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Chow DJX, Tan TCY, Upadhya A, Lim M, Dholakia K, Dunning KR. Viewing early life without labels: optical approaches for imaging the early embryo†. Biol Reprod 2024; 110:1157-1174. [PMID: 38647415 PMCID: PMC11180623 DOI: 10.1093/biolre/ioae062] [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: 01/28/2024] [Revised: 03/26/2024] [Accepted: 04/18/2024] [Indexed: 04/25/2024] Open
Abstract
Embryo quality is an important determinant of successful implantation and a resultant live birth. Current clinical approaches for evaluating embryo quality rely on subjective morphology assessments or an invasive biopsy for genetic testing. However, both approaches can be inherently inaccurate and crucially, fail to improve the live birth rate following the transfer of in vitro produced embryos. Optical imaging offers a potential non-invasive and accurate avenue for assessing embryo viability. Recent advances in various label-free optical imaging approaches have garnered increased interest in the field of reproductive biology due to their ability to rapidly capture images at high resolution, delivering both morphological and molecular information. This burgeoning field holds immense potential for further development, with profound implications for clinical translation. Here, our review aims to: (1) describe the principles of various imaging systems, distinguishing between approaches that capture morphological and molecular information, (2) highlight the recent application of these technologies in the field of reproductive biology, and (3) assess their respective merits and limitations concerning the capacity to evaluate embryo quality. Additionally, the review summarizes challenges in the translation of optical imaging systems into routine clinical practice, providing recommendations for their future development. Finally, we identify suitable imaging approaches for interrogating the mechanisms underpinning successful embryo development.
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Affiliation(s)
- Darren J X Chow
- Robinson Research Institute, School of Biomedicine, The University of Adelaide, Adelaide, Australia
- Institute for Photonics and Advanced Sensing, The University of Adelaide, Adelaide, Australia
- Centre of Light for Life, The University of Adelaide, Adelaide, Australia
| | - Tiffany C Y Tan
- Robinson Research Institute, School of Biomedicine, The University of Adelaide, Adelaide, Australia
- Institute for Photonics and Advanced Sensing, The University of Adelaide, Adelaide, Australia
| | - Avinash Upadhya
- Institute for Photonics and Advanced Sensing, The University of Adelaide, Adelaide, Australia
- Centre of Light for Life, The University of Adelaide, Adelaide, Australia
- School of Biological Sciences, The University of Adelaide, Adelaide, Australia
| | - Megan Lim
- Robinson Research Institute, School of Biomedicine, The University of Adelaide, Adelaide, Australia
- Institute for Photonics and Advanced Sensing, The University of Adelaide, Adelaide, Australia
- Centre of Light for Life, The University of Adelaide, Adelaide, Australia
- School of Biological Sciences, The University of Adelaide, Adelaide, Australia
| | - Kishan Dholakia
- Centre of Light for Life, The University of Adelaide, Adelaide, Australia
- School of Biological Sciences, The University of Adelaide, Adelaide, Australia
- Scottish Universities Physics Alliance, School of Physics and Astronomy, University of St Andrews, St Andrews, United Kingdom
| | - Kylie R Dunning
- Robinson Research Institute, School of Biomedicine, The University of Adelaide, Adelaide, Australia
- Institute for Photonics and Advanced Sensing, The University of Adelaide, Adelaide, Australia
- Centre of Light for Life, The University of Adelaide, Adelaide, Australia
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Canosa S, Licheri N, Bergandi L, Gennarelli G, Paschero C, Beccuti M, Cimadomo D, Coticchio G, Rienzi L, Benedetto C, Cordero F, Revelli A. A novel machine-learning framework based on early embryo morphokinetics identifies a feature signature associated with blastocyst development. J Ovarian Res 2024; 17:63. [PMID: 38491534 PMCID: PMC10941455 DOI: 10.1186/s13048-024-01376-6] [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: 08/25/2023] [Accepted: 02/16/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Artificial Intelligence entails the application of computer algorithms to the huge and heterogeneous amount of morphodynamic data produced by Time-Lapse Technology. In this context, Machine Learning (ML) methods were developed in order to assist embryologists with automatized and objective predictive models able to standardize human embryo assessment. In this study, we aimed at developing a novel ML-based strategy to identify relevant patterns associated with the prediction of blastocyst development stage on day 5. METHODS We retrospectively analysed the morphokinetics of 575 embryos obtained from 80 women who underwent IVF at our Unit. Embryo morphokinetics was registered using the Geri plus® time-lapse system. Overall, 30 clinical, morphological and morphokinetic variables related to women and embryos were recorded and combined. Some embryos reached the expanded blastocyst stage on day 5 (BL Group, n = 210), some others did not (nBL Group, n = 365). RESULTS The novel EmbryoMLSelection framework was developed following four-steps: Feature Selection, Rules Extraction, Rules Selection and Rules Evaluation. Six rules composed by a combination of 8 variables were finally selected, and provided a predictive power described by an AUC of 0.84 and an accuracy of 81%. CONCLUSIONS We provided herein a new feature-signature able to identify with an high performance embryos with the best developmental competence to reach the expanded blastocyst stage on day 5. Clear and clinically relevant cut-offs were identified for each considered variable, providing an objective tool for early embryo developmental assessment.
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Affiliation(s)
- S Canosa
- Gynecology and Obstetrics 1U, Physiopathology of Reproduction and IVF Unit, Department of Surgical Sciences, S. Anna Hospital, University of Turin, Turin, Italy.
- IVIRMA Global Research Alliance, Livet, Turin, Italy.
