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Showing posts with label follicles. Show all posts
Showing posts with label follicles. Show all posts

Thursday, February 4, 2010

EU Approves First Long-Acting Fertility Treatment

Thursday, February 4, 2010
EU Approves First Long-Acting Fertility TreatmentFebruary 2, 2010 — The European Commission (EC) has approved corifollitropin alfa subcutaneous injection (Elonva, Merck and Company, Inc), the first sustained follicle stimulant.

Corifollitropin is indicated for controlled ovarian stimulation (COS) in combination with a gonadotropin-releasing hormone antagonist for the development of multiple follicles in women participating in an assisted reproductive technology program.

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Tuesday, October 6, 2009

Infertility Causing Gene, Smad-3 Identified

Tuesday, October 6, 2009
Infertility Causing Gene, Smad-3 IdentifiedScientists at Virginia Commonwealth University have identified a gene, which they assert causes infertility. They said that, such types of genes send molecular signals used for the ovarian follicle development. This may be a guiding source for learning the fertility related issues in humans.

The scientists used a mouse model to examine the role of Smad-3 in the early stages of follicular growth.

They on careful observation found that, follicle-stimulating hormone, or FSH needs a particular gene to function in the body. So they confirmed that, the mice didn’t experience normal ovulation due to the absence of such gene.

Further, the researchers concluded that Smad-3 is an important class of proteins that are essential for follicle development.

"Learning precisely how the FSH receptor is regulated is an important step in understanding the subtle defects in signal transduction that can interfere with follicle development and female fertility and could lead to new types of fertility treatments," Prof Elizabeth McGee said.

These findings have been published in the current issue of 'Biology of Reproduction' journal.

Source

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Monday, July 20, 2009

Fertility First: Human Egg Cells Grow Up in Lab

Monday, July 20, 2009
Human Egg Cells Grow Up in LabFor the first time, scientists have managed to grow mature human eggs from immature cells in the lab, a technique that may eventually help save the fertility of female cancer patients who aren’t eligible for traditional egg harvest.

Researchers from Northwestern University took immature egg cells, encased in a protective sac called a follicle, from 14 women who wanted to preserve their fertility before undergoing chemotherapy. By placing the cells in a unique three-dimensional growing environment for 30 days, the scientists coaxed the cells into becoming what appear to be healthy, functional human eggs.

“It is a major first,” said infertility expert Sherman Silber of St. Luke’s Hospital in St. Louis, who was not involved in the research. “No one has yet tested the eggs by in-vitro fertilization and pregnancy, but they look quite normal and we are all excited about it.”

Read more: http://www.wired.com/wiredscience/2009/07/humanegg/



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Thursday, September 18, 2008

UT Doctor Discovers Potential Source for Human Eggs

Thursday, September 18, 2008
Photo by host1.bondware.com
Dr. Antonin Bukovsky MD, PhD., reviews microscope images projected onto a computer screenIn the May 5, 2005, issue of Reproductive Biology and Endocrinology, the discovery that new human eggs can be developed in vitro from cells scraped from the surface of adult human ovaries was made in the laboratory of Dr. Antonin Bukovsky, MD, PhD.

These results suggest that cells scraped from the ovary could be a potential source of new eggs for women who have trouble conceiving — either due to age or other complications such as a lack of ovarian follicles, the structures composed of an egg surrounded by granulosa cells.

For women who want to delay having babies, these results suggest the possibility of having ovarian surface epithelium (OSE) cells frozen in order to produce new eggs at a later date.

Full story: http://host1.bondware.com/~knoxvillemed/news.php?viewStory=151



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Wednesday, April 30, 2008

New hope for women who face infertility as hundreds more eggs could be grown in lab

Wednesday, April 30, 2008
Photo by www.dailymail.co.uk
A major breakthrough by British scientists could bring new hope for women facing the heartbreak of infertilityA major breakthrough by British scientists could bring new hope for women facing the heartbreak of infertility.

For the first time a team has managed to grow hundreds of eggs in the laboratory using a new technique which could help cancer patients whose treatment can leave them infertile.

It would also allow thousands more women to wait until middle age to have children.

The scientists from Edinburgh University have shown that immature eggs can be frozen, grown and matured in the lab.

The process could lead to women having pieces of ovary containing the immature eggs removed and stored. Much later on, they could be thawed, fertilised and finally implanted into the womb.

The breakthrough, which comes as MPs prepare to debate the controversial Human Fertilisation and Embryology Bill, raises again the ethical debate surrounding the freezing of eggs.

Some say it is morally wrong for a woman to do so and have them fertilised years later in order to delay having children while she pursues a career.

However, scientists hope the new process will revolutionise fertility preservation for women because it will allow them to store many more eggs than they can under traditional IVF techniques.

And, because immature eggs survive the freezing process much better than the mature ones used in IVF, it is much more likely that older women will be able to conceive using them.

It brings forward the prospect that thousands of women will use the technique to side-step the menopause, delaying motherhood for the sake of their careers.

