Journal

Journal of Assisted Reproduction and Genetics

Papers (17)

Quality of IVM ovarian tissue oocytes: impact of clinical, demographic, and laboratory factors

Abstract Purpose To determine how clinical, demographic, and laboratory characteristics influence ovarian tissue oocyte quality. Methods Immature cumulus-oocyte complexes were isolated from removed ovaries and cultured for 48–52 h in either monophasic standard or biphasic CAPA media for fertility preservation. A total of 355 MII oocytes from 53 patients were described for intracytoplasmic and extracytoplasmic anomalies. Multiple clinical, laboratory, and demographic characteristics were analyzed. Statistically significant differences between independent groups in qualitative variables were identified using Pearson’s χ2 and Fisher’s exact tests. The diagnostic value of quantitative variables was assessed using the ROC curve analysis. Factors associated with the development of dysmorphism, taking patient age into account, were identified using the binary logistic regression analysis. Results Dysmorphisms were observed in 245 oocytes (69.0%), with a median number of dysmorphisms of 2. Oocyte dysmorphisms were found to be 2.211 times more likely to be detected in patients with ovarian cancer, while the presence of dark-colored cytoplasm was associated with gynecologic surgery in the anamnesis (p = 0.002; OR 16.652; 95% CI, 1.977–140.237; Cramer’s V 0.187). Small polar bodies developed 2.717 times more often (95% CI, 1.195–6.18) in patients older than 35. In the case of ovarian transportation on ice at 4 ℃, the chances of development of cytoplasmic granularity increased 2.569 times (95% CI, 1.301–5.179). The use of biphasic CAPA IVM media contributed to a decrease in the probability of large polar body formation (p = 0.034) compared to the standard monophasic IVM media. Conclusions Both patients’ characteristics and laboratory parameters have an impact on the quality of IVM ovarian tissue oocytes.

Female cancer survivors: sexual function, psychological distress, and remaining fertility

Abstract Purpose Improved survivorship in cancer patients leads to new challenging issues including potential impairment of quality of life, sexual function, and fertility. The aim of this study was to assess sexual dysfunction (SD) and psychological distress in female cancer survivors who underwent fertility preservation in the past in comparison to reviewed healthy control data from other published studies. Additionally, our focus was on the difference in SD between women with current desire to get pregnant and already completed family planning. Methods In this prospective study, 53 female cancer survivors who underwent fertility preservation at time of cancer diagnosis between 2010 and 2020 were invited to a gynecological exam, laboratory assessment, and two questionnaires (Female Sexual Function Index (FSFI) and Hospital anxiety and depression scale (HADS)) in 2022. These scores were compared to results in the literature of healthy controls and depending on anti-Mullerian-hormone (AMH) levels, current desire to have a child, and age. Results After a mean follow-up time of 70 ± 50 months, SD was detected in 60.4% (n = 32) of the 53 included patients. Normal results regarding HADS-D/anxiety and HADS-D/depression were found in 88.7% and 94.3% of patients, respectively. At time of follow-up, 69.9% (n = 40) regained regular menstrual cycles, 52.6% (n = 20) < 40 years showed a diminished ovarian reserve with AMH levels < 1.1 ng/ml and 28.3% (n = 15) suffered from infertility. Conclusion Female cancer survivors may be at risk for SD. Cancer patients should be informed about possible sexual dysfunction already at the start of cancer treatment and during follow-up. In addition, contraception needs to be addressed if regular cycles occur as more than two-thirds of the women regained regular menstrual cycles.

Long-term outcomes and re-intervention rates in women undergoing mri-guided focused ultrasound (mrgfus) for uterine fibroids: a 7-year follow-up study

Abstract Purpose To assess the long-term outcomes of MR-guided focused ultrasound (MRgFUS) for treating uterine fibroids, focusing on re-intervention rates, pregnancy outcomes, and the onset of menopause over a 7-year follow-up period. Materials and Methods We conducted a historical cohort study of 99 women with symptomatic uterine fibroids who underwent MRgFUS between 2013 and 2020 at a single tertiary medical center. Data collection included patient demographics, treatment details, and follow-up interviews. Re-intervention rates were evaluated using Kaplan–Meier curves and Cox regression analysis to identify predictors of further treatments, with a specific focus on age-related differences. Results Over a median follow-up of 6.1 years, 33.1% of women required re-intervention for persistent fibroid symptoms. The median patient's age was 43 years old. Women aged ≤ 43 years had significantly higher re-intervention rates than those aged 44 + years (47.5% vs. 16.7%, p = 0.005). Multivariable Cox regression identified age as the sole significant predictor of re-intervention (HR44+vs. <43 0.303 95% CI 0.128–0.714, p = 0.006). Sixteen women conceived after MRgFUS, resulting in 21 pregnancies, with 72.2% live births and a spontaneous miscarriage rate of 22.2%. The mean age of menopause was 51.4 years, similar to global averages. Conclusions MRgFUS is a practical, noninvasive option for treating symptomatic uterine fibroids. Older women show lower re-intervention rates. Pregnancies post-MRgFUS are possible, and the procedure does not appear to affect the onset of menopause. Age remains a crucial predictor for further re-intervention.