| | - N Licheri
- Department of Computer Science, University di Turin, Turin, Italy
| | - L Bergandi
- Department of Oncology, University of Turin, Turin, Italy
| | - G Gennarelli
- Gynecology and Obstetrics 1U, Physiopathology of Reproduction and IVF Unit, Department of Surgical Sciences, S. Anna Hospital, University of Turin, Turin, Italy
- IVIRMA Global Research Alliance, Livet, Turin, Italy
| | - C Paschero
- Gynecology and Obstetrics 1U, Physiopathology of Reproduction and IVF Unit, Department of Surgical Sciences, S. Anna Hospital, University of Turin, Turin, Italy
| | - M Beccuti
- Department of Computer Science, University di Turin, Turin, Italy
| | - D Cimadomo
- IVIRMA Global Research Alliance, Genera, Clinica Valle Giulia, Rome, Italy
| | - G Coticchio
- IVIRMA Global Research Alliance, 9.Baby, Bologna, Italy
| | - L Rienzi
- IVIRMA Global Research Alliance, Genera, Clinica Valle Giulia, Rome, Italy
- Department of Biomolecular Sciences, University of Urbino "Carlo Bo", Urbino, Italy
| | - C Benedetto
- Gynecology and Obstetrics 1U, Physiopathology of Reproduction and IVF Unit, Department of Surgical Sciences, S. Anna Hospital, University of Turin, Turin, Italy
| | - F Cordero
- Department of Computer Science, University di Turin, Turin, Italy
| | - A Revelli
- Gynecology and Obstetrics 1U, Physiopathology of Reproduction and IVF Unit, Department of Surgical Sciences, S. Anna Hospital, University of Turin, Turin, Italy
- Gynecology and Obstetrics 2U, Department of Surgical Sciences, S. Anna Hospital, University of Turin, Turin, Italy
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Luong TMT, Le NQK. Artificial intelligence in time-lapse system: advances, applications, and future perspectives in reproductive medicine. J Assist Reprod Genet 2024; 41:239-252. [PMID: 37880512 PMCID: PMC10894798 DOI: 10.1007/s10815-023-02973-y] [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: 07/17/2023] [Accepted: 10/13/2023] [Indexed: 10/27/2023] Open
Abstract
With the rising demand for in vitro fertilization (IVF) cycles, there is a growing need for innovative techniques to optimize procedure outcomes. One such technique is time-lapse system (TLS) for embryo incubation, which minimizes environmental changes in the embryo culture process. TLS also significantly advances predicting embryo quality, a crucial determinant of IVF cycle success. However, the current subjective nature of embryo assessments is due to inter- and intra-observer subjectivity, resulting in highly variable results. To address this challenge, reproductive medicine has gradually turned to artificial intelligence (AI) to establish a standardized and objective approach, aiming to achieve higher success rates. Extensive research is underway investigating the utilization of AI in TLS to predict multiple outcomes. These studies explore the application of popular AI algorithms, their specific implementations, and the achieved advancements in TLS. This review aims to provide an overview of the advances in AI algorithms and their particular applications within the context of TLS and the potential challenges and opportunities for further advancements in reproductive medicine.
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Affiliation(s)
- Thi-My-Trang Luong
- International Master Program in Medicine, College of Medicine, Taipei Medical University, Taipei, 110, Taiwan
- AIBioMed Research Group, Taipei Medical University, Taipei, 110, Taiwan
| | - Nguyen Quoc Khanh Le
- AIBioMed Research Group, Taipei Medical University, Taipei, 110, Taiwan.
- Professional Master Program in Artificial Intelligence in Medicine, College of Medicine, Taipei Medical University, Taipei, 110, Taiwan.
- Research Center for Artificial Intelligence in Medicine, Taipei Medical University, Taipei, 110, Taiwan.
- Translational Imaging Research Center, Taipei Medical University Hospital, Taipei, 110, Taiwan.
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Abdullah KAL, Atazhanova T, Chavez-Badiola A, Shivhare SB. Automation in ART: Paving the Way for the Future of Infertility Treatment. Reprod Sci 2023; 30:1006-1016. [PMID: 35922741 PMCID: PMC10160149 DOI: 10.1007/s43032-022-00941-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 04/09/2022] [Indexed: 01/11/2023]
Abstract
In vitro fertilisation (IVF) is estimated to account for the birth of more than nine million babies worldwide, perhaps making it one of the most intriguing as well as commoditised and industrialised modern medical interventions. Nevertheless, most IVF procedures are currently limited by accessibility, affordability and most importantly multistep, labour-intensive, technically challenging processes undertaken by skilled professionals. Therefore, in order to sustain the exponential demand for IVF on one hand, and streamline existing processes on the other, innovation is essential. This may not only effectively manage clinical time but also reduce cost, thereby increasing accessibility, affordability and efficiency. Recent years have seen a diverse range of technologies, some integrated with artificial intelligence, throughout the IVF pathway, which promise personalisation and, at least, partial automation in the not-so-distant future. This review aims to summarise the rapidly evolving state of these innovations in automation, with or without the integration of artificial intelligence, encompassing the patient treatment pathway, gamete/embryo selection, endometrial evaluation and cryopreservation of gametes/embryos. Additionally, it shall highlight the resulting prospective change in the role of IVF professionals and challenges of implementation of some of these technologies, thereby aiming to motivate continued research in this field.
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Affiliation(s)
- Kadrina Abdul Latif Abdullah
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Level 3, Women's Centre, John Radcliffe Hospital, Oxford, OX3 9DU, England
| | - Tomiris Atazhanova
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Level 3, Women's Centre, John Radcliffe Hospital, Oxford, OX3 9DU, England
| | | | - Sourima Biswas Shivhare
- TFP Simply Fertility, W Hanningfield Rd, Great Baddow, Chelmsford, CM2 8HN, England.
- The Centre for Reproductive and Genetic Health, London, UK.
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Kim J, Lee J, Jun JH. Non-invasive evaluation of embryo quality for the selection of transferable embryos in human in vitro fertilization-embryo transfer. Clin Exp Reprod Med 2022; 49:225-238. [PMID: 36482497 PMCID: PMC9732075 DOI: 10.5653/cerm.2022.05575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 11/09/2022] [Accepted: 11/10/2022] [Indexed: 07/28/2023] Open
Abstract
The ultimate goal of human assisted reproductive technology is to achieve a healthy pregnancy and birth, ideally from the selection and transfer of a single competent embryo. Recently, techniques for efficiently evaluating the state and quality of preimplantation embryos using time-lapse imaging systems have been applied. Artificial intelligence programs based on deep learning technology and big data analysis of time-lapse monitoring system during in vitro culture of preimplantation embryos have also been rapidly developed. In addition, several molecular markers of the secretome have been successfully analyzed in spent embryo culture media, which could easily be obtained during in vitro embryo culture. It is also possible to analyze small amounts of cell-free nucleic acids, mitochondrial nucleic acids, miRNA, and long non-coding RNA derived from embryos using real-time polymerase chain reaction (PCR) or digital PCR, as well as next-generation sequencing. Various efforts are being made to use non-invasive evaluation of embryo quality (NiEEQ) to select the embryo with the best developmental competence. However, each NiEEQ method has some limitations that should be evaluated case by case. Therefore, an integrated analysis strategy fusing several NiEEQ methods should be urgently developed and confirmed by proper clinical trials.