The process, which could be available in five years, also provides hope for cancer sufferers who at the moment are often left infertile following chemotherapy and radiotherapy.

Powerful anti-cancer drugs can destroy follicles in the ovaries, wiping out any possibility of women having children.

At the moment, these women have a piece of ovary removed, frozen and then re-transplanted after their cancer treatment. But there is always the danger that the cancer could be reintroduced by the implant.

The new technique means women's immature eggs contained in the patch of ovary could be grown in the lab and then screened for cancer before being used in IVF treatment.

There are also hopes it will provide a rich source of eggs for scientists to study for clues on ways to treat a range of diseases.

There is a shortage of human eggs for medical research, and if the technique works it would bypass the controversy over the use of animal-human 'hybrid' embryos.

The Human Fertilisation and Embryology Bill, which MPs are due to debate next month, would allow scientists to use these embryos in medical research, but many MPs plan to vote against.

The research, carried out by an Edinburgh University team led by Dr Evelyn Telfer, is published today in the journal Human Reproduction.

"This is a significant step in developing immature eggs to maturity outside the body," said Dr Telfer.

"Women who face infertility as a result of chemotherapy, or who want to put their biological clock on hold, could benefit from this system.

"However, there is a lot more research to be carried out before this technique could be safely applied within a clinical setting."

Last year, Canadian scientists announced the first birth of a child created from a human egg matured in the laboratory.

However, they did not use the same "primordial follicles" studied by the researchers from Edinburgh.

These are the tiny egg-bearing pockets within the ovaries that are present in their millions at birth, but gradually die off over the course of a woman's life.

They represent a woman's fertility "battery" which once depleted cannot be recharged.

Many remain dormant, but some go on to mature and eventually release their eggs in preparation for fertilisation.

For the first time, the team led by Dr Telfer has succeeded in growing primordial follicles to a late stage of maturation in the lab.

They took pieces of ovary containing the follicles from six volunteer women who were giving birth by caesarean section.

These were then exposed to a chemical that promotes growth, similar to the one that functions in the ovaries.

Around a third of them survived and went on to reach the advanced 'antral' stage of development.

At this stage, the follicles are filled with fluid and contain eggs almost ready to be fertilised.

It means that it could soon be possible to grow hundreds of eggs in the laboratory.

The Canadian team which managed to create a child from immature eggs was working with only around a dozen.

Another advantage is that the follicles mature much more quickly in the lab than they do in the ovary.

The scientists do not yet know whether eggs - or oocytes, to give them their technical name - matured in this way are completely normal and suitable for in-vitro fertilisation. But animal studies suggest they are.

The next step is to use hormones and other substances to try to nudge the 'antral' eggs on to the next stage of maturation, and then test the technique on humans.

"We believe there's good evidence that we can get normal oocytes, but of course you would never apply this technique clinically until you are sure," said Dr Telfer.

"We're seeking funding for further research to bridge that gap. It might take five to ten years from now before we get to the stage of a clinical trial."

Dr Jane Stewart, consultant in reproductive medicine at the Newcastle Fertility Centre, said:

"This work increases our understanding of the maturation of human eggs in the lab and takes us a step nearer the goal of strong immature eggs for fertility preservation for women."

Source: http://www.dailymail.co.uk/pages/live/articles/health/healthmain.html?in_article_id=560951&in_page_id=1774


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Friday, April 25, 2008

Breakthrough may preserve fertility post menopause

Friday, April 25, 2008
Photo by stylesr1
London, April 21 (ANI): Scot scientists have achieved a breakthrough in taking early stage follicles tiny egg-bearing pockets in the ovaries from a woman’s ovaries, and maturing them into eggs in the lab for the first time.

The achievement of Edinburgh University researchers means that women undergoing cancer treatment, or wishing to delay motherhood to concentrate on their careers, may have a way of preserving their fertility in the next five to 10 years.

Dr Evelyn Telfer and her colleagues say that they have established a procedure to develop early stage follicles to a much later stage.

The researchers took pieces of ovary containing the follicles from six volunteer women who were giving birth by elective caesarean section, and exposed them to an artificial growth factor.

They revealed that about one-third of the follicles survived, and went on to reach an advanced stage.

“This is a significant step in developing immature eggs to maturity outside the body. Women who face infertility as a result of chemotherapy, or who want to put their biological clock on hold, could benefit from this system, the Scotsman quoted Dr. Telfer as saying.

“However, there is a lot more research to be carried out before this technique could be safely applied within a clinical setting,” she added.

Normally, a woman undergoing cancer treatment has to have a piece of ovary removed and frozen for future transplantation, a procedure that carries the risk of reintroducing cancer cells to the patient.

They may also rely on fertility medication to produce eggs to be harvested for use at a later date, but this poses risks in delaying treatment, and defrosting the eggs does not always work.

Dr Telfer says that one alternative may be to maturing eggs in the laboratory may make it possible to screen them for cancer before they are returned.

