Lab 1 Assessment
Article 1 PMID 6241855 
The aim of this study was to look at in vitro Maturation (IVM) in women with Polycycsitc Ovarian Syndrome (PCOS) undergoing in vitro fertilization (IVF) compared to women who do not have PCOS. To do this the authors of the article wanted too analyse past studies regarding IVM and PCOS so created an algorithm to aid in their search, with the end of the search date being October 15th 2013. Studies deemed eligible for use in this research compared the rates of various outcomes such as live births and cycle cancellations between people with PCOS, PCO and control women undergoing IVM. Animal studies, case reports and trials on ovum recipients were excluded. An excel spreadsheet was created by 3 of the authors to record and sort their data.
The extent of publication bias was not assessed as it was deemed not necessary due to the small study pool per outcome. To evaluate the quality of the data used in this study, the authors used the nine-item Newcastle Ottawa Quality scale. The main outcome measured was live births per women and per cycle. Other measures included clinical pregnancy per woman, miscarriage rate and fertilization rate. Based on the frequencies of the outcomes between the 3 groups, 95% confidence intervals (CI's) were calculated. Two additional analyses were conducted with regards to clinical pregnancy and live births, namely one based on women and the other on cycles. Statistical analysis was done using STATA Software/SE 13.
268 PCOS, 100 PCO and 440 control patients were included in the analysis. The authors found that live birth rates did not differ between PCOS and non-PCOS women was seen in the cycle-based analysis but in the women-based analysis, a slightly higher birth rate was seen for PCOS women. According to both the woman and cycle based approaches, higher rates of clinical pregnancy were seen for PCOS women compared to non-PCOS women. The same trend was seen for implantation rates in women with PCOS compared to women without PCOS. Cancellation rates were lower in women with PCOS in both subgroups however maturation and miscarriage rates did not differ between the 3 groups assessed. Fertilization rates were minimally lower between women with PCOS compared to non-PCOS women.
A higher rate of clinical pregnancy rates were seen in women with PCOS who have undergone stimulation with FSH and hCG priming during both women and cycle based analysis. No pattern between the 3 groups was seen when there was a lack of priming with hCG. When rating the quality of the studies,the scores ranged between 5 and 9, with older studies receiving a lower score compared to newer studies. To conclude, it was found that IVM appears to be a good approach when it comes to treating women with PCOS during IVF as opposed to women without PCOS. It is an efficient treatment option in terms of implantation, clinical pregnancy and cycle cancellation rates.
Article 2 PMID 26238449 
The aim of this article was to evaluate the effects of progesterone elevation as a result of human chorionic gonadotropin (hCG) administration on the outcome of IVF with transferred embryos at various stages of development. The study looked at an excess of 10,000 women undergoing day 3 cleavage-stage embryo transfer and an additional 1146 women undergoing day 5 blastocyst-stage embryo transfer. Both groups of women underwent controlled ovarian stimulation using gonadotropin and GnRH agonist. Certain exclusion criteria were set for participants in the study, including the exclusion of couples in which either member had chromosomal abnormalities. Various patient characteristics were evaluated, such as BMI, cause of infertility and basal FSH levels. Ovarian stimulation was controlled by patients doctor on a case by case basis, assigning them either standard long GnRH agonist or modified prolonged GnRH agonist protocol. Serum levels of FSH and LH were suppressed using triptorelin acetate. Doses were adjusted after 4 days depending on how the ovary had responded and when more than 3 follicles had reached 17mm, GnRH was injected into the patient and after ~36 hours, oocytes were retrieved. The cleavage-stage embryos were graded against a criteria for quality and women with 3 or more quality embryos were selected to go onto blastocyst stage development. A grading criteria was also used for the blastocyst-stage embryos.
2-4 days prior to IVF, basal FSH levels were measured. Throughout the ovarian stimulation, the levels of hormones such as LH and progesterone were assessed while fasting. A clinical pregnancy (CP) was considered to be present is if, upon ultrasound, cardiac pulsations were heard and a intrauterine gestational sac is present, 35-45 days post embryo transfer. Patients in both groups were divided into subgroups based on their serum progesterone levels due to the fact that the relationship between pregnancy rate and serum progesterone levels was thought to be non-linear. Various statistical analyses were then carried out to establish results for the aims. These included Mantel-Haenszel test for trend analysis and 95% confidence intervals.