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Affiliation(s)
- Jihyun Kim
- Department of Obstetrics and Gynaecology, Seoul Medical Center, Seoul, Republic of Korea
| | - Jaewang Lee
- Department of Biomedical Laboratory Science, College of Health Science, Eulji University, Seongnam, Republic of Korea
| | - Jin Hyun Jun
- Department of Biomedical Laboratory Science, College of Health Science, Eulji University, Seongnam, Republic of Korea
- Department of Senior Healthcare, Graduate School, Eulji University, Seongnam, Republic of Korea
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Piquette T, Rydze RT, Pan A, Bosler J, Granlund A, Schoyer KD. The effect of maternal body mass index on embryo division timings in women undergoing in vitro fertilization. F S Rep 2022; 3:324-331. [PMID: 36568924 PMCID: PMC9783148 DOI: 10.1016/j.xfre.2022.10.004] [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: 02/25/2022] [Revised: 10/08/2022] [Accepted: 10/14/2022] [Indexed: 11/05/2022] Open
Abstract
Objective To measure the impact of maternal body mass index (BMI) on the morphokinetics of embryo development as monitored by a time-lapse system. Design A retrospective chart review of in vitro fertilization (IVF) cycles from September 2016 to January 2019. Setting Academic IVF practice. Patients Patients <age 38 years undergoing IVF with their own gametes. Interventions Not applicable. Main outcome measures The primary outcome was to compare embryo division timings between morbidly obese, obese, overweight, and normal-weight patients. A multilevel mixed effects model was performed to investigate the relationships between BMI categories and embryo division timings. Log or square transformation were used to improve fit. Results A total of 366 patients met inclusion criteria, yielding 4,475 embryos: 1,948 embryos from 162 normal-weight women (BMI 18.5-24.9), 1,242 embryos from 96 overweight women (BMI 25.0-29.9), 1,119 embryos from 91 obese women (BMI 30.0-39.9), and 166 embryos from 17 morbidly obese women (BMI ≥40). There were no differences in age, Antimüllerian hormone, or IVF cycle outcomes among the different BMI categories. When comparing embryo division timings based on BMI, controlling for covariates, embryos from obese patients had a shorter time to division to 2 cell embryo (T2) than normal-weight patients. When analyzing BMI as a continuous variable, there was no significant relationship between BMI and embryo division timing. Conclusions Early embryo divisions were accelerated in only certain categories of obesity. This suggests a more complex mechanism for the effect of obesity on embryo development that may not be perceptible through the assessment of cell division timing events.
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Affiliation(s)
- Theresa Piquette
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Robert T. Rydze
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Amy Pan
- Division of Quantitative Health Sciences, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Jayme Bosler
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Amy Granlund
- Reproductive Medicine Center, Froedtert Hospital, North Hills Health Center, Menomonee Falls, Wisconsin
| | - Kate D. Schoyer
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, Wisconsin,Reprint requests: Kate D. Schoyer, M.D., Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Medical College of Wisconsin, 8701 W. Watertown Plank Rd, Milwaukee, Wisconsin; 53226.
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Kljajic M, Saymé N, Krebs T, Wagenpfeil G, Baus S, Solomayer EF, Kasoha M. Zygote Diameter and Total Cytoplasmic Volume as Useful Predictive Tools of Blastocyst Quality. Geburtshilfe Frauenheilkd 2022; 83:97-105. [PMID: 36643875 PMCID: PMC9833892 DOI: 10.1055/a-1876-2231] [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: 11/21/2021] [Accepted: 06/13/2022] [Indexed: 01/18/2023] Open
Abstract
Introduction According to the Embryo Protection Act, the selection of embryos with the greatest potential for successful implantation in Germany must be performed in the pronucleus stage. The main aim of this study was to identify morphokinetic parameters that could serve as noninvasive biomarkers of blastocyst quality in countries with restrictive reproductive medicine laws. Materials and Methods The sample comprised 191 embryos from 40 patients undergoing antagonist cycles for intracytoplasmic sperm injection. Blastocysts were cultured in an EmbryoScope chamber and video records were validated to determine the post-injection timing of various developmental stages, cleavage stages, and blastocyst formation. The Gardner and Schoolcraft scoring system was used to characterize blastocyst quality. Results Morphokinetic data showed that the zygote diameter and total cytoplasmic volume were significantly different between good and poor blastocysts quality groups, where zygotes, which formed better blastocyst quality, had smaller diameter and smaller total cytoplasmic volume. Zygotes with more rapid pronuclear disappearance developed in better-quality blastocysts. Differences between good- and poor-quality blastocysts were also observed for late-stage parameters and for the spatial arrangement of blastomere where tetrahedral embryos more frequently forming good-quality blastocyst compare to the non-tetrahedral. Conclusions The study findings could be used to enhance embryo selection, especially in countries with strict Embryo Law Regulations. Further studies, including those in which the implantation potential and pregnancy rate are considered, are warranted to confirm these preliminary results.
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Affiliation(s)
- Marija Kljajic
- 39072Department of Gynecology, Obstetrics and Reproductive Medicine, Saarland University Hospital, Homburg, Saarland, Germany,Korrespondenzadresse Marija Kljajic 39072Department of Gynecology, Obstetrics and Reproductive Medicine, Saarland University
HospitalKirrberger Str. 10066421 Homburg,
SaarlandGermany
| | - Nabil Saymé
- Team Kinderwunsch Hannover, Hannover, Germany
| | | | - Gudrun Wagenpfeil
- 9379Institute of Medical Biometry, Epidemiology and Medical Informatics, Saarland University, Homburg, Saar, Germany
| | - Simona Baus
- 39072Department of Gynecology, Obstetrics and Reproductive Medicine, Saarland University Hospital, Homburg, Saarland, Germany
| | - Erich-Franz Solomayer
- 39072Department of Gynecology, Obstetrics and Reproductive Medicine, Saarland University Hospital, Homburg, Saarland, Germany
| | - Mariz Kasoha
- 39072Department of Gynecology, Obstetrics and Reproductive Medicine, Saarland University Hospital, Homburg, Saarland, Germany
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Song X, Li T, Xiong X, Shan H, Feng T, Cui K, Shi D, Liu Q, Li Z. RNA-Seq Reveals the Underlying Molecular Mechanism of First Cleavage Time Affecting Porcine Embryo Development. Genes (Basel) 2022; 13:genes13071251. [PMID: 35886034 PMCID: PMC9320770 DOI: 10.3390/genes13071251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/12/2022] [Accepted: 07/13/2022] [Indexed: 02/01/2023] Open
Abstract
The selection and evaluation of high-quality embryos are the key factors affecting in vitro embryo development and pregnancy outcome. The timing of first embryonic cleavage has been considered a positive indicator of the in vitro developmental potential of embryos, while the underlying molecular mechanism is still not fully understood. In this study, the embryos generated by parthenogenetic activation (PA) or in vitro fertilization (IVF) were monitored and recorded every 2 h and divided into two groups (early cleavage or late cleavage) based on the cleavage rate and blastocyst formation data. RNA sequencing was used to analyze the gene expression pattern of the embryos. We identified 667 and 71 different expression genes (DEGs) in early cleavage and late cleavage porcine PA and IVF embryos, respectively. Further Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses showed that the DEGs are mainly enriched in pathways concerning the proteasome, DNA repair, cell cycle arrest, autophagy, and apoptosis, suggesting that severe endoplasmic reticulum stress (ERS) and DNA damage may be the key factors that led to the low development potential of late cleavage embryos. This study provides a theoretical basis for the following application and offers important information about the understanding of the timely manner of porcine embryo development.
