IVF Australia

Maroubra, Australia

IVF Australia

Maroubra, Australia

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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.


Sullivan E.A.,University of New South Wales | Wang Y.A.,University of New South Wales | Hayward I.,University of New South Wales | Chambers G.M.,University of New South Wales | And 3 more authors.
Human Reproduction | Year: 2012

STUDY QUESTIONDo births following single embryo transfers (SET) have a reduced risk of perinatal mortality compared with those following double embryo transfers (DET)?SUMMARY ANSWERSET is associated with reduced risk of perinatal mortality compared with DET. WHAT IS KNOWN ALREADYFetal, neonatal and perinatal mortality are important indicators for monitoring pregnancy and childbirth, particularly for births following assisted reproductive technology (ART) treatments. Following the introduction of SET, there has been a decline in the perinatal mortality rate (PMR) among babies born after ART in Australia and New Zealand. STUDY DESIGN, SIZE, DURATIONThis population study (census) included 50 258 births of <20 weeks gestation and/or <400 g of birthweight following embryos transfer cycles in Australia and New Zealand during the period 2004-2008. PARTICIPANTS/MATERIALS, SETTING, METHODSThe PMR was calculated according to the number of embryos transferred and other demographic and treatment-related factors. Perinatal deaths were defined as the number of fetal deaths (stillbirths) plus the number of neonatal deaths (deaths that occur before 28 days after birth). MAIN RESULTS AND THE ROLE OF CHANCEThe PMR was 16. 2 per 1000 births (n=813). Of the 813 perinatal deaths, 630 were fetal deaths and 183 neonatal deaths. Twins had a significantly higher PMR (27. 8 per 1000 births) than singletons (12. 4 per 1000 births). The risk of perinatal mortality for all births following DET was 53 higher than for all births following SET (adjusted risk ratio 1. 53, 95 confidence interval (95 CI): 1. 29-1. 80). Births following fresh DET had a 58 increased risk of perinatal mortality compared with births following fresh SET (risk ratio 1. 58, 95 CI: 1. 32-1. 90). LIMITATIONS, REASONS FOR CAUTIONInformation on outcomes was missing from <1 of clinical pregnancies recorded in Australian and New Zealand Assisted Reproduction Database for the study period. There are no data on the timing of fetal death, the cause of perinatal death or on late termination of pregnancy at <20 weeks' gestation. WIDER IMPLICATIONS OF THE FINDINGSDouble and higher order embryo transfer is associated with a higher risk of perinatal mortality when compared with SET. The number of embryos transferred is determined by the clinician with consent of the patient and is a modifiable treatment factor. SET should be advocated as the first-line management in ART as it is the single most effective public health intervention for preventing excess perinatal mortality among ART pregnancies. STUDY FUNDING/COMPETING INTEREST(S)Nil. © 2012 The Author.


News Article | October 26, 2016
Site: www.newscientist.com

An analysis of 300,000 births has suggested that older women who fall pregnant with help from assisted reproduction techniques are less likely to have children with birth defects than those who conceive on their own. Higher maternal age and assisted reproduction are both linked to congenital anomalies, including Down’s syndrome, heart defects and cleft palates, meaning that IVF babies conceived by older mothers are thought to be especially at risk. But a study led by Michael Davies at the University of Adelaide, Australia, challenges this assumption. Analysing births registered in the state of South Australia between 1986 and 2002, his team found that older women who conceived via IVF or intra-cytoplasmic sperm injection (ICSI) were less likely to have children with abnormalities. In addition, older women who had assisted pregnancies were less likely to have babies with birth defects than younger women who conceived using the same technologies. Women aged 29 or under who conceived naturally had children with major birth defects at a rate of 6 per cent, compared to 8 per cent in women aged 40 or over. But in women who had IVF, birth defects dropped from 9 per cent in the younger group to 4 per cent in the older group, while for those who had ICSI, the rate fell from 11 per cent to 6 per cent. One explanation for the results could be that the drugs used to stimulate ovulation during assisted reproduction have a protective effect on the development of an older women’s eggs, says Davies. While younger women receive these drugs during fertility treatments too, the effects may vary according to age, he suggests. An alternative theory is that IVF and ICSI embryos are still more likely to have birth defects, but that these are less likely to survive to full-term in older women. “The implications are really quite profound because the age of first birth is increasing for women around the world,” says Davies. “Instead of seeing more adverse events from the age of 35, it would be very interesting if we could extend that optimal reproductive period to the age of 40, for example.” But Peter Illingworth, at fertility company IVF Australia, says that although the results are intriguing, they will need to be validated in other populations because of their highly surprising nature. “I don’t think there’s enough evidence yet to start telling older women who are doing IVF that they’re going to lower their chance of congenital anomalies,” he says.


