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Liu RL, Wang T, Yao YL, Lv XY, Hu YL, Chen XZ, Tang XJ, Zhong ZH, Fu LJ, Luo X, Geng LH, Yu SM, Ding YB. Association of ambient air pollutant mixtures with IVF/ICSI-ET clinical pregnancy rates during critical exposure periods. Hum Reprod Open 2024; 2024:hoae051. [PMID: 39301245 PMCID: PMC11412601 DOI: 10.1093/hropen/hoae051] [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: 04/01/2024] [Revised: 08/04/2024] [Indexed: 09/22/2024] Open
Abstract
STUDY QUESTION Does exposure to a mixture of ambient air pollutants during specific exposure periods influence clinical pregnancy rates in women undergoing IVF/ICSI-embryo transfer (ET) cycles? SUMMARY ANSWER The specific exposure period from ET to the serum hCG test was identified as a critical exposure window as exposure to sulfur dioxide (SO2) or a combination of air pollutants was associated with a decreased likelihood of clinical pregnancy. WHAT IS KNOWN ALREADY Exposure to a single pollutant may impact pregnancy outcomes in women undergoing ART. However, in daily life, individuals often encounter mixed pollution, and limited research exists on the effects of mixed air pollutants and the specific exposure periods. STUDY DESIGN SIZE DURATION This retrospective cohort study involved infertile patients who underwent their initial IVF/ICSI-ET cycle at an assisted reproduction center between January 2020 and January 2023. Exclusions were applied for patients meeting specific criteria, such as no fresh ET, incomplete clinical and address information, residency outside the 17 cities in the Sichuan Basin, age over 45 years, use of donor semen, thin endometrium (<8 mm) and infertility factors unrelated to tubal or ovulation issues. In total, 5208 individuals were included in the study. PARTICIPANTS/MATERIALS SETTING METHODS Daily average levels of six air pollutants (fine particulate matter (PM2.5), inhalable particulate matter (PM10), SO2, nitrogen dioxide (NO2), carbon monoxide (CO), and ozone (O3)) were acquired from air quality monitoring stations. The cumulative average levels of various pollutants were determined using the inverse distance weighting (IDW) method across four distinct exposure periods (Period 1: 90 days before oocyte retrieval; Period 2: oocyte retrieval to ET; Period 3: ET to serum hCG test; Period 4: 90 days before oocyte retrieval to serum hCG test). Single-pollutant logistic regression, two-pollutant logistic regression, Quantile g-computation (QG-C) regression, and Bayesian kernel machine regression (BKMR) were employed to evaluate the influence of pollutants on clinical pregnancy rates. Stratified analyses were executed to discern potentially vulnerable populations. MAIN RESULTS AND THE ROLE OF CHANCE The clinical pregnancy rate for participants during the study period was 54.53%. Single-pollutant logistic models indicated that for PM2.5 during specific exposure Period 1 (adjusted odds ratio [aOR] = 0.83, 95% CI: 0.70-0.99) and specific exposure Period 4 (aOR = 0.83, 95% CI: 0.69-0.98), and SO2 in specific exposure Period 3 (aOR = 0.92, 95% CI: 0.86-0.99), each interquartile range (IQR) increment exhibited an association with a decreased probability of clinical pregnancy. Consistent results were observed with dual air pollution models. In the multi-pollution analysis, QG-C indicated a 12% reduction in clinical pregnancy rates per IQR increment of mixed pollutants during specific exposure Period 3 (aOR = 0.89, 95% CI: 0.79-0.99). Among these pollutants, SO2 (33.40%) and NO2 (33.40%) contributed the most to the negative effects. The results from BKMR and QG-C were consistent. Stratified analysis revealed increased susceptibility to ambient air pollution among individuals who underwent transfer of two embryos, those with BMI ≥ 24 kg/m2 and those under 35 years old. LIMITATIONS REASONS FOR CAUTION Caution was advised in interpreting the results due to the retrospective nature of the study, which was prone to selection bias from non-random sampling. Smoking and alcohol, known confounding factors in IVF/ICSI-ET, were not accounted for. Only successful cycles that reached the hCG test were included, excluding a few patients who did not reach the ET stage. While IDW was used to estimate pollutant concentrations at residential addresses, data on participants' work locations and activity patterns were not collected, potentially affecting the accuracy of exposure prediction. WIDER IMPLICATIONS OF THE FINDINGS Exposure to a mixture of pollutants, spanning from ET to the serum hCG test (Period 3), appeared to be correlated with a diminished probability of achieving clinical pregnancy. This association suggested a potential impact of mixed pollutants on the interaction between embryos and the endometrium, as well as embryo implantation during this critical stage, potentially contributing to clinical pregnancy failure. This underscored the importance of providing women undergoing ART with comprehensive information to comprehend the potential environmental influences and motivating them to adopt suitable protective measures when feasible, thereby mitigating potential adverse effects of contaminants on reproductive health. STUDY FUNDING/COMPETING INTERESTS This work received support from the National Key Research and Development Program of China (No. 2023YFC2705900), the National Natural Science Foundation of China (Nos. 82171664, 81971391, 82171668), the Natural Science Foundation of Chongqing Municipality of China (Nos. CSTB2022NSCQ-LZX0062, CSTB2023TIAD-KPX0052) and the Foundation of State Key Laboratory of Ultrasound in Medicine and Engineering (No. 2021KFKT013). The authors report no conflicts of interest. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Rui-Ling Liu
- Department of Obstetrics and Gynecology, Women and Children's Hospital of Chongqing Medical University, Chongqing, China
- Department of Toxicology, Joint International Research Laboratory of Reproduction and Development of the Ministry of Education of China, School of Public Health, Chongqing Medical University, Chongqing, China
| | - Tong Wang
- Department of Toxicology, Key Lab of Medical Protection for Electromagnetic Radiation, Ministry of Education of China, Institute of Toxicology, College of Preventive Medicine, Third Military Medical University (Army Medical University), Chongqing, China
| | - Ying-Ling Yao
- Department of Toxicology, Joint International Research Laboratory of Reproduction and Development of the Ministry of Education of China, School of Public Health, Chongqing Medical University, Chongqing, China
| | - Xing-Yu Lv
- The Reproductive Center, Sichuan Jinxin Xinan Women & Children's Hospital, Chengdu, Sichuan, China
| | - Yu-Ling Hu
- The Reproductive Center, Sichuan Jinxin Xinan Women & Children's Hospital, Chengdu, Sichuan, China
| | - Xin-Zhen Chen
- Department of Obstetrics and Gynecology, Women and Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Xiao-Jun Tang
- Department of Toxicology, Joint International Research Laboratory of Reproduction and Development of the Ministry of Education of China, School of Public Health, Chongqing Medical University, Chongqing, China
| | - Zhao-Hui Zhong
- Department of Toxicology, Joint International Research Laboratory of Reproduction and Development of the Ministry of Education of China, School of Public Health, Chongqing Medical University, Chongqing, China
| | - Li-Juan Fu
- Department of Toxicology, Joint International Research Laboratory of Reproduction and Development of the Ministry of Education of China, School of Public Health, Chongqing Medical University, Chongqing, China
- Department of Pharmacology, Academician Workstation, Changsha Medical University, Changsha, China
| | - Xin Luo
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Li-Hong Geng
- The Reproductive Center, Sichuan Jinxin Xinan Women & Children's Hospital, Chengdu, Sichuan, China
| | - Shao-Min Yu
- Department of Obstetrics and Gynecology, The People's Hospital of Yubei, Chongqing, China
| | - Yu-Bin Ding
- Department of Obstetrics and Gynecology, Women and Children's Hospital of Chongqing Medical University, Chongqing, China
- Department of Pharmacology, Academician Workstation, Changsha Medical University, Changsha, China
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Wang J, Xiong S, Hao X, Gao Y, Xia F, Liao H, Zou J, Huang G, Han W. Evaluating the developmental potential of 2.1PN-derived embryos and associated chromosomal analysis. J Assist Reprod Genet 2024; 41:1597-1603. [PMID: 38613651 PMCID: PMC11224204 DOI: 10.1007/s10815-024-03113-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 03/28/2024] [Indexed: 04/15/2024] Open
Abstract
PURPOSE Zygotes with 2.1 pronuclei (2.1PN) present with two normal-sized pronuclei, and an additional smaller pronucleus, that is approximately smaller than two thirds the size of a normal pronucleus. It remains unclear whether the additional pronucleus causes embryonic chromosome abnormalities. In the majority of cases, in vitro fertilization (IVF) clinics discarded 2.1PN zygotes. Thus, the present study aimed to evaluate the developmental potential and value of 2.1PN zygotes. METHODS 2.1PN-derived embryos from 164 patients who underwent IVF or intracytoplasmic sperm injection (ICSI) treatment between January 2021 and December 2022 were included in the present study. All embryos were monitored using a time-lapse system, and blastocyst formation was used to assess 2.1PN-derived embryo developmental potential. The blastocyst formation was quantified using generalized estimating equations, and chromosome euploidy was analyzed using next-generation sequencing (NGS). In addition, the potential association between age and occurrence of 2.1PN zygotes was determined. RESULTS The present study demonstrated that numerous 2.1PN zygotes developed into blastocysts. Early cleavage patterns and embryo quality on Day 3 were the independent predictors for the blastocyst formation of 2.1PN-derived embryos. The 2.1PN zygotes displayed a comparable developmental potential compared to 2PN zygotes in advanced age patients (≥ 38). Moreover, there was a tendency that 2.1PN-derived blastocysts showed a similar euploidy rate compared to 2PN-derived blastocysts. CONCLUSION Clinicians should consider using 2.1PN-derived euploid embryos for transfer after preimplantation genetic testing in the absence of available 2PN embryo cycles. 2.1PN-derived embryos could be a candidate, particularly beneficial for patients at advanced age.
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Affiliation(s)
- Jiang Wang
- Center for Reproductive Medicine, Women and Children's Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Clinical Research Center for Reproductive Medicine, Chongqing Health Center for Women and Children, Chongqing, China
| | - Shun Xiong
- Center for Reproductive Medicine, Women and Children's Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Clinical Research Center for Reproductive Medicine, Chongqing Health Center for Women and Children, Chongqing, China
| | - Xiangwei Hao
- Center for Reproductive Medicine, Women and Children's Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Clinical Research Center for Reproductive Medicine, Chongqing Health Center for Women and Children, Chongqing, China
| | - Yang Gao
- Center for Reproductive Medicine, Women and Children's Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Clinical Research Center for Reproductive Medicine, Chongqing Health Center for Women and Children, Chongqing, China
| | - Fei Xia
- Center for Reproductive Medicine, Women and Children's Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Clinical Research Center for Reproductive Medicine, Chongqing Health Center for Women and Children, Chongqing, China
| | - Haiyuan Liao
- Center for Reproductive Medicine, Women and Children's Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Clinical Research Center for Reproductive Medicine, Chongqing Health Center for Women and Children, Chongqing, China
| | - Jiayi Zou
- Center for Reproductive Medicine, Women and Children's Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Clinical Research Center for Reproductive Medicine, Chongqing Health Center for Women and Children, Chongqing, China
| | - Guoning Huang
- Center for Reproductive Medicine, Women and Children's Hospital of Chongqing Medical University, Chongqing, China.
- Chongqing Clinical Research Center for Reproductive Medicine, Chongqing Health Center for Women and Children, Chongqing, China.
| | - Wei Han
- Center for Reproductive Medicine, Women and Children's Hospital of Chongqing Medical University, Chongqing, China.
- Chongqing Clinical Research Center for Reproductive Medicine, Chongqing Health Center for Women and Children, Chongqing, China.
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Sun LJ, Liang SS, Liu MH, Pan JP, Huang MY, Teng XM, Wu HX. Early cumulus cell removal increases cumulative live birth rate while having no negative effect on the malformation rate in in vitro fertilization: a propensity score-matched cohort study. Arch Gynecol Obstet 2024; 309:287-293. [PMID: 37755532 DOI: 10.1007/s00404-023-07212-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 08/30/2023] [Indexed: 09/28/2023]
Abstract
PURPOSE The aim of this study was to investigate the efficacy and safety of early cumulus cell removal (ECCR) during human in vitro fertilization (IVF). METHODS A retrospective analysis was performed between January 2011 and December 2019. The study enrolled 1131 couples who underwent IVF treatment with ECCR. After propensity score matching at a 1:1 ratio, 1131 couples who underwent overnight coincubation of gametes were selected. The main outcome measure was the cumulative live birth rate. Secondary outcome measures included the cumulative pregnancy rate, polyspermy rate, available embryo rate, miscarriage rate, malformation rate, time to live birth, and oocyte-to-baby rate. RESULTS There were no significant differences found between the two groups in the polyspermy rate, available embryo rate, miscarriage rate, time to live birth, oocyte-to-baby rate, and neonatal congenital anomalies rate. The results of the study showed that ECCR was associated with a significantly higher cumulative live birth rate and cumulative pregnancy rate, along with a significantly lower fertilization rate. CONCLUSIONS ECCR tended to confer increased cumulative live birth rate and had no negative effect on the neonatal malformation rate.