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Affiliation(s)
- Xinhui Song
- State Key Laboratory for Conservation and Utilization of Subtropical Agro-Bioresources, Guangxi University, Nanning 530004, China; (X.S.); (H.S.); (T.F.); (K.C.); (D.S.)
| | - Tiantian Li
- Guangdong-Hong Kong-Macao Central Nervous Research Institute, Medical School, Jinan University, Guangzhou 510632, China; (T.L.); (X.X.)
| | - Xin Xiong
- Guangdong-Hong Kong-Macao Central Nervous Research Institute, Medical School, Jinan University, Guangzhou 510632, China; (T.L.); (X.X.)
| | - Huiquan Shan
- State Key Laboratory for Conservation and Utilization of Subtropical Agro-Bioresources, Guangxi University, Nanning 530004, China; (X.S.); (H.S.); (T.F.); (K.C.); (D.S.)
| | - Tong Feng
- State Key Laboratory for Conservation and Utilization of Subtropical Agro-Bioresources, Guangxi University, Nanning 530004, China; (X.S.); (H.S.); (T.F.); (K.C.); (D.S.)
| | - Kuiqing Cui
- State Key Laboratory for Conservation and Utilization of Subtropical Agro-Bioresources, Guangxi University, Nanning 530004, China; (X.S.); (H.S.); (T.F.); (K.C.); (D.S.)
| | - Deshun Shi
- State Key Laboratory for Conservation and Utilization of Subtropical Agro-Bioresources, Guangxi University, Nanning 530004, China; (X.S.); (H.S.); (T.F.); (K.C.); (D.S.)
| | - Qingyou Liu
- Guangdong Provincial Key Laboratory of Animal Molecular Design and Precise Breeding, School of Life Science and Engineering, Foshan University, Foshan 528225, China;
| | - Zhipeng Li
- State Key Laboratory for Conservation and Utilization of Subtropical Agro-Bioresources, Guangxi University, Nanning 530004, China; (X.S.); (H.S.); (T.F.); (K.C.); (D.S.)
- Correspondence: ; Tel.: +86-185-0136-1752
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Comprehensive guidance for human embryology, andrology, and endocrinology laboratories: management and operations: a committee opinion. Fertil Steril 2022; 117:1183-1202. [PMID: 35487770 DOI: 10.1016/j.fertnstert.2022.02.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 02/15/2022] [Indexed: 11/04/2022]
Abstract
This document is a comprehensive guidance for human embryology, andrology, and endocrinology laboratories. Universal guidance applicable to all laboratories includes requirements and recommendations for accreditation and staffing in the United States, and specific guidance is included for each laboratory specialty.
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Affiliation(s)
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- American Society for Reproductive Medicine, Birmingham, AL
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10
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Sciorio R, Miranian D, Smith GD. Non-invasive oocyte quality assessment. Biol Reprod 2022; 106:274-290. [PMID: 35136962 DOI: 10.1093/biolre/ioac009] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 01/04/2022] [Accepted: 01/11/2022] [Indexed: 12/27/2022] Open
Abstract
Oocyte quality is perhaps the most important limiting factor in female fertility; however, the current methods of determining oocyte competence are only marginally capable of predicting a successful pregnancy. We aim to review the predictive value of non-invasive techniques for the assessment of human oocytes and their related cells and biofluids that pertain to their developmental competence. Investigation of the proteome, transcriptome, and hormonal makeup of follicular fluid, as well as cumulus-oocyte complexes are currently underway; however, prospective randomized non-selection-controlled trials of the future are needed before determining their prognostic value. The biological significance of polar body morphology and genetics are still unknown and the subject of debate. The predictive utility of zygotic viscoelasticity for embryo development has been demonstrated, but similar studies performed on oocytes have yet to be conducted. Metabolic profiling of culture media using human oocytes are also limited and may require integration of automated, high-throughput targeted metabolomic assessments in real time with microfluidic platforms. Light exposure to oocytes can be detrimental to subsequent development and utilization of time-lapse imaging and morphometrics of oocytes is wanting. Polarized light, Raman microspectroscopy, and coherent anti-Stokes Raman scattering are a few novel imaging tools that may play a more important role in future oocyte assessment. Ultimately, the integration of chemistry, genomics, microfluidics, microscopy, physics, and other biomedical engineering technologies into the basic studies of oocyte biology, and in testing and perfecting practical solutions of oocyte evaluation, are the future for non-invasive assessment of oocytes.
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Affiliation(s)
- Romualdo Sciorio
- Edinburgh Assisted Conception Programme, EFREC, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Daniel Miranian
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
| | - Gary D Smith
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA.,Department of Physiology, Urology, and Reproductive Sciences Program, University of Michigan, Ann Arbor, MI, USA
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11
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Comparison of two culture media on morphokinetics and ploidy status of sibling embryos. ZYGOTE 2021; 30:410-415. [PMID: 34879892 DOI: 10.1017/s0967199421000927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
To investigate the effects of culture media with different lactate concentrations on early embryonic development, data collected from our patients undergoing preimplantation genetic testing (PGT) were assessed using the EmbryoScope™ time-lapse culturing system. After intracytoplasmic sperm injection (ICSI), sibling oocytes were cultured in the same EmbryoScope (Vitrolife) slides including two different commercially available media. The patients with fewer than five mature oocytes were not included in the analyses. All embryos were hatched on day 3, and trophectoderm biopsies (n = 212) were performed accordingly. PGT for aneuploidy (PGT-A) on biopsied materials was carried out using next generation sequencing. Morphokinetic parameters, fertilization, irregular division, degeneration, blastulation, euploidy, and pregnancy rates of embryos cultured in LifeGlobal Global Total medium (LGGT) and Continuous Single Culture-NX Complete medium (CSCM-NXC) were compared. There were no differences observed in time to pronuclear fade, or in time spent as 2-cell (cc2) and 3-cell (s2), to 4-cell, 5-cell, morula and blastocyst stages (P > 0.05). Embryos reached the 2-cell (t2) and 3-cell (t3) stages significantly faster in LGGT (P < 0.05), whereas embryos grown in CSCM-NXC with lower lactate reached starting blastulation significantly sooner (P = 0.026). However, there were no statistical differences observed in fertilization, blastulation, degeneration, irregular division euploidy, and pregnancy rates between the two groups (P > 0.05). Even though pregnancy and fertilization rates did not indicate statistical differences, results are significant to provide better insight on potential roles of lactate in embryo development. These finding will advance the fundamental knowledge of human embryo development and assisted reproductive technologies.
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Sciorio R, Meseguer M. Focus on time-lapse analysis: blastocyst collapse and morphometric assessment as new features of embryo viability. Reprod Biomed Online 2021; 43:821-832. [PMID: 34593324 DOI: 10.1016/j.rbmo.2021.08.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 06/29/2021] [Accepted: 08/05/2021] [Indexed: 11/28/2022]
Abstract
The main goal of assisted reproductive technology (ART) is to achieve a healthy singleton live birth after the transfer of one embryo. A major objective of IVF scientists has always been to use adequate criteria for selecting the embryo for transfer according to its implantation potential. Indeed, embryo quality is usually assessed by evaluating visual morphology, which relies on the removal of the embryo from the incubator and might include inter- and intra-evaluator variation among embryologists. Recently, an advancement in embryo culture has taken place with the introduction of a new type of incubator with an integrated time-lapse monitoring system, which enables embryologists to analyse the dynamic events of embryo development from fertilization to blastocyst formation. This novel practice is rapidly growing and has been used in many IVF centres worldwide. Therefore, the main aim of this review is to present the benefits of time-lapse monitoring in a modern embryology laboratory; in particular, we discuss blastocyst collapse and morphometric blastocyst assessment, and analyse their association with embryo viability and implantation potential. In addition, we highlight preliminary studies involving artificial intelligence and machine learning models as non-invasive markers of clinical pregnancy.