Lahoud R.,IVF Australia | Kwik M.,IVF Australia | Ryan J.,IVF Australia | Al-Jefout M.,Mu'tah University | And 2 more authors.
Archives of Gynecology and Obstetrics | Year: 2012

Objective To assess the impact of pre-hCG elevated progesterone on live birth outcomes during GnRH agonist long down regulated protocol assisted reproduction cycles. Design Retrospective cohort study. Setting Single Centre Private IVF Clinic. Patients A total of 582 consecutive cycles of IVF/ICSI in 2003. Interventions All patients underwent a long down-regulation protocol, controlled ovarian stimulation and IVF/ ICSI. Serum progesterone concentrations were measured just prior to HCG administration. 253 patients were followed to 2009 for outcomes of their frozen embryo cycles. Main Outcome measure Live birth rate in fresh and frozen cycles. Results Patients in the upper quartile pre-hCG progesterone concentration (≥5.4 pmol/L) had a higher final estradiol level, more oocytes collected and more usable embryos, when compared to those with lower quartiles. They also had lower live birth rates per cycle started (21.9% vs. 15%, P < 0.05). However, live birth rates from frozen embryo cycles were not significantly different between the groups. Conclusions Pre-hCG progesterone elevation leads to lower live birth rates in stimulated IVF cycles. Live birth rates achieved with frozen embryos in the high progesterone cycles suggest, that pre-hCG progesterone elevation negatively affects endometrial receptivity without adversely affecting embryo quality. © 2011 Springer-Verlag.


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.


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.


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.


Atkinson P.,Royal Hospital for Women | Koch J.,IVF Australia | Ledger W.L.,Royal Hospital for Women
Australian and New Zealand Journal of Obstetrics and Gynaecology | Year: 2014

Aims To analyse the data from all controlled ovarian hyperstimulation antagonist cycles that used an agonist trigger and a freeze-all strategy to quantify the risk of ovarian hyperstimulation syndrome (OHSS) and subsequent pregnancy rates. Materials and Methods A retrospective study of all women attending fertility clinics at IVF Australia, Sydney, undergoing controlled ovarian hyperstimulation (COH) using an antagonist protocol that had a subsequent gonadotropin-releasing hormone (GnRH) agonist trigger and freezing of all oocytes or embryos. The primary outcome measure was to determine the rate of OHSS. The secondary outcome measure was the clinical pregnancy rate. Results We collected data for 123 women. 25.2% were undergoing oocyte freezing and 74.8% underwent embryo freezing. There were no cases of OHSS, either early or late onset. The pregnancy rate was 31.7% after the first frozen cycle transfer with a cumulative pregnancy rate of 50% after two frozen embryo transfers. Conclusion Our results support the hypothesis that a GnRH agonist trigger and a freeze-all approach prevents OHSS with a good pregnancy rate. © 2014 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.


Cummins L.,IVF Australia | Koch J.,IVF Australia | Kilani S.,IVF Australia
Reproductive BioMedicine Online | Year: 2016

The significance of conjoined oocytes in the clinical IVF laboratory setting has been of question due to the extremely limited data available. The most reliable criterion for true binovularity is the inclusion of two oocytes within a common zona pellucida or their fusion in the zonal region. This is a relatively rare event and owing to the limited number of embryo transfers performed and information on their outcomes, it is highly probable that these oocytes would be discarded without attempts at fertilization and subsequent embryo culture. To our knowledge, this is the first reported pregnancy resulting from a conjoined oocyte. Our experience involved a blastocyst transfer of a genetically screened embryo, performed after removal of the germinal vesicle from the conjoined oocyte/embryo on day 3. A clinical pregnancy with a gestational sac and fetal heartbeat was achieved and a healthy baby girl was delivered via Caesarean section at 37 weeks' gestation. © 2015 Reproductive Healthcare Ltd.


Kwik M.,IVF Australia | Kwik M.,Royal North Shore Hospital | 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.

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