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Milewski R.,Medical University of Bialystok | Kuc P.,Medical University of Bialystok | Kuc P.,Center for Reproductive Medicine | Kuczynska A.,Center for Reproductive Medicine | And 7 more authors.
Journal of Assisted Reproduction and Genetics | Year: 2015

Purpose: The aim of the study was to create a predictive model of blastocyst development based on morphokinetic parameters of time-lapse embryoscope monitoring. Methods: Time-lapse recordings of 432 embryos (obtained from 77 patients), monitored in Embryoscope, were involved in the study. Patients underwent in vitro fertilization according to standard procedure between June 2012 and April 2013. A retrospective analysis of morphokinetic features, focused on duration of time from the Intracytoplasmic Sperm Injection (ICSI) procedure to consecutive embryo division for 2, 3, 4 and 5 blastomeres, as well as time intervals between each division, was conducted. All embryos were observed for 5 days. Results: Based on the distribution of analyzed morphokinetic parameters and number of embryos developed to blastocyst, a range denoting the possibility of an embryo reaching blastocyst stage was determined. According to the obtained results, univariate and multivariate logistic regression analyses were performed. Based on the times of division for two and five blastomeres and intervals between the second and third division, a multivariate predictive model was created. The predictive equation was constructed based on the parameters of logistic regression analysis (odds ratios). Statistically significant differences (p < 0.001) in the size of the prediction parameter between the group of embryos developed to blastocyst (the median value: Me = 9.95, and quartiles: Q1 = 7.59, Q3 = 12.30) and embryos that did not develop to the blastocyst stage (Me = 4.66, Q1 = 2.33, Q3 = 8.19) were found. A Receiver Operating Characteristic (ROC) curve was created for the constructed predictive model. The Area Under the Curve was AUC = 0.806 with a 95 % confidence interval (0.747, 0.864). The predictive model constructed in this study has been validated using an independent data set, which indicates that the model is reliable and repeatable. Conclusions: Time-lapse imaging presents a new diagnostic tool for parametric evaluation of embryo development, from the oocyte stage, through fertilization, up to the blastocyst stage. The assessment of morphokinetic parameters can help us to provide more accurate information about the reproductive potential of embryos. It allows for early selection of embryos with high reproductive potential and shortens embryo incubation. © 2015, The Author(s).

Szlendak-Sauer K.,Medical University of Warsaw | Jakubik D.,Medical University of Warsaw | Kunicki M.,Medical University of Warsaw | Kunicki M.,Fertility and Reproductive Center | And 2 more authors.
European Journal of Obstetrics Gynecology and Reproductive Biology | Year: 2016

Objectives Autoimmune polyglandular syndrome type 3 - (APS-3), is defined as the coexistence of autoimmune thyroiditis with other non-ovarian autoimmune diseases without primary adrenal insufficiency. Additionally the definition of APS-3 also includes primary ovarian insufficiency (POI) coexistence with autoimmune thyroiditis. The main goal of that study is to assess the prevalence of APS-3 defined as coexistence of autoimmune thyroiditis with POI in population of 46 XX karyotype women with primary ovarian insufficiency (POI). The second goal is to investigate hormonal profile and insulin sensitivity in women with POI and subgroups of women with APS-3 - POI/APS-3(+) and without APS 3 - POI/APS-3(-). Materials and methods Anthropometric measurements, coexistence of autoimmune diseases, androgens, fasting glucose and insulin, glucose and insulin at 60′ and 120′ of oral glucose tolerance test (OGTT) and homeostasis model for insulin resistance (HOMA-IR), were determine in 98 patients aged between 18 and 39 with spontaneous 46 XX primary ovarian insufficiency (POI), in 33 POI/APS-3(+), 65 POI/APS-3(-), and 75 healthy controls. Results Continuous data were summarized by the mean ± standard deviation (SD), and categorical data by number (percentages). Data were checked for normality using Shapiro-Wilk test, the comparison between groups were performed using non-parametric Mann-Whitney or Kruskall-Wallis test. Pearson's correlation coefficient was used to assess the relationships between parameters. Statistical significance was defined as p values <0.05. Autoimmune thyroid disease (ATD) was presented in 33/98 (33.7%) patients with POI. The groups did not differ significantly in respect to age and body mass index (BMI). Women with POI, POI/APS-3(+) and POI/APS-3(-) showed significantly lower serum androgens in comparison to controls. Additionally women with POI/APS-3(+) showed hyperinsulinemia after 1 h of OGTT; No significant differences in serum fasting glucose, insulin and during 2 h OGTT between groups were observed. Conclusions The prevalence of APS-3 is 33.7% in patients with spontaneous 46 XX primary ovarian insufficiency. Women with POI, POI/APS-3(+) and POI/APS-3(-) feature lower testosterone, androstendione, dehydroepiandrostendione sulphate in comparison to controls. Women with POI/APS-3(+) could have hyperinsulinemia and should be carefully evaluated for metabolic disorders. © 2016 Elsevier Ireland Ltd.