In a report published in the journal Human Reproduction, the researcher says that women wishing to preserve their fertility past the menopause may also have their follicles stored for later use when they are ready to start a family.

She has revealed that in animal studies, eggs matured in this way appear to be completely normal and suitable for in vitro fertilisation.

However, her team have yet to confirm the same for humans.

“We believe there’s good evidence that we can get normal oocytes (eggs], but of course you would never apply this technique clinically until you are sure,” said Dr Telfer. (ANI)

Source: http://www.thaindian.com/newsportal/india-news/breakthrough-may-preserve-fertility-post-menopause_10040356.html



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Wednesday, April 9, 2008

Short Follicular Phase in Older Women

Wednesday, April 9, 2008
Is the Short Follicular Phase in Older Women Secondary to Advanced or Accelerated Dominant Follicle Development?

Abstract

This study sought to determine whether the shortened follicular phase in ovulatory older women is secondary to advanced (i.e. earlier) or accelerated (i.e. more rapid) folliculogenesis. Normal ovulatory women, aged 40–45 yr (n = 15) and 20–25 yr (n = 13), underwent daily venipuncture and transvaginal ultrasonography throughout the follicular phase of a spontaneous menstrual cycle (control cycle) and after pituitary down-regulation with a GnRH agonist (study cycle).


As expected, the older subjects in the control cycles demonstrated an elevated day 3 FSH and a shortened follicular phase compared with the younger subjects. After release from hypothalamic-pituitary-ovarian axis suppression, the early follicular phase FSH peak occurred earlier (6.8 vs. 9.8 d; P greater than 0.01) and was of a greater magnitude (12.1 vs. 6.5 mIU/ml; P greater than 0.01) in the older subjects.

The time from release of suppression until the subsequent LH surge was also shorter (17.5 vs. 20.8 d; P greater than 0.01) in the older group. However, the time from FSH peak to LH surge was similar in the older and younger groups (10.7 vs. 11.0 d; P = 0.74). Compared with younger women, older subjects had normal follicular phase levels of estradiol and inhibin A and lower levels of inhibin B in both control and study cycles.

We conclude that the shortened follicular phase observed in older ovulatory women is due to earlier dominant follicle selection, independent of hormonal influences from the preceding luteal phase.

Full article: http://jcem.endojournals.org/cgi/content/full/87/12/5746?ck=nck
Source: http://jcem.endojournals.org/cgi/content/abstract/87/12/5746?ck=nck


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Tuesday, April 8, 2008

A Method To Select Eggs With The Best Chance Of Leading To Successful Pregnancy Developed By Researchers

Tuesday, April 8, 2008
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choosing the best eggA research team supervised by Universite Laval scientist Marc-Andre Sirard has identified genetic markers that allow the selection of eggs with the best chance of leading to successful pregnancy after in vitro fertilization (IVF). This finding could both increase the success rate of single embryo transfer and diminish the risk of multiple pregnancies. The details of the method developed by the researchers, for which an international patent application has been filed, are explained on the website of the scientific journal Human Reproduction.

Eggs recovered in the course of the IVF process are surrounded by follicular cells that are removed before the actual fertilization procedure begins. "While in the ovaries, these cells and the eggs are in very close interaction," explains Sirard. "A first experiment we conducted on bovine follicular cells led us to believe that these cells might possess specific markers that would be able to give us information about the quality of an egg."

With the help of 40 women recruited in a fertility clinic, researchers compared follicular cells surrounding eggs that ultimately led to successful pregnancies - i.e. "good" eggs - to cells surrounding ovules that did not result in pregnancy. This comparison led to the identification of five genes expressed more abundantly in follicular cells surrounding good eggs.

Currently, the way to assess which embryos are to be transferred into a woman's uterus is based on visible criteria such as appearance and division rate. "At least 30% of embryos that look normal through visual examination nonetheless show chromosome abnormalities," explains Professor Sirard, illustrating the limits of this type of assessment. The method developed by Sirard's team makes it possible to objectively select ovules that have the best chance of success without altering the integrity of the embryos.

This new genomic tool could also solve an ethical problem confronting both fertility clinic doctors and the people who consult them: In order to increase the chances of pregnancy, many embryos are implanted simultaneously into the woman in the hope that at least one will survive. This procedure along with improved IVF techniques has led to an increase in multiple pregnancies. Even if doctors now tend to transfer fewer embryos, multiple pregnancies still occur in 30% of couples who resort to IVF in North America and 23% in European couples.


"By selecting the embryo with the best potential, it would be possible to limit the number of embryos transferred, and thus the number of multiple pregnancies, while maintaining good success rates," concludes Marc-André Sirard.

