Itai Gat - Academia.edu (original) (raw)
Papers by Itai Gat
Journal of Maternal-fetal & Neonatal Medicine, Feb 15, 2017
Fertility and Sterility, Sep 1, 2012
Human Reproduction, Nov 13, 2020
What are the perceptions of infertility patients and the factors correlating with their psycholog... more What are the perceptions of infertility patients and the factors correlating with their psychological distress, following suspension of fertility treatments during the Corona Virus Disease-19 (COVID-19) pandemic? SUMMARY ANSWER: Most patients preferred to resume treatment given the chance regardless of background characteristics; higher self-mastery and greater perceived social support were associated with lower distress, while feeling helpless was associated with higher distress. WHAT IS KNOWN ALREADY: Infertility diagnosis and treatment frequently result in significant psychological distress. Recently published data have shown that clinic closure during the COVID-19 pandemic was associated with a sharp increase in the prevalence of anxiety and depression among infertile patients undergoing IVF and was perceived as an uncontrollable and stressful event. Personal resources play an important protective role in times of crisis, helping reduce levels of distress. STUDY DESIGN, SIZE, DURATION: This cross-sectional questionnaire study included patients whose fertility treatment was suspended following the COVID-19 pandemic, in a tertiary hospital. The survey was delivered to 297 patients within 12 days at the beginning of April 2020. PARTICIPANTS/MATERIALS, SETTING, METHODS: The self-administered questionnaire included items addressing: (i) patients' demographic characteristics, (ii) anxiety related to COVID-19 infection risk and level of social support, (iii) patients' perceptions of the new guidelines and description of subsequently related emotions and (iv) two validated scales assessing levels of emotional distress and self-mastery. Multivariate analysis was conducted to assess factors alleviating or increasing emotional distress during the COVID-19 pandemic. MAIN RESULTS AND THE ROLE OF CHANCE: There were 168 patients who completed the survey, giving a response rate of 57%. Study variables in the regression model explained 38.9% of the variance in psychological distress experienced by patients during treatment suspension. None of the background characteristics (e.g. age, marital status, parity, economic level or duration of treatments) had a significant contribution. Feeling helpless following the suspension of treatments was associated with higher distress (P < 0.01). Higher selfmastery and greater perceived social support were associated with lower distress (P < 0.01). Despite the ministry of health's decision, 72% of patients wished to resume treatment at the time of survey. LIMITATIONS, REASONS FOR CAUTION: This was a cross-sectional study, thus information about patients' characteristics prior to the COVID-19 pandemic was not available. The length and implications of this pandemic are unknown. Therefore, the ability to draw conclusions about the psychological consequences of the crisis is limited at this point of time. WIDER IMPLICATIONS OF THE FINDINGS: Personal resources play an important protective role in times of crisis, helping to reduce levels of distress. Study findings suggest that attention should be paid to strengthening and empowering patients' personal resources † The authors consider that the first two authors should be regarded as joint First Authors.
Fertility and Sterility, May 1, 2021
OBJECTIVE To investigate mechanisms of primordial follicle (PMF) loss in vivo in human ovaries sh... more OBJECTIVE To investigate mechanisms of primordial follicle (PMF) loss in vivo in human ovaries shortly after alkylating agent (AA) chemotherapy. DESIGN Cohort study. SETTING Tertiary university medical center. PATIENT(S) Ninety-six women aged 15-39 years who underwent ovarian tissue cryopreservation for fertility preservation. INTERVENTION(S) Fresh ovarian tissue samples were harvested from women treated with AA (n = 24) or non-AA (n = 24) chemotherapy <6 months after treatment and age-matched untreated women (n = 48). MAIN OUTCOME MEASURE(S) Differential follicle counts, time from chemotherapy exposure, immunostaining for apoptosis (cleaved caspase-3) and FOXO3A on tissue harvested within ultrashort time intervals (4-12 days), collagen (Sirius red) and neovascularization (CD34). RESULT(S) AA-treated ovaries had significant loss of PMFs, and significant increase in absolute numbers of growing follicles compared with untreated control ovaries. The number of growing follicles was inversely correlated with time from chemotherapy. Representative staining for FOXO3A observed decreased nuclear localization in PMF oocytes in AA-treated ovaries removed within the ultrashort time interval compared with untreated ovaries. Neither significant loss of PMFs, increase in growing follicles, nor decrease in nuclear FOXO3A were observed in non-AA-treated ovaries. No increased expression of cleaved caspase-3 was seen in PMFs within the ultrashort time interval after AA or non-AA chemotherapy. Significant stromal fibrosis and neovascularization were observed in AA-treated ovaries only after follicle loss had already occurred (4-6 months). CONCLUSION(S) Follicle activation occurs in vivo in ovaries of patients treated with AA, indicating a pathologic mechanism which may contribute to chemotherapy-induced follicle loss.
International Journal of Andrology, Nov 21, 2022
We would like to thank you for the option to correspond to Rhodes et al. 1 For the best of our kn... more We would like to thank you for the option to correspond to Rhodes et al. 1 For the best of our knowledge, our study 2 is the longest published post-covid-19 vaccination follow-up. Three different statistical analyses resulted with identical outcome-selective sperm concentration and total motile count reduction 3 months post-vaccination. Generalized estimated equation (GEE) model was used for repeated measures analysis. The working correlation structure was first-order autoregressive relationship. The robust covariance matrix estimator was used to calculate standard errors. As accepted for several decades 3 and mentioned by Rhodes et al., corrections for multiplicity are not mandatory and therefore were not performed. To confirm GEE results, our approach was to use additional different analyses including median comparisons between T1-T3 to T0 for first and means sample per donor. Analysis of first sample only does not necessary align with donor's mean in each time frame. For example, in case of impaired semen sample, a possible action by sperm bank laboratory would be to postpone further samples from that donor for several weeks. Such hypothetical bias may have resulted with different outcome between first versus mean comparison. Consequently, these two analyses manifest different approaches with similar findings which further support GEE outcome. We decided to define specific time frames (T1 = 15-45 days after vaccine; T2 = 75-125 days; T3 = 145+). Most current literature is focused short term (correlating with T1 for comparison). However, we were most interested in three-and six-months post-vaccination time frames. T2 is based on physiological duration of spermatogenesis to evaluate the impact of the first days-weeks after vaccination completion, while T3 was expected to express possible continuous vaccination impact. This time frames approach is widely accepted. Since the study included anonymous sperm donors, participants' anonymity is highly crucial. According to our protocols, raw data, which include ages and dates of vaccination doses, can be shared only under very strict and limited conditions. However, processed data were shared with other researchers upon their request to perform meta-analysis on that topic, and we wait for their results.
