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Karadbhajne P, More A. Effect of Hyaluronic Acid-Enriched Media in Embryo Implantation. Cureus 2022; 14:e27083. [PMID: 36000102 PMCID: PMC9391666 DOI: 10.7759/cureus.27083] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 07/20/2022] [Indexed: 11/09/2022] Open
Abstract
EmbryoGlue (Vitrolife, Sweden) is a hyaluronan-rich medium manufactured specifically for embryo transfer. Normally, culture media is used for embryo transfer. Culture media is enriched with albumin. Embryo transfer success depends upon the implantation rate. According to some researchers, hyaluronic acid-enriched media may be responsible for the success of embryo transfers. The aim of the study is to check the efficacy of hyaluronic acid-enriched media for previous in-vitro fertilization (IVF) failure patients. A 48-year patient was unable to conceive naturally for 20 years. The patient was enrolled for an IVF cycle at Wardha Test Tube Baby Centre in November 2020. The patient was enrolled for three IVF cycles. She was counseled for IVF treatment after failure of three intrauterine inseminations (IUI). Due to menopause, the patient was suggested for IVF with a donor egg and husband's sperm. The uterine septum was found in hysteroscopy and a septum section was done. The patient was conceived after the sixth embryo transfer by using EmbryoGlue. The case report highlighted that the pregnancy may be achieved by the use of EmbryoGlue for embryo transfer.
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Rosas IM, Anagnostopoulou C, Singh N, Gugnani N, Singh K, Desai D, Darbandi M, Manoharan M, Darbandi S, Chockalingam A, Leonardi Diaz SI, Gupta S, Kuroda S, Finelli R, Sallam HN, Wirka KA, Boitrelle F, Agarwal A. Optimizing embryological aspects of oocyte retrieval, oocyte denudation, and embryo loading for transfer: a state of the art review. Panminerva Med 2022; 64:156-170. [PMID: 35146991 DOI: 10.23736/s0031-0808.22.04675-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Oocyte retrieval, oocyte denudation, and embryo transfer are crucial processes during assisted reproduction (ART). Air quality in the ART laboratory, temperature, pH of the media used and the time interval between oocyte retrieval and insemination are all critical factors. Anesthesia is required for oocyte retrieval, however evidence regarding the potential impact of different methods (general anesthesia, conscious sedation, and local anesthesia) on the clinical outcomes is unclear. The optimal timing of oocyte denudation following retrieval has not been established. Regarding the mechanical denudation process, there is a lack of evidence to demonstrate the safest minimum inner diameter of denuding pipettes used to complete the removal of granulosa cells surrounding the oocytes. During embryo transfer, many clinics worldwide flush the catheter before embryo loading, in an attempt to potentially rinse off any toxic agents; however, there is insufficient evidence to show that flushing the embryo transfer catheter before loading increases the success of ART outcome. Considering the serious gaps in knowledge in ART practice, the aim of this review is to provide an updated overview of the current knowledge regarding the various steps and techniques involved in oocyte retrieval, oocyte denudation, and embryo loading for transfer.
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Affiliation(s)
- Israel M Rosas
- Citmer Reproductive Medicine, IVF LAB, Mexico City, Mexico
| | | | | | - Nivita Gugnani
- BabySoon Fertility and IVF Center, India Institute of Medical Sciences, New Delhi, India
| | - Keerti Singh
- Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, Barbados
| | - Dimple Desai
- DPU IVF & ENDOSCOPY CENTER, Dr. D. Y. Patil Hospital & Research Centre, Pune, India
| | - Masha Darbandi
- Fetal Health Research Center, Hope Generation Foundation, Tehran, Iran.,Gene Therapy and Regenerative Medicine Research Center, Hope Generation Foundation, Tehran, Iran
| | | | - Sara Darbandi
- Fetal Health Research Center, Hope Generation Foundation, Tehran, Iran.,Gene Therapy and Regenerative Medicine Research Center, Hope Generation Foundation, Tehran, Iran
| | | | | | - Sajal Gupta
- American Center for Reproductive Medicine, Cleveland, OH, USA
| | | | - Renata Finelli
- American Center for Reproductive Medicine, Cleveland, OH, USA
| | - Hassan N Sallam
- Department of Obstetrics and Gynaecology, Alexandria University Faculty of Medicine, Alexandria, Egypt
| | - Kelly A Wirka
- Fertility & Endocrinology, Medical Affairs, EMD Serono, USA
| | - Florence Boitrelle
- Reproductive Biology, Fertility Preservation, Andrology, CECOS, Poissy Hospital, Poissy, France.,Department of Biology, Reproduction, Epigenetics, Environment and Development, Paris Saclay University, UVSQ, INRAE, BREED, Jouy-en-Josas, France
| | - Ashok Agarwal
- American Center for Reproductive Medicine, Cleveland, OH, USA -