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Affiliation(s)
- Li Juan Sun
- Department of Reproductive Medicine, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Shan Shan Liang
- Department of Reproductive Medicine, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Min Hao Liu
- Department of Reproductive Medicine, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jia Ping Pan
- Department of Reproductive Medicine, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Mei Yuan Huang
- Department of Reproductive Medicine, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiao Ming Teng
- Department of Reproductive Medicine, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Hai Xia Wu
- Department of Reproductive Medicine, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China.
- Department of Reproductive Medicine, Longhua Women and Children's Health Hospital, 68 Huawang Road, Shenzhen, China.
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Fan Y, Wu Z, Peng F, Peng H, Liang X, Zhu S. Brief and long co-incubation of sperm and oocytes for in vitro fertilization: a meta-analysis of randomized controlled trials. BMC Pregnancy Childbirth 2023; 23:200. [PMID: 36959550 PMCID: PMC10035113 DOI: 10.1186/s12884-023-05490-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 03/02/2023] [Indexed: 03/25/2023] Open
Abstract
Background There is still no consensus on the optimal time of oocyte–sperm co-incubation during in vitro fertilization and embryo transfer (IVF-ET). The aim of this meta-analysis was to compare the effects of brief (1-6 h) and long (16-24 h) gametes co-incubation time on IVF outcomes. Methods The study protocol was registered online through PROSPERO (CRD42022337503) and PRISMA guidelines were followed in the present study. The following databases were searched from inception to May 2022 for randomized controlled trials (RCTs): PubMed, Embase, Cochrane library, Web of Science, using search terms related to IVF, gametes, time of co-incubation and reproductive outcome measure. Studies comparing outcomes of brief co-incubation to that of long co-incubation during IVF, and reporting primary outcome (live birth rate), secondary outcomes (clinical pregnancy rate; ongoing pregnancy rate; miscarriage rate; normal fertilization rate; polyspermy rate; top-quality embryo rate; implantation rate) were searched. A total of 11 studies were included in the meta-analysis. Combined odds ratio (OR) and 95% confidence interval (CI) were calculated for the data. Statistical heterogeneity analysis between studies was assessed by Cochran Q and I2 statistic with a significant threshold of P < 0.05. Methodologic quality assessment of RCTs was made for potential risk of bias with Cochrane Risk of Bias Tool. Results Compared to long-term co-incubation, brief co-incubation had an advantage in increasing implantation rate (OR: 1.97, 95% CI: 1.52–2.57), ongoing pregnancy rate (OR: 2.18, 95% CI: 1.44–3.29) and top-quality embryo rate (OR: 1.17, 95% CI: 1.02–1.35). However, brief co-incubation of gametes had no advantages in the live-birth rate (OR: 1.09, 95% CI: 0.72–1.65), miscarriage rate (OR: 1.32, 95% CI: 0.55–3.18), clinical pregnancy rate (OR: 1.36, 95% CI: 0.99–1.87) and polyspermy rate (OR: 0.80, 95% CI: 0.48–1.33) than long-term co-incubation. Additionally, the brief co-incubation was associated with lower normal fertilization rate (OR: 0.89, 95% CI: 0.80–0.99), compared with long co-incubation. Conclusions Brief co-incubation of gametes had the advantages in increasing implantation rate, ongoing pregnancy rate and top-quality embryo rate than long-term co-incubation. However, the live-birth rate displayed no difference between the two in vitro fertilization methods. Gametes co-incubation time should be individualized according to each patient’s IVF history, infertility causes and the semen parameters.
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Affiliation(s)
- Yiyue Fan
- grid.411304.30000 0001 0376 205XSchool of Medical and Life Sciences/Reproductive &Women-Children Hospital, Chengdu University of Traditional Chinese Medicine, No.1166 Liutai Avenue, Wenjiang District, Chengdu City, 611137 Sichuan Province China
| | - Zeyu Wu
- grid.449525.b0000 0004 1798 4472The Affiliated Nanchong Central Hospital of North Sichuan Medical University, Nanchong City, Sichuan Province China
| | - Fang Peng
- grid.411304.30000 0001 0376 205XSchool of Medical and Life Sciences/Reproductive &Women-Children Hospital, Chengdu University of Traditional Chinese Medicine, No.1166 Liutai Avenue, Wenjiang District, Chengdu City, 611137 Sichuan Province China
| | - Hongyao Peng
- grid.411304.30000 0001 0376 205XSchool of Medical and Life Sciences/Reproductive &Women-Children Hospital, Chengdu University of Traditional Chinese Medicine, No.1166 Liutai Avenue, Wenjiang District, Chengdu City, 611137 Sichuan Province China
| | - Xin Liang
- grid.411304.30000 0001 0376 205XSchool of Medical and Life Sciences/Reproductive &Women-Children Hospital, Chengdu University of Traditional Chinese Medicine, No.1166 Liutai Avenue, Wenjiang District, Chengdu City, 611137 Sichuan Province China
| | - Shaomi Zhu
- grid.411304.30000 0001 0376 205XSchool of Medical and Life Sciences/Reproductive &Women-Children Hospital, Chengdu University of Traditional Chinese Medicine, No.1166 Liutai Avenue, Wenjiang District, Chengdu City, 611137 Sichuan Province China
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Hu YL, Wang Y, Geng LH, Meng XQ, Xu HJ, Adu-Gyamfi EA, Zhong ZH, Wan Q, Ding YB. Effects of sequential cleavage and blastocyst embryo transfer on pregnancy outcomes in patients with poor ovarian response. J Reprod Immunol 2023; 155:103780. [PMID: 36481385 DOI: 10.1016/j.jri.2022.103780] [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: 05/28/2022] [Revised: 11/14/2022] [Accepted: 11/25/2022] [Indexed: 11/29/2022]
Abstract
The management of patients with poor ovarian response (POR) remains a major challenge for fertility specialists in in vitro fertilization-embryo transfer (IVF-ET). In this retrospective cohort study, we aimed to evaluate the clinical effect of sequential transfer on pregnancy outcomes in patients with POR. A total of 3579 POR patients who underwent the first frozen embryo transfer (FET) cycle were enrolled from January 2018 to April 2021. The patients were divided into three groups according to the embryo transfer (ET) strategy adopted: a study group that included POR patients in whom a cleavage-stage embryo (day 3) and a blastocyst (day 5/6) were transferred (sequential transfer group), and two control groups in whom two cleavage-stage embryos (D3-dET group) or two blastocysts (D5/6-dET group) were transferred. The study group was matched with the control groups at a ratio of 1:4 by propensity score matching (PSM). The main pregnancy outcomes measured were the live birth rate and multiple pregnancy rate. After PSM, the live birth rate in the sequential transfer group was significantly higher than that in the D3-dET group (44.2% vs. 34.3%, P = 0.019), and was similar to that in the D5/6-dET group (44.2% vs. 45.3%; P = 0.90). In addition, there was no increase in the risk of multiple pregnancy among POR patients undergoing sequential transfer compared with both D3-dET (26.7% vs. 25.6%, P = 0.85) and D5/6-dET (26.7% vs. 28.4%, P = 0.97) groups. These findings imply that sequential transfer is an effective option for POR patients and could be utilized after careful consideration.
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Affiliation(s)
- Yu-Ling Hu
- Chengdu Jinjiang Hospital for Women's and Children's Health, Chengdu 610011, China
| | - Yue Wang
- Department of Epidemiology, School of Public Health, Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing 400016, China; Joint International Research Laboratory of Reproduction and Development of the Ministry of Education of China, Department of Reproductive Biology, School of Public Health, Chongqing Medical University, Chongqing 400016, China
| | - Li-Hong Geng
- Chengdu Jinjiang Hospital for Women's and Children's Health, Chengdu 610011, China
| | - Xiang-Qian Meng
- Chengdu Jinjiang Hospital for Women's and Children's Health, Chengdu 610011, China
| | - Hai-Jiao Xu
- Chengdu Jinjiang Hospital for Women's and Children's Health, Chengdu 610011, China
| | - Enoch Appiah Adu-Gyamfi
- Joint International Research Laboratory of Reproduction and Development of the Ministry of Education of China, Department of Reproductive Biology, School of Public Health, Chongqing Medical University, Chongqing 400016, China
| | - Zhao-Hui Zhong
- Department of Epidemiology, School of Public Health, Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing 400016, China
| | - Qi Wan
- Chengdu Jinjiang Hospital for Women's and Children's Health, Chengdu 610011, China.
| | - Yu-Bin Ding
- Department of Obstetrics and Gynecology, Women and Childrens' Hospital of Chongqing Medical University, Chongqing 400000, China; Joint International Research Laboratory of Reproduction and Development of the Ministry of Education of China, Department of Reproductive Biology, School of Public Health, Chongqing Medical University, Chongqing 400016, China.
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Balli M, Cecchele A, Pisaturo V, Makieva S, Carullo G, Somigliana E, Paffoni A, Vigano’ P. Opportunities and Limits of Conventional IVF versus ICSI: It Is Time to Come off the Fence. J Clin Med 2022; 11:jcm11195722. [PMID: 36233589 PMCID: PMC9572455 DOI: 10.3390/jcm11195722] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 09/20/2022] [Accepted: 09/22/2022] [Indexed: 12/04/2022] Open
Abstract
Conventional IVF (c-IVF) is one of the most practiced assisted reproductive technology (ART) approaches used worldwide. However, in the last years, the number of c-IVF procedures has dropped dramatically in favor of intracytoplasmic sperm injection (ICSI) in cases of non-male-related infertility. In this review, we have outlined advantages and disadvantages associated with c-IVF, highlighting the essential steps governing its success, its limitations, the methodology differences among laboratories and the technical progress. In addition, we have debated recent insights into fundamental questions, including indications regarding maternal age, decreased ovarian reserve, endometriosis, autoimmunity, single oocyte retrieval-cases as well as preimplantation genetic testing cycles. The “overuse” of ICSI procedures in several clinical situations of ART has been critically discussed. These insights will provide a framework for a better understanding of opportunities associated with human c-IVF and for best practice guidelines applicability in the reproductive medicine field.
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Affiliation(s)
- Martina Balli
- Infertility Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milano, Italy
| | - Anna Cecchele
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milano, Italy
| | - Valerio Pisaturo
- Infertility Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milano, Italy
| | - Sofia Makieva
- Kinderwunschzentrum, Klinik für Reproduktions-Endokrinologie, Universitätsspital Zürich, 8091 Zurich, Switzerland
| | - Giorgia Carullo
- Infertility Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milano, Italy
| | - Edgardo Somigliana
- Infertility Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milano, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milano, Italy
| | | | - Paola Vigano’
- Infertility Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milano, Italy
- Correspondence:
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Fertilization and neonatal outcomes after early rescue intracytoplasmic sperm injection: a retrospective analysis of 16,769 patients. Arch Gynecol Obstet 2022; 306:249-258. [PMID: 35380279 PMCID: PMC9300487 DOI: 10.1007/s00404-022-06445-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 02/09/2022] [Indexed: 01/04/2023]
Abstract
Purpose To evaluate the efficacy and safety of short-term insemination and early-rescue intracytoplasmic sperm injection (ICSI), an approach that rescued oocytes with unclear second polar body 6 h after initial insemination by ICSI (early R-ICSI) to avoid total or near-total fertilization failure in conventional in vitro fertilization (IVF). Methods We performed a retrospective study in 16,769 patients (short-term IVF, n = 12,094; ICSI, n = 3452; early R-ICSI, n = 1223) who received IVF/ICSI treatment in our hospital from January 2009 to October 2018. Fertilization and clinical outcomes were compared among those three groups. Results When considering the R-ICSI embryos in the early R-ICSI group independently, the rates of fertilization and day-3 cleaved embryos in 2PN oocytes were comparable, the rates of fertilization (2PN) and high-quality embryos were lower, whereas the multi-PN fertilization rate (3.27%) was significantly higher than the ICSI group (1.26%). The difference of clinical pregnancy rate between the part of transferred R-ICSI embryos (40.81%) and the ICSI group (44.73%) remained nonsignificant. Furthermore, the rate of congenital birth defects in the early R-ICSI group (0.99%) was not significantly different from those in the short-term IVF (0.76%) and ICSI groups (1.07%). Conclusion Despite the multi-PN fertilization rate, our study highlights early R-ICSI as a safe and effective alternative in assisted reproduction to decrease complete IVF fertilization failure and reduce ICSI utilization. Additional large amount and long-term follow-up studies are needed to further validate the use of early R-ICSI.