International Journal of Andrology, Aug 18, 2022
International Journal of Andrology, Jun 27, 2022
Background: The development of covid-19 vaccinations represents a notable scientific achievement.... more Background: The development of covid-19 vaccinations represents a notable scientific achievement. Nevertheless, concerns have been raised regarding their possible detrimental impact on male fertility Objective: To investigate the effect of covid-19 BNT162b2 (Pfizer) vaccine on semen parameters among semen donors (SD). Methods: Thirty-seven SD from three sperm banks that provided 216 samples were included in that retrospective longitudinal multicenter cohort study. BNT162b2 vaccination included two doses, and vaccination completion was scheduled 7 days after the second dose. The study included four phases: T0-pre-vaccination baseline control, which encompassed 1-2 initial samples per SD; T1, T2 and T3-short, intermediate, and long terms evaluations, respectively. Each included 1-3 semen samples per donor provided 15-45, 75-125 and over 145 days after vaccination completion, respectively. The primary endpoints were semen parameters. Three statistical analyses were conducted: (1) generalized estimated equation model; (2) first sample and (3) samples' mean of each donor per period were compared to T0. Results: Repetitive measurements revealed −15.4% sperm concentration decrease on T2 (CI −25.5%-3.9%, p = 0.01) leading to total motile count 22.1% reduction (CI −35%-−6.6%, p = 0.007) compared to T0. Similarly, analysis of first semen sample only and samples' mean per donor resulted in concentration and total motile count (TMC) reductions on T2 compared to T0-median decline of 12 million/ml and 31.2 million motile spermatozoa, respectively (p = 0.02 and 0.002 respectively) on first sample evaluation and median decline of 9.5 × 10 6 and 27.3 million motile spermatozoa (p = 0.004 and 0.003, respectively) on samples' mean examination. T3 evaluation demonstrated overall recovery without. Semen volume and sperm motility were not impaired. Discussion: This longitudinal study focused on SD demonstrates selective temporary sperm concentration and TMC deterioration 3 months after vaccination followed by later recovery verified by diverse statistical analyses.
European Journal of Obstetrics & Gynecology and Reproductive Biology, 2022
OBJECTIVE To determine the clinical pregnancy rate following sequential hydrosonography and hyste... more OBJECTIVE To determine the clinical pregnancy rate following sequential hydrosonography and hysterosalpingo-foam sonography (HyFoSy) in tubal patency assessment among women undergoing infertility work-up. STUDY DESIGN Prospective follow-up of women referred to our department between July 2019 and October 2020. Sequential hydrosonography and HyFoSy were carried out. RESULTS Out of 250 having the procedure, 100 women were excluded from study due to limited infertility, semen abnormal or not examined, evaluation for social egg freezing or they were single. Of the remaining 150 women, 48 (32%) conceived during a 10-24 months follow-up period: 17 (11%) conceived naturally and 7 (4.7%) by IUI. The mean time to conception was 5.5 ± 5.4 months and the pregnancy rate was 52% within 6 months. Among the spontaneous pregnancies 47% occurred within a month and 76% within 3 months. CONCLUSION Sequential hydrosonography and HyFoSy is a promising method for assessing the uterine cavity and tubal patency in women undergoing infertility workup. The findings suggest that the procedure may increase the chance of a spontaneous pregnancy following the procedure. Given the other known advantages of sequential hydrosonography and HyFoSy, this test is worth including in the initial workup for infertile patients.
Ultrasound in Obstetrics & Gynecology, 2014
In spite of the high dose administration of artificial lung surfactant, some neonates show the se... more In spite of the high dose administration of artificial lung surfactant, some neonates show the severe respiratory disorder (SRD) in premature delivery. In these cases, the problem is not the deficiency of surfactant, but the maturity of the lung. Since lung fluid secreted by fetal lungs is essential for the fetal lung maturity, the measurement of water content of the lung on T2-weighted images may predict the fetal lung maturity. Therefore, we measured the fetal lung-to-liver signal intensity ratio (LLSIR) on T2-weighted images and examined the relations between LLSIR and presence of the SRD after birth. The purpose of this study is to determine the fetal LLSIR on T2-weighted images as an accurate prenatal evaluating method for fetal lung maturity. Methods: One hundred twenty fetuses who underwent MRI examination in various indications after 22nd week of gestation participated in this study with their parents' consent. LLSIR was measured on T2-weighted images of MRI. We examined the changes of the ratio with the progress of gestational week at first and then the relations between LLSIR and presence of the SRD after birth. The best cutoff value of the LLSIR to predict respiratory outcome after birth was calculated using Receiver Operating Characteristic (ROC) analysis. Results: LLSIR correlated significantly with advancing of gestational age. The relationship between LLSIR(y) and gestational age(x) was shown as y = 0.037x + 0.97 (R = 0.31, p < 0.005). The non-SRD group had higher LLSIR when compared with the SRD group (2.16 ± 0.30 vs. 1.53 ± 0.40, p < 0.001). ROC curve analysis showed that fetuses with an LLSIR below 2.00 were more likely to develop SRD (sensitivity: 100%, specificity: 75%). Conclusions: The fetal LLSIR on T2-weighted images is an important and useful marker to diagnose the fetal lung maturity.
Human Reproduction
Study question What is the actual preference of sperm donors with identity disclosure vs. anonymo... more Study question What is the actual preference of sperm donors with identity disclosure vs. anonymous donors among recipient patients? Does this selection affect clinical outcomes? Summary answer Identity disclosure donation is important for certain sections, while almost half of the patients used anonymous donation. An Identity disclosure-only policy should be considered carefully. What is known already A major shift over the last decades focuses on sperm donation identity disclosure. Opposed to historic anonymity, related to heterosexual parents’ tendency to avoid conception disclosure to their children, the growing proportion of single women and same-sex lesbian couples has raised this issue to high priority. Recipients’ perceptions of anonymity vs. identity disclosure are influenced by family structure. Study design, size, duration Israeli regulations permit two sets of sperm donation - local and imported. Israeli sperm donors is anonymous only, while imported sperm donors may be ...
