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Fertility preservation is effective in female cancer patients

Fertility preservation is effective in female cancer patients

The largest study looking at long-term outcomes of fertility preservation in female cancer patients has demonstrated how successful it can be, in particular for breast cancer patients.

The research, presented at the virtual meeting of the European Society of Human Reproduction and Embryology 2020 followed 879 young female patients (mean age 33.8) over a period of 19 years (2000-2019) – the longest reported follow-up of fertility preservation in cancer patients.

‘Currently, there is limited long-term outcome data [on fertility preservation] and this makes it difficult to counsel patients about the likelihood of success.’ said study author Dr Dalia Khalife from Guy’s and St Thomas’ Hospital, London. ‘Our study offers the largest cohort and longest follow-up of fertility preservation in female cancer patients… Around one in six of those who stored their gametes had a good outcome.’

However, she noted that there is a need for longer follow-up of patients and that early referral for fertility treatment is vital.

After counselling, 373 patients (42 percent) chose to have fertility preservation using one of three fertility preservation techniques: egg freezing (53 percent), embryo freezing (41 percent) and ovarian tissue cryopreservation (1%); with 5% using both egg and embryo freezing.

A total of 61 patients (16.4 percent) returned to use their eggs and 44 of them were successful following fertility treatment (live birth rate 72.1 percent).

Women diagnosed with breast cancer were the most likely to return for treatment and also had the highest live birth rate (70 percent versus 30 percent for lymphoma patients).

‘A fertility preservation service must be integral to a modern cancer care pathway. Fertility preservation with eggs and embryos has been beyond experimental for some time. And it’s important that clinicians across the world continue to collect and share data on long-term outcome for all methods, including ovarian tissue preservation, to provide patients with robust information’ said Dr Khalife.

Commenting on the study, Dr Melanie Davies, consultant obstetrician and gynaecologist at University College London Hospitals NHS trust and chair of Fertility Preservation UK, :

‘This is fantastic news – proof positive that fertility preservation is effective and worthwhile. It gives excellent outcomes for those women who return to use frozen eggs/embryos, as 44 of 61 achieved successful pregnancies and births. The proportion of patients who came back to the fertility clinic to use their frozen eggs/embryos (16 percent) is notably higher than for men who store sperm. More will return as the years pass. These results confirm that young women with a new diagnosis of cancer should be offered fertility preservation as part of their treatment pathway as long as they are well enough and time allows.’

Read more: https://www.eshre.eu/ESHRE2020/Media/2020-Press-releases/Khalife

Female hormone in hair could predict response to ovarian stimulation for IVF

Female hormone in hair could predict response to ovarian stimulation for IVF

The prospect of a non-invasive test of ovarian reserve is a little closer following results from a study showing that measurement of a fertility hormone can be accurately taken from a sample of human hair.

Anti-Mullerian hormone — or AMH — has become a key marker in the assessment of how women may respond to fertility treatment.

The hormone is produced by small cells surrounding each egg as it develops in the ovary, and is thus seen as a measure of ovarian reserve. Although studies have not correlated AMH levels to a reliable chance of live birth (nor to forecasting the time of menopause), AMH measurement has become an intrinsic marker in assessing how a patient will respond to ovarian stimulation for IVF — as a normal responder, poor responder (with few eggs), or over-responder (with many eggs and a risk of ovarian hyperstimulation syndrome, OHSS).

AMH is presently measured in serum taken from a blood sample drawn intravenously. The readings represent a measurement at a short moment in time and are relatively invasive to complete.

Now, a new study presented at the online Annual Meeting of ESHRE has tested the quantification of AMH from human hair and found it to be a less invasive and a “more appropriate representation of hormone levels” than from an “acute” source like serum.

The results are presented this week in a poster from PhD student Sarthak Sawarkar, working in the laboratory of Professor Manel Lopez-Bejar in Barcelona, with collaborators from MedAnswers Inc in the USA.

The study, which still continues, now reports results from 152 women from whom hair and blood samples were routinely collected during hospital visits. AMH measured in serum from the same subjects was used to provide a control, as was an ultrasound count of developing follicles in the ovary (AFC) as a further measure of ovarian reserve.

“Biologically relevant” AMH levels were successfully detected in the hair samples, with levels declining with patient age, as expected. As ovarian reserve declines with age, so do AMH levels. The AMH levels from hair strongly correlated with both serum levels and AFC.

It was also seen that the hair test was able to detect a wide range of AMH levels within individuals from a similar age cohort, suggesting a greater accuracy than from a single blood sample.

Hormones accumulate in hair shafts over a period of months, while hormone levels in serum can change over the course of hours.