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Yung SSF, Lai SF, Lam MT, Lui EMW, Ko JKY, Li HWR, Wong JYY, Lau EYL, Yeung WSB, Ng EHY. Hyaluronic acid-enriched transfer medium for frozen embryo transfer: a randomized, double-blind, controlled trial. Fertil Steril 2021; 116:1001-1009. [PMID: 33845988 DOI: 10.1016/j.fertnstert.2021.02.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 01/25/2021] [Accepted: 02/10/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To compare the effects of hyaluronic acid (HA)-enriched transfer medium versus standard medium on live birth rate after frozen embryo transfer (FET). DESIGN Randomized, double-blind, controlled trial. SETTING Two tertiary fertility centers. PATIENT(S) Infertile women aged <43 years at the time of in vitro fertilization undergoing FET. INTERVENTION(S) The women were randomly assigned to 2 groups in a 1:1 ratio. The HA group used EmbryoGlue (Vitrolife, Gothenburg, Sweden) with an HA concentration of 0.5 mg/mL, while the control group used supplemented G-2 (Vitrolife) medium with an HA concentration of 0.125 mg/mL. MAIN OUTCOME MEASURE(S) Live birth rate. RESULT(S) Five hundred fifty women were recruited from April 2016 to April 2018 and included in the intention-to-treat analysis. Eight women in the HA group and 5 women in the control group did not undergo FET because the embryos did not survive on thawing. One woman in the HA group cancelled FET because of fever. One woman in the HA group withdrew and received conventional medium. The 2 groups were similar in demographic characteristics. The live birth rates in the HA group and the control group were comparable (25.5% vs. 25.8%; relative risk 0.99; 95% confidence interval 0.74-1.31). The other clinical outcomes were also similar between the 2 groups. Logistic regression showed that the type of transfer medium was not associated with live birth. CONCLUSION(S) The use of HA-enriched transfer medium does not improve the live birth rate of FET compared with standard medium. TRIAL REGISTRATION NUMBER NCT02725827 (ClinicalTrials.gov).
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Affiliation(s)
- Sofie Shuk Fei Yung
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, People's Republic of China.
| | - Shui Fan Lai
- Department of Obstetrics and Gynaecology, Kwong Wah Hospital, Yaumatei, Kowloon, Hong Kong Special Administrative Region, People's Republic of China
| | - Mei Ting Lam
- Department of Obstetrics and Gynaecology, Kwong Wah Hospital, Yaumatei, Kowloon, Hong Kong Special Administrative Region, People's Republic of China
| | - Ellen Man Wa Lui
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, People's Republic of China
| | - Jennifer Ka Yee Ko
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, People's Republic of China
| | - Hang Wun Raymond Li
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, People's Republic of China
| | - Jacki Yuk Ying Wong
- Department of Obstetrics and Gynaecology, Kwong Wah Hospital, Yaumatei, Kowloon, Hong Kong Special Administrative Region, People's Republic of China
| | - Estella Yee Lan Lau
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, People's Republic of China
| | - William Shu Biu Yeung
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, People's Republic of China
| | - Ernest Hung Yu Ng
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, People's Republic of China
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Dong M, Sun L, Huang L, Yi Y, Zhang X, Tan Y, Song G, Liu L, Wei F, Liu F. Gonadotropin-releasing hormone agonist combined with hormone replacement therapy does not improve the reproductive outcomes of frozen-thawed embryo transfer cycle in elderly patients: a retrospective study. Reprod Biol Endocrinol 2020; 18:73. [PMID: 32669123 PMCID: PMC7362427 DOI: 10.1186/s12958-020-00626-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 06/30/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND With the rapid development of whole embryo freezing technology, more and more frozen-thawed embryo transfer (FET) was used in assisted reproductive technology. However, the best FET program for elderly women has not been finalized. We intended to explore the reproductive outcomes of traditional hormone replacement treatment and a gonadotropin-releasing hormone agonist (GnRHa) combined with hormone replacement treatment in the frozen-thawed embryo transfer cycle of elderly patients. METHODS In this retrospective analysis, we analyzed 1264 elderly patients (aged 38 years or older) who underwent FET at three reproductive centers between 2015 and 2017. According to the endometrial preparation protocol, we divided the patients into a GnRHa combined with hormone replacement treatment (GnRHa-HRT) group and traditional hormone replacement treatment (HRT) group. The clinical pregnancy, ongoing pregnancy, live birth, and abortion rates were compared between groups. RESULTS One-way analysis of variance of the two groups revealed no significant difference in the clinical (33.58% vs. 37.15%) and ongoing pregnancy rates (19.40% vs. 25.10%) between the GnRHa-HRT and HRT groups. The live birth rate (17.54% vs. 24.10% p = 0.0229) of the GnRHa-HRT group was lower than that of the HRT group, whereas the abortion rate (45.56% vs. 32.97% p = 0.0252) was higher than that of the HRT group. However, multivariate analysis showed no significant difference in the live birth rate (p = 0.1333) or abortion rate (p = 0.1881) between the GnRHa-HRT and HRT groups. The number of embryos transferred, level of the embryo, and age and ovarian reserve of the patient significantly affected final reproductive outcomes. CONCLUSION A GnRH agonist combined with hormone replacement therapy did not improve the reproductive outcomes of frozen-thawed embryo cycles in elderly patients.