Basic and Clinical Andrology
Background Sperm banks face a continuously evolving gap between the increasing demand for sperm d... more Background Sperm banks face a continuously evolving gap between the increasing demand for sperm donation (SD) vs. limited available reserve. To improve donors’ recruitment and increase supply, motivations towards SD should be investigated specifically among young men who have the potential to become donors. Our aim was to evaluate factors which increase and decrease predisposition to donate sperm among non-donor students, who represent a “potential pool” for possible donors’ recruitment. Results Ninety-three men fulfilled the questionnaire with mean age of 28.2 ± 4.5 years. The most powerful incentive to donate sperm was financial reward followed by a willingness to help others to build a family (3.8 and 3.4, respectively). The most dominant consideration to decline donation was the fear of anonymity loss and future regret (4 and 3.8). While participants’ willingness for anonymous SD was fair (2.8), the open-identity donation was rated significantly lower (1.75, p < 0.01). Famili...
Fertility and Sterility, Sep 1, 2017
A retrospective study carried out in men undergoing routine semen analysis and CASA at LAR (8/201... more A retrospective study carried out in men undergoing routine semen analysis and CASA at LAR (8/2014-12/2016). MATERIALS AND METHODS: Semen samples were obtained from men for semen evaluation as part of routine andrology work-up and CASA. Statistical analyses were done using GraphPad-InStat software. Results were compared by means of Mann-Whitney or Kruskal-Wallis tests. RESULTS: The analysis done on 4,897 semen samples revealed a negative correlation between age and routine semen parameters (p<0.0001) and several CASA (p<0.005) variables (Table). When semen samples were distributed in 4 age-groups (G1¼18-29; G2¼30-39; G3¼40-49; G4R50 yr), G1 samples had higher (p<0.05) values for those parameters than G4, as expected. Moreover, significant differences were also observed in several parameters between G2 and G3 samples. These results led us to use 40 yr as a cutoff value, an analysis that revealed decreased (p<0.0005) parameters in the older (R40 yr; n¼1,285) group compared to the younger one (<40 yr; n¼1,285). Taking into account the negative impact of diverse clinical and lifestyle conditions upon semen quality, the same evaluations were performed in samples from a selected 'not-exposed' population. As a result, some parameters were still decreased (p<0.05) in the older group. CONCLUSIONS: A negative effect of age upon routine semen parameters was found in a large cohort of samples assessed under same laboratory standards. The negative impact of age upon sperm motility was further supported by reporting, for the first time, a negative correlation between age and sperm kinematics. These parameters were found decreased in older (R40 yr) men.
PubMed, Mar 1, 2014
Background: Physicians are often insufficiently trained in bedside teaching and mentoring skills.... more Background: Physicians are often insufficiently trained in bedside teaching and mentoring skills. Objectives: To develop, implement and assess a simulation-based training program designed to improve clinical teaching among physicians. Methods: We developed a one-day tutor training program based on six simulated scenarios with video-based debriefing. The program's efficacy was assessed using questionnaires completed by the participating physicians and their students. Main outcome measures were self-perceived teaching skills at baseline, after participation in the program, and following completion of the tutor role. Secondary outcome measures were the students' perceptions regarding their tutor skills. Results: Thirty-two physicians (mean age 35.5 years, 56% females) participated in the program. Self-assessment questionnaires indicated statistically significant improvement following the program in 13 of 20 measures of teaching skills. Additional improvement was observed upon completion of the tutor role, leading to significant improvement in 19 of the .20 measures. Questionnaires completed by their students indicated higher scores in all parameters as compared to a matched control group of tutors who did not participate in the program, though not statistically significant. Most participants stated that the program enhanced their teaching skills (88%), they implement program-acquired skills when teaching students (79%), and they would recommend it to their peers (100%). Satisfaction was similar among participants with and without previous teaching experience. Conclusions: A novel one-day simulation-based tutor training program was developed and implemented with encouraging results regarding its potential to improve clinical teaching and mentoring skills.
PubMed, Dec 1, 2016
Successful pregnancy involves a synchronized, coordinated cross-talk between an embryo capable of... more Successful pregnancy involves a synchronized, coordinated cross-talk between an embryo capable of implanting, and an endometrium enabling implantation. Recurrent implantation failure (RIF) refers to unsuccessful implantation after repeated transfers of morphologically good quality embryos into a normal uterus. The etiology for RIF can be attributed to the embryo itself, the mother or, in some cases, both. Despite extensive research on underlying causes for RIF, our understanding of this condition is still limited. With the evolving molecular technologies, efforts are focused on studying the implantation process itself, including the molecular aspects of endometrial-embryonic interactions, normal human embryonic development, and preimplantation genetic evaluation. This knowledge will pave the way toward new diagnostic and therapeutic strategies for RIF. In this article, we present a comprehensive review of our current knowledge on this topic.
Gynecological Endocrinology, Oct 3, 2017
Sperm DNA fragmentation is a known etiology for male infertility. We evaluated the impact of sper... more Sperm DNA fragmentation is a known etiology for male infertility. We evaluated the impact of sperm DNA fragmentation index (DFI) on blastocyst euploidy in IVF cycles with egg donors. This observational retrospective study, which was conducted in a university affiliated fertility clinic, included IVF-ICSI-pre-implantation Genetic Screening (PGS) egg donor cycles in which DFI was tested prior to IVF, between January 1st, 2014 and July 31st, 2016. Twenty-seven cycles with DFI &amp;amp;amp;amp;amp;gt; 15% were included in the study group and compared with 18 cycles of DFI &amp;amp;amp;amp;amp;lt; 15% within control group. Research group participants had significantly lower sperm count and motility (55.4*106/ml and 37.4%, respectively) compared with controls (92.5*106/ml and 55.7%, respectively, p &amp;amp;amp;amp;amp;lt; .05). The groups were similar in terms of donors&amp;amp;amp;amp;amp;#39; demography (age, BMI), ovarian reserve (AMH, AFC) and response to hormonal stimulation (E2 level on triggering day and number of retrieved eggs). Embryo development (from 2PN through day 3 embryos to blastocysts) was similar as well. The number of biopsied blastocysts from study and control groups was 171 and 87, respectively. PGS with array comprehensive genomic hybridization revealed comparable euploidy rates of 69.3% and 67.3%, respectively (p &amp;amp;amp;amp;amp;gt; .05). DFI did not have an impact on the blastocyst euploidy rate in IVF cycles with egg donors.