“So hair,” explain the authors, “is a medium that can accumulate biomarkers over several weeks, while serum is an acute matrix representing only current levels. While hormone levels in blood can fluctuate rapidly in response to stimuli, hormone levels measured in hair would represent an accumulation over several weeks. A measurement using a hair sample is more likely to reflect the average hormone levels in an individual.”

Among the other advantages of a hair test, the authors note that hormone levels are assessed non-invasively, which reduces testing stress and offers a less expensive assay. Testing can be done without visiting a clinic, and thus makes this type of test available to a broader range of women.

“Finally,” explains Mr Sawarkar, “as hair offers a look at the long-term accumulation of hormones, this measurement may allow a better understanding of an individual’s hormone levels — unlike blood-based assays, which can only measure the hormone at the moment of the testing.”

AMH has so far had an important — though sometimes controversial — role in reproductive medicine. Thus, while its role as a measure of ovarian reserve in predicting response to ovarian stimulation for IVF now seems beyond question, there has been doubt over its broader application as a measure of female fertility in the general population.

Commenting on the biology of the test, Mr Sawarkar explains that hormones are incorporated into the matrix of hair before the growing hair reaches the skin surface, thereby allowing an accumulating measurement of hormone concentration.

Story Source: European Society of Human Reproduction and Embryology

Embryo vitrification is safe but longer storage reduces chances of pregnancy success

Embryo vitrification is safe but longer storage reduces chances of pregnancy success

Freezing and storing embryos during fertility treatment using a technique called vitrification is safe, although women are less likely to become pregnant and have a live birth the longer the embryos are stored, according to new research published in Human Reproduction, one of the world’s leading reproductive medicine journals.

There have been concerns that vitrification technology could be unsafe for the embryo, leading to complications at the time of birth and later, including preterm birth, low or high birthweight and birth defects.

Until now, it was also unclear whether storage time after vitrification affected embryo viability, pregnancy outcomes or neonatal outcomes. The study, which is the largest to investigate these questions, found that the chances of becoming pregnant and giving birth to a live baby significantly decreased with longer storage time.

The researchers from the Shanghai Ninth People’s Hospital (Shanghai, China) analysed outcomes from 24,698 patients who had vitrified embryos transferred for the first time between January 2011 and December 2017.

They compared patients who had vitrified embryos stored for up to three months (group one) with patients whose embryos were stored for 3-6 months (group two), 6-12 months (group three) and 12-24 months (group four). They found that the implantation rate fell from 40% in group one to 26% in group four; the clinical pregnancy rate fell from 56% in group one to 26% in group four; and the live birth rate fell from 47% in group one to 26% in group four.

This means that among women who had embryos stored for less than three months, 47 out every 100 women would achieve a live birth. Whereas among women who had embryos stored for between 12-24 months, 34 out of every 100 women would achieve a live birth.

The rate of miscarriages and ectopic pregnancies also increased with longer storage time. However, these associations were not statistically significant after taking into account factors that could affect the results such as the mother’s age, mother’s body mass index, the cause of infertility, parity and embryo quality and stage of development. There was no evidence that storage time affected neonatal outcomes.

Groups three and four had a greater proportion of older women or patients with a poor prognosis due to smaller numbers of available eggs than groups one and two; so the researchers carried out a second analysis to investigate whether it could be the women’s ages and the amount of viable eggs they had in their ovaries at the time of vitrification and embryo transfer that led to the lower pregnancy and birth rates.

They analysed a subset of 7,270 women who were younger than 36 years and whose infertility was caused by blocked or damaged fallopian tubes. This produced similar results; there was a 50% live birth rate among women in group one, compared to a 38% live birth rate in group four.

Dr Qianqian Zhu is a research assistant who led the study. She said: “We think the results from this sub-analysis support our main results about the relationship between the duration of storage with pregnancy and neonatal outcomes.”

Co-author, Professor Qifeng Lyu is deputy director of the department of assisted reproduction at the hospital. He said: “Our study suggests that although the storage time of vitrified embryos negatively affected pregnancy outcomes, including clinical pregnancy and live birth rates, it did not affect neonatal outcomes. Concerns have arisen over the safety of prolonged storage time of vitrified embryos worldwide following the wide application of vitrification, and neonatal health is related to growth, development and health in childhood, adolescence and adulthood. Our study demonstrated the safety of using long-stored embryos after vitrification on neonatal health.

This is reassuring news for couples seeking fertility treatment. The reduction in live birth rates can be overcome through additional embryo transfer cycles. If we had found that neonatal health was adversely affected by vitrification, it would impose a heavy burden on individuals, family and society.”

The study is unable to show the effect of storing embryos for longer than 24 months, and the researchers did not undertake long-term follow-up of babies, so do not have information about their growth and development. As the study was retrospective, the researchers say that prospective studies with long-term follow-up are needed to investigate the safety of vitrification for longer periods of time.