Information:
Marc-André Sirard
Centre de recherche en biologie de la reproduction
Université Laval

Source: Jean-François Huppé,
Université Laval
http://www.medicalnewstoday.com/articles/100529.php



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Monday, March 24, 2008

Effect of short follicular phase with follicular maturity on conception outcome

Monday, March 24, 2008
Photo by CatherineShort Follicular phase reduces fertility
Purpose: To determine if a short follicular phase despite attaining a mature follicle is associated with a lower pregnancy rate. Furthermore the study would determine if delaying the maturation of the follicle by the use of ethinyl estradiol could improve the pregnancy rate.

Methods: The clinical and viable pregnancy rates of 32 infertile patients were matched to 32 similar controls who ovulated at or past day 11. After 2-3 cycles of demonstrating ovulation before day 11 some patients were treated with ethinyl E[2], 20 mcg daily, from day 2 of the cycle until ovulation.


Results: Clinical and viable pregnancy rates for the normal ovulators (84.4%, 59.3%) were significantly higher than the rates for early ovulators (21.8%, 9.3%). However, the pregnancy rates were 83.3% and 66.7% for the subset of early ovulators who were made to ovulate later by ethinyl E[2].

Conclusions: The short follicular phase per se reduces fecundity.

Journal Title
Clinical and experimental obstetrico & gynecology (Clin. exp. obstet. gynecol.) ISSN 0390-6663 Clinical and experimental obstetrics and gynecology

Source
2003, vol. 30, no4, pp. 195-196 [2 page(s) (article)]

Full article: http://cat.inist.fr/?aModele=afficheN&cpsidt=15335930


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Tuesday, January 1, 2008

Natural cycle as first approach in aged patients with elevated FSH

Tuesday, January 1, 2008
Natural cycle as first approach in aged patients with elevated follicle-stimulating hormone undergoing intracytoplasmic sperm injection: A pilot study

Background. Poor ovarian response to standard in vitro fertilization–embryo transfer (IVF-ET) protocols or different regimens of treatment, as consequence of a diminished ovarian reserve, correlates strictly with patient age, elevated follicle stimulating hormone (FSH) and reduced antral follicle count. The aim of the present pilot study was to evaluate the outcome of patients with poor prognostic features undergoing IVF-ET with natural cycles as a first approach and not as a consequence of a previous failure treatment.

Materials and methods. Eighteen aged patients (mean+standard deviation 40.2+0.7 years, range 37–43 years) with elevated serum FSH and reduced antral follicle count underwent intracytoplasmic sperm injection (ICSI) after spontaneous ovulation.

Results. A total of 26 natural cycles with ICSI were analyzed. Pregnancy was observed in three patients, of which two were ongoing as assessed by fetal heart beat at ultrasound scan performed 4–5 weeks after ET.

Conclusion. The overall pregnancy rates achieved (11.5% per cycle, 20.0% per ET) are comparable with those of conventional IVF-ET in aged patients, and not impaired by a single embryo transferred. Better embryo quality, as a consequence of natural selection of oocytes, better endometrium receptivity and monthly repeatability of the procedure, can balance the relatively low chance to perform ET.

Keywords: Aged patients, elevated follicle-stimulating hormone, natural cycle, intracytoplasmic sperm injection

Gynecological Endocrinology, July 2006; 22(7): 351–354
Source:
http://www.ingentaconnect.com/content/tandf/ge/2006/00000022/00000007/art00001

More scientific articles:
http://www.naturalcycle.org/scientific%20papers.htm

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Monday, December 3, 2007

Smoking before, after pregnancy harms daughters' fertility

Monday, December 3, 2007
Offspring had fewer egg follicles, mouse study shows

WEDNESDAY, Nov. 21 (HealthDay News) -- Researchers have identified the chemical pathway by which a mother's smoking before and after pregnancy might reduce her daughter's fertility by as much as two-thirds.

Cigarette smoking during pregnancy has been shown in retrospective studies to affect the fertility of a woman's offspring, but this is the first study to offer an explanation of the biology behind the effect, the Canadian scientists claim.

A team at the Samuel Lunenfeld Research Institute at Mount Sinai Hospital in Toronto investigated the impact of polycyclic aromatic hydrocarbons (PAH), a byproduct of smoking, on mouse fertility.

Researchers injected three groups of female mice with a low-dose mixture of PAH: One group received PAH before conception and again when they were providing milk for their pups; one group received PAH only before conception; and the third group received PAH only during lactation. A fourth control group did not receive PAH but were mated at the same time as the others. The total amount of PAH given to each mouse over the three-week injection cycle was equivalent to 25 packs of cigarettes, according to the researchers. The exposed mice did not have fewer pups in their own litters, but when researchers investigated the number of eggs in their female offspring, they found about 70 percent fewer follicles available to produce eggs.

"Mothers, mice in this case, exposed to PAHs -- environmental pollutants found in cigarette smoke, car exhaust, smoke produced by fossil fuel combustion, as well as in smoked food --before pregnancy and/or during breast-feeding, but not during pregnancy, can cause a reduction in the number of eggs in the ovaries of their female offspring by two-thirds. This limits the window in which the daughter will be able to reproduce," explained lead researcher Dr. Andrea Jurisicova.