Fertility and Sterility, Mar 1, 2017
Objective: To optimize culture conditions for human testicular somatic cells (TSCs) and spermatog... more Objective: To optimize culture conditions for human testicular somatic cells (TSCs) and spermatogonial stem cells. Design: Basic science study. Setting: Urology clinic and stem cell research laboratory. Patient(s): Eight human testicular samples. Interventions(s): Testicular tissues were processed by mechanical and enzymatic digestion. Cell suspensions were subjected to differential plating (DP) after which floating cells (representing germ cells) were removed and attached cells (representing TSCs) were cultured for 2 passages (P0-P1) in StemPro-34-or DMEM-F12-based medium. Germ cell cultures were established in both media for 12 days. Main Outcome Measure(s): TSC cultures: proliferation doubling time (PDT), fluorescence-activated cell sorting for CD90, nextgeneration sequencing for 89 RNA transcripts, immunocytochemistry for TSC and germ cell markers, and conditioned media analysis; germ cell cultures: number of aggregates. Result(s): TSCs had significantly prolonged PDT in DMEM-F12 versus StemPro-34 (319.6 AE 275.8 h and 110.5 AE 68.3 h, respectively). The proportion of CD90-positive cells increased after P1 in StemPro-34 and DMEM-F12 (90.1 AE 10.8% and 76.5 AE 17.4%, respectively) versus after DP (66.3 AE 7%). Samples from both media after P1 clustered closely in the principle components analysis map whereas those after DP did not. After P1 in either medium, CD90-positive cells expressed TSC markers only, and fibroblast growth factor 2 and bone morphogenetic protein 4 were detected in conditioned medium. A higher number of germ cell aggregates formed in DMEM-F12 (59 AE 39 vs. 28 AE 17, respectively). Conclusion(s): Use of DMEM-F12 reduces TSC proliferation while preserving their unique characteristics, leading to improved germ cell aggregates formation compared with StemPro-34, the standard basal medium used in the majority of previous reports. (Fertil Steril Ò 2017;107:595-605. Ó2017 by American Society for Reproductive Medicine.
Human Reproduction, Feb 25, 2022
Does prior severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection in women underg... more Does prior severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection in women undergoing fertility treatments affect the outcomes of fresh ART cycles? SUMMARY ANSWER: SARS-CoV-2 infection does not affect fresh ART treatment outcomes, except for a possible long-term negative effect on oocyte yield (>180 days postinfection). WHAT IS KNOWN ALREADY: A single previous study suggested no evidence that a history of asymptomatic or mild SARS-CoV-2 infection in females caused impairment of fresh ART treatment outcomes. STUDY DESIGN, SIZE, DURATION: Retrospective cohort study, including all SARS-CoV-2 infected women who underwent fresh ART cycles within a year from infection (the first cycle postinfection), between October 2020 and June 2021, matched to non-diagnosed controls. PARTICIPANTS/MATERIALS, SETTING, METHODS: Patients from two large IVF units in Israel who were infected with SARS-CoV-2 and later underwent fresh ART cycles were matched by age to non-diagnosed, non-vaccinated controls. Demographics, cycle characteristics and cycle outcomes, including oocyte yield, maturation rate, fertilization rate, number of frozen embryos per cycle and clinical pregnancy rates, were compared between groups. MAIN RESULTS AND THE ROLE OF CHANCE: One hundred and twenty-one infected patients and 121 controls who underwent fresh ART cycles were included. Oocyte yield (12.50 versus 11.29; P ¼ 0.169) and mature oocyte rate (78% versus 82%; P ¼ 0.144) in all fresh cycles were similar between groups, as were fertilization rates, number of frozen embryos per cycle and clinical pregnancy rates (43% versus 40%; P ¼ 0.737) in fresh cycles with an embryo transfer. In a logistic regression model, SARS-CoV-2 infection more than 180 days prior to retrieval had a negative effect on oocyte yield (P ¼ 0.018, Slope ¼ À4.08, 95% CI À7.41 to À0.75), although the sample size was small. LIMITATIONS, REASONS FOR CAUTION: A retrospective study with data that was not uniformly generated under a study protocol, no antibody testing for the control group. WIDER IMPLICATIONS OF THE FINDINGS: The study findings suggest that SARS-CoV-2 infection does not affect treatment outcomes, including oocyte yield, fertilization and maturation rate, number of good quality embryos and clinical pregnancy rates, in fresh ART cycles, except for a possible long-term negative effect on oocyte yield when retrieval occurs >180 days post-SARS-CoV-2 infection. Further studies are warranted to support these findings.
Fertility and Sterility, Sep 1, 2015
We were interested in evaluating the ability of the mesenchymal stromal cell (MSC) population, hu... more We were interested in evaluating the ability of the mesenchymal stromal cell (MSC) population, human umbilical cord perivascular cells (HUCPVCs), to undergo cardiomyocyte reprogramming in an established coculture system with rat embryonic cardiomyocytes. Results were compared with human bone marrow-derived (BM) MSCs. The transcription factors GATA4 and Mef 2c were expressed in HUCPVCs but not BM-MSCs at baseline and, at 7 days, increased 7.6-and 3.5-fold, respectively, compared with BM-MSCs. Although cardiac-specific gene expression increased in both cell types in coculture, upregulation was more significant in HUCPVCs, consistent with Mef 2c-GATA4 synergism. Using a lentivector with eGFP transcribed from the a-myosin heavy chain (a-MHC) promoter, we found that cardiac gene expression was greater in HUCPVCs than BM-MSCs after 14 days coculture (52 ± 17% vs. 29 ± 6%, respectively). A higher frequency of HUCPVCs expressed a-MHC protein compared with BM-MSCs (11.6 ± 0.9% vs. 5.3 ± 0.3%); however, both cell types retained MSC-associated determinants. We also assessed the ability of the MSC types to mediate cardiac regeneration in a NOD/SCID g mouse model of acute myocardial infarction (AMI). Fourteen days after AMI, cardiac function was significantly better in cell-treated mice compared with control animals and HUCPVCs exhibited greater improvement. Although human cells persisted in the infarct area, the frequency of a-MHC expression was low. Our results indicate that HUCPVCs exhibit a greater degree of cardiomyocyte reprogramming but that differentiation for both cell types is partial. We conclude that HUCPVCs may be preferable to BM-MSCs in the cell therapy of AMI.