Krzysztof L.,Fertility and Reproductive Center | Krzysztof L.,Medical University of Gdansk | Joanna L.,Fertility and Reproductive Center
Ginekologia Polska | Year: 2011

Objectives: To prevent OHSS by interruption of the early stage of stimulation ("internal coasting"). Design: Prospective, randomized study. Material and Methods: 139 women who had unsuccessfully undergone standard long protocol ICSI procedure, complicated by OHSS of moderate or severe degree. The women were randomized to two groups - 68 undergoing stimulation in which, after 2 days of 225 IU hMG there were 2 days without hMG, and then, for the remainder of the stimulation period, 150 IU hMG. The control group (71 women) received standard doses of hMG, as in the first ICSI cycle. The main outcome measures was the prevalence and severity of OHSS, implantation and pregnancy rates. Results: There were 39 cases of OHSS of moderate (32) and severe (7) degree in the control group and 7 (moderate) cases in the investigated group (p = 0.05). No differences were found in the implantation rate and pregnancy rate, the mean number of oocytes fertilized, fertilization rate and the mean number of embryos transferred. Conclusion: Stimulation with internal coasting is safe for women at a high risk of OHSS. It does not negatively influence fertilization, implantation or pregnancy rates. © Polskie Towarzystwo Ginekologiczne.

Kunicki M.,Fertility and Reproductive Center | Lukaszuk K.,Medical University of Gdansk | Lukaszuk K.,University of Varmia and Masuria | Lukaszuk K.,Fertility and Reproductive Center | And 4 more authors.
BioMed Research International | Year: 2014

The aim of the study was to assess the granulocyte colony-stimulating factor (G-CSF) effects on unresponsive thin (<7 mm) endometrium in women undergoing in vitro fertilization (IVF). We included thirty-seven subjects who had thin unresponsive endometrium on the day of triggering ovulation. These patients also failed to achieve an adequate endometrial thickness in at least one of their previous IVF cycles. In all the subjects at the time of infusion of G-CSF, endometrial thickness was 6,74 ± 1,75 mm, and, after infusion, it increased significantly to 8,42 ± 1,73 mm. When we divided the group into two subgroups according to whether the examined women conceived, we showed that the endometrium expanded significantly from 6,86 ± 1,65 to 8,80 ± 1,14 mm in the first group (who conceived) and from 6,71 ± 1,80 to 8,33 ± 1,85 mm in the second, respectively. There were no significant differences between the two subgroups in respect to the endometrial thickness both before and after G-CSF infusion. The clinical pregnancy rate was 18,9%. We concluded that the infusion of G-CSF leads to the improvement of endometrium thickness after 72 hours. © 2014 Michał Kunicki et al.

Kunicki M.,Fertility and Reproductive Center | Lukaszuk K.,Medical University of Gdansk | Lukaszuk K.,University of Varmia and Masuria | Lukaszuk K.,Fertility and Reproductive Center | And 2 more authors.
PLoS ONE | Year: 2015

Objective: The aim of our study was to determine whether serum dehydroepiandrosterone sulphate (DHEAS) concentration and the models incorporating it could help clinicians to predict IVF outcomes in women with normal ovarian reserve undergoing their first long protocol. Study Design: We performed a retrospective analysis of 459 women undergoing cycles of intracytoplasmic sperm injection (ICSI) for the first time in a long GnRH agonist protocol. Results: Embryo transfer was performed in 407 women (88.7%). The fertilisation rate was 78.6%. The clinical pregnancy rate was 44.8% per started cycle and 50.6% per embryo transfer. Our univariate model revealed that the best predictors of clinical pregnancy were the number of mature oocytes, the number of embryos transferred and the number of good quality embryos, account for the clinical parameters that reflect ovarian reserve the best being AMH level and AFC. DHEAS did not predict clinical pregnancy (OR 1.001, 95% CI, 0.999-1.004). After adjusting for the number of embryos transferred and class of embryos in a multivariate model, the best predictors were age (OR 0.918, 95% CI, 0.867-0.972) and AFC (OR 1.022, 95% CI, 0.992-1.053). Serum DHEAS levels were positively correlated with AFC (r = 0.098, P<0.039) and testosterone levels (r = 0.371, P<0.001), as well as the number of mature oocytes (r = 0.109, P<0.019); serum DHEAS levels were negatively correlated with age (r = -0.220, P<0.001), follicle-stimulating hormone (FSH), (r = -0.116, P<0.015) and sex hormone-binding globulin (SHBG), (r = -0.193, P<0.001). Conclusions: DHEAS concentration (in addition to the known factors of ovarian reserve) does not predict clinical pregnancy in women with normal ovarian reserve who are undergoing ICSI. © 2015 Kunicki et al.

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