Dr Zhu said: “Our results suggest that clinicians should consider the effect of storage duration before making decisions about the numbers of embryos to freeze and store. This is especially important for cancer patients, who may have their ovaries destroyed by cancer therapies and who have to delay fertility treatment until they have recovered from their disease.”

Vitrification involves placing embryos briefly in a solution to dehydrate them before they are rapidly frozen into a glass-like state. Chemicals called cryoprotectants are used during this process to prevent ice crystals forming, which could damage the embryos. Then the embryos are immediately exposed to liquid nitrogen to freeze them rapidly, ready for storage. When needed, this process is reversed to thaw and warm the embryos quickly. Vitrification is a simple, fast and inexpensive technique, which has become a fundamental tool in fertility treatments in recent years because of its higher embryo survival rates and better clinical outcomes.

Read more: https://academic.oup.com/DocumentLibrary/humrep/PR_Papers/deaa136.pdf

Endometriosis fertility index predicts if a woman needs IVF

Endometriosis fertility index predicts if a woman needs IVF

The Endometriosis Fertility Index (EFI) is a good indicator for predicting pregnancy achieved without use of assisted reproductive technology (ART), according to a meta-analysis of 17 studies involving 4,598 women.

Patients with low Endometriosis Fertility Index (EFI) scores may not have a strong chance of a pregnancy achieved without use of assisted reproductive technology (ART), according to a meta-analysis from BJOG.

The Iranian authors of the review in BJOG noted that study results to evaluate the EFI score for predicting non-ART pregnancy have been inconsistent.

The cumulative rate of non-ART pregnancy at 36 months was 10% for women with an EFI of 0 to 2, which significantly increased to 69% for women with an EFI of 9 to 10. Furthermore, compared to women with an EFI of 3 to 4 combined cumulative non-ART pregnancies were 44% for women with an EFT of 5 to 6, and 55% for women with an EFI of 7 to 8. A significant difference existed between all categories.

The odds ratio (OR) for EFI was 1.33 and the summary area under the curve (AUC) was 72%.

Conclusions

The authors stated that the existing revised American Fertility Society (rAFS) score for staging endometriosis has considerable limitations, including arbitrary point scores and wide score ranges within the categories. There is also the “potential for observer error because of numerous morphological presentations, some subtle and microscopic and the timing of the laparoscopy, and whether the staging is performed at laparoscopy or laparotomy,” they wrote.

Furthermore, there is poor correlation between the extent of disease and pelvic pain and rAFS stages align poorly with infertility. For these and many other reasons, EFI has been proposed as having greater predictive power than rAFS for a successful pregnancy, with or without ART, in endometriosis patients.

Specifically, patients with an EFI score of 0 to 3 should be informed as to the low likelihood of non-ART pregnancy; therefore, ART should be strongly recommended.

Women unlikely to achieve non-ART pregnancy or spontaneous pregnancy, based on their EFI score, might be candidates for earlier in vitro fertilization and embryo transfer to prevent treatment delays and increase their chances for pregnancy.

The non-ART pregnancy rate might be linked with duration before attempting ART. For fertility management, EFI can be used as a predictive factor for a spontaneous second pregnancy.

Despite the review concluding that the EFI score is a good predictor for non-ART pregnancy, “these findings should be considered with caution due to the substantial heterogeneity between studies,” the authors said.

Read more: https://pubmed.ncbi.nlm.nih.gov/31967727/

Ο δείκτης γονιμότητας ενδομητρίωσης δείχνει με αξιοπιστία εάν μια γυναίκα χρειάζεται εξωσωματική γονιμοποίηση

Ο δείκτης γονιμότητας ενδομητρίωσης δείχνει με αξιοπιστία εάν μια γυναίκα χρειάζεται εξωσωματική γονιμοποίηση

Όταν μία γυναίκα κάνει λαπαροσκόπηση για τη θεραπεία της ενδομητρίωσης, ο γιατρός της μπορεί να υπολογίσει τον λεγόμενο “δείκτη γονιμότητας ενδομητρίωσης”.

Πρόκειται για μία βαθμολόγηση που δείχνει κατά πόσο είναι πιθανό μία γυναίκα με ενδομητρίωση να συλλάβει φυσιολογικά ή εάν χρειάζεται να στραφεί στην εξωσωματική γονιμοποίηση.