Journal of Maternal-fetal & Neonatal Medicine, Feb 15, 2017
Fertility and Sterility, Sep 1, 2012
Human Reproduction, Nov 13, 2020
What are the perceptions of infertility patients and the factors correlating with their psycholog... more What are the perceptions of infertility patients and the factors correlating with their psychological distress, following suspension of fertility treatments during the Corona Virus Disease-19 (COVID-19) pandemic? SUMMARY ANSWER: Most patients preferred to resume treatment given the chance regardless of background characteristics; higher self-mastery and greater perceived social support were associated with lower distress, while feeling helpless was associated with higher distress. WHAT IS KNOWN ALREADY: Infertility diagnosis and treatment frequently result in significant psychological distress. Recently published data have shown that clinic closure during the COVID-19 pandemic was associated with a sharp increase in the prevalence of anxiety and depression among infertile patients undergoing IVF and was perceived as an uncontrollable and stressful event. Personal resources play an important protective role in times of crisis, helping reduce levels of distress. STUDY DESIGN, SIZE, DURATION: This cross-sectional questionnaire study included patients whose fertility treatment was suspended following the COVID-19 pandemic, in a tertiary hospital. The survey was delivered to 297 patients within 12 days at the beginning of April 2020. PARTICIPANTS/MATERIALS, SETTING, METHODS: The self-administered questionnaire included items addressing: (i) patients' demographic characteristics, (ii) anxiety related to COVID-19 infection risk and level of social support, (iii) patients' perceptions of the new guidelines and description of subsequently related emotions and (iv) two validated scales assessing levels of emotional distress and self-mastery. Multivariate analysis was conducted to assess factors alleviating or increasing emotional distress during the COVID-19 pandemic. MAIN RESULTS AND THE ROLE OF CHANCE: There were 168 patients who completed the survey, giving a response rate of 57%. Study variables in the regression model explained 38.9% of the variance in psychological distress experienced by patients during treatment suspension. None of the background characteristics (e.g. age, marital status, parity, economic level or duration of treatments) had a significant contribution. Feeling helpless following the suspension of treatments was associated with higher distress (P < 0.01). Higher selfmastery and greater perceived social support were associated with lower distress (P < 0.01). Despite the ministry of health's decision, 72% of patients wished to resume treatment at the time of survey. LIMITATIONS, REASONS FOR CAUTION: This was a cross-sectional study, thus information about patients' characteristics prior to the COVID-19 pandemic was not available. The length and implications of this pandemic are unknown. Therefore, the ability to draw conclusions about the psychological consequences of the crisis is limited at this point of time. WIDER IMPLICATIONS OF THE FINDINGS: Personal resources play an important protective role in times of crisis, helping to reduce levels of distress. Study findings suggest that attention should be paid to strengthening and empowering patients' personal resources † The authors consider that the first two authors should be regarded as joint First Authors.
Fertility and Sterility, May 1, 2021
OBJECTIVE To investigate mechanisms of primordial follicle (PMF) loss in vivo in human ovaries sh... more OBJECTIVE To investigate mechanisms of primordial follicle (PMF) loss in vivo in human ovaries shortly after alkylating agent (AA) chemotherapy. DESIGN Cohort study. SETTING Tertiary university medical center. PATIENT(S) Ninety-six women aged 15-39 years who underwent ovarian tissue cryopreservation for fertility preservation. INTERVENTION(S) Fresh ovarian tissue samples were harvested from women treated with AA (n = 24) or non-AA (n = 24) chemotherapy <6 months after treatment and age-matched untreated women (n = 48). MAIN OUTCOME MEASURE(S) Differential follicle counts, time from chemotherapy exposure, immunostaining for apoptosis (cleaved caspase-3) and FOXO3A on tissue harvested within ultrashort time intervals (4-12 days), collagen (Sirius red) and neovascularization (CD34). RESULT(S) AA-treated ovaries had significant loss of PMFs, and significant increase in absolute numbers of growing follicles compared with untreated control ovaries. The number of growing follicles was inversely correlated with time from chemotherapy. Representative staining for FOXO3A observed decreased nuclear localization in PMF oocytes in AA-treated ovaries removed within the ultrashort time interval compared with untreated ovaries. Neither significant loss of PMFs, increase in growing follicles, nor decrease in nuclear FOXO3A were observed in non-AA-treated ovaries. No increased expression of cleaved caspase-3 was seen in PMFs within the ultrashort time interval after AA or non-AA chemotherapy. Significant stromal fibrosis and neovascularization were observed in AA-treated ovaries only after follicle loss had already occurred (4-6 months). CONCLUSION(S) Follicle activation occurs in vivo in ovaries of patients treated with AA, indicating a pathologic mechanism which may contribute to chemotherapy-induced follicle loss.
International Journal of Andrology, Nov 21, 2022
We would like to thank you for the option to correspond to Rhodes et al. 1 For the best of our kn... more We would like to thank you for the option to correspond to Rhodes et al. 1 For the best of our knowledge, our study 2 is the longest published post-covid-19 vaccination follow-up. Three different statistical analyses resulted with identical outcome-selective sperm concentration and total motile count reduction 3 months post-vaccination. Generalized estimated equation (GEE) model was used for repeated measures analysis. The working correlation structure was first-order autoregressive relationship. The robust covariance matrix estimator was used to calculate standard errors. As accepted for several decades 3 and mentioned by Rhodes et al., corrections for multiplicity are not mandatory and therefore were not performed. To confirm GEE results, our approach was to use additional different analyses including median comparisons between T1-T3 to T0 for first and means sample per donor. Analysis of first sample only does not necessary align with donor's mean in each time frame. For example, in case of impaired semen sample, a possible action by sperm bank laboratory would be to postpone further samples from that donor for several weeks. Such hypothetical bias may have resulted with different outcome between first versus mean comparison. Consequently, these two analyses manifest different approaches with similar findings which further support GEE outcome. We decided to define specific time frames (T1 = 15-45 days after vaccine; T2 = 75-125 days; T3 = 145+). Most current literature is focused short term (correlating with T1 for comparison). However, we were most interested in three-and six-months post-vaccination time frames. T2 is based on physiological duration of spermatogenesis to evaluate the impact of the first days-weeks after vaccination completion, while T3 was expected to express possible continuous vaccination impact. This time frames approach is widely accepted. Since the study included anonymous sperm donors, participants' anonymity is highly crucial. According to our protocols, raw data, which include ages and dates of vaccination doses, can be shared only under very strict and limited conditions. However, processed data were shared with other researchers upon their request to perform meta-analysis on that topic, and we wait for their results.
