Live birth of monochorionic triamniotic triplets after in vitro fertilization and blastocyst transfer: case report and review of the literature

Monozygotic triplet pregnancies are very rare, even after in vitro fertilization (IVF). We present a case of a live birth of triplets from a monochorionic triamniotic pregnancy after blastocyst transfer. A 29-year-old woman underwent intracytoplasmic sperm injection (IVF-ICSI). Her medical history included a 4-year infertility treatment with ovarian stimulation, three cycles of intrauterine insemination, hysteroscopy and an unsuccessful attempt at IVF. During the second IVF attempt, the patient underwent ovulation simulation according to the long GnRH agonist protocol. Eleven metaphase II (MII) oocytes were injected with spermatozoa, resulting in four expanded blastocysts. In the end, two blastocysts (4AA) were transferred into the uterine cavity. Ultrasound examination performed at 7 weeks of gestation showed an ongoing triamniotic triplet pregnancy. Regular uterine contractions began at 33 weeks of gestation and a cesarean section was performed, resulting in a birth of three healthy girls, weighing 2060g (Apgar 7), 1860g (Apgar 6), 2000g (Apgar 6). After 13 days of hospitalization the infants and the mother were discharged home. Conclusion: The causes of monozygotic multiple gestations in spontaneous and ART pregnancies are poorly understood. They seem to occur more often after IVF. Any definitive relationship between particular stages of the IVF procedure and monozygotic multiple pregnancies remains controversial

Successful autotransplantation of cryopreserved ovarian tissue with recovery of the ovarian function

Cel pracy: Celem pracy był autologiczny przeszczep tkanki jajnikowej poddanej kriokonserwacji u pacjentki z przedwczesnym wygaśnięciem czynności jajników po agresywnej terapii onkologicznej. Materiał i metody: W 18 tygodniu ciąży u 28 letniej ciężarnej (C2P1) rozpoznano inwazyjną postać gruczołowego raka szyjki macicy. W 31 tygodniu przeprowadzono elektywne cięcie cesarskie, podczas, którego urodził się noworodek płci męskiej (1780g Apgar 8/10). Następnie wykonano radykalne wycięcie macicy techniką „nervesparing” z przydatkami, węzłami chłonnymi biodrowymi i około aortalnymi dolnymi. Jajniki poddano kriokonserwacji techniką powolnego zamrażania. Pacjentka przeszła cykl radiochemioterapii z następczą brachyterapią. Przedwczesne wygaśnięcie czynności jajników potwierdzono pomiarem hormonów płciowych: estradiol – 2 pg/ml, FSH – 96,52 IU/ml, LH – 37,55 IU/ml, AMH – 0,03 ng/ml. Trzynaście miesięcy po zabiegu chirurgicznym w powłokach brzusznych laparoskopowo wytworzono zachyłek otrzewnowy, w którym umieszczono rozmrożoną tkankę jajnikową Wyniki: Dziewięć tygodni po transplantacji uzyskano remisje objawów wypadowych, wzrost stężenia estradiolu (53 pg/ml), spadek FSH (64,89 IU/ml) i LH (33,39 IU/ml). Dwadzieścia cztery tygodnie po zabiegu zaobserwowano wysokie stężenia estradiolu (269 pg/ml), fizjologiczne stężenia FSH (5,92 IU/ml), LH (4,09 IU/ml) oraz wzrost stężenia AMH (0,37 ng/ml). Podczas badania ultrasonograficznego w przeszczepionej tkance jajnika uwidoczniono pęcherzyk dominujący. Wnioski: Przeszczep tkanki jajnikowej spowodował powrót czynność hormonalnej jajnika. Transplantacja tkanki jajnikowej może posłużyć, jako alternatywne leczenie przedwczesnej menopauzy spowodowanej agresywnym leczeniem onkologicznym.  Objectives: The aim of the study was autotransplantation of cryopreserved ovarian tissue to a patient suffering from premature ovarian failure caused by aggressive oncological therapy. Material and methods: A 28-year-old woman, GII PI, was diagnosed with invasive adenocarcinoma of the cervix at 18 weeks of gestation. At 31 weeks of gestation, a cesarean section was performed, resulting in the delivery of a healthy male newborn, followed by simultaneous, radical hysterectomy with bilateral salpingo-oophorectomy and lymphadenectomy. Half of each ovary was cryopreserved. The patient was scheduled for radiochemotherapy, supplemented with brachytherapy. After the intervention, the patient experienced menopausal symptoms. The basal hormonal levels were: estradiol – 2 pg/ml, FSH – 96.52 IU/ml, LH – 37.55 IU/ml, AMH – 0.03 ng/ml. Thirteen months after surgery, the peritoneal pocket was formed on the anterior abdominal wall during laparoscopy and heterotrophic autotransplantation of the frozen-thawed ovarian tissue was performed, replacing 59% of the tissue. Results: Nine weeks after transplantation, symptom resolution, an increase in estradiol (53 pg/ml), and a decrease in FSH (64.89 IU/ml) and LH (33.39 IU/ml) levels were noted. Twenty-four weeks after transplantation, high estradiol levels (269 pg/ml), normal level of FSH (5.92 IU/ml) and LH (4.09 IU/ml), and an increase in AMH (0.37 ng/ml) were observed. Follicular development in the transplanted ovarian tissue was confirmed. Conclusions: Cryopreservation and transplantation of ovarian tissue allowed to restore the ovarian function. It could offer an alternative physiological solution to treating premature ovarian failure caused by oncological therapy.