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Xiong S, Hao X, Gao Y, Wu L, Liu J, Wang J, Zhu J, Li J, Liu D, Han W, Huang G. Accumulation of Cleavage-Stage Embryos by Vitrification may Compromise Embryonic Developmental Potential in Preimplantation Genetic Testing. Reprod Sci 2022; 29:1930-1938. [PMID: 35212931 DOI: 10.1007/s43032-022-00880-8] [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: 11/03/2021] [Accepted: 02/07/2022] [Indexed: 11/26/2022]
Abstract
It was suggested that the embryo pooling was an alternative for patients with insufficient number of embryos for preimplantation genetic testing (PGT) in a single ovarian stimulation cycle. However, limited study noticed whether it is an efficient strategy to pool cleavage-stage embryos by vitrification. This study included 71 cycles with vitrified-warmed and fresh embryos simultaneously for PGT between May 2016 and May 2021. The embryos from the same patients were split into two groups based on the origin: warming group and fresh group. Embryo development, sequencing results, clinical and neonatal outcomes were compared. The results showed that the rate of high-quality embryos in the warming group was significantly higher than that in the fresh group (64.53% versus 52.61%, P = 0.011); however, the available blastocyst rate in this group was significantly lower than that in the fresh group (47.29% versus 57.83%, P = 0.026). There were 96 and 144 blastocysts that underwent trophectoderm (TE) biopsy in warming and fresh groups, respectively. The high-quality blastocyst rate was significantly lower in the warming group compared to the fresh group (57.29% versus 70.14%, P = 0.041). The rates of genetic transferable blastocyst were comparable between the two groups (P = 0.956). There were no statistical differences in terms of embryo implantation, clinical pregnancy, miscarriage rates, and neonatal outcomes between the two groups. In conclusion, this study demonstrated that the cleavage-stage embryo pooling strategy might be unfavorable for the maintenance of embryonic development potential. If not necessary, it is not recommended to pool cleavage-stage embryos for PGT.
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Affiliation(s)
- Shun Xiong
- Chongqing Health Center for Women and Children, Chongqing, People's Republic of China
| | - Xiangwei Hao
- Chongqing Health Center for Women and Children, Chongqing, People's Republic of China
| | - Yang Gao
- Chongqing Health Center for Women and Children, Chongqing, People's Republic of China
| | - Lihong Wu
- Chongqing Health Center for Women and Children, Chongqing, People's Republic of China
| | - Junxia Liu
- Chongqing Health Center for Women and Children, Chongqing, People's Republic of China
| | - Jiang Wang
- Chongqing Health Center for Women and Children, Chongqing, People's Republic of China
| | - Jiahong Zhu
- Chongqing Health Center for Women and Children, Chongqing, People's Republic of China
| | - Jingyu Li
- Chongqing Key Laboratory of Human Embryo Engineering, Chongqing, People's Republic of China
| | - Dongyun Liu
- Chongqing Clinical Research Center for Reproductive Medicine, Chongqing, People's Republic of China
| | - Wei Han
- Chongqing Health Center for Women and Children, Chongqing, People's Republic of China.
| | - Guoning Huang
- Chongqing Health Center for Women and Children, Chongqing, People's Republic of China.
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Li J, Li C, Liu X, Yang J, Zhang Q, Han W, Huang G. GDF9 concentration in embryo culture medium is linked to human embryo quality and viability. J Assist Reprod Genet 2022; 39:117-125. [PMID: 34845575 PMCID: PMC8866627 DOI: 10.1007/s10815-021-02368-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 11/24/2021] [Indexed: 01/03/2023] Open
Abstract
PURPOSE We aimed to evaluate the link between the GDF9 concentration in day 3 human embryo culture medium and embryo quality and viability. METHODS Two independent, prospective, observational studies were conducted. In study 1, a total of 280 embryos from 70 patients who obtained at least 4 embryos with 6-10 blastomeres (2 transferable and 2 non-transferable embryos) at day 3 were enrolled. In study 2, a total of 119 embryos from 61 patients (29 fully implanted and 32 non-implanted patients) were enrolled. The corresponding GDF9 concentrations in spent culture medium of embryos were quantified by ELISA assay. The expression pattern of GDF9 in human embryos was investigated using Q-PCR and immunofluorescence. RESULTS GDF9 mRNA and protein were detected from human oocytes to eight-cell embryos and displayed a slow decreasing trend. In study 1, GDF9 concentration in culture medium is lower for transferable embryos compared with non-transferable embryos (331 pg/mL (quartiles: 442, 664 pg/mL) vs. 518 pg/mL (quartiles: 328, 1086 pg/mL), P < 0.001), and increased commensurate with the diminution of the embryo quality (P < 0.001). In study 2, significantly lower GDF9 concentration was detected for implanted embryos than non-implanted embryos (331 pg/mL (quartiles: 156, 665 pg/mL) vs. 518 pg/mL (quartiles: 328, 1086 pg/mL), P < 0.001). The same trend was found between the embryos that led to live birth and those that failed. CONCLUSION The GDF9 concentration in culture medium is linked to embryo quality and viability, and exhibited the potential to be a non-invasive biomarker for embryo selection.
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Affiliation(s)
- Jingyu Li
- Chongqing Reproduction and Genetics Institute, Chongqing Health Center for Women and Children, No.64 Jin Tang Street, Yu Zhong District, Chongqing, 400013 China ,Chongqing Key Laboratory of Human Embryo Engineering, Chongqing, China
| | - Chong Li
- Chongqing Reproduction and Genetics Institute, Chongqing Health Center for Women and Children, No.64 Jin Tang Street, Yu Zhong District, Chongqing, 400013 China ,Chongqing Key Laboratory of Human Embryo Engineering, Chongqing, China
| | - Xuemei Liu
- Chongqing Reproduction and Genetics Institute, Chongqing Health Center for Women and Children, No.64 Jin Tang Street, Yu Zhong District, Chongqing, 400013 China ,Chongqing Key Laboratory of Human Embryo Engineering, Chongqing, China
| | - Jingwei Yang
- Chongqing Reproduction and Genetics Institute, Chongqing Health Center for Women and Children, No.64 Jin Tang Street, Yu Zhong District, Chongqing, 400013 China ,Chongqing Clinical Research Center for Reproductive Medicine, Chongqing, China
| | - Qi Zhang
- Chongqing Reproduction and Genetics Institute, Chongqing Health Center for Women and Children, No.64 Jin Tang Street, Yu Zhong District, Chongqing, 400013 China ,Chongqing Clinical Research Center for Reproductive Medicine, Chongqing, China
| | - Wei Han
- Chongqing Reproduction and Genetics Institute, Chongqing Health Center for Women and Children, No.64 Jin Tang Street, Yu Zhong District, Chongqing, 400013 China ,Chongqing Key Laboratory of Human Embryo Engineering, Chongqing, China
| | - Guoning Huang
- Chongqing Reproduction and Genetics Institute, Chongqing Health Center for Women and Children, No.64 Jin Tang Street, Yu Zhong District, Chongqing, 400013 China ,Chongqing Key Laboratory of Human Embryo Engineering, Chongqing, China ,Chongqing Clinical Research Center for Reproductive Medicine, Chongqing, China
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10
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Luo X, Pei L, He Y, Li F, Han W, Xiong S, Han S, Li J, Zhang X, Huang G, Ye H. High initial FSH dosage reduces the number of available cleavage-stage embryos in a GnRH-antagonist protocol: Real-world data of 8,772 IVF cycles from China. Front Endocrinol (Lausanne) 2022; 13:986438. [PMID: 36325448 PMCID: PMC9618590 DOI: 10.3389/fendo.2022.986438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 09/30/2022] [Indexed: 11/22/2022] Open
Abstract
To evaluate the relationship between the initial follicle stimulating hormone (FSH) dose and the number of available cleavage-stage embryos in in vitro fertilization (IVF) cycles.We included 8772 fresh IVF cycles using a GnRH antagonist protocol at the Genetic and Reproductive Institution of Chongqing, P. R. China, from January 2016 to June 2021.Univariate linear regression was used to evaluate the associations between the initial FSH dosage (≤ 150, 187.5-200, 225, 250, or 300 IU) with the number of available cleavage-stage embryos on day 3. A two-factor linear regression model was applied to calculate the threshold effect of the initial FSH dosage on the number of available cleavage-stage embryos based on a smoothing plot. The initial FSH dose was negatively correlated with the number of available cleavage-stage embryos, independent of female age, body mass index, infertility factors, duration of infertility, anti-Müllerian hormone and basal FSH levels, antral follicle count and the proportions of patients with poor ovarian response or polycystic ovarian syndrome. Using a two-factor linear regression model, we calculated the inflection point to be 200 IU of FSH. The relationship between the initial FSH dose and the number of available cleavage-stage embryos was nonlinear. The initial FSH dose was negatively associated with the number of available cleavage-stage embryos when the initial FSH dose was > 200 IU. Therefore, clinicians should try to avoid unnecessarily increasing the initial FSH dose.
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Affiliation(s)
- Xiu Luo
- Center for Reproductive Medicine, Chongqing Health Center for Women and Children, Chongqing, China
- Key Laboratory of Human Embryo Engineering, Chongqing Maternal and Child Health Care Hospital, Chongqing, China
| | - Li Pei
- Center for Reproductive Medicine, Chongqing Health Center for Women and Children, Chongqing, China
- Key Laboratory of Human Embryo Engineering, Chongqing Maternal and Child Health Care Hospital, Chongqing, China
| | - Yao He
- Center for Reproductive Medicine, Chongqing Health Center for Women and Children, Chongqing, China
| | - Fujie Li
- Center for Reproductive Medicine, Chongqing Health Center for Women and Children, Chongqing, China
| | - Wei Han
- Center for Reproductive Medicine, Chongqing Health Center for Women and Children, Chongqing, China
- Key Laboratory of Human Embryo Engineering, Chongqing Maternal and Child Health Care Hospital, Chongqing, China
| | - Shun Xiong
- Center for Reproductive Medicine, Chongqing Health Center for Women and Children, Chongqing, China
| | - Shubiao Han
- Center for Reproductive Medicine, Chongqing Health Center for Women and Children, Chongqing, China
- Key Laboratory of Human Embryo Engineering, Chongqing Maternal and Child Health Care Hospital, Chongqing, China
| | - Jingyu Li
- Key Laboratory of Human Embryo Engineering, Chongqing Maternal and Child Health Care Hospital, Chongqing, China
| | - Xiaodong Zhang
- Key Laboratory of Human Embryo Engineering, Chongqing Maternal and Child Health Care Hospital, Chongqing, China
| | - Guoning Huang
- Center for Reproductive Medicine, Chongqing Health Center for Women and Children, Chongqing, China
- Key Laboratory of Human Embryo Engineering, Chongqing Maternal and Child Health Care Hospital, Chongqing, China
| | - Hong Ye
- Center for Reproductive Medicine, Chongqing Health Center for Women and Children, Chongqing, China
- Key Laboratory of Human Embryo Engineering, Chongqing Maternal and Child Health Care Hospital, Chongqing, China
- *Correspondence: Hong Ye,
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11
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Jiang L, Qian Y, Chen X, Ji X, Ou S, Li R, Yang D, Li Y. Effect of early rescue ICSI and split IVF-ICSI in preventing low fertilization rate during the first ART cycle: A real-world retrospective cohort study. Reprod Med Biol 2021; 21:e12420. [PMID: 34934401 PMCID: PMC8656193 DOI: 10.1002/rmb2.12420] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/25/2021] [Accepted: 09/28/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose To determine the utility of short gamete coincubation in in vitro fertilization (IVF‐S) combined with early rescue intracytoplasmic sperm injection (R‐ICSI) and split IVF‐ICSI in preventing low fertilization based on a retrospective cohort study. Methods Couples with a high risk of low IVF fertilization during the first ART cycle underwent IVF‐S with R‐ICSI or split IVF‐ICSI. Fertilization rate, embryo quality, and clinical outcomes were measured. Results After propensity score matching, we included 188 couples in the IVF‐S with R‐ICSI group as Group 1 and 720 in the split IVF‐ICSI group as Group 2. Normal fertilization rates were similar; however, Group 1 had a higher multiple pronuclei rate (10.42% vs. 4.50%, p < 0.001) but a higher embryo utilization rate (59.84% vs. 53.60%, p < 0.001). The groups were similar in the rates of high‐quality embryos, embryo implantation, clinical pregnancy, and live birth. Low IVF fertilization rate was 4.79% and 9.03% in Group 1 and Group 2, respectively, with similar fertilization rate and embryo development. Conclusion IVF‐S with early R‐ICSI and split IVF‐ICSI were effective strategies in preventing low fertilization rate. IVF‐S with early R‐ICSI could become the preferred approach because of its advantages—higher embryo utilization rate, fewer ICSI procedures, similar clinical pregnancy rate, and live birth rate.
