1
|
Alteri A, Reschini M, Guarneri C, Bandini V, Bertapelle G, Pinna M, Rabellotti E, Ferrari S, Papaleo E, Paffoni A, Viganò P, Somigliana E. The effect of laser-assisted hatching on vitrified/warmed blastocysts: the ALADDIN randomized controlled trial. Fertil Steril 2024; 122:106-113. [PMID: 38342371 DOI: 10.1016/j.fertnstert.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 02/05/2024] [Accepted: 02/06/2024] [Indexed: 02/13/2024]
Abstract
OBJECTIVE To evaluate whether laser-mediated assisted hatching (AH) performed on vitrified/warmed blastocysts before embryo transfer can improve live birth rate. DESIGN The "pArtiaL zonA pelluciDa removal by assisteD hatchINg of blastocysts (ALADDIN)" is a 2-center comparative study with a parallel randomized controlled design. SETTING University hospital. PATIENTS Participants were recruited between September 2018 and November 2021. They were aged 18-39 years, underwent nondonor in vitro fertilization cycles, and were scheduled for elective single embryo transfer with vitrified/warmed blastocysts. Those with uterine abnormalities, body mass index of >35 kg/m2, severe male factor infertility, or performing preimplantation genetic testing were excluded. INTERVENTION Assisted hatching was performed using a 1,480 nm diode laser, removing approximately one-third of the zona pellucida with continuous 0.2 ms pulses applied from the 1-5 o'clock positions. MAIN OUTCOME MEASURES The primary outcome was the live birth rate. Secondary end points included clinical pregnancy, miscarriage, multiple pregnancies, preterm births, obstetric and neonatal complications, and congenital anomalies. RESULTS Overall, 698 participants met the inclusion criteria and were randomized: 352 patients were assigned to the AH arm and 346 to the control arm. Of the participants, 105 (29.8%) and 101 (29.2%), respectively, achieved a live birth after treatment. The relative risk of live birth in patients with vitrified/warmed blastocysts treated with AH was 1.02 (95% confidence interval, 0.86-1.19). Exploratory subgroup analyses for women's age, recruiting centers, indications for in vitro fertilization, method of insemination, blastocyst quality, and days of blastocyst development failed to highlight any clinical situation that could benefit from AH in thawed blastocysts. CONCLUSION In patients undergoing frozen embryo transfer with vitrified/warmed blastocysts, laser AH does not improve the live birth rate. Further studies are required to rule out milder but potentially interesting benefits in specific subgroups of patients. TRIAL REGISTRATION ClinicalTrials.gov: NCT03623659.
Collapse
Affiliation(s)
- Alessandra Alteri
- Obstetrics and Gynaecology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Marco Reschini
- Infertility Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Cristina Guarneri
- Infertility Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Veronica Bandini
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Giulia Bertapelle
- Obstetrics and Gynaecology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Monica Pinna
- Infertility Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Elisa Rabellotti
- Obstetrics and Gynaecology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Stefania Ferrari
- Infertility Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Enrico Papaleo
- Obstetrics and Gynaecology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Paola Viganò
- Obstetrics and Gynaecology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Edgardo Somigliana
- Infertility Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| |
Collapse
|
2
|
Baatarsuren M, Jamiyansuren J, Ganbaatar C, Sengebaljir D, Erdenekhuyag B, Enkhbaatar S, Baljinnyam L, Radnaa E, Dorjpurev A, Ganbat G, Boris T, Khangarid A. Clinical and neonatal outcomes of complete zona pellucida removal by laser-assisted hatching after single vitrified-warmed blastocyst transfer. Lasers Med Sci 2024; 39:51. [PMID: 38285329 DOI: 10.1007/s10103-024-04002-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 01/22/2024] [Indexed: 01/30/2024]
Abstract
Laser-assisted hatching (LAH) is a widely used and unavoidable technique in assisted reproductive technology after frozen embryo transfer (FET). We aimed to investigate the safety and efficacy of completely ZP (zona pellucida) removed by an assisted laser group compared to an intact group after FET. This retrospective study involved 320 SVBT single vitrified-warmed blastocyst transfers of 213 patients who underwent clomiphene citrate (CC) based minimal stimulation protocol. This study compared 160 SVBT with ZP that were completely removed using laser-assisted (laser beams of 10-15, a wavelength of 1.48 μm, and duration of 1.8-2.2 ms) to 160 cases of intact SVBT. Fisher's exact test, chi-squared test, and logistic regression are used for statistical analysis. The women's age, cause of infertility, BMI, transferred embryo day, insemination methods, and blastocyst grade were not significantly different between two groups. The implantation rate (66.2% vs. 51.2%, P < 0.01), the clinical pregnancy rate (CPR, 52.5% vs. 39.3%, P = 0.01), and the live birth rate (LBR, 43.7% vs. 29.3%, P < 0.01) were significantly higher in the completely ZP removed than the intact group. In logistic regression analysis, the laser-assisted hatching group showed about 2 times higher implantation rate and CPR and LBR than the control group. But miscarriage, gestational weeks, gender, birth weight, and twin births were insignificant between two groups. Our study suggests ZP free embryo transfer by assisted laser is more effective and safer than intact embryo transfer.