Μετα-ανάλυση 17 μελετών, με τη συμμετοχή 4.598 γυναικών έδειξε ότι ο δείκτης γονιμότητας ενδομητρίωσης μπορεί να προβλέψει εάν μία γυναίκα θα μείνει έγκυος φυσιολογικά ή εάν χρειάζεται κάποια μέθοδος υποβοηθούμενης αναπαραγωγής. Εάν μετά τη λαπαροσκόπηση έχει χαμηλό δείκτη γονιμότητας ενδομητρίωσης, δεν έχει πολλές πιθανότητες φυσικής σύλληψης. Στις έρευνες που αναλύθηκαν υπήρχαν πάντως σημαντικές διαφορές στα αποτελέσματα.

Η ανάλυση του συνόλου των στοιχείων έδειξε ότι για τις γυναίκες που είχαν δείκτη γονιμότητας ενδομητρίωσης 0-2, οι πιθανότητες να μείνουν φυσιολογικά έγκυοι τους επόμενους 36 μήνες ήταν μόλις 10%. Οι γυναίκες που είχαν 3-4 είχαν πιθανότητες 44% και οι γυναίκες που είχαν δείκτη 7-8, είχαν πιθανότητες 55% να μείνουν έγκυοι χωρίς κάποια μέθοδο υποβοηθούμενης αναπαραγωγής.

Μέχρι να εισαχθεί στην καθημερινή κλινική πράξη ο δείκτης γονιμότητας της ενδομητρίωσης (EFI), παγκοσμίως χρησιμοποιείτο η αναθεωρημένη βαθμολογία της Αμερικανικής Εταιρείας Γονιμότητας (rAFS) για τη σταδιοποίηση της ενδομητρίωσης, η οποία έχει σημαντικούς περιορισμούς.

Ο δείκτης γονιμότητας ενδομητρίωσης είναι πιο αξιόπιστος για να μάθει μία γυναίκα εάν χρειάζεται εξωσωματική γονιμοποίηση ή έχει μεγάλες πιθανότητες να μείνει φυσιολογικά έγκυος.

Κατά τη λαπαροσκόπηση εντοπίζονται οι εστίες της ενδομητρίωσης και προσδιορίζεται η έκταση και το στάδιο της νόσου.

Ανάλογα με τη βαθμολογία, τα στάδια της ενδομητρίωσης είναι τέσσερα.

Στάδιο Ι – ελάχιστη

Στάδιο ΙΙ – ελαφρά

Στάδιο ΙΙΙ – μέτρια

Στάδιο IV– σοβαρή

Η παλιά μέθοδος εκτίμησης της ενδομητρίωσης και σταδιοποίησής της, είχε περιορισμένη συσχέτιση με τον πυελικό πόνο, αλλά και δεν μπορούσε να προβλέψει την υπογονιμότητα.

Δηλαδή, κάποιες γυναίκες με σοβαρή ενδομητρίωση δεν έχουν καθόλου πόνο, ενώ γυναίκες με ελάχιστη ενδομητρίωση υποφέρουν από σοβαρή δυσμηνόρροια.

Σύμφωνα με τους ερευνητές, για τις ασθενείς με ενδομητρίωση, ο δείκτης γονιμότητας ενδομητρίωσης είναι καλύτερος προγνωστικός παράγοντας επιτυχημένης εγκυμοσύνης είτε κάνει η ασθενής τεχνητή γονιμοποίηση είτε όχι, γιατί για να υπολογίσουμε τον δείκτη γονιμότητας της ενδομητρίωσης, λαμβάνουμε υπόψιν την ηλικία της γυναίκας, τη βατότητα των σαλπίγγων και αν έχει μείνει στο παρελθόν έγκυος.

Οι ασθενείς με βαριά ενδομητρίωση (EFI 0-3) πρέπει να ενημερώνονται σχετικά με τη χαμηλή πιθανότητα επίτευξης εγκυμοσύνης χωρίς εξωσωματική γονιμοποίηση για να μην χάνουν πολύτιμο χρόνο, είπαν οι ερευνητές.

Μπορείτε να διαβάστε περισσότερα: https://pubmed.ncbi.nlm.nih.gov/31967727/

Η ανδρική παχυσαρκία έχει άγνωστες μέχρι τώρα επιπτώσεις στα σπερματοζωάρια

Η ανδρική παχυσαρκία έχει άγνωστες μέχρι τώρα επιπτώσεις στα σπερματοζωάρια

Σημαντικές διαφορές στην ποσότητα 27 πρωτεϊνών που περιέχονται στα σπερματοζωάρια έχουν οι παχύσαρκοι άνδρες. Σύμφωνα με τα αποτελέσματα νέας μελέτης, οι διαφορές αυτές δεν εντοπίζονται από τις κοινές εξετάσεις.

Από τους δέκα άνδρες που έλαβαν μέρος στην έρευνα, οι 5 ήταν παχύσαρκοι και οι άλλοι 5 είχαν φυσιολογικό βάρος.