The results were logged based on a variety of criteria including patients characteristics. They found the average basal FSH levels of patients to be 7.16 with the majority of patients being in their first IVF cycles. Advanced age and PCOS were two of several causes of infertility found. In the 3 day ET group, an inverse relationship between serum progesterone levels (SPL) and CP's was seen, however, a decrease in CP's was seen when the SPL reached >1.0ng/ml, indicating a detrimental affect on the likelihood of pregnancy when the progesterone reaches a certain threshold and exponentially worsens with increasing levels of progesterone. A similar pattern was seen in the 5 day ET group which showed an inverse relationship between SPL and CP's until SPL's reached >1.75ng/ml
Various factors were shown to be significantly associated with CP's through a multivariate logistic regression analysis. For example, in the 3 day ET group, a negative relationship was seen between CP's and serum progesterone levels where as a positive one was seen between CP's and the transfer of top-quality embryos. A similar trend was seen for the 5 day ET, however, female age was negatively associated with CP. The conclusion of this study showed that administration of progesterone on the day oh hCG administration decreased the rate of clinical pregnancies in both cleavage and blastocyst embryo stages whilst the woman underwent controlled ovarian stimulation.
Lab 2 Assessment
|Uploading Images in 5 Easy Steps|
|First Read the help page Images and Copyright Tutorial.
Students cannot delete images once uploaded. You will need to email me with the full image name and request deletion, that I am happy to do with no penalty if done before I assess.
Embryo development from pro-nuclei stage to blastocyst stage
Lab 3 Assessment
Topic: Ovarian Hyper-stimulation Syndrome
Subtopic: Symptoms and Diagnosis
PMID 22416285 
Initially women with OHSS will present with abdominal bloating, as a result of fluid in the peritoneal cavity and an increase in ovary size. Whilst symptoms can occur as soon as 24 hours post hCG administration, they are usually seen in women 7-10 days post administration. When women present with severe OHSS they are often dehydrated, due to increased vascular permeability, and have hemoconcentration. The above results in a decrease in intravascular volume, leading to oligouria.
A key diagnostic tool for clinicians regarding women who are taking gonadotropins is to identify if they are at an increased risk of developing OHSS. Some risk factors include woman aged less than 30, women who have polycystic ovaries, woman with a previous history of OHSS and women who have greater than 20 oocytes retrieved. After a history of the patient is taken, the next step is to perform a physical exam on the woman. Women who present with abdominal bloating will produce a shifting dullness upon abdominal percussion. If the clinician further suspects a women of having OHSS, a ultrasound can be done.The intraperitoneal fluid is best images via vaginal ultrasound due to the enlarged ovaries making it difficult to image the pelvis using transabdominal ultrasound.
Once a women has been diagnosed as having OHSS, they are classified based on a criteria from mild, moderate and severe
PMID 24996451 
This article is good because it goes into OHSS well in the background and it speaks about predictive factors for OHSS and how they affect recovery. This article ties in well with treatment and recovery and touches on the protocol used for Ovarian Hyper-Stimulation.
PMID 23378404 
This article is good because it speaks generlly and specifically about OHSS and ties in well with the complications of the syndrome e.g. thromboembolism, which can also be used as a diagnostic factor depending on when the women present to a health care professional.
--Mark Hill (talk) 19:21, 27 August 2015 (AEST) These are relevant to Ovarian Hyper-stimulation Syndrome. Would have been good to have a one line description of the papers here and on project page. (5/5)
Lab 4 Assessment
--Mark Hill (talk) 9:45, 6 November 2015 (AEST) These are good quiz questions. I am not a fan of negative selectors (question 2) but this is reasonable. Your explanations in the answer are useful learning tools. (8/10)
Lab 5 Assessment
What is the difference between gastroschisis and omphalocele?
