In order to explore the relationship between serum progesterone (P) level on the day of human chorionic gonadotrophin (HCG) administration and cumulative live birth rate in patients with different ovarian response during in vitro fertilization (IVF), we carried out this retrospective cohort study including a total of 4,651 patients undergoing their first IVF cycles from January 2011 to December 2012. All patients with a final live birth outcome (4,332 patients) were divided into three groups according to ovarian response: poor ovarian responder (≤5 oocytes, 785 patients), intermediate ovarian responder (6–19 oocytes, 3065 patients) and high ovarian responder (≥20 oocytes, 482 patients). The thresholds for serum P elevation were 1.60 ng/ml, 2.24 ng/ml, and 2.50 ng/ml for poor, intermediate, and high ovarian responders, respectively. Cumulative live birth rate per oocyte retrieval cycle was calculated in each group. The relationship between serum P level and cumulative live birth rate was evaluated by both univariate and multivariate logistic regression analysis. Cumulative live birth rate per oocyte retrieval cycle was inversely associated with serum P level in patients with different ovarian response. For all responders, patients with elevated P level had significantly higher number of oocytes retrieved, but lower high quality embryo rate, and lower cumulative live birth rate compared with patients with normal serum P level. In addition, serum P level adversely affected cumulative live birth rate by both univariate and multivariate logistic regression analysis, independent of ovarian response. Serum P elevation on the day of HCG administration adversely affects cumulative live birth rate per oocyte retrieval cycle in patients with different ovarian response.
Reciprocal translocations (RecT) and Robertsonian translocations (RobT) are among the most common chromosomal abnormalities that cause infertility and birth defects. Preimplantation genetic testing for aneuploidy using comprehensive chromosome screening for in vitro fertilization enables embryo selection with balanced chromosomal ploidy; however, it is normally unable to determine whether an embryo is a translocation carrier. Here we report a method named "Mapping Allele with Resolved Carrier Status" (MaReCs), which enables chromosomal ploidy screening and resolution of the translocation carrier status of the same embryo. We performed MaReCs on 108 embryos, of which 96 were from 13 RecT carriers and 12 were from three RobT carriers. Thirteen of the sixteen patients had at least one diploid embryo. We have confirmed the accuracy of our carrier status determination in amniotic fluid karyotyping of seven cases as well as in the live birth we have thus far. Therefore, MaReCs accurately enables the selection of translocation-free embryos from patients carrying chromosomal translocations. We expect MaReCs will help reduce the propagation of RecT/RobT in the human population.
We retrospectively analyzed clinical data from 45,912 in vitro fertilization/intracytoplasmic sperm injection cycles in our reproductive medical center. We compared the clinical outcomes of three different ovarian hyperstimulation protocols in poor ovarian responders (classified by the POSEIDON criteria) to determine the most effective protocol for each POSEIDON group. In POSEIDON groups 1 and 3, the early-follicular-phase longacting GnRH-agonist long (EFLL) protocol was associated with higher pregnancy rates per transfer and higher live birth rates than the mid-luteal-phase short-acting GnRH-agonist long (MLSL) and GnRH-antagonist protocols. We also examined the relationship between advanced age and reproductive outcomes, and observed a negative correlation between age and live birth rate for each protocol (EFLL:
While the present understanding of pituitary-adrenal function predicts attenuation of responses to a repeated stressor, experimental observations often show occurrence of potentiation rather than inhibition. The role of the CNS in this phenomenon was investigated in rats sustaining either a single (S-HEM) or a double episode (R-HEM) of hemorrhage. For S-HEM, blood was withdrawn over 3min and retransfused at 10min; for R-HEM, the stimulus was repeated at 90 min. S-HEM elicited 26- and 9-fold increases in circulating adrenocorticotropin (ACTH) and corticosterone, respectively. After R-HEM the plasma ACTH response was potentiated by 82%. Sixty min after S-HEM, Fos-like immunoreactivity (Fos-IR) was increased in medullary (solitary nucleus, NTS and ventrolateral medulla, VLM), pontine (locus coeruleus, LC and parabrachial nucleus, PBN), limbic (central amygdala, CNA and bed nucleus, BNST), and hypothalamic (supraoptic nucleus, SON and paraventricular nucleus, PVN) regions activated by hemodynamic stimuli. However after R-HEM, the Fos-IR response was significantly potentiated only in the VLM and PVN, while only a moderate increase was evident in the NTS. In other brain regions (LC, PBN, CNA, BNST, HPC and SON), Fos-IR either did not change or the increases were less than those observed after S-HEM. It is suggested that this plasticity in the pattern of neuronal activation following repetition of a stimulus may account for the maintenance of pituitary-adrenal secretory responses and its potentiation after R-HEM.
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