Rebecca K. Chung

Background/Objectives: Efficient sperm separation is critical for Assisted Reproductive Technology (ART). This study evaluates how assisted liquefaction (AL), a faster sperm preparation technique, affects motile sperm recovery and ART outcomes. Methods: A prospective pair analysis to address the efficiency of AL and retrospective cohort analysis of IUI and IVF/ICSI cycles were performed. Results: The average time to perform AL was 3 min, in comparison to the 15 to 30 min for traditional liquefaction (TL) until initiating sperm preparation. The total motility (p = 0.252) and progressive motility (p = 0.227) of the sperm samples were about 4% higher in the AL group although there was no significant difference. No significant differences were observed between AL and TL in fertilization (80.0% vs. 81.9%, p = 0.297), blastocyst rates (48.2% vs. 48.1%, p = 0.595), positive pregnancy (70.5% vs. 75.0%, p = 0.667), clinical pregnancy (65.9% vs. 68.4%, p = 0.841), or live birth (52.3% vs. 51.3%, p = 0.831) outcomes in IVF. The Positive pregnancy (p = 0.669) and clinical pregnancy (p = 0.841) of IUI were not significantly different between both groups. Conclusions: AL offers similar results to TL while reducing preparation time without interrupting ART outcomes. AL may have benefit to asthenozoospermia cases for ART due to reduced exposure time of sperm to semen that may prevent sperm quality impact.

Objectives: To investigate the impact of α-chymotrypsin treatment on sperm recovery rate and total motile sperm count (TMC) in highly viscous semen for intrauterine insemination (IUI) and in vitro fertilization (IVF), particularly in cases of severely low sperm count. Methods: High viscosity was defined by the inability to form a thread exceeding 2 cm from a semen drop after 30 min of incubation at 37 °C with repeated pipetting. Semen samples were treated with 5 mg of α-chymotrypsin for 5–10 min at 37 °C and washed using a 90% gradient solution. A total of 35 patients were included, with comparisons made to the same patients’ prior untreated samples using paired t-tests. Severely low sperm count was classified as TMC below 10 million. Results: Treatment with α-chymotrypsin significantly improved TMC (22.2 million vs. 11.6 million, p = 0.0004) and motile sperm recovery rate (38.9% vs. 16.2%, p = 0.00002). In cases of severely low sperm count, α-chymotrypsin treatment resulted in a marked increase in recovery rate (43.0% vs. 10.0%, p = 0.02) and TMC (5.89 million vs. 1.21 million, p = 0.004). Fertilization using treated samples achieved an 87.8% success rate, with a 56.4% usable blastocyst rate, comparable to standard IVF outcomes (n = 9, average age = 34.9 years). Conclusions: α-chymotrypsin treatment significantly enhances sperm recovery and TMC in highly viscous semen, demonstrating particular efficacy in patients with severely low sperm counts without affecting fertilization or blastocyst rate in IVF.

Objective: To improve informed medical decision-making, principles for family-centered neonatal care recommend that parents have access to their child’s medical record on an ongoing basis during neonatal intensive unit care (NICU) hospitalization. Currently, many NICUs do not allow independent parent access to their child’s electronic medical record (EMR) during hospitalization. We undertook a cross-sectional survey pilot study of medical professionals and parents to explore opinions regarding this practice. Study design: Inclusion criteria: 18-years old, English-literate, legal guardian of patients admitted to the NICU for 14 days. NICU medical professionals included physicians, nurse practitioners, nurses, and respiratory therapists. Result: Medical professionals believed parent access would make their work more difficult, increase time documenting and updating families, making them more liable to litigation and hesitant to chart sensitive information. However, parents felt that they lacked control over their child’s care and desired direct access to the EMR. Parents believed this would improve accuracy of their child’s medical chart, and increase advocacy and understanding of their child’s illness. Conclusion: NICU parents and medical professionals have differing perspectives on independent parental access to their child’s EMR. More research is needed to explore the potential of independent parental EMR access to further improve family-centered neonatal care.

Nearly one-third of serous ovarian cancer (OVCA) patients will not respond to initial treatment with surgery and chemotherapy and die within one year of diagnosis. If patients who are unlikely to respond to current standard therapy can be identified up front, enhanced tumor analyses and treatment regimens could potentially be offered. Using the Cancer Genome Atlas (TCGA) serous OVCA database, we previously identified a robust molecular signature of 422-genes associated with chemo-response. Our objective was to test whether this signature is an accurate and sensitive predictor of chemo-response in serous OVCA. We first constructed prediction models to predict chemo-response using our previously described 422-gene signature that was associated with response to treatment in serous OVCA. Performance of all prediction models were measured with area under the curves (AUCs, a measure of the model’s accuracy) and their respective confidence intervals (CIs). To optimize the prediction process, we determined which elements of the signature most contributed to chemo-response prediction. All prediction models were replicated and validated using six publicly available independent gene expression datasets. The 422-gene signature prediction models predicted chemo-response with AUCs of ~70 %. Optimization of prediction models identified the 34 most important genes in chemo-response prediction. These 34-gene models had improved performance, with AUCs approaching 80 %. Both 422-gene and 34-gene prediction models were replicated and validated in six independent datasets. These prediction models serve as the foundation for the future development and implementation of a diagnostic tool to predict response to chemotherapy for serous OVCA patients.

Objective: One-third of women with epithelial ovarian cancer are resistant to standard platinum-based chemotherapy, and insufficient data exist in predicting response to chemotherapy. We describe the clinical and pathological factors of patients with complete and incomplete response to treatment. Method: In this retrospective study, data was reviewed from 75 medical charts of 243 patients with primary epithelial ovarian cancers as a preliminary study. All patients underwent chemotherapy and cytoreductive surgery for primary disease. Fifty-six patients had complete response (CR) to chemotherapy and 19 had incomplete response (IR). Fifty-eight and 17 patients had optimal and suboptimal cytoreductive surgery, respectively. Clinical and pathological factors were compared in patients with complete and incomplete response to treatment, and optimal and suboptimal surgery. Overall survival (OS), cancer-specific survival (CSS), and time to recurrence (TTR) were estimated using the Kaplan-Meier method for patient groups. Results: The majority of patients in both the CR and IR groups were diagnosed at advanced stage ovarian cancer. The CR group had significantly lower preoperative CA125 and was more likely to have optimal chemotherapy. The CR group was also more likely to have lymph nodes removed during cytoreductive surgery. A significantly lower percentage of CR patients died from the disease and had statistically longer disease free survival. Patients who underwent suboptimal surgery had significantly shorter survival, but no difference existed in the time until recurrence between patients with optimal and suboptimal surgery. OS, CSS, and TTR were significantly increased in the CR group and in patients that had optimal surgery. Conclusion: Complete response during treatment and optimal surgery significantly increases OS, CSS, and TTR. Preoperative CA125 and lymph node removal during surgery may be predictive of complete treatment response.