Omphalocele and gastroschisis are both congenital deformations in which the abdominal viscera herniates extra-peritoneal to the abdominal wall. In Omphalocele, the herniating abdominal viscera are covered by a transparent membrane, which upon contact with air becomes opaque. This membrane consists of three layers; from the inside to the outside, they are peritoneum, Wharton's Jelly and amniotic membrane. The omphalocele can contain the large and small intestines, stomach, liver and even spleen. Essentially the abdominal viscera protrude from the abdomen within the layers of the umbilical cord. In Gastroschisis, the abdominal viscera do not protrude from the stomach in conjunction with the umbilical cord, rather it is located paraumbilically to the right with the umbilical cord normally inserted into the abdomen. The intestines are exposed to and floating in the amniotic fluid which has an irritant effect to them. The intestine walls are a dark red and thickened as a result of irritation and ischemia. There is a noted shortening of the bowel and nutrition absorption imbalances. PMID 24524464 
Various risk factors are associated with both Omphalocele and gastroschisis. Research has shown that younger mothers, less than 25 years of age, have a higher risk of having babies with gastroschisis whilst older mothers, greater than 35 years of age, have an increased risk of having a baby with omphalocele. The evidence is inconclusive to suggest that the reason younger mothers have a higher frequency of babies with gastroschisis, is due to smoking and the use of recreational drugs. Typically in babies with Omphalocele, they have an increased rate of cardiac and chromosomal defects and has a poorer survival rate than babies with gastroschisis. With regard to race, Indians have the lowest incidence of omphalocele. PMID 18204766  PMID 19942960 
An elevated level of maternal serum α-fetoprotein (MSAFP) is seen in mothers carrying a child with an abdominal wall defect. Which regards to omphalocele, the median value for MSAFP is 4.18 times the median whilst for gastroschisis it is 9.42 times the median. The prognosis for a baby with omphalocele comes down to its associated chromosomal abnormalities and cardiac defects. It has a mortality rate of 80%. The prognosis for gastroschisis is based on the condition of the herniated bowel. The mortality rate is 8%. PMID 14557321 
Lab 7 Assessment
1. Identify and write a brief description of the findings of a recent research paper on development of one of the endocrine organs covered in today's practical.
A study conducted in 2013 by Xie et. al. sought to research further into the role of chromatin remodelling with regards to pancreatic differentiation of human embryonic stem cells. To do this, they harvested embryonic stem cells at specific stages of pancreatic endocrine development and profiled their transcriptomes and chromatin modifications. They used various experimental procedures such as hESC cultures and ChIP-seq sample preparation and analysis to name a few. They noted that the methylation of histone H3 at lysine 4 and 27 (H3K4me3 and H3K27me3) plays a role in the co-ordination of gene expression. H3K27me3 appears in genes transcriptionally repressed by the PcG protein and this mechanism plays a role in the regulation of undifferentiated embryonic stem cells. They found that one of the key mechanisms with regards to the regulation of development was Polycomb group (PcG)-mediated repression. They also found that when transistory genes are silenced during lineage progression, it was associated with the re-instatement of PcG repression. It is these mechanisms that play a key role in the early development of the pancreas. Xie et. al. conclude their paper by suggesting further experiments that may be done to further their research regarding transcription factors and the differentiation of pancreatic beta-cells.
PMID 23318056 
2. Identify the embryonic layers and tissues that contribute to the developing teeth.
Tooth development is a complex specialization that can be divided into 4 key stages: bud (week 8), cap (week 11), bell (Week 14) and terminal differentiation. These stages are controlled by a common protein called sonic hedgehog. Both mesoderm, ectoderm (from the 1st Pharyngeal arch) and neural crest (ectomesenchyme) cells contribute to their formation.
Odontoblasts- Odontoblasts (derived from cells in the dental papilla) form predentin which goes on to calcify and form dentin. These cells are neural crest derived mesenchymal cells that, due to the enamel epithelium's influence, differentiate to form odontoblasts.
Ameloblasts- Ameloblast cells (derived from the enamel organ) produce the enamel of the teeth, the outer covering of the crown of the tooth.
Peridontal ligament- This ligament holds the tooth in the bone socket. The PDL is a specialised connective tissue that also acts as a shock absorber and relays sensory information such as heat and cold. "Sharpeys fibres" are collagen fibre bundles within the ligament.
Cementoblasts (form the cementum of the tooth), osteoblasts (priduce the bone around the base of the tooth) and fibroblasts (assist in the formation of the PDL) all arise from the dental sac/follicle.
(Tooth Development UNSW embryology)
It would be nice if the history section could start earlier in time e.g. who came up with the idea of 3 person embryos. It kind of feels as though 3 person embryos popped out of nowhere. This is just a small nuance but the first sentence in “Hereditary mitochondrial Disease” doesn't really make sense. It sounds incomplete. I think you have too many timelines going on in your page and it makes it a bit confusing. There is one under “History” and another timeline in “technical progression”. I understand they may be timelines for different things, but it’s all too much history. Maybe the “technical progression” timeline could be simplified into a paragraph?