International Journal of Andrology, Aug 18, 2022
International Journal of Andrology, Jun 27, 2022
Background: The development of covid-19 vaccinations represents a notable scientific achievement.... more Background: The development of covid-19 vaccinations represents a notable scientific achievement. Nevertheless, concerns have been raised regarding their possible detrimental impact on male fertility Objective: To investigate the effect of covid-19 BNT162b2 (Pfizer) vaccine on semen parameters among semen donors (SD). Methods: Thirty-seven SD from three sperm banks that provided 216 samples were included in that retrospective longitudinal multicenter cohort study. BNT162b2 vaccination included two doses, and vaccination completion was scheduled 7 days after the second dose. The study included four phases: T0-pre-vaccination baseline control, which encompassed 1-2 initial samples per SD; T1, T2 and T3-short, intermediate, and long terms evaluations, respectively. Each included 1-3 semen samples per donor provided 15-45, 75-125 and over 145 days after vaccination completion, respectively. The primary endpoints were semen parameters. Three statistical analyses were conducted: (1) generalized estimated equation model; (2) first sample and (3) samples' mean of each donor per period were compared to T0. Results: Repetitive measurements revealed −15.4% sperm concentration decrease on T2 (CI −25.5%-3.9%, p = 0.01) leading to total motile count 22.1% reduction (CI −35%-−6.6%, p = 0.007) compared to T0. Similarly, analysis of first semen sample only and samples' mean per donor resulted in concentration and total motile count (TMC) reductions on T2 compared to T0-median decline of 12 million/ml and 31.2 million motile spermatozoa, respectively (p = 0.02 and 0.002 respectively) on first sample evaluation and median decline of 9.5 × 10 6 and 27.3 million motile spermatozoa (p = 0.004 and 0.003, respectively) on samples' mean examination. T3 evaluation demonstrated overall recovery without. Semen volume and sperm motility were not impaired. Discussion: This longitudinal study focused on SD demonstrates selective temporary sperm concentration and TMC deterioration 3 months after vaccination followed by later recovery verified by diverse statistical analyses.
European Journal of Obstetrics & Gynecology and Reproductive Biology, 2022
OBJECTIVE To determine the clinical pregnancy rate following sequential hydrosonography and hyste... more OBJECTIVE To determine the clinical pregnancy rate following sequential hydrosonography and hysterosalpingo-foam sonography (HyFoSy) in tubal patency assessment among women undergoing infertility work-up. STUDY DESIGN Prospective follow-up of women referred to our department between July 2019 and October 2020. Sequential hydrosonography and HyFoSy were carried out. RESULTS Out of 250 having the procedure, 100 women were excluded from study due to limited infertility, semen abnormal or not examined, evaluation for social egg freezing or they were single. Of the remaining 150 women, 48 (32%) conceived during a 10-24 months follow-up period: 17 (11%) conceived naturally and 7 (4.7%) by IUI. The mean time to conception was 5.5 ± 5.4 months and the pregnancy rate was 52% within 6 months. Among the spontaneous pregnancies 47% occurred within a month and 76% within 3 months. CONCLUSION Sequential hydrosonography and HyFoSy is a promising method for assessing the uterine cavity and tubal patency in women undergoing infertility workup. The findings suggest that the procedure may increase the chance of a spontaneous pregnancy following the procedure. Given the other known advantages of sequential hydrosonography and HyFoSy, this test is worth including in the initial workup for infertile patients.
Ultrasound in Obstetrics & Gynecology, 2014
In spite of the high dose administration of artificial lung surfactant, some neonates show the se... more In spite of the high dose administration of artificial lung surfactant, some neonates show the severe respiratory disorder (SRD) in premature delivery. In these cases, the problem is not the deficiency of surfactant, but the maturity of the lung. Since lung fluid secreted by fetal lungs is essential for the fetal lung maturity, the measurement of water content of the lung on T2-weighted images may predict the fetal lung maturity. Therefore, we measured the fetal lung-to-liver signal intensity ratio (LLSIR) on T2-weighted images and examined the relations between LLSIR and presence of the SRD after birth. The purpose of this study is to determine the fetal LLSIR on T2-weighted images as an accurate prenatal evaluating method for fetal lung maturity. Methods: One hundred twenty fetuses who underwent MRI examination in various indications after 22nd week of gestation participated in this study with their parents' consent. LLSIR was measured on T2-weighted images of MRI. We examined the changes of the ratio with the progress of gestational week at first and then the relations between LLSIR and presence of the SRD after birth. The best cutoff value of the LLSIR to predict respiratory outcome after birth was calculated using Receiver Operating Characteristic (ROC) analysis. Results: LLSIR correlated significantly with advancing of gestational age. The relationship between LLSIR(y) and gestational age(x) was shown as y = 0.037x + 0.97 (R = 0.31, p < 0.005). The non-SRD group had higher LLSIR when compared with the SRD group (2.16 ± 0.30 vs. 1.53 ± 0.40, p < 0.001). ROC curve analysis showed that fetuses with an LLSIR below 2.00 were more likely to develop SRD (sensitivity: 100%, specificity: 75%). Conclusions: The fetal LLSIR on T2-weighted images is an important and useful marker to diagnose the fetal lung maturity.
Human Reproduction
Study question What is the actual preference of sperm donors with identity disclosure vs. anonymo... more Study question What is the actual preference of sperm donors with identity disclosure vs. anonymous donors among recipient patients? Does this selection affect clinical outcomes? Summary answer Identity disclosure donation is important for certain sections, while almost half of the patients used anonymous donation. An Identity disclosure-only policy should be considered carefully. What is known already A major shift over the last decades focuses on sperm donation identity disclosure. Opposed to historic anonymity, related to heterosexual parents’ tendency to avoid conception disclosure to their children, the growing proportion of single women and same-sex lesbian couples has raised this issue to high priority. Recipients’ perceptions of anonymity vs. identity disclosure are influenced by family structure. Study design, size, duration Israeli regulations permit two sets of sperm donation - local and imported. Israeli sperm donors is anonymous only, while imported sperm donors may be ...