Further analysis indicated that the effects of PAHs on the number of follicles in female offspring were mediated through a receptor that affects the expression of a gene that makes a protein that causes cells to die. The researchers then demonstrated similar effects in human ovarian tissue transplanted into immunocompromised mice.

Jurisicova described the process: "Toxic compounds were injected under the skin of mice and were picked up by the bloodstream and carried throughout the body until they reached the ovaries. Once at the ovaries, they passed through the cell membrane and bound to the receptor. When this happens, it activates the receptor, which then enters the cell nucleus. The receptor then finds a specific DNA sequence that turns on the gene, which accumulates and eventually kills the eggs."

"This study now is providing a chemical pathway, which is very nice," said Dr. Norman Edelman, consultant for scientific affairs with the American Lung Association. The new data provides biological support for epidemiological results, such as the previously observed reduction in fertility among daughters of smoking women, he added.

Whether the news will have an impact on a woman's decision to smoke is another question, said Edelman.

"If we do our job right and these results get good press, this data could remind women of what they are doing to their unborn fetuses," Edelman said.

Another expert noted this latest finding adds to a growing body of evidence that shows a strong connection between smoking and fertility.

"I think it is an interesting study, but it doesn't add much new. Other studies have shown similar outcomes. The theory is that smoking could affect the follicles or the fallopian tubes," said Dr. Amos Grunebaum, director of obstetrics at New York Weill Cornell Medical Center, in New York City. "We have known for many years that smoking affects fertility on many levels."

"The key is women should quit smoking before they are thinking of getting pregnant," Grunebaum said.

The Canadian researchers did offer some good news in their report, published in the Dec. 3 edition of the Journal of Clinical Investigation. Injecting resveratrol in the mice who were exposed to PAH prevented the reduction in egg follicles in their offspring. Resveratrol is a naturally occurring antioxidant found in wine and grape skins. However, that reversal of damage does not mean that women who smoke can counter the effects with a nutritional supplement or a glass of red wine, the researchers stressed.

"We have found that oral consumption of resveratrol as a food supplement, at least in mice, is not effective, as levels of resveratrol do not reach sufficient amount in the bloodstream to provide protection," Jurisicova said.

Although the findings do not define the length of time between quitting smoking and healthier fertility in offspring, Jurisicova noted that previous studies have shown that women who smoke have better results with in vitro fertilization one year after they quit smoking. The mice in the current study conceived up to two weeks after their final PAH injection, which is approximately equivalent to three menstrual cycles in women.

The effect of a mother's cigarette smoking is not limited to her female children. A study published in the Jan. 1 issue of the American Journal of Epidemiology suggested that the male offspring of mothers who smoke have lower sperm counts.

There is still more research to be done, Jurisicova noted.

"We hope to continue studying the female offspring to see if they enter the mouse version of menopause earlier than mice whose mothers were not exposed to PAHs," Jurisicova said. "We also hope to study if their reduced fertility passes on to subsequent generations, and if the granddaughters are predisposed to similar problems."

Source: http://www.nlm.nih.gov/medlineplus/news/fullstory_57913.html


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Sunday, October 14, 2007

Folic acid supplementation affects the maturing oocyte

Sunday, October 14, 2007
Preconception folic acid treatment affects the microenvironment of the maturing oocyte in humans.

OBJECTIVE: To investigate the influence of folic acid supplementation on the follicular fluid concentrations of folate and total homocysteine and their relationship to the diameter of the follicle
.

SETTING: Tertiary referral fertility clinic at the Erasmus MC, University Medical Center, Rotterdam, The Netherlands.

PATIENT(S): Thirty-seven women undergoing IVF or intracytoplasmic sperm injection treatment.

INTERVENTION(S): No interventions other than routine stimulation treatment and the recommendation of folic acid supplementation.

MAIN OUTCOME MEASURE(S): Concentrations of folate and total homocysteine in monofollicular and pooled follicular fluid and the diameter of the follicle.

RESULT(S): Folic acid supplementation significantly increased folate and decreased total homocysteine concentrations in pooled follicular fluid. In monofollicular fluid, folate concentrations only were significantly increased in supplemented women. The total homocysteine concentration appeared to be significantly correlated with the diameter of the follicle (r = 0.27). Samples from single follicles were less prone to artifacts in the measurements of the folate and total homocysteine concentration.

CONCLUSION(S): Preconception folic acid supplementation significantly alters both folate and total homocysteine concentrations in follicular fluid. The correlation between the diameter of the follicle and total homocysteine concentration in follicular fluid warrants further investigation.

Source:
http://www.ncbi.nlm.nih.gov/sites/entrez?tmpl=NoSidebarfile&db=PubMed&cmd=Retrieve&list_uids=17923130&dopt=AbstractPlus

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Sunday, September 23, 2007

A Trial of Dehydroepiandrosterone (DHEA) Treatment for in Vitro Fertilization (IVF)

Sunday, September 23, 2007
Purpose
Our long term goal is to elucidate the role of DHEA on follicular dynamics in the human ovary and to better understand the interaction of DHEA supplementation with other treatments for ovulation induction, especially among older reproductive age women.