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Affiliation(s)
- Romualdo Sciorio
- Edinburgh Assisted Conception Programme, EFREC, Royal Infirmary of Edinburgh, UK.
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13
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Chera-Aree P, Thanaboonyawat I, Thokha B, Laokirkkiat P. Comparison of pregnancy outcomes using a time-lapse monitoring system for embryo incubation versus a conventional incubator in in vitro fertilization: An age-stratification analysis. Clin Exp Reprod Med 2021; 48:174-183. [PMID: 34024081 PMCID: PMC8176153 DOI: 10.5653/cerm.2020.04091] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 01/11/2021] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE The aim of this study was to compare the pregnancy outcomes of in vitro fertilization with embryo transfer between embryos cultured in a time-lapse monitoring system (TLS) and those cultured in a conventional incubator (CI). METHODS The medical records of 250 fertilized embryos from 141 patients undergoing infertility treatment with assisted reproductive technology at a tertiary hospital from June 2018 to May 2020 were reviewed. The study population was divided into TLS and CI groups at a 1 to 1 ratio (125 embryos per group). The primary outcome was the live birth rate. RESULTS The TLS group had a significantly higher clinical pregnancy rate (46.4% vs. 27.2%, p=0.002), implantation rate (27.1% vs. 12.0%, p=0.004), and live birth rate (32.0% vs. 18.4%, p=0.013) than the CI group. Furthermore, subgroup analyses of the clinical pregnancy rate and live birth rate in the different age groups favored the TLS group. However, this difference only reached statistical significance in the live birth rate in women aged over 40 years and the clinical pregnancy rate in women aged 35-40 years (p=0.048 and p=0.031, respectively). The miscarriage rate, cleavage rate, and blastocyst rate were comparable. CONCLUSION TLS application improved the live birth rate, implantation rate, and clinical pregnancy rate, particularly in the advanced age group in this study, while the other reproductive outcomes were comparable. Large randomized controlled trials are needed to further explore the ramifications of these findings, especially in different age groups.
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Affiliation(s)
- Pattraporn Chera-Aree
- Infertility and Reproductive Biology Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Isarin Thanaboonyawat
- Infertility and Reproductive Biology Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Benjawan Thokha
- Infertility and Reproductive Biology Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pitak Laokirkkiat
- Infertility and Reproductive Biology Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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14
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Letterie G. Three ways of knowing: the integration of clinical expertise, evidence-based medicine, and artificial intelligence in assisted reproductive technologies. J Assist Reprod Genet 2021; 38:1617-1625. [PMID: 33870475 DOI: 10.1007/s10815-021-02159-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 03/16/2021] [Indexed: 12/12/2022] Open
Abstract
Decision-making in fertility care is on the cusp of a significant frameshift. Online tools to integrate artificial intelligence into the decision-making process across all aspects of ART are rapidly emerging. These tools have the potential to improve outcomes and transition decision-making from one based on traditional provider centric assessments toward a hybrid triad of expertise, evidence, and algorithmic data analytics using AI. We can look forward to a time when AI will be the third part of a provider's tool box to complement expertise and medical literature to enable ever more accurate predictions and outcomes in ART. In their fully integrated format, these tools will be part of a digital fertility ecosystem of analytics embedded within an EMR. To date, the impact of AI on ART outcomes is inconclusive. No prospective studies have shown clear cut benefit or cost reductions over current practices, but we are very early in the process of developing and evaluating these tools. We owe it to ourselves to begin to examine these AI-driven analytics and develop a very clear idea about where we can and should go before we roll these tools into clinical care. Thoughtful scrutiny is essential lest we find ourselves in a position of trying to modulate and modify after entry of these tools into our clinics and patient care. The purpose of this commentary is to highlight the evolution and impact AI has had in other fields relevant to the fertility sector and describe a vision for applications within ART that could improve outcomes, reduce costs, and positively impact clinical care.
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Affiliation(s)
- Gerard Letterie
- Seattle Reproductive Medicine, 1505 Westlake Avenue, Suite 400, Seattle, WA, 98104, USA.
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15
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Thirumalaraju P, Kanakasabapathy MK, Bormann CL, Gupta R, Pooniwala R, Kandula H, Souter I, Dimitriadis I, Shafiee H. Evaluation of deep convolutional neural networks in classifying human embryo images based on their morphological quality. Heliyon 2021; 7:e06298. [PMID: 33665450 PMCID: PMC7907476 DOI: 10.1016/j.heliyon.2021.e06298] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 11/08/2020] [Accepted: 02/11/2021] [Indexed: 01/14/2023] Open
Abstract
A critical factor that influences the success of an in-vitro fertilization (IVF) treatment cycle is the quality of the transferred embryo. Embryo morphology assessments, conventionally performed through manual microscopic analysis suffer from disparities in practice, selection criteria, and subjectivity due to the experience of the embryologist. Convolutional neural networks (CNNs) are powerful, promising algorithms with significant potential for accurate classifications across many object categories. Network architectures and hyper-parameters affect the efficiency of CNNs for any given task. Here, we evaluate multi-layered CNNs developed from scratch and popular deep-learning architectures such as Inception v3, ResNET-50, Inception-ResNET-v2, NASNetLarge, ResNeXt-101, ResNeXt-50, and Xception in differentiating between embryos based on their morphological quality at 113 h post insemination (hpi). Xception performed the best in differentiating between the embryos based on their morphological quality.
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Affiliation(s)
- Prudhvi Thirumalaraju
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Manoj Kumar Kanakasabapathy
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Charles L Bormann
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics & Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Raghav Gupta
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Rohan Pooniwala
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Hemanth Kandula
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Irene Souter
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics & Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Irene Dimitriadis
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics & Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Hadi Shafiee
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
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16
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Zhao M, Xu M, Li H, Alqawasmeh O, Chung JPW, Li TC, Lee TL, Tang PMK, Chan DYL. Application of convolutional neural network on early human embryo segmentation during in vitro fertilization. J Cell Mol Med 2021; 25:2633-2644. [PMID: 33486848 PMCID: PMC7933952 DOI: 10.1111/jcmm.16288] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 01/05/2021] [Indexed: 11/29/2022] Open
Abstract
Selection of the best quality embryo is the key for a faithful implantation in in vitro fertilization (IVF) practice. However, the process of evaluating numerous images captured by time-lapse imaging (TLI) system is time-consuming and some important features cannot be recognized by naked eyes. Convolutional neural network (CNN) is used in medical imaging yet in IVF. The study aims to apply CNN on day-one human embryo TLI. We first presented CNN algorithm for day-one human embryo segmentation on three distinct features: zona pellucida (ZP), cytoplasm and pronucleus (PN). We tested the CNN performance compared side-by-side with manual labelling by clinical embryologist, then measured the segmented day-one human embryo parameters and compared them with literature reported values. The precisions of segmentation were that cytoplasm over 97%, PN over 84% and ZP around 80%. For the morphometrics data of cytoplasm, ZP and PN, the results were comparable with those reported in literatures, which showed high reproducibility and consistency. The CNN system provides fast and stable analytical outcome to improve work efficiency in IVF setting. To conclude, our CNN system is potential to be applied in practice for day-one human embryo segmentation as a robust tool with high precision, reproducibility and speed.