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Affiliation(s)
- Linlin Jiang
- Department of Obstetrics and Gynecology Sun Yat-Sen Memorial Hospital Sun Yat-Sen University Guangzhou China
| | - Yifan Qian
- Department of Obstetrics and Gynecology Sun Yat-Sen Memorial Hospital Sun Yat-Sen University Guangzhou China
| | - Xiaoli Chen
- Department of Obstetrics and Gynecology Sun Yat-Sen Memorial Hospital Sun Yat-Sen University Guangzhou China
| | - Xiaohui Ji
- Department of Obstetrics and Gynecology Sun Yat-Sen Memorial Hospital Sun Yat-Sen University Guangzhou China
| | - Songbang Ou
- Department of Obstetrics and Gynecology Sun Yat-Sen Memorial Hospital Sun Yat-Sen University Guangzhou China
| | - Ruiqi Li
- Department of Obstetrics and Gynecology Sun Yat-Sen Memorial Hospital Sun Yat-Sen University Guangzhou China
| | - Dongzi Yang
- Department of Obstetrics and Gynecology Sun Yat-Sen Memorial Hospital Sun Yat-Sen University Guangzhou China
| | - Yu Li
- Department of Obstetrics and Gynecology Sun Yat-Sen Memorial Hospital Sun Yat-Sen University Guangzhou China
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12
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Pongsuthirak P. Comparison of embryonic competence and clinical outcomes between early and late cumulus cell removal for in vitro fertilization. Clin Exp Reprod Med 2021; 48:362-367. [PMID: 34875743 PMCID: PMC8651761 DOI: 10.5653/cerm.2021.04497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 05/31/2021] [Indexed: 12/02/2022] Open
Abstract
Objective The impact of early mechanical removal of cumulus cells on fertilization and embryonic development is not yet precisely known. This study aimed to investigate the effects of early and late cumulus cell removal on fertilization, polyspermy, embryonic development potential, blastocyst development, and clinical outcomes. Methods A prospective study was conducted of patients who underwent in vitro fertilization between September 2019 and October 2020. Sibling oocytes were randomly allocated after insemination to early cumulus cell removal at 6 hours (group I) and late cumulus cell removal at 16–18 hours (group II). If total fertilization failure (TFF) was determined to have occurred at early cumulus cell removal, rescue intracytoplasmic sperm injection (ICSI) was performed. Fertilization, embryonic development, and pregnancy outcomes were compared. Results A total of 912 oocytes were assigned to group I (458 oocytes) and group II (454 oocytes). Fertilization, polyspermy, embryo quality, and pregnancy outcomes were not significantly different between both groups. Rescue ICSI enabled fertilization of 79.2% of the TFF oocytes. Conclusion Early cumulus cell removal at 6 hours had no significant difference in fertilization, polyspermy, embryo development, or obstetric and perinatal outcomes compared to late removal. Early cumulus cell removal combined with early rescue ICSI may have the potential to help couples with TFF.
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Affiliation(s)
- Pallop Pongsuthirak
- Department of Obstetrics and Gynecology, Buddhachinaraj Hospital Medical School, Phitsanulok, Thailand
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13
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Liu Z, Liu Q, Jiang M, Chen X, Lin C, Guo Y. Timing considerations for removal of early cumulus cells in short-term insemination strategies. Reprod Fertil Dev 2021; 33:881-885. [PMID: 34852900 DOI: 10.1071/rd21259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 10/25/2021] [Indexed: 11/23/2022] Open
Abstract
Context The timing of early cumulus cell removal (ECCR) can be changed within a range. The change has an effect on the multiple pronuclei (MPN) rate and the exposure time of oocytes to sperm waste products. The timing of ECCR effects the outcomes of assisted reproductive technology, however, it is still unclear what time is best for ECCR. Aims To find the best time for ECCR based on clinical outcomes in order to increase the success rate of assisted reproductive technology. Methods A retrospective study was performed. Cycles were categorised into six groups according to the timing of ECCR. The clinical outcomes of these six groups were compared by Kruskal-Wallis test and Pearson X 2 test. Key results The timing of ECCR had a significant effect on the MPN rate, 0PN without cleavage rate and grade 1-2 embryo rate at Day3. Among our six time groups of ECCR, the cumulus cell removal ≤4h post-insemination group had the highest MPN rate and grade 1-2 embryo rate at Day3, and the 5.5h<time≤6h group had the highest pronuclear formation failure rate. In addition, 2PN rate was not significantly different among the six time groups. Conclusions Within the time range of ECCR in our study, selecting an earlier timing to remove the cumulus cells may have a better outcome. Implications ECCR is helpful for optimisation of the short-term insemination strategy.
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Affiliation(s)
- Zhiren Liu
- Center for Reproductive Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350000, People's Republic of China
| | - Qicai Liu
- Center for Reproductive Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350000, People's Republic of China
| | - Mingting Jiang
- Institute for Translational Medicine, Fujian Medical University, Fuzhou, Fujian, People's Republic of China
| | - Xingting Chen
- Center for Reproductive Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350000, People's Republic of China
| | - Chen Lin
- Center for Reproductive Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350000, People's Republic of China
| | - Yujia Guo
- Center for Reproductive Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350000, People's Republic of China
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14
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Paffoni A, Reschini M, Pisaturo V, Guarneri C, Palini S, Viganò P. Should rescue ICSI be re-evaluated considering the deferred transfer of cryopreserved embryos in in-vitro fertilization cycles? A systematic review and meta-analysis. Reprod Biol Endocrinol 2021; 19:121. [PMID: 34348713 PMCID: PMC8336078 DOI: 10.1186/s12958-021-00784-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 06/14/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Total fertilization failure represents a particularly frustrating condition for couples undergoing in vitro fertilization. With the aim of reducing the occurrence of total fertilization failure, intracytoplasmic sperm injection (ICSI) has become the first choice over conventional in vitro fertilization (IVF) procedures although evidence of improved results is still debated and its use in couples without male factor infertility is not recommended. Among the strategies potentially useful to promote the use of conventional IVF, we herein call attention to the late rescue ICSI, which consists in performing ICSI after 18-24 h from conventional insemination on oocytes that show no signs of fertilization. This treatment has however been reported to be associated with a low success rate until recent observations that embryos derived from late rescue ICSI may be transferred after cryopreservation in a frozen-thawed cycle with improved results. The aim of the present study was to assess whether frozen embryos deriving from rescue ICSI performed about 24 h after conventional IVF may represent a valuable option for couples experiencing fertilization failure. METHODS A systematic review on the efficacy of late rescue ICSI was performed consulting PUBMED and EMBASE. RESULTS Including twenty-two original studies, we showed that clinical pregnancy rate per embryo transfer and implantation rate obtainable with fresh embryo transfers after rescue ICSI are not satisfactory being equal to 10 and 5%, respectively. The transfer of cryopreserved rescue ICSI embryos seems to offer a substantial improvement of success rates, with pregnancy rate per embryo transfer and implantation rate equal to 36 and 18%, respectively. Coupling rescue ICSI with frozen embryo transfer may ameliorate the clinical pregnancy rate for embryo transfer with an Odds Ratio = 4.7 (95% CI:2.6-8.6). CONCLUSION Results of the present review support the idea that r-ICSI coupled with frozen embryo transfer may overcome most of the technical and biological issues associated with fresh transfer after late r-ICSI, thus possibly representing an efficient procedure for couples experiencing fertilization failure following conventional IVF cycles. TRIAL REGISTRATION Prospero registration ID: CRD42021239026 .
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Affiliation(s)
| | - Marco Reschini
- Infertility Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, 20122, Italy
| | - Valerio Pisaturo
- Infertility Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, 20122, Italy
| | - Cristina Guarneri
- Infertility Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, 20122, Italy
| | - Simone Palini
- IVF Unit, AUSL Romagna Cervesi Hospital, 47841, Cattolica, Italy
| | - Paola Viganò
- Infertility Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, 20122, Italy
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15
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Xiong S, Liu W, Wang J, Liu J, Gao Y, Wu L, Zhu J, Hao X, Li J, Liu D, Han W, Huang G. Trophectoderm biopsy protocols may impact the rate of mosaic blastocysts in cycles with pre-implantation genetic testing for aneuploidy. J Assist Reprod Genet 2021; 38:1153-1162. [PMID: 33660205 PMCID: PMC7929899 DOI: 10.1007/s10815-021-02137-w] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 02/25/2021] [Indexed: 12/02/2022] Open
Abstract
PURPOSE This study aimed to analyze the impact of different biopsy protocols on the rate of mosaic blastocysts. METHODS This is a retrospective cohort study which included 115 cycles with pre-implantation genetic testing for aneuploidy (PGT-A). Two groups were allocated based on the biopsy protocols: method 1 group, the zona pellucida (ZP) was drilled on day 3 embryos followed by trophectoderm (TE) biopsy; and method 2 group, the ZP was opened on day 5 or 6 blastocysts followed by TE biopsy. All biopsy samples were assessed using next-generation sequencing (NGS) at a single reference laboratory. The euploid, aneuploid, and mosaic blastocyst rates and clinical outcomes were compared. RESULTS The mosaicism rate in the method 1 group was 19.58%, significantly higher than the method 2 group (8.12%; P < 0.05). No statistically significant difference was observed in euploid, aneuploid blastocyst rates, and clinical pregnancy rates between the two groups. Logistic regression analysis indicated that the biopsy protocols were independently associated with the mosaicism rates among all the variables. CONCLUSIONS The present study showed that different biopsy protocols may have an impact on the mosaic blastocyst rate. ZP opening on day 3 combined with TE biopsy might increase the incidence of mosaic blastocysts.
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Affiliation(s)
- Shun Xiong
- Chongqing Health Center for Women and Children, Chongqing, People's Republic of China
| | - Weiwei Liu
- Chongqing Health Center for Women and Children, Chongqing, People's Republic of China
| | - Jiang Wang
- Chongqing Health Center for Women and Children, Chongqing, People's Republic of China
| | - Junxia Liu
- Chongqing Health Center for Women and Children, Chongqing, People's Republic of China
| | - Yang Gao
- Chongqing Health Center for Women and Children, Chongqing, People's Republic of China
| | - Lihong Wu
- Chongqing Health Center for Women and Children, Chongqing, People's Republic of China
| | - Jiahong Zhu
- Chongqing Health Center for Women and Children, Chongqing, People's Republic of China
| | - Xiangwei Hao
- Chongqing Clinical Research Center for Reproductive Medicine, Chongqing, People's Republic of China
| | - Jingyu Li
- Chongqing Key Laboratory of Human Embryo Engineering, Chongqing, People's Republic of China
| | - Dongyun Liu
- Chongqing Health Center for Women and Children, Chongqing, People's Republic of China
| | - Wei Han
- Chongqing Health Center for Women and Children, Chongqing, People's Republic of China.
| | - Guoning Huang
- Chongqing Health Center for Women and Children, Chongqing, People's Republic of China.