The specific hypothesis behind the proposed research is that DHEA is a regulator of follicular dynamics acting in the early pre-gonadotropin dependent stage of initial primordial follicle recruitment and growth.

* Clinical Pregnancy per cycle of treatment

Secondary Outcome Measures:
* Embryos per cycle of treatment
* Oocytes per cycle of treatment

Total Enrollment: 200

Study start: January 2007

Specific Aims:
Our long term goal is to elucidate the role of DHEA on follicular dynamics in the human ovary and to better understand the interaction of DHEA supplementation with other treatments for ovulation induction, especially among older reproductive age women.

Based on these observations the experimental focus of this project is on the interaction of DHEA adjuvant treatment with gonadotropin treatment during ovulation induction. The specific aims are designed to provide a comprehensive assessment of this effect.

1. DHEA treatment will increase pregnancy rates among women 40 to 45 years old.
2. DHEA treatment will increase antral follicle counts.
3. DHEA will lead to increased anti-mullerian (AMH) hormone levels.
4. DHEA treatment will increase mean and peak follicular phase estradiol.
5. DHEA treatment will increase the number of oocytes retrieved in IVF cycles compared to placebo.

Research Plan:
Placebo controlled randomized trial of 2 months of DHEA pretreatment prior to ovulation induction for IVF-ET.

Hypothesis 1:
Two months of DHEA pretreatment will improve the chance of pregnancy and lead to greater oocyte and embryo yields relative to placebo treated control patients.

Hypothesis 2:
Embryos produced following 2 months of pretreatment with either DHEA alone OR with DHEA plus supplemental FSH 150 units per day will result in embryos with better morphology

Hypothesis 3a-c:
Two months of DHEA pretreatment will result in:

a) increased antral follicle counts, increased AMH,
b) increased mean and peak estradiol and
c) increased oocyte production

More Info: http://clinicaltrials.gov/ct/show/NCT00419913?order=4

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Monday, September 17, 2007

The fourth (luteal) phase: (Day 15-27)

Monday, September 17, 2007
Around 20 eggs develop and the most mature egg gets released. While the eggs are developing, the sacs produce estrogen. And just before the most mature egg gets released, progesterone is also secreted in addition to estrogen.

Estrogen and progesterone have their respective functions. Estrogen increases the flow of blood to the uterus and helps thicken its lining. Progesterone helps produce substances that will nourish a Ovum fertilized egg implanted in the lining.

The sacs (follicles) produce estrogen and progesterone due to the stimulation of LH and FSH. And once estrogen and progesterone reach a certain level, the production of LH and FSH stops. This stops the development of the other eggs, after the most mature egg has released.

If fertilization takes place:

The ruptured sac, after the egg has broken through (Corpus luteum), continues producing progesterone, aimed at nourishing the growth of the embryo. Progesterone blocks the release of further eggs till pregnancy is terminated.

Estrogen, while regulating progesterone, begins one of the major processes of fetal maturation. Without estrogen, the lungs, liver and other organs and tissues cannot mature.

If fertilization does not take place:

Estrogen and progesterone levels drop. Without these hormones, the lining of the uterus breaks up and is released through the vagina, to mark the onset of the menstrual period.

What happens after the uterine lining is shed?

A new cycle menstrual begins.

Source: http://www.allaboutpregnancysymptoms.com/ebook/chap1_2.htm

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Friday, August 3, 2007

Stimulatory Effect of Morning Bright Light on Reproductive Hormones and Ovulation

Friday, August 3, 2007
Stimulatory Effect of Morning Bright Light on Reproductive Hormones and Ovulation: Results of a Controlled Crossover Trial

Objectives: Studies have shown a shortening of the menstrual cycle following light exposure in women with abnormally long menstrual cycles or with winter depression, suggesting that artificial light can influence reproductive hormones and ovulation. The study was designed to investigate this possibility.

Design: Placebo-controlled, crossover, counterbalanced order.

Setting: Medical centres and participants' homes in Novosibirsk (55°N), Russia.

Participants: Twenty-two women, aged 19–37 years, with baseline menstrual cycle length 28.1–37.8 d and no clinically evident endocrine abnormalities completed the study. The study lasted for two menstrual cycles separated by at least one off-protocol cycle.

Interventions: During one experimental cycle, bright light was administered at home for 1 wk with a light box emitting white light at 4,300 lux at 41 cm for 45 min shortly after awakening. During the other experimental cycle, dim light was less than 100 lux at 41 cm with a one-tube fluorescent source.

