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Assisted Reproductive Technology: Clinical Advances and Challenges
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Assisted Reproductive Technology: Clinical Advances and Challenges

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Obstetrics & Gynecology".

Deadline for manuscript submissions: 25 August 2024 | Viewed by 2214

Special Issue Editors

Dr. Luigi Carbone

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Guest Editor
Gynecology and Obstetrics Unit, Department of Neurosciences, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
Interests: ovarian reserve; antral follicle count; 3D-AFC; anti-Mullerian hormone; fertility preservation; fertility in multiple sclerosis; assisted reproductive technology; IVF pregnancy
Dr. Raffaella Di Girolamo

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Guest Editor
Gynecology and Obstetrics Unit, Department of Public Health, School of Medicine, University of Naples Federico II, Naples, Italy
Interests: antral follicle count; 3D-AFC; anti-Mullerian hormone; fertility preservation; endometriosis; assisted reproductive technology; reproductive endocrinology; IVF pregnancy; recurrent implantation failure; reproductive immunology

Special Issue Information

Dear Colleagues,

Nowadays, assisted reproductive technology (ART) treatments are becoming increasingly in demand, due to social reasons such as late motherhood and the improvements in the management of chronic degenerative and neoplastic disease allowing fertility preservation and family planning, among others. Therefore, many aspects of the process are continuously studied, refined and renewed to increase the chance of live birth. The aim of this Special Issue is to provide a wide overview of the recent advances in assisted reproduction, and to eventually explore the challenges of any step of the treatment, from the inclusion criteria (or diseases to consider) to allowing a couple to perform ART treatments or fertility preservation, the evaluation of the ovarian reserve (new methods such as 3D.antral follicle count), ovarian stimulation protocols (dual trigger, dual stimulation, gonadotrophin dose and type, pharmacogenomics), embryo transfer and endometrial preparation with the window of implantation and endometrial receptivity (endometrial metabolism, immunology and microbiome) and pregnancy outcomes after IVF. Hence, researchers in the field of reproductive medicine are encouraged to submit their findings as original articles or reviews to this Special Issue.

Dr. Luigi Carbone
Dr. Raffaella Di Girolamo
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • endometrial microbiome
  • endometrial receptivity
  • recurrent implantation failure
  • preimplantation genetic testing
  • artificial intelligence in ART
  • Poseidon classification
  • fertility preservation
  • immunology of reproduction
  • assisted reproductive technology
  • ovarian stimulation

Published Papers (3 papers)

