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Maroubra, Australia

Kilani S.,IVF Australia | Chapman M.G.,University of New South Wales
Expert Review of Obstetrics and Gynecology | Year: 2011

LC-PolScope™ technology, formally sold as Spindle View, is a microscopic imaging system that utilizes polarized light. It was initially designed for noninvasive imaging of structures within living cells, for example, the meiotic spindle, zona pellucida and sperm acrosome. The system has been developed as an adjustment to the standard light microscope with the addition of two polarizers and image analysis computer software. The unique feature of this device is the ability to capture live images of these biological structures, thus enabling quantitative analysis. As a noninvasive tool, this system has been used in IVF laboratories during intracytoplasmic sperm injection to avoid damaging the meiotic spindle while injecting individual spermatozoa into the oocyte. The latest version of this device (Oosight™) allows instant image analysis for quicker and easier use in IVF laboratories. This version also has better resolution, which allows a more detailed assessment of intracellular structures and may assist scientists in the selection of oocytes with the greatest potential to produce a pregnancy. Recent published data show higher pregnancy rates in embryos derived from oocytes where a normally shaped meiotic spindle was identified. © 2011 Expert Reviews Ltd. Source

Kwik M.,IVF Australia | Maxwell E.,Royal North Shore Hospital
Current Opinion in Obstetrics and Gynecology | Year: 2016

Purpose of review Severe ovarian hyperstimulation syndrome (OHSS) is an iatrogenic condition that affects 1% of women that undergo treatment with assisted reproductive technology. The review aims to summarize recent evidence on pathophysiology, treatment, and prevention of OHSS. Recent findings The pathophysiology is still not completely understood; however, vascular endothelial growth factor is likely to be an important mediator. Human chorionic gonadotropin was previously thought to be necessary for OHSS to occur; however, recent case reports have proven otherwise. The contribution of an attenuated anti-Mullerian hormone signalling pathway and CD11c + HLA-DR + dendritic cells and associated interleukins has been explored recently as contributors to pathogenesis. Treatment is largely supportive and is based mainly on consensus statements rather than evidence. Therefore, it is important to prevent this condition by identifying women at risk, allowing the clinician to implement preventive strategies, including the use of GnRH antagonist cycles with agonist triggers. Summary More research is required to elucidate the pathophysiology behind the condition. Clinicians should employ strategies to prevent OHSS. © 2016 Wolters Kluwer Health, Inc. All rights reserved. Source

Koch J.,IVF Australia | Rowan K.,Genea | Rombauts L.,Monash University | Yazdani A.,University of Queensland | And 2 more authors.
Australian and New Zealand Journal of Obstetrics and Gynaecology | Year: 2012

Endometriosis is common in women with infertility but its management is controversial and varied. This article summarises the consensus developed by a group of Australasian subspecialists in reproductive endocrinology and infertility (the Australasian CREI Consensus Expert Panel on Trial evidence group) on the evidence concerning the management of endometriosis in infertility. Endometriosis impairs fertility by causing a local inflammatory state, inducing progesterone resistance, impairing oocyte release and reducing sperm and embryo transport. Medical treatments have a limited role, whereas surgical and assisted reproductive treatments improve pregnancy rates. The role of surgery for deep infiltrative endometriosis and repeat surgery requires further evaluation and there is insufficient evidence for the use of anti-adhesives to improve fertility. Intrauterine insemination (IUI) and in vitro fertilisation (IVF) improve pregnancy rates but women with endometriosis have lower pregnancy rates than those with other causes of infertility. The decision about whether to operate or pursue assisted reproduction will depend on a variety of factors such as the patient's symptoms, the presence of complex masses on ultrasound, ovarian reserve and ovarian access for IVF, risk of surgery and cost. Some women with infertility and endometriosis may benefit from a combination of assisted reproduction and surgery. © 2012 The Authors ANZJOG © 2012 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Source

Russell P.,GynaePath | Russell P.,University of Sydney | Sacks G.,IVF Australia | Tremellen K.,Repromed | Gee A.,Genea
Pathology | Year: 2013

Aim: Abnormally functioning immunocompetent cells in the endometrium are thought to be responsible for at least some cases of recurrent reproductive failure [recurrent miscarriage or recurrent in vitro fertilisation (IVF) failure], but their detailed investigation has been hampered by a lack of a standardised protocol of counting such cells in study or control patients. The purpose of this study is to use a standardised protocol for the assessment of immune cells in the endometrial biopsies of a large cohort ofwomen with recurrent reproductive failure and establish relevant reference ranges. Method: In a recent study, we reported the presence and distribution of selected immune cells and macrophages in the endometria from 222 women who had a routine endometrial biopsy for investigation of recurrent miscarriage or IVF failure. Since the completion of that study, a further 1767 cases have been examined, using the same assessment parameters of the earlier study. Results: This updated analysis of 1989 endometrial biopsies provides reference ranges for CD8 +, CD163+, CD56+ and CD57+ cells for individual 'days' of a normalised menstrual cycle. CD8+ T-cells displayed a modest (50%) increase in numbers in the luteal phase and periglandular aggregation was a useful indicator of a subtle focal endometritis, possibly of infective origin, and generally not identified in H&E sections. A rapid accumulation of CD163+ macrophages occurs in the superficial stroma after day 22 of the cycle, while a significant number of cases displayed single or clustered macrophages within glandular lumens of the superficial endometrium in luteal phase, especially after day 20 of the cycle. The significance of this change is unclear but may relate to a macrophage response to abnormal glandular secretion or to bleeding occurring at the time of ovulation. CD56+ uterine natural killer (uNK) cells show such a dramatic rise in both absolute numbers and percentage of stromal cells from day 22 of the standardised 28 day cycle that this needs to be taken into account in all clinical studies or individual assessments of endometrial biopsies. CD57+ NK cells are seen in small numbers in most cases and cell counts of greater than 10 per mm2 are regarded as abnormal. Conclusions: This large database provides a daily range which is the most accurate survey yet of uNK cell numbers. Co-location of CD8+ T-cells and CD56+ uNK cells in perviascular aggregates has been demonstrated. © 2013 Royal College of Pathologists of Australasia. Source

Fleming T.,St George Hospital | Sacks G.,IVF Australia | Nasser J.,Go Health Group
Australian and New Zealand Journal of Obstetrics and Gynaecology | Year: 2012

Two cases of women who developed internal jugular vein (IJV) thrombosis associated with ovarian hyperstimulation syndrome (OHSS) are reported in this article. There are 27 cases of IJV thrombosis associated with in vitro fertilisation (IVF) reported in the literature, and in 78% of cases, this outcome was following OHSS. The hypercoagulable state of OHSS increases the risk of venous thromboembolism, and the IJV appears to have a preponderance in uncommon-site thrombosis. © 2012 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Source

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