Early oocyte collection offers cancer victims fertility hope

Ovaries can be stimulated to produce oocytes for collection during the first phase of the menstrual cycle, German scientists have discovered in findings that offer the hope of restoring fertility to women following cancer treatment.

As conventional ovarian stimulation can leave cancer patients waiting up to 6 weeks before collecting oocytes and starting cancer therapy, Michael von Wolff, from the University of Heidelberg, and colleagues conducted a pilot study of stimulation in the first phase of the menstrual cycle.

Twenty-eight women underwent ovarian stimulation in the proliferative phase of the menstrual cycle using standard medication (group 1). A comparison group of 12 women started stimulation during the luteal phase, using GnRH antagonists and recombinant follicle stimulating hormone to reduce the luteal phase (group 2)

Average ovarian stimulation time was 10.3 days in group 1 and 11.4 days in group 2. The average number of oocytes collected was 13 and 10, respectively, of which 77 percent and 73 percent, respectively, were mature. Intracytoplasmic sperm injection led to fertilization in 70 percent and 75 percent of oocytes, respectively.

Dr von Wolff said: "This new protocol would enable patients with cancers such as breast cancer and Hodgkin lymphoma to have ovarian stimulation and oocyte collection. Waiting for 2 weeks before they start cancer treatment is acceptable for most patients while this process happens."

Endometrial leukaemia inhibitory factor expression predicts IVF success

The success of IVF can be predicted by measuring the endometrial expression of leukaemia inhibitory factor (LIF) during the luteal phase of the menstrual cycle, Brazilian study findings indicate.

Paulo Serafini, from the University of São Paulo, and colleagues immunostained luteal phase endometrial biopsy specimens of 52 women due to undergo IVF. Standard protocols were used to perform embryo culture and transfer.

The median age of the women was 35 years. Immunostaining for LIF was weak in 5.8 percent, mild in 61.5 percent, and strong in 32.7 percent of samples. The average number of embryos transferred was three, and their cumulative quality score was 20.

In all, 39 percent of the women achieved clinical pregnancy following IVF. Strong endometrial LIF expression was significantly associated with pregnancy, such that women with strong expression were 6.4 times more likely to become pregnant than those with weaker expression.

Age was also associated with clinical pregnancy, with each 1-year increase in maternal age associated with a 30 percent decrease in the likelihood of becoming pregnant.

"Midluteal endometrial LIF expression can be assessed immunohistochemically and used both as a biomarker of adequate endometrial development and a predictor of IVF success," the team says.

First 'fast-freeze' IVF baby born

A couple have become the first in the UK to have a baby using a pioneering IVF technique which fast-freezes embryos, doctors in Cardiff say. Evie, who was conceived through "vitrification", was born to Ian and Rebecca Bloomer on 23 July. The method uses liquid nitrogen to freeze embryos quickly, reducing the risk of damage when they are thawed.
The couple, of Cwmbran, had tried for a baby for seven years and say their success should offer hope to others.
The couple had been trying for a baby since they married in 2001 but tests revealed Mrs Bloomer, 28, had endometriosis, a condition which was making it difficult for her to conceive.
They attended the IVF clinic at the University Hospital of Wales, in Cardiff, and after a failed attempt, the hospital offered the Bloomers a new way of freezing their unused embryos.
The technique - vitrification - gives embryos a better chance of surviving until couples are ready to try IVF again because the fast-freeze method prevents the formation of crystals that can damage embryos when they are thawed.
It's overwhelming. I'm still staring at her now thinking 'wow, she's ours - it's actually happened for us'
Mrs Bloomer became pregnant almost immediately using one of the fast-frozen embryos and gave birth to Evie at the Royal Gwent Hospital, in Newport, on 23 July.
"We were willing to try anything really, we'd both always wanted children. It's overwhelming. I'm still staring at her now thinking 'wow, she's ours - it's actually happened for us'," said Mrs Bloomer.
"I hope that if anybody going through treatment sees us and sees Evie it gives them one last little bit of hope to go for it.
"It's been a real emotional rollercoaster. There's been ups and downs, but you get through it and to have Evie now, you forget what you went through. It makes it all worthwhile."
The Cardiff hospital was the first in the UK to begin offering embryo vitrification, in August 2007.
Lyndon Miles, head of embryology and andrology for IVF Wales, said 17 out of the 39 women offered the treatment so far had fallen pregnant and four of those were expecting twins.
He said the process would also be helpful to women diagnosed with cancer who wanted to freeze a number of eggs in case chemotherapy left them infertile.
"Though this is a new technique for the UK, early results and publications in Japan and the USA have been extremely encouraging," Mr Miles said.
Lyndon Miles said he was delighted to have helped the Bloomers. "The first published study on babies born from vitrification shows no adverse effects of the technique and there are no implications to Evie's health as a result of the vitrification process.
"I'm delighted we have been able to help Ian and Rebecca."
Vitrification involves rapidly cooling and storing embryos at very low temperatures for future use.
"An IVF cycle produces a number of embryos. Those that aren't immediately transferred back to the patient and that are of good enough quality are cooled slowly to the temperature of liquid nitrogen (-196C) and stored until needed.
"Conventional, slow freezing creates ice crystals which can damage the embryo as it is thawed," Mr Miles said.
"Vitrification differs from traditional cooling and storing techniques in that it allows instantaneous 'glass-like' solidification of eggs and embryos without the formation of ice crystals.
"Since no ice crystals form, a much greater percentage of embryos survive thawing following vitrification."
He said with conventional freezing methods, post-thaw survival rates varied from 50% to 80% whereas with vitrification they had achieved 98%.
"In addition, since the introduction of the technique, our pregnancy rate has more than doubled compared to conventional freezing methods," Mr Miles added.

Serum anti-Müllerian hormone levels predict ICSI outcomes

The number of oocytes retrieved for intracytoplasmic sperm injection (ICSI) is strongly associated with midluteal, early follicular, and ovulatory anti-Müllerian hormone (AMH) levels, Egyptian researchers have discovered.

Dahlia El-Haieg and colleagues from the University of Zagazig, measured AMH, follicle-stimulating hormone (FSH), and leuteinizing hormone levels, and conducted ultrasound evaluation, during the menstrual cycle of 33 patients undergoing their first ICSI treatment cycle.

Nine women had a poor response to ICSI. The number of oocytes retrieved from normal and poor responders was 9.4 and 3.0, respectively.

AMH levels were significantly lower in poor than normal responders in both the ovulatory and midluteal phases. The number of oocytes retrieved positively correlated with midluteal AMH, day 3 AMH, and ovulatory AMH levels, as well as antral follicle counts and average ovarian volume. Day 3 FSH levels negatively correlated with the number of oocytes retrieved.

Poor response was predicted by midluteal, day 3, and ovulatory AMH levels, with areas under the receiver operating characteristics curves of 0.977, 0.900, and 0.980, respectively. Midluteal and early AMH also significantly predicted clinical pregnancy.

"Midluteal and early follicular AMH may offer a better prognostic value for clinical pregnancy than other currently available markers of assisted reproductive technology outcomes," the team concludes.

Phonics Unleashed

Sent by a School-teacher friend of mine. Makes for really interesting reading!

"My five-year old students are learning to read. Yesterday one of them pointed at a picture in a zoo book and said,
'Look at this! It's a frickin' elephant!'

I took a deep breath, then asked...'What did you call it?'

'It's a frickin' elephant! It says so on the picture!'

And so it does...

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