Basic and Clinical Andrology
Background Sperm banks face a continuously evolving gap between the increasing demand for sperm d... more Background Sperm banks face a continuously evolving gap between the increasing demand for sperm donation (SD) vs. limited available reserve. To improve donors’ recruitment and increase supply, motivations towards SD should be investigated specifically among young men who have the potential to become donors. Our aim was to evaluate factors which increase and decrease predisposition to donate sperm among non-donor students, who represent a “potential pool” for possible donors’ recruitment. Results Ninety-three men fulfilled the questionnaire with mean age of 28.2 ± 4.5 years. The most powerful incentive to donate sperm was financial reward followed by a willingness to help others to build a family (3.8 and 3.4, respectively). The most dominant consideration to decline donation was the fear of anonymity loss and future regret (4 and 3.8). While participants’ willingness for anonymous SD was fair (2.8), the open-identity donation was rated significantly lower (1.75, p < 0.01). Famili...
Fertility and Sterility, Sep 1, 2017
A retrospective study carried out in men undergoing routine semen analysis and CASA at LAR (8/201... more A retrospective study carried out in men undergoing routine semen analysis and CASA at LAR (8/2014-12/2016). MATERIALS AND METHODS: Semen samples were obtained from men for semen evaluation as part of routine andrology work-up and CASA. Statistical analyses were done using GraphPad-InStat software. Results were compared by means of Mann-Whitney or Kruskal-Wallis tests. RESULTS: The analysis done on 4,897 semen samples revealed a negative correlation between age and routine semen parameters (p<0.0001) and several CASA (p<0.005) variables (Table). When semen samples were distributed in 4 age-groups (G1¼18-29; G2¼30-39; G3¼40-49; G4R50 yr), G1 samples had higher (p<0.05) values for those parameters than G4, as expected. Moreover, significant differences were also observed in several parameters between G2 and G3 samples. These results led us to use 40 yr as a cutoff value, an analysis that revealed decreased (p<0.0005) parameters in the older (R40 yr; n¼1,285) group compared to the younger one (<40 yr; n¼1,285). Taking into account the negative impact of diverse clinical and lifestyle conditions upon semen quality, the same evaluations were performed in samples from a selected 'not-exposed' population. As a result, some parameters were still decreased (p<0.05) in the older group. CONCLUSIONS: A negative effect of age upon routine semen parameters was found in a large cohort of samples assessed under same laboratory standards. The negative impact of age upon sperm motility was further supported by reporting, for the first time, a negative correlation between age and sperm kinematics. These parameters were found decreased in older (R40 yr) men.
PubMed, Mar 1, 2014
Background: Physicians are often insufficiently trained in bedside teaching and mentoring skills.... more Background: Physicians are often insufficiently trained in bedside teaching and mentoring skills. Objectives: To develop, implement and assess a simulation-based training program designed to improve clinical teaching among physicians. Methods: We developed a one-day tutor training program based on six simulated scenarios with video-based debriefing. The program's efficacy was assessed using questionnaires completed by the participating physicians and their students. Main outcome measures were self-perceived teaching skills at baseline, after participation in the program, and following completion of the tutor role. Secondary outcome measures were the students' perceptions regarding their tutor skills. Results: Thirty-two physicians (mean age 35.5 years, 56% females) participated in the program. Self-assessment questionnaires indicated statistically significant improvement following the program in 13 of 20 measures of teaching skills. Additional improvement was observed upon completion of the tutor role, leading to significant improvement in 19 of the .20 measures. Questionnaires completed by their students indicated higher scores in all parameters as compared to a matched control group of tutors who did not participate in the program, though not statistically significant. Most participants stated that the program enhanced their teaching skills (88%), they implement program-acquired skills when teaching students (79%), and they would recommend it to their peers (100%). Satisfaction was similar among participants with and without previous teaching experience. Conclusions: A novel one-day simulation-based tutor training program was developed and implemented with encouraging results regarding its potential to improve clinical teaching and mentoring skills.
PubMed, Dec 1, 2016
Successful pregnancy involves a synchronized, coordinated cross-talk between an embryo capable of... more Successful pregnancy involves a synchronized, coordinated cross-talk between an embryo capable of implanting, and an endometrium enabling implantation. Recurrent implantation failure (RIF) refers to unsuccessful implantation after repeated transfers of morphologically good quality embryos into a normal uterus. The etiology for RIF can be attributed to the embryo itself, the mother or, in some cases, both. Despite extensive research on underlying causes for RIF, our understanding of this condition is still limited. With the evolving molecular technologies, efforts are focused on studying the implantation process itself, including the molecular aspects of endometrial-embryonic interactions, normal human embryonic development, and preimplantation genetic evaluation. This knowledge will pave the way toward new diagnostic and therapeutic strategies for RIF. In this article, we present a comprehensive review of our current knowledge on this topic.
Gynecological Endocrinology, Oct 3, 2017
Sperm DNA fragmentation is a known etiology for male infertility. We evaluated the impact of sper... more Sperm DNA fragmentation is a known etiology for male infertility. We evaluated the impact of sperm DNA fragmentation index (DFI) on blastocyst euploidy in IVF cycles with egg donors. This observational retrospective study, which was conducted in a university affiliated fertility clinic, included IVF-ICSI-pre-implantation Genetic Screening (PGS) egg donor cycles in which DFI was tested prior to IVF, between January 1st, 2014 and July 31st, 2016. Twenty-seven cycles with DFI &amp;amp;amp;amp;amp;gt; 15% were included in the study group and compared with 18 cycles of DFI &amp;amp;amp;amp;amp;lt; 15% within control group. Research group participants had significantly lower sperm count and motility (55.4*106/ml and 37.4%, respectively) compared with controls (92.5*106/ml and 55.7%, respectively, p &amp;amp;amp;amp;amp;lt; .05). The groups were similar in terms of donors&amp;amp;amp;amp;amp;#39; demography (age, BMI), ovarian reserve (AMH, AFC) and response to hormonal stimulation (E2 level on triggering day and number of retrieved eggs). Embryo development (from 2PN through day 3 embryos to blastocysts) was similar as well. The number of biopsied blastocysts from study and control groups was 171 and 87, respectively. PGS with array comprehensive genomic hybridization revealed comparable euploidy rates of 69.3% and 67.3%, respectively (p &amp;amp;amp;amp;amp;gt; .05). DFI did not have an impact on the blastocyst euploidy rate in IVF cycles with egg donors.