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Affiliation(s)
- Mingpeng Zhao
- Assisted Reproductive Technology Unit, Department of Obstetrics and Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Murong Xu
- Assisted Reproductive Technology Unit, Department of Obstetrics and Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.,School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Hanhui Li
- School of Computer Science and Information Security, Guilin University of Electronic and Technology, Guilin, China
| | - Odai Alqawasmeh
- Assisted Reproductive Technology Unit, Department of Obstetrics and Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Jacqueline Pui Wah Chung
- Assisted Reproductive Technology Unit, Department of Obstetrics and Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Tin Chiu Li
- Assisted Reproductive Technology Unit, Department of Obstetrics and Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Tin-Lap Lee
- School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Patrick Ming-Kuen Tang
- Department of Anatomical and Cellular Pathology, State Key Laboratory of Translational Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - David Yiu Leung Chan
- Assisted Reproductive Technology Unit, Department of Obstetrics and Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
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Mascarenhas M, Kalampokas T, Sunkara SK, Kamath MS. Concordance between systematic reviews of randomized controlled trials in assisted reproduction: an overview. Hum Reprod Open 2020; 2020:hoaa058. [PMID: 33381658 PMCID: PMC7753002 DOI: 10.1093/hropen/hoaa058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 10/14/2020] [Indexed: 11/20/2022] Open
Abstract
STUDY QUESTION Are systematic reviews published within a 3-year period on interventions in ART concordant in their conclusions? SUMMARY ANSWER The majority of the systematic reviews published within a 3-year period in the field of assisted reproduction on the same topic had discordant conclusions. WHAT IS KNOWN ALREADY Systematic reviews and meta-analyses have now replaced individual randomized controlled trials (RCTs) at the top of the evidence pyramid. There has been a proliferation of systematic reviews and meta-analyses, many of which suffer from methodological issues and provide varying conclusions. STUDY DESIGN SIZE DURATION We assessed nine interventions in women undergoing ART with at least three systematic reviews each, published from January 2015 to December 2017. PARTICIPANTS/MATERIALS SETTING METHODS The systematic reviews which included RCTs were considered eligible for inclusion. The primary outcome was extent of concordance between systematic reviews on the same topic. Secondary outcomes included assessment of quality of systematic reviews, differences in included studies in meta-analyses covering the same search period, selective reporting and reporting the quality of evidence. MAIN RESULTS AND THE ROLE OF CHANCE Concordant results and conclusions were found in only one topic, with reviews in the remaining eight topics displaying partial discordance. The AMSTAR grading for the majority of the non-Cochrane reviews was critically low whilst it was categorized as high for all of the Cochrane reviews. For three of the nine topics, none of the included systematic reviews assessed the quality of evidence. We were unable to assess selective reporting as most of the reviews did not have a pre-specified published protocol. LIMITATIONS REASONS FOR CAUTION We were limited by the high proportion of reviews lacking a pre-specified protocol, which made it impossible to assess for selective reporting. Furthermore, many reviews did not specify primary and secondary outcomes which made it difficult to assess reporting bias. All the authors of this review were Cochrane review authors which may introduce some assessment bias. The categorization of the review's conclusions as beneficial, harmful or neutral was subjective, depending on the tone and wording of the conclusion section of the review. WIDER IMPLICATIONS OF THE FINDINGS The majority of the systematic reviews published within a 3-year period on the same topic in the field of assisted reproduction revealed discordant conclusions and suffered from serious methodological issues, hindering the process of informed healthcare decision-making. STUDY FUNDING/COMPETING INTERESTS All the authors are Cochrane authors. M.S.K. is an editorial board member of Cochrane Gynaecology and Fertility group. No grant from funding agencies in the public, commercial or not-for-profit sectors was obtained.
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Affiliation(s)
| | - Theodoros Kalampokas
- 2nd Department of Obstetrics and Gynecology-“Rea Maternity Hospital”, University of Athens, Athens, Greece
| | - Sesh Kamal Sunkara
- Division of Women’s Health, Faculty of Life Sciences and Medicine, King’s College London, London, UK
| | - Mohan S Kamath
- Department of Reproductive Medicine, Christian Medical College, Vellore, India
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18
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Abstract
During human in vitro culture, a morphological microscope analysis is normally performed to select the best embryo to transfer, with the hope of obtaining a successful pregnancy. The morphological evaluation may combine number and size of blastomeres, fragmentation, multinucleation, blastocyst expansion, inner-cell mass and trophectoderm appearance. However, standard microscopy evaluation involves the removal of the embryos from the incubator, exposing them to changes in pH, temperature, and oxygen level. Additionally, morphological assessments might include high inter-observer variability. Recently, continuous embryo culture using time-lapse monitoring (TLM) has allowed embryologists to analyse the dynamic and morphokinetic events of embryo development and, based on that, the embryologist is able to scrutinize the complete sequence of embryonic evolution, from fertilization to the blastocyst formation. Therefore, TLM allows an uninterrupted culture condition, reducing the need to remove embryos from the incubator. The monitoring system is normally composed of a standard incubator with an integrated microscope coupled to a digital camera, which is able to collect images at regular times, and subsequently processed into video. These data can be annotated and analyzed using an integrated software, therefore this allows embryologists to facilitate the process of embryo selection for transfer. The main aim of this paper is to discuss the potential benefits and uses of the TLM in the embryology laboratory.
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19
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Choosing the best embryo with the help of artificial intelligence. Fertil Steril 2020; 114:1171. [PMID: 33138978 DOI: 10.1016/j.fertnstert.2020.09.166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 09/30/2020] [Indexed: 01/09/2023]
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20
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Bormann CL, Kanakasabapathy MK, Thirumalaraju P, Gupta R, Pooniwala R, Kandula H, Hariton E, Souter I, Dimitriadis I, Ramirez LB, Curchoe CL, Swain J, Boehnlein LM, Shafiee H. Performance of a deep learning based neural network in the selection of human blastocysts for implantation. eLife 2020; 9:e55301. [PMID: 32930094 PMCID: PMC7527234 DOI: 10.7554/elife.55301] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 09/01/2020] [Indexed: 11/13/2022] Open
Abstract
Deep learning in in vitro fertilization is currently being evaluated in the development of assistive tools for the determination of transfer order and implantation potential using time-lapse data collected through expensive imaging hardware. Assistive tools and algorithms that can work with static images, however, can help in improving the access to care by enabling their use with images acquired from traditional microscopes that are available to virtually all fertility centers. Here, we evaluated the use of a deep convolutional neural network (CNN), trained using single timepoint images of embryos collected at 113 hr post-insemination, in embryo selection amongst 97 clinical patient cohorts (742 embryos) and observed an accuracy of 90% in choosing the highest quality embryo available. Furthermore, a CNN trained to assess an embryo's implantation potential directly using a set of 97 euploid embryos capable of implantation outperformed 15 trained embryologists (75.26% vs. 67.35%, p<0.0001) from five different fertility centers.
