Extracellular embryo genomic DNA and its potential for genotyping applications

none8noBackground: Preimplantation genetic diagnosis (PGD) currently relies on biopsy of one or few embryo cells. Our aim was to evaluate the embryo extracellular matrices (spent medium and blastocoele fluid) as source of DNA for embryo genotyping. Results/methodology: We first evaluated the amplifiability and the amount of genomic DNA in spent embryo culture media from day 3 (n = 32) and day 5/6 (n = 54). Secondly, we evaluated the possibility to genotype the MTHFR polymorphism C677T from media at day 5/6 (n = 8) and blastocoele fluids (n = 9) by direct sequencing. The C677T polymorphism detection rate was 62.5 and 44.4% in medium and fluid, respectively. Conclusion: A noninvasive approach for embryo genotyping was possible, but still with limitations due to low detection rate and possible allele dropout.openGalluzzi, Luca; Palini, Simone; Destefani, Silvia; Andreoni, Francesca; Primiterra, Mariangela; Diotallevi, Aurora; Bulletti, Carlo; Magnani, MauroGalluzzi, Luca; Palini, Simone; Destefani, Silvia; Andreoni, Francesca; Primiterra, Mariangela; Diotallevi, Aurora; Bulletti, Carlo; Magnani, Maur

Artificial intelligence algorithms for optimizing assisted reproductive technology programs: A systematic review

Artificial intelligence (AI) has been experiencing rapid growth in recent years, and numerous applications are improving the single-step efficiency of the whole assisted reproductive technology (ART) procedure. In this review, we collected all the algorithms supplying ART and selected those supporting the clinical assistance to the procedure up to the successful attempt. Those with a clear role in improving ART performances were further selected. We found a questionnaire-based algorithm identifying patients at risk for endometriosis with early management and better fertility outcome. An algorithm can detect the values of simple gamete production (male) and reservoir (female) according to gradual scale allocation, and display themas normal or abnormal, spontaneousor stimulated gamete production. This can provide significant benefits for infertile couples undergoing diagnostic and therapeutic journeys. The calculators for the starting dose of gonadotropins and the trigger timing during controlled ovarian stimulation make clinical management more efficient. With the application of AI in ART, the ability to determine the optimal number of metaphase II oocytes required for blastocyst formation and number of oocytes needed for embryo production has been significantly improved. The calculation of the implantation rate as proposed in different calculators, using the ultrasound of endometrial vascularization or the age and euploidy of the embryo transferred, may provide further advancement in managing the ART procedure with more participation from the couples to increase the efficacy of the procedures. Finally, the calculator of presumptive success with an ART program based on couples or medical center profiling and efficiency is of tremendous comfort to couples. In conclusion, algorithms and machine learning development in human reproduction are growing daily with evident benefits. Infertility treatments by in vitro fertilization (IVF) are assisted by several algorithms that improve the efficiency of each procedure step, making IVF program's management more effortless

Progesterone: The Key Factor of the Beginning of Life

Progesterone is the ovarian steroid produced by the granulosa cells of follicles after the LH peak at mid-cycle. Its role is to sustain embryo endometrial implantation and ongoing pregnancy. Other biological effects of progesterone may exert a protective function in supporting pregnancy up to birth. Luteal phase support (LPS) with progesterone is the standard of care for assisted reproductive technology. Progesterone vaginal administration is currently the most widely used treatment for LPS. Physicians and patients have been reluctant to change an administration route that has proven to be effective. However, some questions remain open, namely the need for LPS in fresh and frozen embryo transfer, the route of administration, the optimal duration of LPS, dosage, and the benefit of combination therapies. The aim of this review is to provide an overview of the uterine and extra-uterine effects of progesterone that may play a role in embryo implantation and pregnancy, and to discuss the advantages of the use of progesterone for LPS in the context of Good Medical Practice

Endometriosis: absence of recurrence in patients after endometrial ablation

The present study was undertaken to evaluate differences between patients with and without eutopic endometrium in the recurrence of ectopic endometriotic implants.Endometrial ablation (EA) was carried out in 14 women out of 28 laparoscopically treated for endometriosis and recurrence of the disease was evaluated 24 months later. Data were compared using paired Student's t-test and chi2 test.Patients undergoing EA procedures did not exhibit recurrence of endometriosis while nine patients without that procedure had recurrence of the disease (P < 0.001). The endometrial cells found in the debris of the cul de sac of eight patients who did not undergo EA were both stromal and epithelial cells. No blood or blood cells were found in the cul de sac of patients undergoing EA.The present study supports a role of eutopic endometrium in the recurrence of endometriosis through tubal dissemination of endometrial debris and implantation of endometrial cells into the abdomen

The artificial womb

Ann N Y Acad Sci. 2011 Mar;1221:124-8. doi: 10.1111/j.1749-6632.2011.05999.x. The artificial womb. Bulletti C1, Palagiano A, Pace C, Cerni A, Borini A, de Ziegler D. Author information Abstract The availability of computer-controlled artificial hearts, kidneys, and lungs, as well as the possibility of implanting human embryos in ex vivo uterus models or an artificial endometrium, presents new perspectives for creating an artificial uterus. Survival rates have also improved, with fetuses surviving from as early as 24 weeks of gestation. These advances bring new opportunities for complete or partial ectogenesis through the creation of an artificial womb, one that could sustain the growth and development of fetuses outside of the human body. © 2011 New York Academy of Sciences

Vaginal parturition decreases recurrence of endometriosis

Despite several hypotheses, the pathogenesis of endometriosis remains unclear. However, the notion that endometriosis results from the retrograde transport of endometrial debris through the uterine tubes and subsequent implantation in the pelvic peritoneum and visceral organs is compelling. The first clinical consequence of endometriosis is \u2018\u2018infertility,\u2019\u2019 and pregnancy may reduce the recurrence of endometriosis and dysmenorrhea through mechanisms that are not yet clear. The present study evaluated the role of parturition in reducing the recurrence rates of endometriosis and dysmenorrhea. We also investigated the role of uterine internal ostium (IOS) enlargement in the recurrence of endometriosis following vaginal parturition