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16
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Blastocyst cryopreservation and cryopreservation-warming transfer is an effective embryo transfer strategy for day 1 rescue intracytoplasmic sperm injection cycles. Sci Rep 2021; 11:8260. [PMID: 33859312 PMCID: PMC8050289 DOI: 10.1038/s41598-021-87693-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 03/30/2021] [Indexed: 11/08/2022] Open
Abstract
This was a retrospective analysis of a total of 625 r-ICSI cycles using freeze-all-embryos and embryo transfers (ET) in subsequent cryopreservation-warming cycles to determine the effect of the ET method for day 1 rescue intracytoplasmic sperm injection cycles (r-ICSI). Two methods were used: in method 1, cleavage-stage embryos were frozen and were directly transferred in a subsequent cryopreservation-warming cycle (r-ICSI frozen cleavage), and 144 cleavage-stage ETs occurred. Similarly, in method 2, there were 188 blastocyst-stage ETs (r-ICSI frozen blast) performed. The live birth rate (LBR) for r-ICSI frozen blast was better than that for r-ICSI frozen cleavage in calculation of ET cycles (19.44% vs. 37.77%) and also remained better after the use of logistic regression analysis (OR = 2.721, 95% CI 1.604–4.616). Conservative cumulative LBR were compared between r-ICSI frozen cleavage and r-ICSI frozen blast with regard to oocyte retrieval cycles (17.39% vs. 15.30%). The same results were obtained for conservative cumulative LBR after logistic regression analysis (OR = 0.925, 95% CI 0.557–1.535). The results of this study confirmed that it was valuable to perform r-ICSI if using freeze-all-embryos. Further, r-ICSI embryos were cultured to blastocyst stage, cryopreserved, and used in subsequent cryopreservation-warming cycles, which was an effective embryo transfer strategy and obtained satisfactory results.
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Prolonged interval time between blastocyst biopsy and vitrification compromised the outcomes in preimplantation genetic testing. ZYGOTE 2021; 29:276-281. [PMID: 33597059 DOI: 10.1017/s0967199420000866] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This study aimed to evaluate to what extent the different interval times between trophectoderm (TE) biopsy and vitrification influence the clinical outcomes in preimplantation genetic testing (PGT) cycles. Patients who underwent frozen embryo transfer (FET) after PGT between 2015 and 2019 were recruited. In total, 297 cycles with single day 5 euploid blastocyst transfer were included. These cycles were divided into three groups according to the interval times: <1 h group, 1-2 h group, and ≥2 h group. Blastocyst survival, clinical pregnancy, miscarriage, and ongoing pregnancy rates were compared. The results showed that, in PGT-SR cycles, survival rate in the ≥2 h group (96.72%) was significantly lower than in the <1 h group (100%, P = 0.047). The clinical pregnancy rate in the ≥2 h group was 55.93%, significantly lower than in the <1 h group (74.26%, P = 0.017). The ongoing pregnancy rates in the 1-2 h group and the ≥2 h group were 48.28% and 47.46%, respectively, significantly lower than that in the <1 h group (67.33%, P < 0.05). The miscarriage rate in the 1-2 h group was 18.42%, significantly higher than that in the <1 h group (5.33%, P = 0.027). In PGT-A cycles, the clinical pregnancy and ongoing pregnancy rates in the <1 h group were 67.44% and 53.49%, respectively, higher than that in the 1-2 h group (52.94%, 47.06%, P > 0.05) and the ≥2 h group (52.63%, 36.84%, P > 0.05). In conclusion, vitrification of blastocysts beyond 1 h after biopsy significantly influences embryo survival and clinical outcomes and is therefore not recommended.
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Kong P, Yin M, Tang C, Zhu X, Bukulmez O, Chen M, Teng X. Effects of Early Cumulus Cell Removal on Treatment Outcomes in Patients Undergoing In Vitro Fertilization: A Retrospective Cohort Study. Front Endocrinol (Lausanne) 2021; 12:669507. [PMID: 34025582 PMCID: PMC8138552 DOI: 10.3389/fendo.2021.669507] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 04/09/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Early cumulus cell removal combined with early rescue intracytoplasmic sperm injection (ICSI) has been widely practiced in many in vitro fertilization (IVF) centers in China in order to avoid total fertilization failure. However, uncertainty remains whether the pregnancy and neonatal outcomes are associated with early cumulus cell removal. OBJECTIVES To investigate if early cumulus cell removal alone after 4 hours co-incubation of gametes (4 h group), has detrimental effect on the pregnancy and neonatal outcomes in patients undergoing IVF, through a comparison with conventional cumulus cell removal after 20 hours of insemination (20 h group). METHODS This retrospective cohort study included 1784 patients who underwent their first fresh cleavage stage embryo transfer at the Centre for Assisted Reproduction of Shanghai First Maternity and Infant Hospital from June 2016 to December 2018 (4 h group, n=570; 20 h group, n=1214). A logistic regression analysis was performed to examine the independent association between early cumulus cell removal and pregnancy outcomes after adjustment for potential confounders. The neonatal outcomes between the two groups were compared. RESULTS When compared with the 20 h group, the 4 h group had similar pregnancy outcomes, including rates for biochemical pregnancy, clinical pregnancy, ongoing pregnancy, miscarriage, ectopic pregnancy, multiple pregnancy, live birth. There were 1073 infants delivered after embryo transfer (4 h group, n=337; 20 h group, n=736). Outcomes in both groups were similar for both singleton and twin gestations, including preterm birth rate and very preterm birth rate, mean birth weight, mean gestational age, sex ratio at birth and rate of congenital birth defects. In addition, findings pertaining to singleton gestations were also similar in the two groups for Z-scores (gestational age- and sex-adjusted birth weight), rates of small for gestational age, very small for gestational age, large for gestational age and very large for gestational age infants. CONCLUSIONS In this study early cumulus cell removal alone was not associated with adverse pregnancy and neonatal outcomes. From this perspective, early cumulus cell removal to assess for a potential early rescue ICSI is therefore considered to be a safe option in patients undergoing IVF.
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Affiliation(s)
- Pengcheng Kong
- Centre for Assisted Reproduction, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Mingru Yin
- Department of Assisted Reproduction, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chuanling Tang
- Centre for Assisted Reproduction, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiuxian Zhu
- Centre for Assisted Reproduction, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Orhan Bukulmez
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Miaoxin Chen
- Centre for Assisted Reproduction, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
- *Correspondence: Xiaoming Teng, ; Miaoxin Chen,
| | - Xiaoming Teng
- Centre for Assisted Reproduction, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
- *Correspondence: Xiaoming Teng, ; Miaoxin Chen,
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Han S, Hou J, Zhang X, Huang G. Predicting The Developmental Potential Of Cleavage Stage Embryos Based On Oxygen Consumption Rate In FET Cycles. JBRA Assist Reprod 2020; 24:241-244. [PMID: 32072993 PMCID: PMC7365525 DOI: 10.5935/1518-0557.20190080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To study the value of oxygen consumption (OC) as a predictor of the developmental potential of D3 embryos in frozen embryo transfer (FET) cycles. METHODS This observational study included 148 patients undergoing FET cycles with two embryos transferred per cycle. OC rates were examined by scanning electrochemical microscopy before embryo transfer. Implantation, clinical pregnancy, miscarriage, and live birth rates were calculated. RESULTS A total of 296 embryos were transferred in 148 cycles, or two embryos per cycle. The embryos were divided into three groups based on OC: Group A included the cases in which the OC rate of each of the two transferred embryos was greater than 3.0 fmol/s; Group B included the cases in which the OC rate of one of the embryos was greater than 3.0 fmol/s and the OC rate of the other embryo was less than 3.0 fmol/s; and Group C included the cases in which the OC rates of the two embryos were less than 3.0 fmol/s. Higher live birth rates and lower miscarriage rates were observed in Group A (p<0.05). CONCLUSIONS Our data suggest that OC is positively correlated with embryo developmental potential. Therefore, measuring the OC of human embryos may be useful in embryo assessment.
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Affiliation(s)
- Shubiao Han
- Chongqing Key Laboratory of Human Embryo Engineering, Chongqing Reproductive and Genetics Institute, Chongqing Health Center for Women and Children. Chongqing, China
| | - Jiying Hou
- Department of Histology and Embryology, Laboratory of Stem Cells and Tissue Engineering, Chongqing Medical University. Chongqing, China
| | - Xiaodong Zhang
- Chongqing Key Laboratory of Human Embryo Engineering, Chongqing Reproductive and Genetics Institute, Chongqing Health Center for Women and Children. Chongqing, China
| | - Guoning Huang
- Chongqing Key Laboratory of Human Embryo Engineering, Chongqing Reproductive and Genetics Institute, Chongqing Health Center for Women and Children. Chongqing, China
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Li J, Chen Q, Wang J, Huang G, Ye H. Does growth hormone supplementation improve oocyte competence and IVF outcomes in patients with poor embryonic development? A randomized controlled trial. BMC Pregnancy Childbirth 2020; 20:310. [PMID: 32434490 PMCID: PMC7238549 DOI: 10.1186/s12884-020-03004-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 05/08/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many studies have demonstrated the benefits of the addition of growth hormone (GH) to the controlled ovarian stimulation protocol in vitro fertilization (IVF) cycles in poor-respond patients, but the effect of GH on patients with poor embryonic development remain unclear. This paper was designed to investigate the efficacy of GH co-treatment during IVF for the patients with poor embryonic development. METHOD A randomized controlled trial including 158 patients with poor embryo development was conducted between July 2017 and February 2019. One hundred and seven patients were randomized for GH treatment (GH group) and 51 patients for untreated (control group). The primary end-points were the clinical pregnancy and live birth rates in the two groups. The oocyte competence were assessed through calculating the mitochondrial DNA (mtDNA) copy number in corresponding cumulus granulosa cells (CGCs). Quantitative PCR were used for calculation of mtDNA copy number. RESULTS Relative to the control group, GH co-treatment resulted in a significantly higher number of retrieved oocytes (10.29 ± 5.92 versus 8.16 ± 4.17, P = 0.023) and cleaved embryos (6.73 ± 4.25 versus 5.29 ± 3.23, P = 0.036). The implantation rate, clinical pregnancy rates per cycle, and live birth rate per cycle were higher in the GH group than in the control group (36.00% versus 17.86%, P = 0.005; 43.93% versus 19.61%, P = 0.005; 41.12% versus 17.65%, P = 0.006). CGCs of the GH group had significantly higher mtDNA copy numbers than CGCs of the control group (252 versus 204, P < 0.001). CONCLUSIONS These data provided further evidence to indicate that GH supplementation may support more live births during IVF, in patients with poor embryonic development. It also appears that oocytes generated under GH co-treatment have a better developmental competence. TRIAL REGISTRATION ChiCTR1900021992 posted March 19, 2019 (retrospectively registered).
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Affiliation(s)
- Jingyu Li
- Chongqing Key Laboratory of Human Embryo Engineering, Chongqing Reproduction and Genetics Institute, Chongqing Health Center for Women and Children, No.64 Jin Tang Street, Yu Zhong District, Chongqing, 400013, China
| | - Qiaoli Chen
- Chongqing Key Laboratory of Human Embryo Engineering, Chongqing Reproduction and Genetics Institute, Chongqing Health Center for Women and Children, No.64 Jin Tang Street, Yu Zhong District, Chongqing, 400013, China
| | - Jiang Wang
- Chongqing Key Laboratory of Human Embryo Engineering, Chongqing Reproduction and Genetics Institute, Chongqing Health Center for Women and Children, No.64 Jin Tang Street, Yu Zhong District, Chongqing, 400013, China
| | - Guoning Huang
- Chongqing Key Laboratory of Human Embryo Engineering, Chongqing Reproduction and Genetics Institute, Chongqing Health Center for Women and Children, No.64 Jin Tang Street, Yu Zhong District, Chongqing, 400013, China
| | - Hong Ye
- Chongqing Key Laboratory of Human Embryo Engineering, Chongqing Reproduction and Genetics Institute, Chongqing Health Center for Women and Children, No.64 Jin Tang Street, Yu Zhong District, Chongqing, 400013, China.