Some sections have too many subsections e.g. “technical progression”, and this makes the section messy and hard to read. It is however good for the table of contents though as it makes it easier to specify what you want to read on the page so my suggestion would be to keep some subheading but cut down a bit. You guys are listing papers to read too often. People want to have the information summarized for them on a wiki page, not have to outsource all the information themselves. It’s too time consuming and if they wanted to read a bunch of articles, they would go on PubMed themselves. However, I do like that some articles have been listed but maybe cut it down to one or two great ones instead of 4-5 etc.
I really like the table under the subheading “prohibited”, however, it would be nice to have a little summary next to the links about what each countries stance is, because again it’s too time consuming to have to read all those links. I also think some sections need a lot more work e.g. “ethics” and “benefits” and some more words could be added to the glossary. For example, a definition of what the word gamete mean would be good as, whilst we may know what it means, other people who view your page may not.
I really likes the images you used in “technical” progression. They were easy to understand and simplified the text a lot. It would be good however to add a few more images, perhaps to “history”. Some hand-drawn ones would be good. You've got a good amount of references in there, just maybe add a few more. This indicates that you have done significant research and they appear to be correctly cited. The key points of your topic are clearly described and I feel as though your intro., whilst short, really opens up the topic well. Your page relates well to the learning aims of embryology.
To conclude, I think you've got a great framework and some really good information in there. Just makes sure your page doesn't look too busy and is easy to read. A little bit more work needs to be done in some of the sections and a bit more technical touch ups and you should be good!
I'm a little confused as to what your actual topic is? Is it female infertility or polycystic ovarian syndrome? I think it is important to clarify that so as the reader of your page continues reading, they know the exact topic they are reading about. I also think that where you have written “definition” under the big picture of the PCOS ovaries, it should say “epidemiology” as that is more what it sounds like. I also think the picture should be below the information, that way we know a bit better what we’re looking at.
I love the little purple box of information under the “Definition” as it stands out and is pleasing to the eye. The purple boxes throughout the page are really great! The image next to it is also really good as it is clear and relates back to the information beside it. Great use of images! They are all relevant and placed well and the hand drawn image is done well. Your “pathogenesis” section is great as are your sections “diagnosis” and “prevention and treatment”. Detailed and easy to read. It was great to see scientific and animal models throughout the page. Perhaps it would be good to include a little more information linking directly to the literature for more advanced readers. I would also suggest adding a glossary to the bottom of your page, as for people with little to no scientific background who may read this, they may not understand all the words and terms.
It appears under the subheading “environmental factors” that there is no referencing? However, aside from that you have an extensive references list and have referenced correctly and thoroughly throughout the page. I would also suggest adding a bit more information under the heading “causes” aside for the subheading “genetics” as the other sections look a bit bare. The layout is great, easy to read and follow however one suggestion may be to get rid of the underline below your subheadings. It just may make things look a little less clustered and final.
You seem to have covered all the key points pertaining to your topic, however, a section on complications of either PCOS or female infertility may be good to add. Your content and headings are good and references are cited properly. I would suggest perhaps relating it back a bit more to the basics of embryology and discuss what a pregnancy would be a life is a woman with PCOS did get pregnant. Overall, this is a really great page with a good layout that flows well. Keep up the good work!
To start, I think some of your subheadings are a bit unnecessary, for example, you could get away without having the subheading “background information” and just having the sub-subheadings as subheadings below your intro. Whilst some subheadings are good as it helps break down the info in the table of contents, it makes the actual page difficult to read and follow.
Great use of images on the page. There are many, without it cluttering the page and they are simple and relevant. However, the pictures you have used under “background information” appear to be a bit lifeless and complex. Perhaps using more simplified images with some colours would help liven up the section as well as allow people who use this page, with less scientific knowledge than you, to understand what they are seeing. They are important images as they set the basis for the rest of the page. It would also be good to see a hand-drawn image on the page.