Όλοι είχαν φαινομενικά φυσιολογικά σπερματοζωάρια. Οι εξετάσεις που είχαν κάνει, δεν έδειχναν κανένα πρόβλημα”, όπως είπε ένας εκ των ερευνητών του Κέντρου Αναπαραγωγικής Ιατρικής του Κολοράντο.

Οι δέκα άνδρες, ηλικίας 33 έως 46 ετών δεν κάπνιζαν και δεν έπασχαν από διαβήτη. Όλοι είχαν φυσιολογικό αριθμό, κινητικότητα και μορφολογία σπερματοζωαρίων, αλλά και κατακερματισμό DNA.

Αυτές οι διαφοροποιήσεις των πρωτεϊνών στα σπερματοζωάρια των ανδρών, δεν ήταν εμφανείς στο σπερμοδιάγραμμα. “Εκτιμούμε ότι οι παραδοσιακές αναλύσεις σπέρματος δεν καταφέρνουν να ανιχνεύσουν σημαντικές βιοχημικές αλλαγές στα σπερματοζωάρια των παχύσαρκων ανδρών, οι οποίες μπορεί να προκαλούν προβλήματα στη γονιμότητα”, αναφέρουν οι ερευνητές.

Οι ερευνητές εντόπισαν 2034 πρωτεΐνες στα σπερματοζωάρια, εκ των οποίων 24 ήταν σημαντικά μειωμένες και 3 ήταν πιο αυξημένες στους παχύσαρκους άνδρες σε σχέση με τους άνδρες που είχαν φυσιολογικό βάρος.

Οι πρωτεΐνες των σπερματοζωαρίων που ήταν χαμηλότερες από το κανονικό στους παχύσαρκους άνδρες, συνδέονται με το οξειδωτικό στρες, τη φλεγμονή, την αποκατάσταση βλαβών του DNA και τη λειτουργία των σπερματοζωαρίων, ενώ εκείνες που ήταν αυξημένες συνδέονται με το οξειδωτικό στρες.

“Τα ευρήματά μας, δείχνουν ότι το οξειδωτικό στρες και η φλεγμονή συνδέονται στενά με την αναπαραγωγική δυσλειτουργία σε παχύσαρκους άνδρες. Αυτές οι διαδικασίες είναι πιθανό να επηρεάζουν την παραγωγή και την τρισδιάστατη δομή των πρωτεϊνών κατά τη διάρκεια της σπερματογένεσης, οδηγώντας σε κακή λειτουργία των σπερματοζωαρίων και σε υπογονιμότητα”.

Οι ερευνητές τόνισαν ότι “έχει δοθεί πολύ περισσότερη έμφαση στη γυναικεία από ό,τι στην ανδρική παχυσαρκία στη διερεύνηση της υπογονιμότητας και αξίζει να λαμβάνουμε υπόψιν και την ανδρική παχυσαρκία εξίσου. Πρέπει στις πρώτες φάσεις των προσπαθειών για επίτευξη εγκυμοσύνης, να εξηγούμε στο ζευγάρι τη σημασία γενικότερα της καλής υγείας και ειδικά της παχυσαρκίας”.

Δεν είναι ξεκάθαρο πάντως πως η παχυσαρκία μπορεί να επηρεάσει σε μοριακό επίπεδο τη γονιμότητα των ανδρών.

Η μελέτη δημοσιεύθηκε στο Assisted Reproduction and Genetics.

Πρέπει πλέον να γίνονται προσπάθειες για την εφαρμογή των θεραπειών που θα διορθώνουν ή θα περιορίζουν αυτές τις αλλαγές των πρωτεϊνών στα σπερματοζωάρια, στις περιπτώσεις που δεν είναι εφικτή η απώλεια βάρους πριν από την προσπάθεια σύλληψης”, καταλήγουν οι ερευνητές.

Μπορείτε να διαβάστε περισσότερα εδώ: https://link.springer.com/article/10.1007/s10815-020-01707-8

Image: SCIENCEphotoLIBRARY/Instagram

Sperm alterations caused by obesity are not detected in traditional tests

Sperm alterations caused by obesity are not detected in traditional tests

An analysis of sperm from men who were part of a couple whose partner was undergoing in-vitro fertilization (IVF) identified differences in samples between obese vs nonobese men. Specifically, there were differences in the levels of 27 proteins contained in the sperm.

Importantly, all 10 men in these infertile couples (5 obese men and 5 nonobese men) had clinically normal semen, lead study author Taylor Pini, PhD, a postdoctoral scientist at the Colorado Center for Reproductive Medicine, Lone Tree, Colorado said.