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Chen ZQ, Wang Y, Ng EHY, Zhao M, Pan JP, Wu HX, Teng XM. A randomized triple blind controlled trial comparing the live birth rate of IVF following brief incubation versus standard incubation of gametes. Hum Reprod 2019; 34:100-108. [PMID: 30445454 DOI: 10.1093/humrep/dey333] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 10/24/2018] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION Does brief incubation of oocytes and spermatozoa improve the live birth rate (LBR) of IVF when compared with that of standard incubation? SUMMARY ANSWER Brief incubation of gametes does not improve the LBR of IVF when compared with standard incubation. WHAT IS KNOWN ALREADY Some small randomized studies showed that brief incubation was associated with a significantly higher ongoing pregnancy rate than standard incubation. STUDY DESIGN, SIZE, DURATION This is a randomized triple blind study of 320 infertile women for their first or repeated cycles undergoing IVF between September 2015 and October 2016. PARTICIPANTS/MATERIALS, SETTING, METHODS Women were randomized into the brief incubation group (n = 160) or the standard incubation group (n = 160) according to a computer-generated randomization list. Oocytes were incubated with spermatozoa (0.3-1.2 million motile sperm/ml) for 3-4 h in the brief incubation group while oocytes were incubated with spermatozoa at similar concentration for 20 h in the standard incubation group. The primary outcome was the LBR (a baby born alive after 22 weeks gestation) in the fresh cycle. MAIN RESULTS AND THE ROLE OF CHANCE There was no significant difference in the LBR between the brief and standard incubation groups based on both intention-to-treat [33.0% (53/160) versus 36.8% (59/160), relative risk (RR) 0.898 (95% CI = 0.666-1.212), P = 0.482] and per protocol [41.4%(53/128) versus 41.0% (59/144), RR1.011 (95% CI = 0.760-1.343), P = 0.942] analyses. Clinical pregnancy, ongoing pregnancy, miscarriage, multiple pregnancy and implantation rates were comparable for the two groups. Similar results were found with subgroup analysis of advanced maternal age, abnormal semen analysis and repeated IVF cycles. No differences were observed in cumulative LBR between two groups. LIMITATIONS, REASONS FOR CAUTION Various motile sperm concentrations of 0.3-1.2 million per ml were used for insemination and the reactive oxygen species level in the insemination medium was not measured. The highest level at 1.2 million per ml is still relatively low compared to prior studies, therefore we do not know whether brief incubation can improve the LBR using higher concentrations of spermatozoa. The present sample size may not be adequate to detect a smaller difference in the LBR. WIDER IMPLICATIONS OF THE FINDINGS The present study demonstrated that a brief incubation of gametes had no significant beneficial effect on the LBR when compared with the standard incubation. The practice of brief incubation of gametes is not necessary and this can save the already tight manpower in many laboratories. STUDY FUNDING/COMPETING INTERESTS The study was supported by the Merck-Serono China Research Fund for Fertility Experts (2015), which was not involved in study design, execution, data analysis and manuscript preparation. There are no conflicts of interest for all authors. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Identifier NCT02534857. TRIAL REGISTRATION DATE 28 August 2015. DATE OF FIRST PATIENT’S ENROLMENT 8 September 2015.
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Affiliation(s)
- Zhi Qin Chen
- Center of Assisted Reproduction, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, No 536.Changle Road, Shanghai, China
| | - Yu Wang
- Center of Assisted Reproduction, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, No 536.Changle Road, Shanghai, China
| | - Ernest Hung Yu Ng
- Department of Obstetrics & Gynaecology, The University of Hong Kong, Pokfulam Road, Hong Kong Special Administrative Region, China
| | - Mei Zhao
- Center of Assisted Reproduction, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, No 536.Changle Road, Shanghai, China
| | - Jia Ping Pan
- Center of Assisted Reproduction, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, No 536.Changle Road, Shanghai, China
| | - Hai Xia Wu
- Center of Assisted Reproduction, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, No 536.Changle Road, Shanghai, China
| | - Xiao Ming Teng
- Center of Assisted Reproduction, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, No 536.Changle Road, Shanghai, China
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Zhang X, Gao Y, Liu W, Liu J, Wu L, Xiong S, Zhu J, Han W, Wang J, Hao X, Han S, Huang G. Frozen blastocyst embryo transfer vs. frozen cleavage-stage embryo transfer in couples with recurrent implantation failure: a cohort study. HUM FERTIL 2019; 24:284-289. [PMID: 31274037 DOI: 10.1080/14647273.2019.1633021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The objective of this prospective cohort study was to investigate whether cryopreservation of cleavage or blastocyst stage embryos improves in vitro fertilization outcomes in recurrent implantation failure (RIF) patients. The study comprised 575 patients who were allocated to receive either single frozen/thawed blastocyst-stage transfer (SBT) or frozen/thawed double-cleavage-stage embryo transfer (DET). The clinical pregnancy rate, implantation rate, and ongoing pregnancy rate were higher in the SBT group compared with the DET group (41.15% vs. 27.11%, p < 0.001; 41.15% vs. 19.28%, p < 0.001; 40.03% vs. 25.9%, p < 0.001), but the miscarriage rate did not differ between the two groups. It was concluded that frozen/thawed SBT could be a preferred strategy for RIF patients.
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Affiliation(s)
- Xiaodong Zhang
- a Chong Qing Obstetric and Gynecology Hospital , Chongqing Reproductive and Genetics Institute , Chongqing , China
| | - Yang Gao
- a Chong Qing Obstetric and Gynecology Hospital , Chongqing Reproductive and Genetics Institute , Chongqing , China
| | - Weiwei Liu
- a Chong Qing Obstetric and Gynecology Hospital , Chongqing Reproductive and Genetics Institute , Chongqing , China
| | - Junxia Liu
- a Chong Qing Obstetric and Gynecology Hospital , Chongqing Reproductive and Genetics Institute , Chongqing , China
| | - Lihong Wu
- a Chong Qing Obstetric and Gynecology Hospital , Chongqing Reproductive and Genetics Institute , Chongqing , China
| | - Shun Xiong
- a Chong Qing Obstetric and Gynecology Hospital , Chongqing Reproductive and Genetics Institute , Chongqing , China
| | - Jiahong Zhu
- a Chong Qing Obstetric and Gynecology Hospital , Chongqing Reproductive and Genetics Institute , Chongqing , China
| | - Wei Han
- a Chong Qing Obstetric and Gynecology Hospital , Chongqing Reproductive and Genetics Institute , Chongqing , China
| | - Jiang Wang
- a Chong Qing Obstetric and Gynecology Hospital , Chongqing Reproductive and Genetics Institute , Chongqing , China
| | - Xiangwei Hao
- a Chong Qing Obstetric and Gynecology Hospital , Chongqing Reproductive and Genetics Institute , Chongqing , China
| | - Shubiao Han
- a Chong Qing Obstetric and Gynecology Hospital , Chongqing Reproductive and Genetics Institute , Chongqing , China
| | - Guoning Huang
- a Chong Qing Obstetric and Gynecology Hospital , Chongqing Reproductive and Genetics Institute , Chongqing , China
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He Y, Liu H, Zheng H, Li L, Fu X, Liu J. Effect of early cumulus cells removal and early rescue ICSI on pregnancy outcomes in high-risk patients of fertilization failure. Gynecol Endocrinol 2018; 34:689-693. [PMID: 29448847 DOI: 10.1080/09513590.2018.1433159] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE The objective of this retrospective study was to evaluate clinical outcomes of early cumulus cells removal and early rescue intracytoplasmic sperm injection (ICSI) in high-risk patients of fertilization failure during human in vitro fertilization (IVF). METHODS A total of 5,518 patients were enrolled between January 2014 to December 2016. Of which 505 couples performed short insemination with >30% fertilization rate were included in short-term IVF group, 102 patients detected total fertilization failure (TFF) were treated with early rescue ICSI (R-ICSI group), and 4911 couples underwent conventional IVF with overnight co-incubation of gametes (traditional IVF group). The clinical outcomes were analyzed among the three groups. RESULTS The embryo implantation rates (40.34%, 39.78% and 42.42% for traditional, short-term IVF and R-ICSI groups, respectively) were comparable in the three groups. The clinical pregnancy rates among traditional IVF group, short-term IVF group and R-ICSI group were 57.95%, 57.03% and 60.78%, respectively, and the difference among three groups didn't reach significance. CONCLUSION The present study indicated that short insemination had no detrimental effects on clinical outcomes in human IVF and could prevent the occurrence of TFF combined with early rescue ICSI for high-risk patients of fertilization failure, which attained acceptable pregnancy outcomes.
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Affiliation(s)
- Yuxia He
- a Department of Reproductive Medicine , the Third Affiliated Hospital of Guangzhou Medical University , Guangzhou , Guangdong , China
- b Key Laboratory of Reproductive Medicine of Guangdong Province , Guangzhou , Guangdong , China
- c Key Laboratory for Major Obstetric Diseases of Guangdong Province , Guangzhou , Guangdong , China
- d Key Laboratory of Reproduction and Genetics of Guangdong Higher Education Institutes , Guangzhou , Guangdong , China
| | - Haiying Liu
- a Department of Reproductive Medicine , the Third Affiliated Hospital of Guangzhou Medical University , Guangzhou , Guangdong , China
| | - Haiyan Zheng
- a Department of Reproductive Medicine , the Third Affiliated Hospital of Guangzhou Medical University , Guangzhou , Guangdong , China
| | - Li Li
- a Department of Reproductive Medicine , the Third Affiliated Hospital of Guangzhou Medical University , Guangzhou , Guangdong , China
| | - Xin Fu
- a Department of Reproductive Medicine , the Third Affiliated Hospital of Guangzhou Medical University , Guangzhou , Guangdong , China
| | - Jianqiao Liu
- a Department of Reproductive Medicine , the Third Affiliated Hospital of Guangzhou Medical University , Guangzhou , Guangdong , China
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Wu L, Han W, Wang J, Zhang X, Liu W, Xiong S, Han S, Liu J, Gao Y, Huang G. Embryo culture using a time-lapse monitoring system improves live birth rates compared with a conventional culture system: a prospective cohort study. HUM FERTIL 2017; 21:255-262. [DOI: 10.1080/14647273.2017.1335886] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Lihong Wu
- Chongqing Reproductive and Genetics Institute, Chongqing, China
| | - Wei Han
- Chongqing Reproductive and Genetics Institute, Chongqing, China
| | - Jiang Wang
- Chongqing Reproductive and Genetics Institute, Chongqing, China
| | - Xiaodong Zhang
- Chongqing Reproductive and Genetics Institute, Chongqing, China
| | - Weiwei Liu
- Chongqing Reproductive and Genetics Institute, Chongqing, China
| | - Shun Xiong
- Chongqing Reproductive and Genetics Institute, Chongqing, China
| | - Shubiao Han
- Chongqing Reproductive and Genetics Institute, Chongqing, China
| | - Junxia Liu
- Chongqing Reproductive and Genetics Institute, Chongqing, China
| | - Yang Gao
- Chongqing Reproductive and Genetics Institute, Chongqing, China
| | - Guoning Huang
- Chongqing Reproductive and Genetics Institute, Chongqing, China
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Xiong S, Han W, Liu W, Wu L, Liu JX, Gao Y, Huang G. Developmental potential of embryos from cycles containing oocytes with severe ovoid zona pellucida. HUM FERTIL 2017; 21:204-211. [PMID: 28545306 DOI: 10.1080/14647273.2017.1324181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The purpose of this study was to determine the incidence of oocytes with severe ovoid zona pellucida (ZP), investigate the development potential of their sibling oocytes and the clinical outcomes from affected cycles. The data were collected from our medical records. Cycles having at least one oocyte with severe ovoid ZP were defined as the 'severe ovoid group', cycles having at least one oocyte with mild ovoid ZP were defined as the 'mild ovoid group', whereas cycles without oocytes with ovoid ZPs were defined as the 'control group' (n = 150 for each group). The results showed that sibling embryos in the 'severe ovoid group' were characterized by delayed development and lower available embryo rate. The implantation, clinical pregnancy and live birth rates in this group were also significantly lower than that in the other two groups. There were five cycles in which only one embryo with severe ovoid ZP was transferred and two healthy babies were born. The mild ovoid group showed comparable embryo development and clinical outcomes compared with the control group. This study suggests that cycles containing oocytes with severe ovoid ZPs had delayed embryo development, lower available embryo rate, compromised implantation, clinical pregnancy and live birth rates.