Outcome Measures: Blood samples and ultrasound scans were obtained in the afternoon before and after the week of light exposure, on day ∼7 and 14 after menstruation onset. Further ultrasound scans after day 14 documented ovulation. Serum was assayed for thyroid-stimulating hormone (TSH), prolactin (PRL), luteinizing hormone (LH), follicle-stimulating hormone (FSH), and estradiol (E2).

Results: Concentrations of PRL, LH, and FSH were significantly increased with bright versus dim light exposure, as was follicle size (ANOVA, intervention × day, p = 0.0043, 0.014, 0.049, and 0.042, respectively). The number of ovulatory cycles increased after exposure to bright compared to dim light (12 versus 6 cycles, Wilcoxon tied p = 0.034).

Conclusions: Morning exposure to bright light in the follicular phase of the menstrual cycle stimulates the secretion of hypophyseal reproductive hormones, promotes ovary follicle growth, and increases ovulation rates in women with slightly lengthened menstrual cycles. This might be a promising method to overcome infertility.

Full article:
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1851732

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Sunday, July 29, 2007

Antral Follicle Count and Serum Follicle-Stimulating Hormone Levels to Assess Functional Ovarian Age

Sunday, July 29, 2007
OBJECTIVE: The objective of this study was 2-fold. The first was to estimate side-to-side variation in antral follicle counts. The second was to determine whether basal follicle-stimulating hormone levels on days 2, 3, and 4 of the same menstrual cycle are significantly different.

METHODS: Forty-one patients between the ages of 20 and 42 years undergoing monitoring for in vitro fertilization-embryo transfer were evaluated ultrasonographically for antral follicle number. The antral follicle counts were determined for each ovary by experienced ultrasonographers at the time of suppression check ultrasonography. In a separate study, 62 normal subjects (ages 20–25 and 40–45 years) underwent serial sequential serum follicle-stimulating hormone determinations on days 2–4 of the menstrual cycle, and these levels were compared.

RESULTS: There was no significant difference between right and left antral follicle counts (P = .30). Serial follicle-stimulating hormone values were not significantly different on days 2, 3, or 4 of the menstrual cycle (P = .22).

CONCLUSION: There is no significant difference between right-sided and left-sided antral follicle counts within the same individual. In turn, there is no significant difference in serial follicle-stimulating hormone levels on days 2, 3, or 4 of the menstrual cycle.

Full article:
http://www.greenjournal.org/cgi/content/full/104/4/801

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Wednesday, July 4, 2007

In Vitro Fertilization with Preimplantation Genetic Screening

Wednesday, July 4, 2007
Abstract:

Background: Pregnancy rates in women of advanced maternal age undergoing in vitro fertilization (IVF) are disappointingly low. It has been suggested that the use of preimplantation genetic screening of cleavage-stage embryos for aneuploidies may improve the effectiveness of IVF in these women.

Methods: We conducted a multicenter, randomized, double-blind, controlled trial comparing three cycles of IVF with and without preimplantation genetic screening in women 35 through 41 years of age. The primary outcome measure was ongoing pregnancy at 12 weeks of gestation. The secondary outcome measures were biochemical pregnancy, clinical pregnancy, miscarriage, and live birth.

Results: Four hundred eight women (206 assigned to preimplantation genetic screening and 202 assigned to the control group) underwent 836 cycles of IVF (434 cycles with and 402 cycles without preimplantation genetic screening). The ongoing-pregnancy rate was significantly lower in the women assigned to preimplantation genetic screening (52 of 206 women [25%]) than in those not assigned to preimplantation genetic screening (74 of 202 women [37%]; rate ratio, 0.69; 95% confidence interval [CI], 0.51 to 0.93). The women assigned to preimplantation genetic screening also had a significantly lower live-birth rate
(49 of 206 women [24%] vs. 71 of 202 women [35%]; rate ratio, 0.68; 95% CI, 0.50 to 0.92).

Conclusions: Preimplantation genetic screening did not increase but instead significantly reduced the rates of ongoing pregnancies and live births after IVF in women of advanced maternal age. (Current Controlled Trials number, ISRCTN76355836 [controlled-trials.com] .)

Full Article:
http://content.nejm.org/cgi/content/full/NEJMoa067744v1

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Tuesday, July 3, 2007

Doctors freeze eggs of girls, 5

Tuesday, July 3, 2007
Doctors have managed to extract eggs from five-year-old girls and freeze them for use when they are old enough to have children.

The scientific advance, which had been thought impossible, will enable girls suffering childhood cancers such as leukaemia to become parents in later life. Thousands are left infertile each year after undergoing chemotherapy.

It also opens the possibility of storing girls’ eggs to protect them against any form of infertility in later life.

Previously it was believed the eggs of prepubescent girls were too immature to be extracted. It was thought they became viable only at puberty by reacting to hormonal changes in the body.

Israeli doctors have, however, managed to extract the eggs and then culture them in test-tubes to make them viable. The resulting eggs are no different to those of a 20-year-old, say the doctors.

The doctors are part of the same research team that made medical history by treating a mother who gave birth to twins from embryos frozen 12 years earlier. The experiment demonstrated that eggs or embryos could be frozen for lengthy periods without damage.