That is, the men all had normal sperm concentration, motility, morphology, and DNA fragmentation, which indicates that “these changes in obese men with no overt andrological diagnosis…suggest that traditional clinical semen assessments fail to detect important biochemical changes in spermatozoa which may compromise fertility,” the authors write.

The researchers identified 2034 sperm proteins, of which 24 were significantly less abundant and 3 were more abundant in the obese men than in the men with a healthy weight (P < .05 for both).

The sperm proteins that were less plentiful in the obese men are involved in oxidative stress, inflammation, protein translation, DNA damage repair, and sperm function, and those that were more plentiful are involved in oxidative stress.

“These results suggest that oxidative stress and inflammation are closely tied to reproductive dysfunction in obese men,” the researchers concluded.

These processes likely impact protein translation and folding during spermatogenesis, leading to poor sperm function and subfertility.

Pini noted that “a lot more emphasis has been placed on female as opposed to male obesity” in couples going for infertility work-up, “but I think it is worth considering on the male side as well.”

“It would be worth counseling patients, especially in the very early stages of trying to conceive, that overall health and particularly things like obesity are really worth considering prior to conception,” she emphasized.

The study was published online in the Journal of Assisted Reproduction and Genetics.

An estimated 38% of men of reproductive age (20 to 59 years) in the United States have obesity (body mass index [BMI] ≥30 kg/m2), Pini and colleagues note.

However, it is unclear how obesity may affect male fertility on a molecular level.

Previous studies of sperm proteins in obese men either used a less sensitive method (two-dimensional difference gel electrophoresis), or the more sensitive liquid chromatography tandem mass spectrometry (LC-MS/MS) but with a very small sample (3 men) including men with diabetes or smokers.

Pini and colleagues identified 5 obese men (BMI ≥ 30 kg/m2) and 5 non-obese men (BMI ≤ 25 kg/m2) seen at their reproductive medicine center who had clinically normal semen and did not smoke or have diabetes.

They collected semen samples from the men on the day of the oocyte retrieval in the men’s partners, and they used LC-MS/MS to determine the protein content of the sperm.

The control patients had a mean BMI of 24, and the obese patients had a mean BMI of 33. On average, the men in each group were 39 years old (range 33 to 46).

Obese and nonobese men had similar rates of average sperm concentration (88 x 106), total motility (62%), normal morphology (2.9%), and DNA fragmentation (3.3%).

Among the 27 proteins with altered abundance in obese vs normal-weight men, some were involved in oxidative stress (5), inflammation (2), protein translation (3), DNA damage repair (1), and sperm function (3).

The LC-MS/MS findings were confirmed for several proteins by qualitative immunofluorescence and a quantitative protein immunoassay.

“We have shown that obesity significantly impacts the human sperm proteome, potentially to the detriment of important spermatogenic processes and the function of mature spermatozoa,” the researchers report.

“These changes may be both symptoms of, and contributors to, the inflammation and oxidative stress associated with obesity, and may help to explain why obese men may have altered semen parameters, potentially leading to altered fertility.”

“While some of the problems created by paternal obesity may be overcome by assisted reproduction techniques, the swath of implications following fertilization remains to be rigorously investigated,” they note.

The authors conclude the study by writing that efforts should be directed toward the implementation of treatments to correct or limit the observed changes “when weight loss prior to conception is neither practical nor realistic.”

Read more: https://link.springer.com/article/10.1007/s10815-020-01707-8

Human eggs use chemical attraction to ‘choose’ sperm

Human eggs use chemical attraction to ‘choose’ sperm

The fluid that surrounds an egg when it is released from the ovary acts as a chemical attractant to sperm, but may also select sperm from certain males over others.

Researchers from the universities of Manchester and Stockholm showed that follicular fluid contains chemical signals that improve the chances of successful fertilisation in humans.

‘Human eggs release chemicals called chemoattractants that attract sperm to unfertilised eggs. We wanted to know if eggs use these chemical signals to pick which sperm they attract,’ said lead author Dr John Fitzpatrick from Stockholm University.

The team used samples of sperm and follicular fluid from 16 couples undergoing assisted reproductive treatment. Sperm were able to swim towards either of two follicular fluids in a dish, or one follicular fluid and a control substance. Sperm swim through follicular fluid on their way to reach an unfertilised egg.

The researchers found that each woman’s follicular fluid attracted more sperm from some men than others. There was no obvious pattern to explain which man’s sperm would be attracted to a woman’s follicular fluid; it appeared to be random and didn’t necessarily correlate with a woman’s chosen partner.

It was a real surprise,” says Fitzpatrick. “This is the first time this has been described in humans It is possible that eggs are more attracted to genetically compatible sperm, which may increase the chance that they are fertilised”.