Assessing the influence of gestational trophoblastic disease history on IVF-ET pregnancy outcomes: a retrospective cohort study

To evaluate the impact of a history of gestational trophoblastic disease on pregnancy outcomes in in vitro fertilization-embryo transfer procedures(IVF-ET) and to utilize logistic regression to analyze potential risk factors influencing re-pregnancy outcomes among women with GTD histories undergoing IVF-ET. This retrospective cohort study collected data from patients with a history of GTD who underwent IVF-ET at the hospital from January 2018 to January 2023. The study group comprised 27 women with a history of GTD. A control group of 54 women, matched at a 1:2 ratio, without a GTD history, was selected from those who underwent IVF-ET during the same period at the same hospital. Statistical analyses were employed to compare baseline characteristics, embryological parameters, and pregnancy outcomes between the two groups. The study group exhibited significantly lower endometrial thickness (EMT) during the mid-luteal phase of the natural menstrual cycle, reduced EMT on the day of embryo transfer (ET), and a decreased blastocyst formation rate compared to the control group (p < 0.05). Furthermore, the study group had a higher number of uterine curettages prior to transfer, an increased rate of discarded embryos, and higher total sperm motility (PR + NP) in their spouses (p < 0.05). Logistic regression analysis revealed that a history of GTD does not significantly affect pregnancy outcomes post-IVF-ET. A history of GTD does not significantly influence pregnancy outcomes following IVF-ET. Therefore, patients with a GTD history and their physicians can approach the IVF-ET process with less anxiety and adopt a more positive and rational outlook.

Analysis of IVF/ICSI outcomes in infertile women with early-stage endometrial cancer and atypical endometrial hyperplasia after conservative treatment

To investigate the in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) outcomes and identify factors that might affect live births in patients with early-stage endometrial cancer (EEC) and atypical endometrial hyperplasia (AEH). This retrospective study was performed in a tertiary hospital. Patients (n = 123) with EEC or AEH, who underwent IVF/ICSI treatment between January 2010 and December 2019, were divided into a live birth group and a non-live birth group. Clinical characteristics and IVF/ICSI outcomes were assessed. A total of 123 patients (28 with EEC and 95 with AEH) underwent 215 ovarian stimulation cycles, resulting in 121 fresh embryo transfer (ET) and 108 frozen-thawed ET. Among 229 ET cycles, 91 (23.7%) of 384 embryos were implanted and 86 pregnancies were achieved, including five ectopic pregnancies (5.8%), 28 miscarriages (32.6%), and 53 live births (61.6%). The clinical pregnancy and live birth rates in each ET cycle were 37.6% and 23.1%, respectively. Fifty-one patients gave birth to 57 live neonates, and the cumulative live birth rate was 41.46%. Multiple logistic regression analysis showed that maternal age, histological type, thin endometrium, and time after complete remission (CR) to IVF cycle started were significantly associated with live births. The live birth rate after IVF/ICSI is promising in infertile patients with EEC and AEH. A shorter interval between CR and IVF/ICSI treatment might be a positive factor, while age > 35 years, endometrial thickness < 8 mm on the day of ET, and degree of endometrial lesion progressing into carcinoma can negatively influence IVF/ICSI outcomes.