Detection of intracavitary lesions in 820 infertile women: comparison of outpatient hysteroscopy with histopathological examination

Objectives: The aim of the study was to compare the results of a diagnostic hysteroscopy with a histopathology examination (referential test) in a group of infertile women. Materials and methods: Eight hundred and twenty infertile patients were included in the study. The subjects with intracavitary lesions underwent operative hysteroscopy to enable the removal of polyps and intracavitary myomas. Endometrial biopsy was performed in all patients with no pathologies in hysteroscopy. The removed tissue underwent histopathological examination. Results: The mean age was 32.9 ±4.1. A total of 648 (79%) patients were diagnosed with primary and 172 (21%) with secondary infertility; 542 (66.1%) hysteroscopies were performed with no anesthesia and 278 (33.9%) hysteroscopies were performed in short total intravenous anesthesia. Sensitivity and specificity, accuracy, error, positive predictive value (PPV) and negative predictive value (NPV) of hysteroscopy in detecting endometrial lesions were 99.6%, 96.6%, 97.4%, 2.6%, 92.2% (PPV) and 99.8% (NPV), respectively. The agreement between hysteroscopy and pathology report was very high (kappa K=0.94). In case of normal uterine cavity, 562 of the 563 endometrial samples showed evidence of normal endometrium. In all 32 cases of resected submucosal myomas histopathology confirmed the hysteroscopic findings (sensitivity100%, specificity 100%, accuracy 100%, error 0%, kappa K=1.0). Both, hysteroscopy and histopathology confirmed the presence of endometrial polyps in 199 cases. The diagnosis of a polyp was not confirmed in histopathological findings (false-positive results) in 20 hysteroscopies. No endometrial polyps were missed during hysteroscopy. Sensitivity, specificity, accuracy, error, positive and negative predictive values in detecting endometrial polyps were 100%, 96.8%, 97.6%, 2.4%, 90.9% (PPV) and 100% (NPV), respectively. The Kappa coefficient agreement between hysteroscopy and histopathology for endometrial polyps was 0.91. Conclusions: Hysteroscopy is a method of high sensitivity and specificity in detecting pathologies, but in case of a pathology it cannot replace histological examination. Our result show that a routine endometrial biopsy performer in infertile patients with no pathology in hysteroscopy should not be recommended

Żywa ciąża bliźniacza otrzymana za pomocą metody ciągłego monitorowania zarodków u pacjentki z niepowodzeniami IVF-ET – opis przypadku i przegląd piśmiennictwa