The researchers measured the number of sperm that were able to move into each follicular fluid sample. They found that the average difference in sperm count between the fluid that attracted the most and the least sperm was approximately 18 per cent.

Eggs attracting around 18 per cent more sperm from specific males would likely be pretty important during fertilisations inside the female reproductive tract”, since only a small fraction of sperm reach the egg after sex, says Fitzpatrick.

The chemical interactions between eggs and sperm after sex may also play a role in why some people have difficulty conceiving. In around one in three couples who have fertility problems, there is no clear cause, says Fitzpatrick.

‘The idea that eggs are choosing sperm is really novel in human fertility,‘ said senior author Professor Daniel Brison, from the Department of Reproductive Medicine at Saint Marys’ Hospital, Manchester. ‘Research on the way eggs and sperm interact will advance fertility treatments and may eventually help us understand some of the currently ‘unexplained’ causes of infertility in couples.’

Future studies need to explore whether the same interactions are also present in regular mammalian (particularly human) reproductive cycles, away from the context of assisted reproductive treatment.

The research was published in the Proceedings of the Royal Society.

Read more: https://royalsocietypublishing.org/doi/10.1098/rspb.2020.0805

Fresh donor eggs appear to be better for IVF than frozen

Fresh donor eggs appear to be better for IVF than frozen

Donor eggs provide the best chance of success for many women undergoing IVF. But it wasn’t clear whether using fresh or frozen donor eggs in IVF improves the chances of success, so a team from the University of Colorado and Duke University analyzed nearly 37,000 IVF cycles using donor eggs over three years.

According to the largest comparison of donor egg IVF cycles to date, using fresh donated eggs for IVF leads to slightly better birth outcomes than frozen.

Data from nearly 37,000 IVF cycles in the US between 2012 and 2015 showed that fresh eggs resulted in a slightly greater chance of a good birth outcome, which the researchers defined as a single, non-premature baby delivered at a healthy birth weight.

‘Our study found that the odds of a good birth outcome were less with frozen than with fresh, but it was a small difference’, says lead author Dr Jennifer Eaton, of Duke Fertility Centre in North Carolina.

When the quality of fertilised eggs and the age of both mother and donor were taken into account, the team found that fresh eggs led to good birth outcomes in 24 percent of cycles compared to 22 percent of the cycles with frozen eggs.

Fresh eggs had a much higher likelihood of implantation and birth than frozen eggs, the study found. Compared to frozen eggs, fresh eggs were associated with almost 25% better chance of live birth and a 10% higher odds for good outcomes.

The rates of embryo implantation, pregnancy and live birth were all significantly higher among the women using fresh eggs compared to frozen, but fresh eggs also led to a 37 percent higher chance of multiple births, which could pose greater risk for both mothers and babies.

Donor eggs are often used for older women or women who have a decreased egg supply. This has led to an increased demand for frozen donor eggs which are a cheaper and faster option than fresh donor eggs. But it was previously unknown which type provides the best birth outcomes.

Although this study is the first to show an advantage of fresh donor eggs over frozen, the researchers say that doctors should take the other benefits of using frozen eggs into account when discussing the best option with patients.

‘Given that frozen eggs have many benefits such as ease, cost, and speed, the decision to use fresh or frozen donor eggs should be made on an individual basis after consultation with a physician’, said Dr Eaton.

In Greece, we do not have egg banks. Therefore, the fresh donor eggs are fertilised by the husband’s sperm. We then proceed to either fresh embryo transfer if the recipient is synchronised with the donor. Otherwise, we perform embryo transfer after thawing the frozen embryos in the future, once the recipient is ready. Success rates are similar in both cases.

The study was published in the journal Obstetrics and Gynaecology: https://journals.lww.com/greenjournal/Abstract/2020/03000/Prevalence_of_a_Good_Perinatal_Outcome_With.27.aspx

Τα φρέσκα ωάρια δότριας έχουν καλύτερα αποτελέσματα στην εξωσωματική

Τα φρέσκα ωάρια δότριας έχουν καλύτερα αποτελέσματα στην εξωσωματική

Τα ωάρια δότριας προσφέρουν υψηλότερα ποσοστά επιτυχίας σε πολλές γυναίκες που κάνουν εξωσωματική γονιμοποίηση. Μέχρι τώρα δεν ήταν σαφές εάν η χρήση φρέσκων ή κατεψυγμένων ωαρίων αυξάνουν τις πιθανότητες επίτευξης εγκυμοσύνης.

Ερευνητές στο Πανεπιστήμιο του Κολοράντο και το Πανεπιστήμιο Duke ανέλυσαν σχεδόν 37.000 κύκλους εξωσωματικής γονιμοποίησης που έγιναν σε τρία χρόνια με ωάρια δότριας.