A prognostic nomogram for assessing the risk of recurrence after laparoscopic myomectomy

This study aimed to identify key predictors of uterine fibroid (UF) recurrence following laparoscopic myomectomy (LM) in reproductive-age women and to construct a predictive nomogram to support individualized clinical decision-making. This retrospective cohort study included 459 women who underwent LM. Recurrence of UFs and risk of recurrence were analyzed. Time to recurrence, defined as the interval between surgery and imaging-confirmed regrowth, was the primary time-to-event outcome. Multivariate Cox regression and Kaplan-Meier analyses identified significant predictors of recurrence, which were used to develop a predictive nomogram. Out of 459 patients, 69 experienced recurrence during a median follow-up of 15.8 months. Significant recurrence predictors included age (30-40 years, HR = 1.74, p = 0.041; 18-30 years, HR = 1.88, p = 0.047); fibroid count (≥ 3 fibroids, HR = 2.73, p = 0.001); and fibroid size (≥ 5 cm, HR = 2.84, p < 0.001). The predictive nomogram, integrating age, number, and size of UFs, showed a C-index of 0.752 and area under the curve (AUC) values for 1-, 2-, and 3-year recurrence of 0.710, 0.783, and 0.797, respectively, reflecting robust predictive performance. Calibration curves confirmed the nomogram's accuracy in aligning predicted with observed outcomes. The study developed a validated nomogram for predicting recurrence in UFs patients after LM, incorporating age, number, and size of UFs to enhance clinical decision-making.

Attitude of BRCA1/2 mutation carriers towards fertility preservation, family planning and preimplantation genetic testing for primary prevention of breast and ovarian cancer in the next generation

To study the attitude of BRCA1/2 mutation carriers regarding family planning, fertility preservation, and preimplantation genetic testing (PGT). A national cross-sectional study was conducted by the distribution of an anonymous questionnaire, from August 2022 to January 2023. The main outcomes measures were discussion, acceptance, and performance rates of fertility preservation and PGT. The questionnaire was completed by 530 BRCA1/2 mutation carriers. The mean (SD) age at mutation detection was 36.4 (9.6) years. At the time of mutation detection, 40% did not have children. Following mutation detection, 37% of responders changed their family planning, mostly choosing to have children earlier or to have less children than planned. Twenty-eight percent of BRCA carriers discussed the option of fertility preservation with a physician, 72% agreed that fertility preservation is an acceptable option for BRCA1/2 mutation carriers and finally 11% underwent oocyte/embryo vitrification before RRBSO. 44% of BRCA carriers discussed the option of PGT, 58% agreed that PGT is justified in BRCA1/2 mutation carriers and finally 8% underwent PGT to select non-carrier embryos. In a multivariate analysis, age under 35 years and the a priori need for fertility treatments were both found significant factors increasing the likelihood of performing fertility preservation and PGT. This study emphasizes that despite a substantial proportion of women admitting that mutation detection affected their family planning and high acceptance rates, performance of fertility preservation and PGT remained exceedingly low. Increasing the knowledge and awareness of these issues is important and should be included in multidisciplinary counselling.

Case report: Analysis of BRCA1 and BRCA2 gene mutations in a hereditary ovarian cancer family

Abstract Objective Breast cancer susceptibility gene 1/2 (BRCA1/2) is the most important susceptibility gene associated with hereditary ovarian cancer (HOC). We aimed to screen BRAC1 and BRAC2 gene mutations in a member of a hereditary ovarian cancer family in China, and to analyze the structure and function of the mutant protein. Methods A typical HOC family was selected. Blood samples and pathological tissue samples were taken from the female members of the family. Blood samples from two patients with sporadic ovaries of the same pathological type were taken as a control group. After RNA extraction, PCR amplification was applied and the PCR products were directly sequenced and aligned, prediction and analysis of protein structure and molecular conformation that may be caused by BRCA1/2 mutation. Results The whole gene analysis of BRCA1 and BRCA2 in ovarian cancer patients in the family showed that there were 8 mutations in BRCA1 whole gene sequencing, including 3 nonsense mutations (2314C&gt;T, 2543T&gt;C, 4540T&gt;C); two mutations have been recorded, which are associated with cervical cancer (2844C&gt;T) and endometriosis (3345A&gt;G); three newly discovered mutations (3780A&gt;G, 5069A&gt;G, 3326A&gt;T). Among them, 3780A&gt;G and 5069A&gt;G caused amino acid changes, while 3326A&gt;T mutation caused Arg mutation to stop codon. A total of 7 mutations were detected in BRCA2 whole-genome sequencing, including 5 non-significant mutations (3623A&gt;G, 4034T&gt;C, 4790A&gt;G, 6740G&gt;C, 7469A&gt;G); one no-record mutation (1716T&gt;A), and 1 recorded mutation (1342A&gt;C), which was associated with breast cancer and ovarian cancer. BRCA1 (3326A&gt;T) and BRCA2 (1342A&gt;C) mutations were co-existing in patients (II1, II3, and II5) identified as serous adenocarcinoma grade II. Two cases of ovarian serous cystadenocarcinoma with no history of family tumors were normalized for BRCA1/2 gene sequencing. In the gene detection of III generation female, four females with BRCA2 (1342A&gt;C) mutation were found, and one of them also carried the BRCA1 (3326A&gt;T) mutation, who can be considered a high-risk group of HOC in this family. Online protein structure predictions revealed that BRCA1 (3326A&gt;T) mutations mutated AGA at this site to TGA resulting in a translated Arg (arginine) mutation as a stop codon, while BRCA2 (1342A&gt;C) mutated AAT at this site to CAT resulting in a translated Asn mutation to His. Conclusion The BRCA1 (3326A&gt;T) and BRCA2 (1342A&gt;C) were detected in the HOC family, which may be the susceptibility gene of the family’s HOC. The BRCA1/2 gene screening may be possible to obtain high-risk populations in this family.