Collapse
Affiliation(s)
| | - Jambaldorj Jamiyansuren
- Ojinmed IVF Center, Ulaanbaatar, Mongolia
- Department of Molecular Biology and Genetics, School of Biomedicine, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
- Department of Biochemistry, School of Medicine, International University of Health and Welfare, Narita, Japan
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
3
|
Chen X, Zhao H, Lv J, Dong Y, Zhao M, Sui X, Cui R, Liu B, Wu K. Calcium ionophore improves embryonic development and pregnancy outcomes in patients with previous developmental problems in ICSI cycles. BMC Pregnancy Childbirth 2022; 22:894. [PMID: 36460987 PMCID: PMC9717248 DOI: 10.1186/s12884-022-05228-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 11/17/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Calcium (Ca2+) ionophores are now mainly considered as efficient treatments for fertilization failure. Recently, its application for rescuing poor embryo development was proposed but still non-routine. This study aimed to explore whether Ca2+ ionophore improves embryo development and pregnancy outcomes in patients with poor embryo development in previous intracytoplasmic sperm injection (ICSI) cycles. METHODS This study included 97 patients undergoing assisted oocyte activation (AOA) with Ca2+ ionophore (calcimycin, A23187) treatment. Preimplantation embryonic development and clinical outcomes were compared between ICSI-AOA cycles (AOA group) and previous ICSI cycles of the same patients in which poor embryo developmental potential was present (non-AOA group). Subgroups stratified by maternal age (< 35, 35-40, ≥ 40 years, respectively) were analyzed separately. RESULTS A total of 642 MII oocytes were collected in AOA group, and 689 in non-AOA group. Significantly higher day 3 good quality embryo rate (P = 0.034), good quality blastocyst formation rate (P < 0.001), and utilization rate (P < 0.001) were seen in AOA group. Similar results were seen in each subgroup. For pregnancy outcomes, there were significant differences in clinical pregnancy rate (P = 0.039) and live birth rate (P = 0.045) in total group. In subgroup aged < 35 years, biochemical (P = 0.038), clinical (P = 0.041), and ongoing pregnancy rate (P = 0.037) in AOA group were significantly higher than that in non-AOA group. No significant improvement for clinical outcomes for subgroups aged 35-40 and aged ≥40. CONCLUSION The study suggests that calcimycin could improve preimplantation development and pregnancy outcomes in patients aged < 35 years with embryo developmental problems in previous ICSI cycles.
Collapse
Affiliation(s)
- Xiaolei Chen
- grid.27255.370000 0004 1761 1174Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, 250012 Shandong China ,grid.27255.370000 0004 1761 1174Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012 Shandong China ,grid.27255.370000 0004 1761 1174Shandong Key Laboratory of Reproductive Medicine, Jinan, 250012 Shandong China ,Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, 250012 Shandong China ,Shandong Technology Innovation Center for Reproductive Health, Jinan, 250012 Shandong China ,grid.27255.370000 0004 1761 1174National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, 250012 Shandong China
| | - Haibin Zhao
- grid.27255.370000 0004 1761 1174Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, 250012 Shandong China ,grid.27255.370000 0004 1761 1174Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012 Shandong China ,grid.27255.370000 0004 1761 1174Shandong Key Laboratory of Reproductive Medicine, Jinan, 250012 Shandong China ,Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, 250012 Shandong China ,Shandong Technology Innovation Center for Reproductive Health, Jinan, 250012 Shandong China ,grid.27255.370000 0004 1761 1174National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, 250012 Shandong China
| | - Jiale Lv
- grid.27255.370000 0004 1761 1174Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, 250012 Shandong China ,grid.27255.370000 0004 1761 1174Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012 Shandong China ,grid.27255.370000 0004 1761 1174Shandong Key Laboratory of Reproductive Medicine, Jinan, 250012 Shandong China ,Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, 250012 Shandong China ,Shandong Technology Innovation Center for Reproductive Health, Jinan, 250012 Shandong China ,grid.27255.370000 0004 1761 1174National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, 250012 Shandong China
| | - Yi Dong
- grid.27255.370000 0004 1761 1174Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, 250012 Shandong China ,grid.27255.370000 0004 1761 1174Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012 Shandong China ,grid.27255.370000 0004 1761 1174Shandong Key Laboratory of Reproductive Medicine, Jinan, 250012 Shandong China ,Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, 250012 Shandong China ,Shandong Technology Innovation Center for Reproductive Health, Jinan, 250012 Shandong China ,grid.27255.370000 0004 1761 1174National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, 250012 Shandong China
| | - Maoning Zhao
- grid.27255.370000 0004 1761 1174Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, 250012 Shandong China ,grid.27255.370000 0004 1761 1174Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012 Shandong China ,grid.27255.370000 0004 1761 1174Shandong Key Laboratory of Reproductive Medicine, Jinan, 250012 Shandong China ,Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, 250012 Shandong China ,Shandong Technology Innovation Center for Reproductive Health, Jinan, 250012 Shandong China ,grid.27255.370000 0004 1761 1174National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, 250012 Shandong China