Your use of tables is also great, it really helps to break down the information. I would suggest however, you include a little more information and references under the section “male infertility disorders”. It is a big vague and there are no citations. Your list of references is incredible and you should be commended on that. It shows a great deal of research has gone into this page. Your citations appear to be correctly done throughout the page. Your “Causes of fertility” section is done really well and is very thorough. The video accompanying it is good to as it is easy to understand and explanatory. Your “risk factors and prevention” heading could use more work. I would suggest actually splitting them up into two separate headings and really delving more into prevention and how to handle infertility.
Your “treatment” section is really well done and thorough. I would suggest however, to make it easier to read, that you simplify some of your paragraphs into bullet points. A glossary section may also be useful for people reading this page with a lesser degree of embryology knowledge than you or I. I will say, this page has covered its chosen topic well and has attacked it from an embryologically focused angle. Lastly I would suggest including a section on animal models and the literature for the more advanced student.
Let me start off by commending this group on a fantastic page! It is incredibly thorough, detailed and long. You can immediately see that a lot of work and research has gone into it. You have a great list of references and they appear to be cited correctly throughout the page. However, some sections which appear to be incomplete and lack some citations e.g. “fertility preservation”.
One suggestion I will make, is it would be good to see the addition of some hand-drawn images, perhaps one under either of the first 3 headings. Some more images could be used under the heading “surgery”. The videos used on this page are great. Really informative, relevant and easy to watch. I also think the “what are cancer cells” section should be higher up on the page as it is part of the basis of what the whole page is about. It also cuts between the two sections “chemotherapy” and “how does chemotherapy work?” which should be one after another. On the topic of formatting, you have a heading in there called “oncofertility timeline”, I think it would be better placed at the beginning of the page where it is more relevant.
I also think there is just too much text in some areas e.g. “Fertility preservation in women” and “surgery”. It makes that part of the page look clustered and difficult to read. Perhaps simplifying it more into bullet points, as you have done in other areas of the page, would be good. Conversely though, I think areas such as “targeted drugs” and “bone marrow or stem cells transplant” could use more work, however, it is possible you still intend to work on those areas anyway.
I would suggest adding a glossary to the bottom of your page to assist in those who view your page with a lower level of scientific knowledge. You have covered an expansive range of topics pertaining to your topic, all of which are relevant and link well with each other. The page has a great focus on the learning aims of embryology. I think with some formatting corrections and some simplification of the text, this will be a really wonderful page.
I’ll start by saying, you have an extremely extensive list of references. Well done! It shows you have really done your research and made good use of it. Your citations are consistent throughout the page and most paragraphs have multiple sources. I would suggest to perhaps include a hand-drawn image somewhere on the page as well as a video. Aside from the section “biopsy methods”, the page could use a few more illustrations. From what I can see, the image under the subheadings “FISH” and “future/current research”, does not appear to have been added correctly according to the guidelines Mark gave us a few weeks back. There is no caption for the image like there are for the other images.
I really like, how under the “diagnosis” heading, you have made the table of applicable diseases for PGD an expandable table. It helps keep the page clean and easier to control. Perhaps though add a little blurb below the table describing it. You have a great set of heading and subheadings that all relate back to your topic. Given that, you have addressed all important areas pertaining to your topic. May I suggest, that in the introduction section, which I am assuming is yet to be done, you add some epidemiological information and perhaps a video speaking briefly on the topic as it can be quite complex.
Well done on the section titled “future/current research”. It is really useful for students seeking a higher degree of information on this topic as it goes into great detail. However, some direct references in the text to some papers would be good. I also suggest adding a glossary of words to the bottom of the page to cater to those who read the page, with a lower level of embryology knowledge than you or I. In addition to that, it may be good to try and break-down some of your paragraphs as there is a lot of text and it can be hard to take in for some people. Bullet points and tables are great. The page does however, focus well on embryological learning aims.
Lastly, to conclude, I feel a though the table and image under “biopsy method” is a little cluttered and could be spaced out a bit more. Overall, this is a really good and detailed framework and with a little more work will be a great project.
Lab 10 Assessment
Lens of the Eye
Link to permalink image: Anterior portion of the Lens of the embryonic eye
The lens of the eye is derived from surface ectoderm. Said ectoderm forms a lens/optic placode in the head region which then invaginates to form a lens pit and then later a lens vessel. Lens fibres then develop and are surrounded by a lens capsule. The main function of the lens is to focus light onto the retina.
Embryology link Vision - Lens Development --Development Overview
PMID 26244658 
- <pubmed>25510244</pubmed>| ReproductiveTechnologyandEndocrinology
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