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Affiliation(s)
- Charles L Bormann
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical SchoolBostonUnited States
- Harvard Medical SchoolBostonUnited States
| | - Manoj Kumar Kanakasabapathy
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical SchoolBostonUnited States
| | - Prudhvi Thirumalaraju
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical SchoolBostonUnited States
| | - Raghav Gupta
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical SchoolBostonUnited States
| | - Rohan Pooniwala
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical SchoolBostonUnited States
| | - Hemanth Kandula
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical SchoolBostonUnited States
| | - Eduardo Hariton
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical SchoolBostonUnited States
| | - Irene Souter
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical SchoolBostonUnited States
- Harvard Medical SchoolBostonUnited States
| | - Irene Dimitriadis
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical SchoolBostonUnited States
- Harvard Medical SchoolBostonUnited States
| | | | - Carol L Curchoe
- San Diego Fertility CenterSan DiegoUnited States
- Colorado Center for Reproductive Medicine IVF Laboratory NetworkEnglewoodUnited States
| | - Jason Swain
- Colorado Center for Reproductive Medicine IVF Laboratory NetworkEnglewoodUnited States
| | - Lynn M Boehnlein
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of WisconsinMadisonUnited States
| | - Hadi Shafiee
- Harvard Medical SchoolBostonUnited States
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical SchoolBostonUnited States
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21
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Li J, Huang J, Han W, Shen X, Gao Y, Huang G. Comparing transcriptome profiles of human embryo cultured in closed and standard incubators. PeerJ 2020; 8:e9738. [PMID: 32864223 PMCID: PMC7427541 DOI: 10.7717/peerj.9738] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 07/26/2020] [Indexed: 11/20/2022] Open
Abstract
It is necessary to compare the transcriptomic profiles of human embryos cultured in time-lapse imaging (TLI) incubators and standard incubators (SI) in order to determine whether a closed culture system has a positive impact on embryos. In this study, we used RNA-sequencing (RNA-Seq) to characterize and compare the gene expression profiles of eight-cell embryos of the same quality grade cultured in TLI and SI. We sequenced a total of 580,952,620 reads for zygotes, TLI-cultured, and SI-cultured eight-cell embryos. The global transcriptomic profiles of the TLI embryos were similar to those of the SI embryos and were highly distinct from the zygotes. We also detected 539 genes showing differential expression between the TLI and SI groups with a false discovery rate (FDR) < 0.05. Using gene ontology enrichment analysis, we found that the highly expressed SI genes tended to execute functions such as transcription, RNA splicing, and DNA repair, and that the highly expressed TLI genes were enriched in the cell differentiation and methyltransferase activity pathways. This study, the first to use transcriptome analysis to compare SI and TLI, will serve as a basis for assessing the safety of TLI application in assisted reproductive technology.
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Affiliation(s)
- Jingyu Li
- Chongqing Key Laboratory of Human Embryo Engineering, Chongqing Reproductive and Genetics Institute, Chongqing Health Center for Women and Children, Chongqing, China
| | - Jiayu Huang
- Department of Gynaecology and Obstetrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Han
- Chongqing Key Laboratory of Human Embryo Engineering, Chongqing Reproductive and Genetics Institute, Chongqing Health Center for Women and Children, Chongqing, China
| | - Xiaoli Shen
- Chongqing Key Laboratory of Human Embryo Engineering, Chongqing Reproductive and Genetics Institute, Chongqing Health Center for Women and Children, Chongqing, China
| | - Ying Gao
- Department of Gynaecology and Obstetrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 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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22
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Morphokinetic analysis of cleavage stage embryos and assessment of specific gene expression in cumulus cells independently predict human embryo development to expanded blastocyst: a preliminary study. J Assist Reprod Genet 2020; 37:1409-1420. [PMID: 32436046 PMCID: PMC7311629 DOI: 10.1007/s10815-020-01806-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 05/01/2020] [Indexed: 12/28/2022] Open
Abstract
To assess whether morphokinetic features at the cleavage stage together with specific gene expression in cumulus cells (CCs) may be used to predict whether human embryos are able to achieve the expanded blastocyst stage on day 5. Eighty-one embryos were cultured using the Geri plus® time-lapse system. Twenty-seven embryos progressing to the expanded blastocyst stage (BL group) were compared with thirty-five embryos showing developmental arrest (AR group) and nineteen reaching the stage of early or not fully expanded blastocyst (nBL group). The analyzed morphokinetic variables were pronuclear appearance (tPNa), pronuclear fading (tPNf), and completion of cleavage to two, three, four, and eight cells (t2, t3, t4, and t8). CCs were analyzed by RT-qPCR for bone morphogenetic protein 15 (BMP15), cytochrome c oxidase subunit II (COXII), ATP synthase subunit 6 (MT-ATP6), connexin 43 (Cx43), and heme oxygenase-1 (HO-1). Embryos of BL group showed a significantly faster kinetic. BMP15, COXII, and MT-ATP6 mRNA expression was significantly higher in CCs of BL group embryos, whereas Cx43 and HO-1 mRNA levels were higher in AR group. Kinetic parameters and gene expression were not significantly different between either the BL and nBL groups or the AR and nBL groups. ROC curves showed that the most predictive cut-offs were t2 < 26.25 for morphokinetics and COXII > 0.3 for gene expression. Multivariable logistic regression analysis showed that morphokinetic variables and gene expression were both valuable, independent predictors of embryo development to expanded blastocyst. Our results suggest the possibility of developing integrated prediction models for early embryo selection at the cleavage stage.