| | - Xinlei Sui
- grid.27255.370000 0004 1761 1174Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, 250012 Shandong China ,grid.27255.370000 0004 1761 1174Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012 Shandong China ,grid.27255.370000 0004 1761 1174Shandong Key Laboratory of Reproductive Medicine, Jinan, 250012 Shandong China ,Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, 250012 Shandong China ,Shandong Technology Innovation Center for Reproductive Health, Jinan, 250012 Shandong China ,grid.27255.370000 0004 1761 1174National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, 250012 Shandong China
| | - Ran Cui
- grid.27255.370000 0004 1761 1174Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, 250012 Shandong China ,grid.27255.370000 0004 1761 1174Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012 Shandong China ,grid.27255.370000 0004 1761 1174Shandong Key Laboratory of Reproductive Medicine, Jinan, 250012 Shandong China ,Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, 250012 Shandong China ,Shandong Technology Innovation Center for Reproductive Health, Jinan, 250012 Shandong China ,grid.27255.370000 0004 1761 1174National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, 250012 Shandong China
| | - Boyang Liu
- grid.27255.370000 0004 1761 1174Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, 250012 Shandong China ,grid.27255.370000 0004 1761 1174Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012 Shandong China ,grid.27255.370000 0004 1761 1174Shandong Key Laboratory of Reproductive Medicine, Jinan, 250012 Shandong China ,Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, 250012 Shandong China ,Shandong Technology Innovation Center for Reproductive Health, Jinan, 250012 Shandong China ,grid.27255.370000 0004 1761 1174National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, 250012 Shandong China
| | - Keliang Wu
- grid.27255.370000 0004 1761 1174Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, 250012 Shandong China ,grid.27255.370000 0004 1761 1174Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012 Shandong China ,grid.27255.370000 0004 1761 1174Shandong Key Laboratory of Reproductive Medicine, Jinan, 250012 Shandong China ,Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, 250012 Shandong China ,Shandong Technology Innovation Center for Reproductive Health, Jinan, 250012 Shandong China ,grid.27255.370000 0004 1761 1174National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, 250012 Shandong China
| |
Collapse
|
4
|
Fu L, Chen S, Wang M, Huang G, Wang F, Lan Y, Liu S, Jiang X. Live birth from a blastocyst derived from a conjoined oocyte in a frozen embryo transfer cycle: a case report and a literature review. J Assist Reprod Genet 2022; 39:1351-1357. [PMID: 35320445 DOI: 10.1007/s10815-022-02465-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 03/15/2022] [Indexed: 11/26/2022] Open
Abstract
The significance of conjoined oocytes in the clinical in vitro fertilization (IVF) laboratory setting has been questionable due to the extremely limited data available. This issue is discussed by presenting one case for conjoined oocyte observed in the program of the assisted reproduction and by including a review of corresponding literature. This report describes a successful clinical pregnancy with subsequent live birth from a conjoined oocyte. To our knowledge, there are only three reported cases of successful live birth from conjoined oocytes, but this is the first case of live birth from a blastocyst derived from a conjoined oocyte fertilized using intracytoplasmic sperm injection (ICSI) in a frozen embryo transfer cycle. Moreover, this study reports the first time that live birth of a conjoined oocyte is achieved without removing the degenerated immature oocyte prior to transfer. It demonstrates that the degenerated immature oocyte has no adverse effect on subsequent embryo development and pregnancy outcome. In addition, we reviewed the literature to evaluate the origin, incidence, safety, and significance of conjoined oocytes in reproductive health. We further confirm previous reports that demonstrate that a mature oocyte from conjoined-oocyte complexes can be fertilized by standard IVF or ICSI and lead to the development of a blastocyst, subsequent pregnancy, and live birth.
Collapse
Affiliation(s)
- Li Fu
- Department of Reproductive Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, China.
| | - Shaowei Chen
- Department of Reproductive Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, China
| | - Mingyong Wang
- Department of Reproductive Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, China
| | - Guiying Huang
- Department of Reproductive Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, China
| | - Fang Wang
- Department of Reproductive Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, China
| | - Yunzhu Lan
- Department of Reproductive Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, China
| | - Shuang Liu
- Department of Reproductive Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, China
| | - Xia Jiang
- Department of Reproductive Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, China
| |
Collapse
|