Dr Ariel Revel, a lecturer in obstetrics and gynaecology at Hadassah University hospital, Jerusalem said: “We have developed a technique which allows us to obtain eggs even from girls and to mature them in vitro. We isolate eggs from the tissue and, following one or two days in culture, they are mature enough for freezing.

“The results are quite surprising. Since these girls are not menstruating, we would expect maturing them to be very difficult, but we have shown that they do mature. The cancer treatment these girls are having will almost certainly cause them to become infertile. Although this is still experimental, any technique that tries to restore fertility to these girls is worth trying.”

Revel will present the full results of his research at the annual meeting of the European Society of Human Reproduction and Embryology in Lyon, France, this week.

About 1,500 children undergo treatment for cancer every year in Britain. Seventy-five per cent survive the disease but many will be left infertile by radiotherapy and chemotherapy treatment.

The breakthrough has been welcomed by British cancer and fertility doctors. Professor Gedis Grudzinskas, medical director of the Bridge Fertility Centre, London, said: “This is very important because this is the first time that human eggs have undergone changes in the test-tube which normally take place during puberty.

“Prior to puberty the ovaries are not sensitive to hormones. They become sensitive to hormones gradually during puberty. This is a subtle change and it is amazing that this can occur in a Petri dish.”

But Josephine Quintavalle of Comment on Reproductive Ethics, a campaign group worried about some forms of in vitro fertilisation techniques, expressed concern that if the eggs were donated to a woman of childbearing age, a resulting child could have a biological mother who was only a few years older.

Quintavalle said: “Are we going to end up with a child who has a mother who is just six years older? What happens if the child dies? Could the eggs be donated to someone else?

“I don’t think this is the first priority for five year olds. Any intervention for a child going through cancer treatment is an added burden. I feel uncomfortable about this development.”


Doctors have previously frozen the ovarian tissue of several young girls and plan to transplant pieces of the organs back into their bodies when they are older.

So far, however, there have been only two reported pregnancies after ovarian tissue of adults has been frozen and transplanted. The outcome for girls is unknown.

Ovarian tissue could also contain cancerous cells. This risk would be eliminated by freezing and implanting eggs. Across the world more than 100 children have been born from frozen eggs.

Dr Hamish Wallace, a consultant paediatric oncologist at the Royal Hospital for Sick Children in Edinburgh, said: “Maturing in vitro a primitive egg from a five-year-old girl would be a huge advance.

“Doctors wouldn’t need to worry about the ovarian tissue being contaminated with some of the original cancer cells and reintroducing the cancer into the body.”

Israeli scientists have also suggested taking eggs from aborted foetuses. Doctors at the Meir Hospital in Kfar Saba said aborted foetuses could one day become the “mother” of a new baby by donating eggs to an infertile woman.

A woman has her greatest number of eggs, about 5m, as a five-month-old foetus. By the time she is born, about 4m will have disintegrated. By the time a girl reaches puberty, only 300,000 will remain.

From then on, a woman will ovulate one egg each month and have few eggs left by her mid-forties. She will have ovulated about 500 and the remainder will have disintegrated.

The first reported birth from a frozen egg was in 1986. The practice began for medical reasons but is now being used for social purposes.

British women in their thirties who have not yet met their partner or who wish to postpone childbirth to concentrate on their career, are increasingly freezing their eggs. Although scientists initially feared the structure of the eggs would be damaged by the process, many now believe the procedure to be safe and effective.

Eggs are currently frozen using a process known as cryo-preservation, where they are placed in a storage tank containing liquid nitrogen. Scientists have recently developed a more advanced freezing technique, called vitrification, which causes less damage to the eggs.

Source: http://www.timesonline.co.uk/tol/news/uk/science/article2010114.ece

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Sunday, May 27, 2007

Genes Controlling Ovarian Development and Follicle Growth

Sunday, May 27, 2007
Summary

Ovarian follicle development is a complex process that begins with the establishment of what is thought to be finite pool of primordial follicles and culminates in either the atretic degradation of the follicle or the release of a mature oocyte for fertilization. The use of transgenic mouse models has provided a great deal of information with regard to the mechanisms underlying ovarian development and follicle growth. The data obtained from these models may provide clues about the reasons for abnormal reproductive conditions in humans, as multiple genes shown to regulate folliculogenesis and fertility in mice have been shown to play a role in human reproduction.

Introduction

During the past several years, studies using transgenic mouse models have revealed novel information about the genes that control the processes of ovarian differentiation, formation of the primordial germ cell pool, primordial follicle formation, growth of follicles from the primordial to antral stage, and ovulation. Recently, many of these studies have been described in detail by Barnett et al., 2006, and are summarized below. In addition, studies have focused on the steroid hormones and growth factors that control ovarian development and follicle growth.

Rest of article: http://ovary.stanford.edu/Litt/transgenicmousemodels

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