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Research

12 pages, 1190 KiB  
Article
Re-Examination of PGT-A Detected Genetic Pathology in Compartments of Human Blastocysts: A Series of 23 Cases
by Andrei V. Tikhonov, Mikhail I. Krapivin, Olga V. Malysheva, Evgeniia M. Komarova, Arina V. Golubeva, Olga A. Efimova and Anna A. Pendina
J. Clin. Med. 2024, 13(11), 3289; https://doi.org/10.3390/jcm13113289 - 3 Jun 2024
Viewed by 355
Abstract
Background: In recent years, preimplantation genetic testing for aneuploidies (PGT-A) has become widespread in assisted reproduction. However, contrary to expectations, PGT-A does not significantly improve the clinical outcomes of assisted reproductive technologies. One of the underlying reasons is the discordance between the PGT-A [...] Read more.
Background: In recent years, preimplantation genetic testing for aneuploidies (PGT-A) has become widespread in assisted reproduction. However, contrary to expectations, PGT-A does not significantly improve the clinical outcomes of assisted reproductive technologies. One of the underlying reasons is the discordance between the PGT-A results and the true chromosomal constitution of the blastocyst. In this case series, we re-examined the PGT-A results in trophectoderm (TE) re-biopsies and in the two isolated blastocyst compartments—the TE and the inner cell mass (ICM). Methods: This study enrolled 23 human blastocysts from 17 couples who were referred for assisted reproduction. The blastocysts were unsuitable for uterine transfer due to the chromosomal imbalance revealed by PGT-A using array comparative genomic hybridization (aCGH) (n = 11) or next-generation sequencing (NGS) (n = 12). The re-examination of the PGT results involved two steps: (1) a TE re-biopsy with subsequent aCGH and (2) blastocyst separation into the TE and the ICM with a subsequent cell-by-cell analysis of each isolated compartment by fluorescence in situ hybridization (FISH) with the DNA probes to chromosomes 13, 16, 18, 21, and 22 as well as to the PGT-A detected imbalanced chromosomes. Results: In 8 out of 23 cases, the PGT-A results were concordant with both the re-biopsy and the isolated TE and ICM analyses. The latter included the diagnoses of full non-mosaic aneuploidies (five cases of trisomies and two cases of monosomies). In one case, the results of PGT-A, aCGH on the TE re-biopsy, and FISH on the isolated TE showed Xp tetrasomy, which contrasted with the FISH results on the isolated ICM, where this chromosomal pathology was not detected. This case was classified as a confined mosaicism. In 4 out of 23 cases, the results were partially discordant. The latter included one case of trisomy 12, which was detected as non-mosaic by PGT-A and the re-biopsy and as mosaic by FISH on the isolated TE and ICM. This case was classified as a true mosaicism with a false negative PGT-A result. In 11 out of 23 cases, the re-examination results were not concordant with the PGT-A results. In one of these discordant cases, non-mosaic tetraploidy was detected by FISH in the isolated TE and ICM, whereas the PGT-A and the TE re-biopsy failed to detect any abnormality, which advocated for their false negative result. In two cases, the re-examination did not confirm full aneuploidies. In eight cases, full or partial mosaic aneuploidies as well as chaotic mosacism were not confirmed in the isolated TE nor the isolated ICM. Thus, in 47.8% of cases, the PGT-A results did not reflect the true chromosomal constitution of a blastocyst. Conclusions: The PGT results may have different prognostic value in the characterization of the chromosomal constitution of a blastocyst. The detected non-mosaic aneuploidies have the highest prognostic value. In stark contrast, most PGT-identified mosaic aneuploidies fail to characterize the true chromosomal constitution of a blastocyst. Once detected, a differential diagnosis is needed. Full article
(This article belongs to the Special Issue Assisted Reproductive Technology: Clinical Advances and Challenges)
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13 pages, 270 KiB  
Article
Intrauterine Infusion and Hysteroscopic Injection of Autologous Platelet-Rich Plasma for Patients with a Persistent Thin Endometrium: A Prospective Case–Control Study
by Tzu-Ning Yu, Tsung-Hsien Lee, Maw-Sheng Lee, Yi-Chun Chen, Chung-I Chen, En-Hui Cheng, Pin-Yao Lin, Chun-Chia Huang and Chun-I Lee
J. Clin. Med. 2024, 13(10), 2838; https://doi.org/10.3390/jcm13102838 - 11 May 2024
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Abstract
Objectives: To evaluate the effect of intrauterine infusion and hysteroscopic injection of autologous platelet-rich plasma (PRP) in patients with a persistent thin endometrium (EM) undergoing euploid frozen embryo transfer (EFET) cycles. Methods: This prospective case–control study enrolled 116 infertile women with [...] Read more.
Objectives: To evaluate the effect of intrauterine infusion and hysteroscopic injection of autologous platelet-rich plasma (PRP) in patients with a persistent thin endometrium (EM) undergoing euploid frozen embryo transfer (EFET) cycles. Methods: This prospective case–control study enrolled 116 infertile women with thin EM (<7 mm) who underwent hormone replacement therapy (HRT) for EFET. These women had experienced at least one previous unsuccessful EFET cycle, which either resulted in the cancellation of the cycle or failure of pregnancy. A total of 55 women received an intrauterine infusion of PRP before FET, 38 received a hysteroscopic injection of PRP, and 23 received standard HRT treatment without PRP (control group). Only euploid embryos were transferred in these cycles. The primary outcomes were the implantation rate (IR) and clinical pregnancy rate (CPR) after EFET. Results: After receiving intrauterine infusion and hysteroscopic injection of PRP, 78.2% and 55.3% of patients, respectively, showed an EM thickness exceeding 7 mm, followed by embryo transfer. The hysteroscopic injection group demonstrated significantly higher IR (52%), a higher trend of CPR (52%), and a higher live birth rate (38%) than the control group (18%, 22%, and 4%). Conclusions: Intrauterine infusion and hysteroscopic injection of autologous PRP may be effective methods to increase EM thickness in HRT cycles. According to our results, both methods could increase EM thickness, while hysteroscopic injection appeared to provide more significant assistance in increasing IR, CPR, and live birth rate after EFET in patients with persistent thin EM. Full article
(This article belongs to the Special Issue Assisted Reproductive Technology: Clinical Advances and Challenges)
15 pages, 672 KiB  
Article
Embryo Transfer Procedural Parameters Do Not Predict IVF Cycle Outcome
by Konstantinos Sfakianoudis, Evangelos Maziotis, Anna Trypidi, Sokratis Grigoriadis, Terpsithea Vaxevanoglou, Irene Angeli, Anna Rapani, Amalia Kotsifaki, Kalliopi Pistola, Agni Pantou, Konstantinos Dafopoulos, Konstantinos Pantos and Mara Simopoulou
J. Clin. Med. 2024, 13(5), 1312; https://doi.org/10.3390/jcm13051312 - 26 Feb 2024
Viewed by 811
Abstract
Background: this study aims to assess the effect of embryo transfer (ET) performance parameters of a technical nature on IVF outcome. Methods: A total of 1417 ETs from a single IVF center were included in this prospective observational study. The parameters investigated were [...] Read more.
Background: this study aims to assess the effect of embryo transfer (ET) performance parameters of a technical nature on IVF outcome. Methods: A total of 1417 ETs from a single IVF center were included in this prospective observational study. The parameters investigated were as follows: the presence of cervical mucus post catheter withdrawal, the presence of blood, catheter reload, the employment of a tenaculum and stylet, catheter resistance as experienced by the physician and patient discomfort. Results: When ET performance parameters were associated with clinical outcomes on a singular level, none of the ET parameters presented with any statistical significance. The evaluation of covariates indicated that the number and the quality of transferred embryos, as well as maternal age, exerted a statistically significant effect on clinical outcomes. In a multivariate analysis, only the presence of mucus along with significant catheter resistance presented with statistical significance; however, when adjusting for covariates, this combination showed no statistically significant effect on clinical outcomes. Conclusions: the results indicate that the time-consuming process of recording and analyzing ET performance parameters fails to offer any additional value in predicting the cycle’s outcome, while factors like embryo quality and number, as well as maternal age, seem to be the sole robust predictive factors of an IVF cycle. Full article
(This article belongs to the Special Issue Assisted Reproductive Technology: Clinical Advances and Challenges)
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