment.","PeriodicalId":425762,"journal":{"name":"The Onco Fertility Journal","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133525437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A case report on severe ovarian hyperstimulation syndrome in a pregnancy with torsion of bilateral enlarged ovaries with acute abdomen","authors":"S. Das, P. Roy","doi":"10.4103/tofj.tofj_2_18","DOIUrl":"https://doi.org/10.4103/tofj.tofj_2_18","url":null,"abstract":"Ovarian hyperstimulation syndrome is a complication of fertility treatment, which uses pharmacological ovarian stimulation to increase the number of oocytes and therefore embryos available during assisted reproductive technology. Ovarian hyperstimulation syndrome is invariably associated with increased volume of ovaries which is itself a threat to undergo torsion, and it may cause an additional threat requiring prompt surgical intervention in many situations. Simple release of torsion, sacrificing the devitalized ovarian tissue in part and complete can have effect in continuation of pregnancy; and something like this happened in our case. The patient, 29-year-old, a known case of polycystic ovary syndrome (PCOS), conceived through ovulation induction; came with an episode of acute pain abdomen with abdominal distension toward the later part of her first trimester. Ultrasonography was done. Bilateral enlarged ovaries of around 23 cm × 11.8 cm each were seen meeting at the pouch of Douglas with ascites. It was a case of ovarian hyperstimulation syndrome, more specifically, a case of late ovarian hyperstimulation syndrome. Serum E2 level was 3263 pg/ml. Laparotomy was then done. Intraperitoneally bilateral ovarian torsion was seen with areas of necrosis. The right oophorectomy was done, while on the left side some portion of normal ovarian tissue was preserved. Following the operation, her symptoms were improved. The pregnancy continued uneventfully. Exposure of ovaries to human chorionic gonadotropin or luteinizing hormone following controlled ovarian stimulation by follicle-stimulating hormone underlies most cases of ovarian hyperstimulation syndrome. The risk of ovarian hyperstimulation syndrome is smaller when using gonadotropin-releasing hormone antagonist (GnRH) antagonist protocol instead of GnRH agonist protocol for suppression of ovulation during ovarian hyperstimulation. To avoid ovarian hyperstimulation syndrome, the best trigger is GnRH agonists. In PCOS patients, metformin is an important aid in reducing ovarian hyperstimulation syndrome.","PeriodicalId":425762,"journal":{"name":"The Onco Fertility Journal","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128571058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fertility preservation in testicular seminoma","authors":"M. Patil, P. Reddy","doi":"10.4103/tofj.tofj_3_18","DOIUrl":"https://doi.org/10.4103/tofj.tofj_3_18","url":null,"abstract":"Testicular cancer is the most common solid malignancy affecting males between the ages of 15 and 35, although it accounts for only 1% of all cancers in men. Germ cell tumors (GCTs) account for 95% of testicular cancers. Two broad categories of testicular tumors have been described, one pure seminoma (no nonseminomatous elements present) and the other is nonseminomatous GCTs. It is one the most curable neoplasm with 5 years survival rate of 98%–99% when diagnosed at an early stage. We present here one such case of metastatic seminoma, where the semen was cryopreserved for fertility preservation. Although the sample was oligoasthenospermic, a successful pregnancy and live birth was obtained with intrauterine insemination of the frozen sample in an controlled ovarian stimulation cycle. Testicular tumors can impair fertility after treatment in majority of patients. Fertility preservation methods such as semen freezing, sperm freezing using epididymal or testicular sperm extraction (TESE) or testicular tissue freezing provides hope for those who wish to father a child latter.","PeriodicalId":425762,"journal":{"name":"The Onco Fertility Journal","volume":"69 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123849490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fertility preservation in a premenarcheal female with sickle cell anemia","authors":"SonuBalhara Ahlawat, Sarabpreet Singh","doi":"10.4103/TOFJ.TOFJ_7_18","DOIUrl":"https://doi.org/10.4103/TOFJ.TOFJ_7_18","url":null,"abstract":"The objective of the study was fertility preservation in a premenarcheal female with sickle cell anemia (SCA) using controlled ovarian hyperstimulation and oocyte preservation. The study design was a case report. The study was conducted at the reproductive medicine unit of a tertiary care private hospital. A 15-year-old premenarcheal female with Tanner stage 3 breast development and Tanner stage 1 pubic hair diagnosed with SCA, referred by a medical oncologist for fertility preservation before undergoing chemotherapy and bone marrow transplant. The interventions were evaluation of ovarian reserve, ovarian stimulation (OS), transvaginal oocyte aspiration, and oocyte cryopreservation (OC). The main outcome measure was cryopreservation of mature oocytes before the antineoplastic therapy. Controlled ovarian hyperstimulation allowed for cryopreservation of ten mature oocytes before the start of the patient's gonadotoxic treatment. OS and OC can be successfully performed in premenarcheal/peripubertal SCA patients before undergoing chemotherapy, thus providing a viable option for fertility preservation.","PeriodicalId":425762,"journal":{"name":"The Onco Fertility Journal","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121625319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}