Fertility preservation using controlled ovarian stimulation in breast cancer: a comparative study of neoadjuvant and adjuvant settings

Abstract Purpose To compare the time to initiation of first therapeutic treatment and the outcomes of controlled ovarian stimulation (COS) in breast cancer patients undergoing fertility preservation (FP) in the neoadjuvant chemotherapy (NAC) versus adjuvant chemotherapy (AC) treatment settings. Methods A retrospective cohort study involving patients with stage 1–3 breast cancer treated with NAC/AC, who underwent FP with random-start COS, between 2015–2023. Baseline, oncologic and COS characteristics and outcomes were collected. Time points related to cancer diagnosis, FP, and first oncologic intervention (surgery or chemotherapy) were calculated. Results 70 NAC-treated patients were compared to 42 AC-treated patients. Groups were similar in terms of age, marital status, parity and BMI. NAC-treated patients had more advanced disease, more often with lymph node involvement. Median time from diagnosis to FP consult (17 vs 30 days) and to stimulation start (22 vs 59 days) was significantly shorter for NAC-treated patients. Median time from diagnosis to first therapeutic intervention was slightly longer for NAC-treated patients (45 vs 41 days, p  &lt; 0.05). Stimulation characteristics were comparable apart from a less frequent use of hCG trigger among NAC-treated patients (4% vs 16%, p  &lt; 0.05). First stimulation cycle outcomes such as peak E2 levels, number of retrieved oocytes and fertilization rate were similar, though median number of M2 oocytes was higher in NAC- treated patients (11 vs 8, p  &lt; 0.05). Conclusion Expedited patient care at the neoadjuvant setting led to a statistically significant, yet clinically minimal, delay of cancer therapy. Neither oncologic treatment timelines nor FP outcomes were compromised in the NAC setting.

Novel extra cellular-like matrices to improve human ovarian grafting

To investigate if human ovarian grafting with pure virgin human recombinant collagen type-1 from bioengineered plant lines (CollPlant™) or small intestine submucosa (SIS) yields better implantation results for human ovarian tissue and which method benefits more when combined with the host melatonin treatment and graft incubation with biological glue + vitamin E + vascular endothelial growth factor-A. Human ovarian tissue wrapped in CollPlant or SIS was transplanted into immunodeficient mice with/without host/graft treatment. The tissue was assessed by follicle counts (including atretic), for apoptosis evaluation by terminal deoxynucleotidyl transferase assay and for immunohistochemical evaluation of neovascularization by platelet endothelial cell adhesion molecule (PECAM) expression, and for identification of proliferating granulosa cells by Ki67 expression. Human ovarian tissue transplanted with CollPlant or SIS fused with the surrounding tissue and promoted neovascularization. In general, implantation with CollPlant even without additives promoted better results than with SIS: significantly higher number of recovered follicles, significantly fewer atretic follicles, and significantly more granulosa cell proliferation. Moreover, results with CollPlant alone seemed to be at least as good as those after host and graft treatments. CollPlant is a biomaterial without any potential risks, and grafting ovarian tissue with CollPlant is easy and the procedure may be easily modified, with limited or no foreseeable risks, for auto-transplantation in cancer survivors. Further studies are needed using other novel methods capable of enhancing neovascularization and reducing apoptosis and follicle atresia.

Publisher

Springer Science and Business Media LLC

ISSN

1058-0468

Journal of Assisted Reproduction and Genetics