Πρόκειται για τη μεγαλύτερη έρευνα που έχει γίνει σχετικά με τη χρήση ωαρίων δότριας και έδειξε ότι τα φρέσκα ωάρια έχουν λίγο καλύτερα ποσοστά γεννήσεων από τα κρυοσυντηρημένα.

Τα δεδομένα από σχεδόν 37.000 κύκλους εξωσωματικής γονιμοποίησης που έγιναν στις Ηνωμένες Πολιτείες από το 2012 μέχρι το 2015 έδειξαν ότι τα φρέσκα ωάρια είχαν ελαφρώς μεγαλύτερες πιθανότητες να γεννηθεί ένα μωρό που δεν είναι πρόωρο και έχει φυσιολογικό βάρος.

Διαπιστώσαμε ότι οι πιθανότητες να γεννηθεί ένα τελειόμηνο και φυσιολογικού βάρους μωρό ήταν μικρότερες όταν χρησιμοποιούνται κατεψυγμένα κι όχι φρέσκα ωάρια, αλλά η διαφορά ήταν μικρή”, είπε η επικεφαλής της έρευνας Δρ Τζένιφερ Ίτον, από το Κέντρο Γονιμότητας του Duke στη Βόρεια Καρολίνα.

Αφού ελήφθη υπόψιν η ποιότητα των γονιμοποιημένων ωαρίων και η ηλικία τόσο της μητέρας όσο και της δότριας, οι ερευνητές διαπίστωσαν ότι τα φρέσκα ωάρια οδήγησαν σε αίσιο τοκετό στο 24% των κύκλων εξωσωματικής, σε σύγκριση με το 22% των κύκλων με κατεψυγμένα ωάρια.

Τα φρέσκα ωάρια δότριας είχαν μεγαλύτερες πιθανότητες εμφύτευσης

Τα φρέσκα ωάρια είχαν πολύ μεγαλύτερες πιθανότητες εμφύτευσης και γέννησης σε σχέση με τα κατεψυγμένα ωάρια, σύμφωνα με τα αποτελέσματα της μελέτης. Σε σχέση με τα κατεψυγμένα ωάρια, τα φρέσκα είχαν περίπου 25% περισσότερες πιθανότητες γέννησης ζωντανού μωρού και 10% περισσότερες πιθανότητες να είναι το μωρό τελειόμηνο και με φυσιολογικό βάρος.

Τα φρέσκα ωάρια είχαν πολύ υψηλότερα ποσοστά πολλαπλής κύησης

Τα ποσοστά εμφύτευσης εμβρύου, εγκυμοσύνης και γέννησης ζωντανού μωρού ήταν σημαντικά υψηλότερα μεταξύ των γυναικών που χρησιμοποίησαν φρέσκα ωάρια σε σύγκριση με τα κατεψυγμένα. Τα φρέσκα ωάρια όμως, βρέθηκε ότι είχαν 37% υψηλότερες πιθανότητες πολλαπλής κύησης, γεγονός που θα μπορούσε να δημιουργήσει μεγαλύτερους κινδύνους τόσο για τις μητέρες όσο και για τα μωρά.

Ωάρια δότριας χρησιμοποιούνται συχνά σε μεγαλύτερης ηλικίας γυναίκες ή γυναίκες που έχουν μειωμένο απόθεμα ωαρίων και συνεχώς αυξάνεται η ζήτηση κατεψυγμένων ωαρίων δότριας, διαδικασία που κοστίζει λιγότερο και δεν είναι χρονοβόρα.

Στην Ελλάδα, δεν υπάρχουν τράπεζες ωαρίων και ως εκ τούτου δεν μπορούμε να χρησιμοποιήσουμε κατεψυγμένα ωάρια δότριας. Στην καθημερινή πράξη, τα φρέσκα ωάρια της δότριας γονιμοποιούνται με το σπέρμα του συζύγου και μεταφέρονται στη μήτρα ως έμβρυα. Η μεταφορά αυτή, μπορεί να γίνει είτε με φρέσκα έμβρυα εφόσον συντονιστεί ο κύκλος της δότριας με τη λήπτρια είτε μετά από απόψυξη κατεψυγμένων εμβρύων στο μέλλον εάν οι κύκλοι δεν συντονιστούν. Έχει βρεθεί ότι τα ποσοστά επιτυχίας είτε χρησιμοποιηθούν φρέσκα είτε κατεψυγμένα έμβρυα δεν έχουν διαφορά.

Μπορείτε να διαβάσετε περισσότερα: https://journals.lww.com/greenjournal/Abstract/2020/03000/Prevalence_of_a_Good_Perinatal_Outcome_With.27.aspx

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