Fertility and Sterility, Mar 1, 2017
Objective: To optimize culture conditions for human testicular somatic cells (TSCs) and spermatog... more Objective: To optimize culture conditions for human testicular somatic cells (TSCs) and spermatogonial stem cells. Design: Basic science study. Setting: Urology clinic and stem cell research laboratory. Patient(s): Eight human testicular samples. Interventions(s): Testicular tissues were processed by mechanical and enzymatic digestion. Cell suspensions were subjected to differential plating (DP) after which floating cells (representing germ cells) were removed and attached cells (representing TSCs) were cultured for 2 passages (P0-P1) in StemPro-34-or DMEM-F12-based medium. Germ cell cultures were established in both media for 12 days. Main Outcome Measure(s): TSC cultures: proliferation doubling time (PDT), fluorescence-activated cell sorting for CD90, nextgeneration sequencing for 89 RNA transcripts, immunocytochemistry for TSC and germ cell markers, and conditioned media analysis; germ cell cultures: number of aggregates. Result(s): TSCs had significantly prolonged PDT in DMEM-F12 versus StemPro-34 (319.6 AE 275.8 h and 110.5 AE 68.3 h, respectively). The proportion of CD90-positive cells increased after P1 in StemPro-34 and DMEM-F12 (90.1 AE 10.8% and 76.5 AE 17.4%, respectively) versus after DP (66.3 AE 7%). Samples from both media after P1 clustered closely in the principle components analysis map whereas those after DP did not. After P1 in either medium, CD90-positive cells expressed TSC markers only, and fibroblast growth factor 2 and bone morphogenetic protein 4 were detected in conditioned medium. A higher number of germ cell aggregates formed in DMEM-F12 (59 AE 39 vs. 28 AE 17, respectively). Conclusion(s): Use of DMEM-F12 reduces TSC proliferation while preserving their unique characteristics, leading to improved germ cell aggregates formation compared with StemPro-34, the standard basal medium used in the majority of previous reports. (Fertil Steril Ò 2017;107:595-605. Ó2017 by American Society for Reproductive Medicine.
Human Reproduction, Feb 25, 2022
Does prior severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection in women underg... more Does prior severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection in women undergoing fertility treatments affect the outcomes of fresh ART cycles? SUMMARY ANSWER: SARS-CoV-2 infection does not affect fresh ART treatment outcomes, except for a possible long-term negative effect on oocyte yield (>180 days postinfection). WHAT IS KNOWN ALREADY: A single previous study suggested no evidence that a history of asymptomatic or mild SARS-CoV-2 infection in females caused impairment of fresh ART treatment outcomes. STUDY DESIGN, SIZE, DURATION: Retrospective cohort study, including all SARS-CoV-2 infected women who underwent fresh ART cycles within a year from infection (the first cycle postinfection), between October 2020 and June 2021, matched to non-diagnosed controls. PARTICIPANTS/MATERIALS, SETTING, METHODS: Patients from two large IVF units in Israel who were infected with SARS-CoV-2 and later underwent fresh ART cycles were matched by age to non-diagnosed, non-vaccinated controls. Demographics, cycle characteristics and cycle outcomes, including oocyte yield, maturation rate, fertilization rate, number of frozen embryos per cycle and clinical pregnancy rates, were compared between groups. MAIN RESULTS AND THE ROLE OF CHANCE: One hundred and twenty-one infected patients and 121 controls who underwent fresh ART cycles were included. Oocyte yield (12.50 versus 11.29; P ¼ 0.169) and mature oocyte rate (78% versus 82%; P ¼ 0.144) in all fresh cycles were similar between groups, as were fertilization rates, number of frozen embryos per cycle and clinical pregnancy rates (43% versus 40%; P ¼ 0.737) in fresh cycles with an embryo transfer. In a logistic regression model, SARS-CoV-2 infection more than 180 days prior to retrieval had a negative effect on oocyte yield (P ¼ 0.018, Slope ¼ À4.08, 95% CI À7.41 to À0.75), although the sample size was small. LIMITATIONS, REASONS FOR CAUTION: A retrospective study with data that was not uniformly generated under a study protocol, no antibody testing for the control group. WIDER IMPLICATIONS OF THE FINDINGS: The study findings suggest that SARS-CoV-2 infection does not affect treatment outcomes, including oocyte yield, fertilization and maturation rate, number of good quality embryos and clinical pregnancy rates, in fresh ART cycles, except for a possible long-term negative effect on oocyte yield when retrieval occurs >180 days post-SARS-CoV-2 infection. Further studies are warranted to support these findings.
Fertility and Sterility, Sep 1, 2015
We were interested in evaluating the ability of the mesenchymal stromal cell (MSC) population, hu... more We were interested in evaluating the ability of the mesenchymal stromal cell (MSC) population, human umbilical cord perivascular cells (HUCPVCs), to undergo cardiomyocyte reprogramming in an established coculture system with rat embryonic cardiomyocytes. Results were compared with human bone marrow-derived (BM) MSCs. The transcription factors GATA4 and Mef 2c were expressed in HUCPVCs but not BM-MSCs at baseline and, at 7 days, increased 7.6-and 3.5-fold, respectively, compared with BM-MSCs. Although cardiac-specific gene expression increased in both cell types in coculture, upregulation was more significant in HUCPVCs, consistent with Mef 2c-GATA4 synergism. Using a lentivector with eGFP transcribed from the a-myosin heavy chain (a-MHC) promoter, we found that cardiac gene expression was greater in HUCPVCs than BM-MSCs after 14 days coculture (52 ± 17% vs. 29 ± 6%, respectively). A higher frequency of HUCPVCs expressed a-MHC protein compared with BM-MSCs (11.6 ± 0.9% vs. 5.3 ± 0.3%); however, both cell types retained MSC-associated determinants. We also assessed the ability of the MSC types to mediate cardiac regeneration in a NOD/SCID g mouse model of acute myocardial infarction (AMI). Fourteen days after AMI, cardiac function was significantly better in cell-treated mice compared with control animals and HUCPVCs exhibited greater improvement. Although human cells persisted in the infarct area, the frequency of a-MHC expression was low. Our results indicate that HUCPVCs exhibit a greater degree of cardiomyocyte reprogramming but that differentiation for both cell types is partial. We conclude that HUCPVCs may be preferable to BM-MSCs in the cell therapy of AMI.