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Affiliation(s)
- Mei Dong
- grid.459579.3Department of Reproductive Medical Center, Guangdong Women and Children Hospital, No. 521 Xingnan Road, Guangzhou, 511400 Guangdong Province China
| | - Li Sun
- grid.459579.3Department of Reproductive Medical Center, Guangdong Women and Children Hospital, No. 521 Xingnan Road, Guangzhou, 511400 Guangdong Province China
| | - Li Huang
- grid.459579.3Department of Reproductive Medical Center, Guangdong Women and Children Hospital, No. 521 Xingnan Road, Guangzhou, 511400 Guangdong Province China
| | - Yanhong Yi
- grid.459579.3Department of Reproductive Medical Center, Guangdong Women and Children Hospital, No. 521 Xingnan Road, Guangzhou, 511400 Guangdong Province China
| | - Xiqian Zhang
- grid.459579.3Department of Reproductive Medical Center, Guangdong Women and Children Hospital, No. 521 Xingnan Road, Guangzhou, 511400 Guangdong Province China
| | - Ying Tan
- Department of Reproductive Medicine Center, Family Planning Special Hospital of Guangdong Province, Guangzhou, China
| | - Ge Song
- Department of Reproductive Medicine Center, Family Planning Special Hospital of Guangdong Province, Guangzhou, China
| | - Liling Liu
- grid.410652.40000 0004 6003 7358Department of Reproductive Medicine and Genetics Center, the People’s Hospital of Guangxi Zhuang Autonomous Region, 6 Taoyuan Road, Nanning, China
| | - Fu Wei
- grid.410652.40000 0004 6003 7358Department of Reproductive Medicine and Genetics Center, the People’s Hospital of Guangxi Zhuang Autonomous Region, 6 Taoyuan Road, Nanning, China
| | - Fenghua Liu
- grid.459579.3Department of Reproductive Medical Center, Guangdong Women and Children Hospital, No. 521 Xingnan Road, Guangzhou, 511400 Guangdong Province China
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Balakier H, Kuznyetsova I, Librach CL. The impact of hyaluronan-enriched culture medium and intrauterine infusion of human chorionic gonadotropin on clinical outcomes in blastocyst transfer cycles. Syst Biol Reprod Med 2020; 66:79-88. [PMID: 32129683 DOI: 10.1080/19396368.2020.1727995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Over the last few decades, advances in ovarian hormonal stimulation, embryology laboratory technologies and embryo genetic testing, have significantly enhanced clinical outcomes in human assisted reproduction technologies (ART). However, embryo implantation remains a major bottleneck in achieving better pregnancy and live birth rates. Thus, there is growing interest in establishing new approaches to enhance implantation efficiency after embryo transfer. With advanced molecular techniques, many promising biomarkers associated with embryonic and endometrial changes occurring prior to and during embryo implantation have been identified. However, despite the progress in applying novel procedures into IVF practice, clinical evaluation of those biomarkers has so far reached modest predictive value for enhancing blastocyst developmental potential and endometrial receptivity. Therefore, other simpler strategies have also been introduced to increase the rates of successful clinical pregnancies and live births. One of these approaches is to investigate the impact of using embryo transfer medium containing high concentrations of an adherence compound, such as hyaluronic acid (HA), on IVF outcomes. Additionally, intrauterine infusion of a small volume of human chorionic gonadotropin (hCG) at the time of embryo transfer (ET) has also been proposed as a technique that might be advantageous for increasing the clinical outcomes, considering the fact that hCG plays a critical role in synchronizing endometrial and fetal development. However, the current findings from both interventions remain controversial, demonstrating a mixture of positive and indifferent results of these treatments in ART cycles. Further research will be crucial for a better understanding of the molecular mechanism of cross-talk between the blastocyst and the maternal endometrium during the optimal implantation period when using either hyaluronan-enriched medium or hCG infusion before embryo transfers. Therefore, this review aims to present existing literature related to both treatments, emphasizing their effects on blastocyst implantation.Abbreviations: ART: assisted reproduction technologies; HA: hyaluronic acid; hCG: human chorionic gonadotrophin; IVF: in vitro Fertilization; ET: embryo transfer; pH: hydrogen ions; CO2: Carbone dioxide; O2: Oxygen; PGT: pre-implantation genetic testing; FET: frozen embryo transfer; PCOS: Polycystic ovarian syndrome; DNA: deoxyribonucleic acid; miRNA: micro-ribonucleic acid; EVs: extracellular vesicles; ERA: endometrial receptivity array; CD44 and RHAMM: primary hyaluronan surface receptors; RCT: randomized clinical trials; LBR: life birth rate; CPR: clinical pregnancy rate; IR: implantation rate.
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Affiliation(s)
| | | | - Clifford L Librach
- CReATe Fertility Centre, Toronto, ON, Canada.,Department of Obstetrics and Gynecology, University of Toronto, Toronto, Canada.,Department of Gynecology, Women's College Hospital, Toronto, Ontario, Canada
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