Introduction: A standard assessment of embryo morphology at given time points does not always allow to transfer the embryo with the highest implantation potential. The effect of transfer of an improper embryo results in a lack of pregnancy or a miscarriage and, as a consequence, exposes the patient to unnecessary emotional stress and necessity to perform yet another transfer of frozen embryos. We present a case of a patient with earlier IVF failures. The use of time-lapse technique in this case helped to choose two good embryos. The transfer resulted in ongoing twin pregnancy. Material and methods: A 35-year-old woman with history of IVF-ET treatment failure was deemed eligible for an ICSI procedure because of the male factor. Ovarian stimulation was performed according to the agonist long protocol. Eight MII oocytes were fertilized and seven embryos were obtained. Continuous embryo monitoring was performed with the use of Primo Vision system. Forty-four hours after fertilization only 2 correctly developing embryos were identified. They were transferred on day 3. The development of the remaining 5 embryos was arrested. These embryos did not achieve the blastocyst stage on day 5-6 after fertilization. Forty days after embryo transfer, a twin pregnancy, confirmed with fetal heart rate of both fetuses, was revealed on ultrasound examination. Currently, the patient is at 27 weeks of ongoing twin gestation. Conclusions: The system of continuous embryo monitoring introduces new criteria for the examination of embryo development. These new parameters can be useful in clinical practice. However, prospective randomized studies are necessary to provide data confirming the usefulness of time-lapse technique in IVF treatment.Wstęp: Standardowa obserwacja zarodków w procedurze IVF nie zawsze pozwala na wybór do transferu zarodka o najwyższym potencjale implantacyjnym. Naraża to pacjentkę na stres emocjonalny spowodowany brakiem ciąży, ewentualnym poronieniem oraz koniecznością powtórnego transferu zarodków mrożonych. W pracy przedstawiamy przypadek pacjentki po dwóch nieudanych próbach zapłodnienia pozaustrojowego in vitro, u której podczas kolejnego IVF-ICSI system time-lapse pomógł w wyborze dwóch prawidłowych zarodków. Zarodki przetransferowano w 3 dobie obserwacji i otrzymano żywą prawidłowo przebiegającą ciążę bliźniaczą. Materiał i metody: Trzydziestopięcioletnia pacjentka z dwoma niepowodzeniami IVF-ICSI została zakwalifikowana do ponownej procedury IVF-ICSI. Wskazaniem do leczenia był czynnik męski. Po stymulacji jajników według protokołu długiego uzyskano 8 prawidłowych komórek MII, uzyskując 7 zarodków. Do ciągłego monitorowania rozwoju zarodków wykorzystano system Primo Vision (Cryo Innovation). 44 godziny po ICSI zidentyfikowano tylko dwa prawidłowo rozwijające się zarodki, które podano do jamy macicy w trzeciej dobie obserwacji. Pozostałe embriony nie wykazały cech dalszych podziałów. Czterdzieści dni po transferze w badaniu ultrasonograficznym uwidoczniono ciążę bliźniaczą dwukosmówkową z czynnością serca obydwu płodów. Obecnie pacjentka jest w 27 tygodniu prawidłowo rozwijającej się ciąży bliźniaczej. Wnioski: System ciągłego monitorowania rozwoju zarodków wprowadza nowe kryteria ich oceny, które mogą być przydatne w praktyce klinicznej. Konieczne są jednak prospektywne randomizowane badania oceniające wartość systemów time-lapse w leczeniu metodą zapłodnienia pozaustrojowego

A case of multiple giant right coronary artery aneurysms

Coronary artery aneurysm is a rare congenital or acquired anomaly. The commonest location of coronary artery aneurysms is the right coronary artery and they are found slightly more often in males. We report an unusual case of multiple and extremely large aneurysms, therefore potentially at risk of rupture or thrombosis. (Cardiol J 2011; 18, 4: 434–436

Pro- and anti-inflammatory cytokines and growth factors in patients undergoing in vitro fertilization procedure treated with prednisone

Embryo implantation is a key moment in pregnancy. Abnormal production of pro- and anti-inflammatory cytokines, their receptors and other immune factors may result in embryo implantation failure and pregnancy loss. The aim of this study was to determine the profile of selected pro- and anti-inflammatory factors in the blood plasma of patients undergoing in vitro fertilization (IVF) and control women who achieved pregnancy after natural conception. The examined patients were administered steroid prednisone. We present results concern the plasma levels of IFN-ɣ, BDNF, LIF, VEGF-A, sTNFR1 and IL-10. We found that IVF patients receiving steroids differed significantly from patients who were not administered such treatment in terms of IFN-γ and IL-10 levels. Moreover, IVF patients differed in secretion of all tested factors with the fertile controls. Our results indicated that women who secrete at least 1409 pg/ml of sTNFR1 have a chance to become pregnant naturally and give birth to a child, while patients after IVF must achieve a concentration of 962.3 pg/ml sTNFR1 in blood plasma for successful pregnancy. In addition, IVF patients secreting VEGF-A above 43.28 pg/ml have a greater risk of miscarriage or a failed transfer in comparison to women secreting below this value. In conclusion, fertile women present a different profile of pro- and anti-inflammatory cytokines, and growth factors compared to patients with recurrent implantation failure (RIF)

Sinus of Valsalva aneurysm

Bicuspid aortic valve is one of the most common congenital cardiac anomalies and it may be accompanied by other cardiovascular anomalies. Sinus of Valsalva aneurysm is a rare anomaly in adult population, but it coexists with bicuspid aortic valve quite often. This report describes a 57 years-old patient who had a bicuspid aortic valve accompanied by unruptured Valsalva sinus aneurysm with significant left anterior narrowing and who underwent successful surgery with ascending aorta and aortic valve replacement as well as coronary by-pass grafting

Heart transcriptome of the bank vole (Myodes glareolus): towards understanding the evolutionary variation in metabolic rate

Longer reads and higher sequence yield per run provided by the 454 Titanium technology in comparison to earlier generations of pyrosequencing proved beneficial for the quality of assembly. An almost full representation of genes known to be expressed in the mouse heart was identified. Usage of the extensive genomic resources available for the house mouse, a moderately (20-40 mln years) divergent relative of the voles, enabled a comprehensive assessment of the transcript completeness. Transcript sequences generated in the present study allowed the identification of candidate SNPs associated with divergence of selection lines and constitute a valuable permanent resource forming a foundation for RNAseq experiments aiming at detection of adaptive changes both at the level of gene expression and sequence variants, that would facilitate studies of the genetic basis of evolutionary divergence