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Affiliation(s)
- Shun Xiong
- a Chongqing Reproductive and Genetics Institute , Chongqing , China
| | - Wei Han
- b Chongqing Obstetrics and Gynecology Hospital , Chongqing , China
| | - Weiwei Liu
- a Chongqing Reproductive and Genetics Institute , Chongqing , China
| | - Lihong Wu
- a Chongqing Reproductive and Genetics Institute , Chongqing , China
| | - Jun Xia Liu
- a Chongqing Reproductive and Genetics Institute , Chongqing , China
| | - Yang Gao
- a Chongqing Reproductive and Genetics Institute , Chongqing , China
| | - Guoning Huang
- a Chongqing Reproductive and Genetics Institute , Chongqing , China
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Liu J, Zhang X, Yang Y, Zhao J, Hao D, Zhang J, Liu Y, Wu W, Wang X. Long-time vs. short-time insemination of sibling eggs. Exp Ther Med 2016; 12:3756-3760. [PMID: 28105107 DOI: 10.3892/etm.2016.3827] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 06/15/2016] [Indexed: 11/06/2022] Open
Abstract
This study aimed to evaluate the impact of a short insemination procedure on embryo development, assess the reliability of a fertilization check prior to the appearance of pronuclei and elucidate the role of rescue intracytoplasmic sperm injection (R-ICSI). Patients who had ≥9 eggs, were aged <38 years and had normal semen samples were included. The sibling eggs of each patient were divided into two groups; one half for conventional in vitro fertilization (IVF; insemination time, 20 h) and the other half for short insemination (insemination time, 5 h). R-ICSI was performed where total fertilization failure (TFF) was deemed to have occurred in the short insemination group. In total, 2,465 eggs were included. No significant differences were found in fertilization, abnormal fertilization, embryo quality, clinical pregnancy and implantation rates between the short insemination and conventional insemination groups. In the short insemination group, R-ICSI was performed in 11 cycles (6.7%); in 6 of these cycles, fertilization occurred in the patient's eggs in the 20 h insemination group, while in the other 5 cycles, the patient's eggs were not fertilized after 20 h insemination either. Following R-ICSI, 19 of 36 eggs were normally fertilized. Subsequently, 7 embryos were transferred in 4 fresh cycles resulting in one ectopic pregnancy. In conclusion, the short insemination procedure does not improve embryo development and pregnancy rates. Short insemination combined with early R-ICSI may be a method of preventing total fertilization failure, albeit with poor accuracy.
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Affiliation(s)
- Jing Liu
- Reproductive Medicine Center, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
| | - Xiao Zhang
- Cork Fertility Centre, T12 YE24 Cork, Republic of Ireland
| | - Yue Yang
- Reproductive Medicine Center, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
| | - Junliang Zhao
- Reproductive Medicine Center, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
| | - Dayong Hao
- Reproductive Medicine Center, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
| | - Jianrui Zhang
- Reproductive Medicine Center, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
| | - Yanli Liu
- Reproductive Medicine Center, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
| | - Wenbin Wu
- Reproductive Medicine Center, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
| | - Xingling Wang
- Reproductive Medicine Center, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
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Zhou L, Wang J, Xiao L, Sun H, Wang Y, Geng L, Hao G, Zhang C, Xu L, Qian W. Differential effects of short co-incubation of gametes and early removal of cumulus cells in patients with different fertilizing capabilities. Reprod Biomed Online 2016; 32:591-6. [DOI: 10.1016/j.rbmo.2016.02.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 02/18/2016] [Accepted: 02/23/2016] [Indexed: 11/26/2022]
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Guo N, Yang F, Liu Q, Ren X, Zhao H, Li Y, Ai J. Effects of cumulus cell removal time during in vitro fertilization on embryo quality and pregnancy outcomes: a prospective randomized sibling-oocyte study. Reprod Biol Endocrinol 2016; 14:18. [PMID: 27072537 PMCID: PMC4830045 DOI: 10.1186/s12958-016-0151-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 04/04/2016] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND To investigate whether cumulus cell removal after a 3 h co-incubation of gametes can affect the outcomes of in vitro fertilization. METHODS A prospective randomized sibling-oocyte study was performed in which sibling oocytes obtained from each patient were randomly assigned to either a 3 h or 20 h group (cumulus cells removed at 3 h or 20 h after insemination, respectively). Same origin embryos (either 3 h or 20 h) were transferred. The study participants were patients < 38 years old and with infertility due to tubal factors. The study outcomes included fertilization, embryo quality, and birth status. RESULTS The study enrolled 172 patients, from whom 2275 oocytes were retrieved (1139 oocytes for the 3 h group and 1136 oocytes for the 20 h group). A total of 134 patients received embryo transfers (74 patients in the 3 h group and 60 patients in the 20 h group), and there were 54 live births (32 in the 3 h group and 22 in the 20 h group). When compared with patients in the 20 h group, patients in the 3 h group produced a larger number of optimal quality embryos, but had higher rates of polyspermy and low birth weight newborns. The two groups showed no differences in their rates of normal fertilization, pregnancy, and live birth. CONCLUSIONS When compared with results obtained using a traditional cumulus cell removal protocol, early cumulus cell removal has both advantages and disadvantages. Further studies, and especially long-term outcome studies on newborns, need to be performed. TRIAL REGISTRATION Current controlled trial ChiCTR-OOC-15006878.
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Affiliation(s)
- Na Guo
- Department of Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou District, Wuhan, 430030 China
| | - Fei Yang
- Department of Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou District, Wuhan, 430030 China
| | - Qun Liu
- Department of Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou District, Wuhan, 430030 China
| | - Xinling Ren
- Department of Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou District, Wuhan, 430030 China
| | - Hua Zhao
- Department of Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou District, Wuhan, 430030 China
| | - Yufeng Li
- Department of Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou District, Wuhan, 430030 China
| | - Jihui Ai
- Department of Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou District, Wuhan, 430030 China
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Cao S, Wu X, Zhao C, Zhou L, Zhang J, Ling X. Determining the need for rescue intracytoplasmic sperm injection in partial fertilisation failure during a conventional IVF cycle. Andrologia 2016; 48:1138-1144. [PMID: 26925571 DOI: 10.1111/and.12551] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2015] [Indexed: 01/21/2023] Open
Abstract
To explore the need for rescue intracytoplasmic sperm injection (ICSI) in cases of partial fertilisation failure during a conventional in vitro fertilisation cycle, rescue ICSI was performed for cycles with a fertilisation rate of <50%. The data were divided into three groups based on the fertilisation rate: group 1 (0%), group 2 (<25%) and group 3 (>25%). The impact of rescue ICSI on each group was then analysed in terms of ovum fertilisation, embryo development, embryo utilisation and selection of embryos for transfer. Rescue ICSI was performed on 1831 unfertilised oocytes from 313 cycles. The fertilisation rates for group 1, group 2 and group 3 were 74.66, 68.35 and 65.46%, and the rate of polyploidy in the three groups was 8.55, 11.33, and 14.47%. The percentage of embryos that can be transferred from rescue ICSI for group 2 was 38.33%, and this value was higher than those of the other two groups. It is concluded that rescue ICSI is not recommended for patients with an IVF rate of >25% as the procedure is associated with a greater risk and low returns. However, it is feasible to perform rescue ICSI for patients with IVF rates of <25%.
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Affiliation(s)
- S Cao
- State Key Laboratory of Reproductive Medicine, Department of Reproduction, Nanjing Maternity and Child Health Care Hospital, Nanjing Medical University, Nanjing, China
| | - X Wu
- State Key Laboratory of Reproductive Medicine, Department of Reproduction, Nanjing Maternity and Child Health Care Hospital, Nanjing Medical University, Nanjing, China
| | - C Zhao
- State Key Laboratory of Reproductive Medicine, Department of Reproduction, Nanjing Maternity and Child Health Care Hospital, Nanjing Medical University, Nanjing, China
| | - L Zhou
- State Key Laboratory of Reproductive Medicine, Department of Reproduction, Nanjing Maternity and Child Health Care Hospital, Nanjing Medical University, Nanjing, China
| | - J Zhang
- State Key Laboratory of Reproductive Medicine, Department of Reproduction, Nanjing Maternity and Child Health Care Hospital, Nanjing Medical University, Nanjing, China
| | - X Ling
- State Key Laboratory of Reproductive Medicine, Department of Reproduction, Nanjing Maternity and Child Health Care Hospital, Nanjing Medical University, Nanjing, China
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Wu L, Han W, Zhang X, Wang J, Liu W, Xiong S, Huang G. A retrospective analysis of morphokinetic parameters according to the implantation outcome of IVF treatment. Eur J Obstet Gynecol Reprod Biol 2016; 197:186-90. [DOI: 10.1016/j.ejogrb.2015.12.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 11/22/2015] [Accepted: 12/09/2015] [Indexed: 10/22/2022]
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Gao Y, Zhang X, Xiong S, Han W, Liu J, Huang G. Motile sperm organelle morphology examination (MSOME) can predict outcomes of conventionalin vitrofertilization: A prospective pilot diagnostic study. HUM FERTIL 2015; 18:258-64. [DOI: 10.3109/14647273.2015.1072645] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Huang B, Qian K, Li Z, Yue J, Yang W, Zhu G, Zhang H. Neonatal outcomes after early rescue intracytoplasmic sperm injection: an analysis of a 5-year period. Fertil Steril 2015; 103:1432-7.e1. [DOI: 10.1016/j.fertnstert.2015.02.026] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 02/17/2015] [Accepted: 02/17/2015] [Indexed: 10/23/2022]
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Liu J, Chen M, Lin C, Weng X, Meng Z, Tang W. Effect of Early Cumulus Cell Removal on the Fertilization and Clinical Outcome in Human <i>in Vitro</i> Fertilization. ACTA ACUST UNITED AC 2015. [DOI: 10.4236/arsci.2015.33006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Zhang X, Liu J, Huang G. Efficiency of an automatic dehydrated carrier for the vitrification of human embryos derived from three pronuclei fertilized zygotes. Reprod Biomed Online 2014; 30:144-9. [PMID: 25498560 DOI: 10.1016/j.rbmo.2014.10.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 10/17/2014] [Accepted: 10/21/2014] [Indexed: 10/24/2022]
Abstract
The efficiency of a new vitrification technique using embryos obtained after abnormal fertilization was assesed. A total of 100 embryos were vitrified, 48 with the automatic dehydrated carrier (ADC) technique and 52 with cryotop. The survival rates in ADC and cryotop groups were similar (85.4% versus 92.3%). The loss rates of 10.4% for the ADC group and 1.9% for the cryotop group were not significantly different. The intact rate was significantly lower in the ADC group (26.8% versus 64.6%; P = 0.001). After 48 h of culture, blastocyst formation rates in the ADC and cryotop groups were 14.6% and 25.0%, respectively, which were not significantly different. In conclusion, the practicability of ADC vitrification was demonstrated. The study has some limitations, which necessitates further work.
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Affiliation(s)
- Xiaodong Zhang
- Chong Qing Reproductive and Genetic Institute, 64 Jing Tang ST, Yu Zhong District, Chong Qing 400013, China.
| | - Junxia Liu
- Chong Qing Reproductive and Genetic Institute, 64 Jing Tang ST, Yu Zhong District, Chong Qing 400013, China; Chong Qing Obstetric and Gynecology Hospital, 64 Jing Tang ST, Yu Zhong District, Chong Qing 400013, China
| | - Guoning Huang
- Chong Qing Reproductive and Genetic Institute, 64 Jing Tang ST, Yu Zhong District, Chong Qing 400013, China
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Beck-Fruchter R, Lavee M, Weiss A, Geslevich Y, Shalev E. Rescue intracytoplasmic sperm injection: a systematic review. Fertil Steril 2014; 101:690-8. [PMID: 24444597 DOI: 10.1016/j.fertnstert.2013.12.004] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 12/01/2013] [Accepted: 12/02/2013] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To assess the feasibility, efficacy, and safety of rescue intracytoplasmic sperm injection (ICSI) in cases of fertilization failure, using a scientific literature search. DESIGN Systematic review. SETTING Centers for reproductive care. PATIENT(S) Infertility patients with total or partial fertilization failure during an IVF cycle. INTERVENTION(S) An electronic literature search was performed in PubMed from 1992 through May 2013. The search was then expanded by using listed references from selected articles. MAIN OUTCOME MEASURE(S) Pregnancy rate. The secondary outcome measures were fertilization rate, normal fertilization rate, cleavage rate, birth rate, and malformation rate. RESULT(S) Thirty-eight studies including 1,863 patients were included. The pooled pregnancy rate was 14.4%; 194 babies were delivered. CONCLUSION(S) Rescue ICSI can result in the delivery of a healthy newborn, although the pregnancy rates are low. The clinical evidence did not indicate an elevated rate of malformations, although the data are limited and incomplete.
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Affiliation(s)
- Ronit Beck-Fruchter
- Fertility and In-Vitro Fertilization Unit, Department of Obstetrics and Gynecology, Ha'Emek Medical Center, Afula, Israel.
| | - Michal Lavee
- Fertility and In-Vitro Fertilization Unit, Department of Obstetrics and Gynecology, Ha'Emek Medical Center, Afula, Israel; Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Amir Weiss
- Fertility and In-Vitro Fertilization Unit, Department of Obstetrics and Gynecology, Ha'Emek Medical Center, Afula, Israel
| | - Yoel Geslevich
- Fertility and In-Vitro Fertilization Unit, Department of Obstetrics and Gynecology, Ha'Emek Medical Center, Afula, Israel
| | - Eliezer Shalev
- Fertility and In-Vitro Fertilization Unit, Department of Obstetrics and Gynecology, Ha'Emek Medical Center, Afula, Israel; Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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Pregnancy with oocytes characterized by narrow perivitelline space and heterogeneous zona pellucida: is intracytoplasmic sperm injection necessary? J Assist Reprod Genet 2014; 31:285-94. [PMID: 24408184 DOI: 10.1007/s10815-013-0169-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 12/26/2013] [Indexed: 12/17/2022] Open
Abstract
PURPOSE This retrospective study analyzed fertilization protocols and pregnancy outcomes for oocytes with with narrow perivitelline space and heterogeneous zona pellucid (NPVS/HZP). METHODS In 63 in-vitro fertilization cycles filled with NPVS/HZP oocytes (abnormal oocytes group) and 521 cycles with normal oocytes (normal oocytes group), major clinical and laboratory parameters were recorded and compared in different fertilization cycles (conventional IVF cycles, rescue ICSI cycles, and traditional ICSI cycles). RESULTS NPVS/HZP oocytes meant lower MIIoocytes rates in both IVF and ICSI cycles compared with normal oocytes (p < 0.05). The 2PN rates for abnormal oocytes were significantly lower than those for normal oocytes in both conventional IVF cycles (58.8% VS 71.3%, P < 0.05) and rescue ICSI cycles (58.0% VS 78.0%, P = 0.0000). The high-quality embryo rates in normal oocytes groups were significantly higher than those in abnormal oocytes groups in different fertilization cycles (52.2% VS 35.0%, P < 0.01; 42.9% VS 23.9%, P < 0.001; 50.6% VS 31.0%, P = 0.0000, respectively). No clinical pregnancy was obtained from abnormal oocytes in 11 conventional IVF cycles. The clinical pregnancy rates in rescue ICSI and traditional ICSI cycles were comparatively lower in abnormal oocytes groups, but there was no significant difference as compared with normal oocytes groups (35.0% VS 48.1% and 26.7% VS 50.7%, P > 0.05, respectively). CONCLUSIONS Retrieval of oocytes characterized by NPVS/PZP from cycle to cycle was one of the reasons for obscure infertility. ICSI may be the right way to avoid fertilization failure and get pregnancy in women with NPVS/HZP oocytes.
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Liu W, Liu J, Zhang X, Han W, Xiong S, Huang G. Short co-incubation of gametes combined with early rescue ICSI: an optimal strategy for complete fertilization failure after IVF. HUM FERTIL 2013; 17:50-5. [PMID: 24313679 DOI: 10.3109/14647273.2013.859746] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Failed fertilization after conventional IVF is one of the most frustrating experiences in assisted reproductive technology. "Late" rescue ICSI may be not an optimal strategy for treating unfertilized oocytes. Short co-incubation of gametes combined with early rescue ICSI has some advantages for complete fertilization failure after IVF. We evaluate the strategy and the optimal time for early rescue ICSI. A total of 180 patients underwent short co-incubation of gametes combined with early rescue ICSI treatment for complete fertilization failure after IVF (study group). A total of 494 ICSI patients with male factor infertility served as a control group. Clinical pregnancy rate, implantation rate, and live birth rate in the two groups were compared. The study group was divided into three different rescue time intervals (<6 h, 6-8 h, and >8 h). Clinical pregnancy rate, implantation rate, and live birth rate were comparable between the study group and the control group. There was a negative correlation between clinical outcomes and rescue time interval.
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Affiliation(s)
- Weiwei Liu
- Chongqing Reproductive and Genetics Institute, Chongqing Obstetrics and Gynecology Hospital , Yuzhong District, Chongqing , P. R. China
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Jiang Y, Cao Q, Zhao X, Li L, Li S, Gao F. Percutaneous epididymal sperm aspiration and short time insemination in the treatment of men with obstructive azoospermia. J Assist Reprod Genet 2013; 30:1175-9. [PMID: 23989999 PMCID: PMC3800539 DOI: 10.1007/s10815-013-0075-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2013] [Accepted: 08/05/2013] [Indexed: 11/24/2022] Open
Abstract
Objective To study the efficacy of percutaneous epididymal sperm aspiration (PESA) in combination with short time insemination to treat infertile men with obstructive azoospermia (OA). Design Paired randomized controlled trial in which each couple’s cohort of oocytes was divided into two equal groups. Setting Center for reproductive care. Patients Twenty men with OA. Interventions Motile spermatozoa were collected using PESA. Half of the oocytes were used for intracytoplasmic sperm injection (ICSI). The rest were inseminated briefly with PESA sperm in vitro fertilization (IVF). After 4–5 h, the remaining cumulus cells were removed mechanically for second polar body observation to decide whether to apply “rescue” ICSI (RE-ICSI). Main outcome measures Rates of oocyte maturation, fertilization, cleavage, and good quality embryos. Numbers of available embryos and good quality embryos were compared between PESA-IVF (using a short incubation protocol + rescue ICSI) group and PESA-ICSI group. Results In the short time insemination group, cumulus cells were dispersed by PESA spermatozoa. No second polar bodies were found, so RE-ICSI was done. PESA-IVF + RE-ICSI and PESA-ICSI outcomes were comparable in terms of fertilization rates, 2PN cleavage rate and good quality embryo rates with no statistically significant differences. Conclusions PESA sperm without centrifugation could disperse the cumulus cells but were infertile and therefore could substitute for synthetic hyaluronidase. The outcomes of PESA-IVF with rescue ICSI were equivalent to PESA-ICSI. Using spermatozoa obtained by PESA and IVF before RE-ICIS is a viable treatment for men with OA.
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Affiliation(s)
- Yan Jiang
- Department of Histology and Embryology, Hebei Medical University, Shijiazhuang, 050017, China,
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Zhang X, Liu J, Liu W, Gao Y, Han W, Xiong S, Wu L, Huang G. Time of insemination culture and outcomes of in vitro fertilization: a systematic review and meta-analysis. Hum Reprod Update 2013; 19:685-95. [DOI: 10.1093/humupd/dmt036] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Xue Y, Tong X, Jiang L, Zhu H, Yang L, Zhang S. Effect of cumulus cell removal 4 h post-insemination on fertilization and embryo quality: a prospective randomized sibling-oocyte study. J Assist Reprod Genet 2013; 30:1049-53. [PMID: 23868532 DOI: 10.1007/s10815-013-0049-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 07/05/2013] [Indexed: 10/26/2022] Open
Abstract
PURPOSE The study was designed to evaluate whether cumulus cell removal 4 h post-insemination could influence fertilization and embryo quality. METHODS The study included 61couples undergoing standard long down regulation protocol from July 2011 to May 2012. Sibling oocytes of each patient were randomly assigned to either the 4 h group or the 20 group. For the 4 h group, cumulus cells were removed 4 h after gamete coincubation; for the 20 group, cumulus cells removal was performed 20 h after insemination. Fertilization rate, embryo quality, pregnancy rate and implantation rate were assessed. RESULTS A total of 801 sibling cumulus-oocyte complexes (COCs) were randomized to the 4 h group (421 COCs) or 20 h group (380 COCs). There was no difference in the two pronuclei, one pronucleus and grade 1-2 embryo rate. Three pronuclei rate was significantly higher in the 4 h group compared to the 20 h group (12.6 % vs. 8.2 %, P = 0.041). Comparison of embryo transfer cycles in which either embryos from the 4 h group or 20 h group were transferred did not reveal any statistically significant differences in pregnancy or implantation rates. CONCLUSION The results of the present study indicate that cumulus cell removal 4 h post-insemination may increase the percentage of tripronuclear zygotes. However, normal fertilization rate, embryo development, clinical pregnancy rate and implantation rates are not influenced by the timing of cumulus cell removal.
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Affiliation(s)
- Yamei Xue
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, No. 3, Qingchun Road, Hangzhou, 310016, China
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Huang Z, Li J, Wang L, Yan J, Shi Y, Li S. Brief co-incubation of sperm and oocytes for in vitro fertilization techniques. Cochrane Database Syst Rev 2013; 2013:CD009391. [PMID: 23633370 PMCID: PMC11375493 DOI: 10.1002/14651858.cd009391.pub2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The in vitro fertilization (IVF) technique is commonly used and is the only treatment option for a proportion of infertile couples. To obtain better outcomes of IVF, it is important to enhance embryo quality by optimizing IVF techniques. In IVF procedures, oocytes and sperm are routinely co-incubated overnight, which may expose oocytes and zygotes to suboptimal culture conditions with increased reactive oxygen species (ROS) produced by sperm in this long term culture. As an attempt to avoid possible detrimental effects on the oocytes from long exposure to sperm, the brief co-incubation insemination protocol was developed. However, despite a number of studies in this area, it is unclear whether brief co-incubation improves the IVF outcomes compared with the standard overnight insemination protocol. OBJECTIVES This Cochrane review aimed to determine whether brief co-incubation of sperm and oocytes improves outcomes compared with the standard overnight insemination protocol for women undergoing IVF. SEARCH METHODS We searched the Cochrane Menstrual Disorders and Subfertility Group Register (14 June 2012), Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, 1st quarter), MEDLINE (1948 to 14 June 2012), EMBASE (1989 to 14 June 2012), PsycINFO (1806 to 14 June 2012) and CINAHL (1980 to 26 July 2012). In addition, we searched trials registers, reference lists of articles, conference proceedings (American Society for Reproductive Medicine (ASRM), European Society of Human Reproduction and Embryology (ESHRE)) and contacted experts in the field. SELECTION CRITERIA We included randomized controlled trials (RCTs) comparing brief co-incubation of gametes with the standard overnight insemination protocol. DATA COLLECTION AND ANALYSIS Two review authors independently assessed studies for inclusion and trial quality, and extracted data. Disagreements were resolved by discussion with a third author. Statistical analysis was performed using RevMan software. MAIN RESULTS Eight RCTs with 733 women in total that compared brief co-incubation and the standard insemination protocol were included. Live birth was not reported in the included studies. For ongoing pregnancy rate, there were 127 ongoing pregnancies in two trials including 426 women. The low quality evidence showed that brief co-incubation was associated with an increased ongoing pregnancy rate compared to the standard insemination protocol (pooled odds ratio (OR) 2.42, 95% confidence interval (CI) 1.55 to 3.77; P < 0.0001, I(2) = 0%). Measuring clinical pregnancy rate, there were 93 clinical pregnancies in three trials including 372 women. The low quality evidence showed that brief co-incubation was associated with a significantly higher clinical pregnancy rate than the overnight insemination protocol (pooled OR 2.36, 95% CI 1.45 to 3.85; P = 0.0006, I(2) = 0%). For the miscarriage rate, there were six miscarriages in one trial including 167 women. This low quality evidence suggested no significant difference in the odds of miscarriage between brief co-incubation and standard insemination (OR 1.98, 95% CI 0.35 to 11.09; P = 0.44). AUTHORS' CONCLUSIONS This review has provided evidence that brief co-incubation of sperm and oocytes may improve the ongoing pregnancy and clinical pregnancy rates for infertile women undergoing IVF cycles. More RCTs are required to assess whether brief co-incubation would contribute to a higher live birth rate and a lower miscarriage rate compared to the standard overnight insemination protocol.
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Affiliation(s)
- Zhongying Huang
- Reproductive Medical Centre, Department of Obstetrics and Gynecology, West China 2nd Hospital, Sichuan University, Chengdu,China.
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