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Apter S, Ebner T, Freour T, Guns Y, Kovacic B, Le Clef N, Marques M, Meseguer M, Montjean D, Sfontouris I, Sturmey R, Coticchio G. Good practice recommendations for the use of time-lapse technology †. Hum Reprod Open 2020; 2020:hoaa008. [PMID: 32206731 PMCID: PMC7081060 DOI: 10.1093/hropen/hoaa008] [Citation(s) in RCA: 91] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 12/05/2019] [Accepted: 01/29/2020] [Indexed: 12/26/2022] Open
Affiliation(s)
| | | | - Thomas Ebner
- Department of Gynecology, Obstetrics, and Gynecological Endocrinology, Kepler Universitätsklinikum, Linz, Austria
| | - Thomas Freour
- Médecine de la Reproduction, CHU de Nantes, Nantes, France
| | - Yves Guns
- Center for Reproductive Medicine, UZ Brussel, Brussels, Belgium
| | - Borut Kovacic
- Department of Reproductive Medicine and Gynecologic Endocrinology, Univerzitetni klinicni center Maribor, Maribor, Slovenia
| | - Nathalie Le Clef
- European Society of Human Reproduction and Embryology, Grimbergen, Belgium
| | | | - Marcos Meseguer
- IVF Laboratory, Instituto Valenciano de Infertilidad, Valencia, Spain
| | - Debbie Montjean
- Médecine et Biologie de la Reproduction, Hopital Saint Joseph, Marseille, France
| | | | - Roger Sturmey
- Centre for Atherothrombosis and Metabolic Disease, Hull York Medical School, University of Hull, Hull, UK
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Babayev E, Feinberg EC. Embryo through the lens: from time-lapse cinematography to artificial intelligence. Fertil Steril 2020; 113:342-343. [PMID: 32106987 DOI: 10.1016/j.fertnstert.2019.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 12/02/2019] [Indexed: 11/28/2022]
Abstract
"Once a new technology rolls over you, if you're not part of the steamroller, you're part of the road." -Stewart Brand.
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Affiliation(s)
- Elnur Babayev
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Eve C Feinberg
- Northwestern University Feinberg School of Medicine, Chicago, Illinois.
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25
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‘There is only one thing that is truly important in an IVF laboratory: everything’ Cairo Consensus Guidelines on IVF Culture Conditions. Reprod Biomed Online 2020; 40:33-60. [DOI: 10.1016/j.rbmo.2019.10.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 09/22/2019] [Accepted: 10/02/2019] [Indexed: 02/06/2023]
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Magdi Y, Samy A, Abbas AM, Ibrahim MA, Edris Y, El-Gohary A, Fathi AM, Fawzy M. Effect of embryo selection based morphokinetics on IVF/ICSI outcomes: evidence from a systematic review and meta-analysis of randomized controlled trials. Arch Gynecol Obstet 2019; 300:1479-1490. [PMID: 31667608 DOI: 10.1007/s00404-019-05335-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 10/15/2019] [Indexed: 12/14/2022]
Abstract
PURPOSE Debate exists for the optimal tool to select embryos for transfer in assisted reproductive technology (ART). Time-lapse monitoring (TLM) is a noninvasive tool suggested where each embryo can be captured every 5-20 min. Given the inconsistency in the existing studies, we conducted this meta-analysis of RCTs to summarize the evidence available concerning the predictive ability of morphokinetics compared with the routine assessment of embryo development in ART. METHODS The primary databases MEDLINE, EMBASE, Cochrane, NHS, WHO, and Other Non-Indexed Citations were consulted for RCTs that have been published until November 2018, with no language restriction. RESULTS AND CONCLUSION Our review includes 6 RCTs (n = 2057 patients). The data showed an improvement (~ 9%) in live birth TLM (OR 1.43; 95% CI 1.10-1.85; P = 0.007), with low-quality evidence. There was no evidence of a significant difference between both groups concerning ongoing pregnancy, clinical pregnancy and implantation rates. The data further showed that morphokinetics is associated with decreased early pregnancy loss rate. These estimates must be interpreted with caution owing to the statistical and clinical heterogeneities and the consequent difficulty in drawing any meaningful conclusion.
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Affiliation(s)
- Yasmin Magdi
- Al-Yasmeen Fertility and Gynecology Center, 5 Farid Nada Street, Benha, 13511, Qalubyia, Egypt.
| | - Ahmed Samy
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed M Abbas
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Mohamed Ahmed Ibrahim
- Department of Obstetrics and Gynecology, Faculty of Medicine, Benha University, Benha, Egypt
| | - Yehia Edris
- Department of Obstetrics and Gynecology, Faculty of Medicine, Benha University, Benha, Egypt
| | - Ayman El-Gohary
- Department of Obstetrics and Gynecology, Faculty of Medicine, Benha University, Benha, Egypt
| | - Ahmed M Fathi
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kafrelsheikh University, Kafr El-Sheikh, Egypt
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Li Z, Ehmke N, Lorenzo IM, Machaty Z, Nolte D. Biodynamic optical assay for embryo viability. JOURNAL OF BIOMEDICAL OPTICS 2019; 24:1-4. [PMID: 31240897 PMCID: PMC6977009 DOI: 10.1117/1.jbo.24.6.060502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 05/31/2019] [Indexed: 06/09/2023]
Abstract
Early stage porcine parthenogenetic embryos were evaluated for metabolic activity using a biodynamic microscope (BDM) that images dynamic light scattering using low-coherence digital holography. The microscope has a 45-deg illumination configuration that reduces specular background for the imaging of small translucent samples. The off-axis illumination is compatible with coherence-gated imaging because of volumetric light scattering in which the coherence plane is tilted at half the illumination angle in a three-dimensional tissue target. The BDM was used to profile the viability of porcine parthenotes with normal and with inhibited mitochondrial adenosine triphosphate (ATP) production using Doppler fluctuation spectroscopy. The ATP concentrations in the parthenotes, which are indicative of developmental potential, were validated by a conventional bioluminescence assay. Biodynamic classifications achieved ∼80 % accuracy correlating sample ATP treatment, providing a quick, label-free surrogate measurement to replace invasive metabolic assays as a candidate for evaluating quality of early embryos in the assisted reproductive technology setting.
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Affiliation(s)
- Zhe Li
- Purdue University, Department of Physics and Astronomy, West Lafayette, Indiana, United States
| | - Natalie Ehmke
- Purdue University, Department of Animal Sciences, West Lafayette, Indiana, United States
| | - Ilka M. Lorenzo
- Purdue University, Department of Animal Sciences, West Lafayette, Indiana, United States
| | - Zoltan Machaty
- Purdue University, Department of Animal Sciences, West Lafayette, Indiana, United States
| | - David Nolte
- Purdue University, Department of Physics and Astronomy, West Lafayette, Indiana, United States
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Liu Y, Sakkas D, Afnan M, Matson P. Time-lapse videography for embryo selection/de-selection: a bright future or fading star? HUM FERTIL 2019; 23:76-82. [PMID: 30963781 DOI: 10.1080/14647273.2019.1598586] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
The recent clinical introduction of time-lapse videography into in vitro fertilization laboratories has offered a novel opportunity for embryologists to explore improved methods for embryo selection. While the concept of uninterrupted culture of embryos provided by such systems is welcomed, the current evidence does not support its full application in routine clinical practice. The issue of whether or not algorithms for embryo selection can be extrapolated between laboratories, which may represent a major hurdle to its wide application, is currently gaining increasing attention amongst embryologists worldwide. In this commentary issues identified in time-lapse embryo selection/de-selection algorithms, such as quantitative versus qualitative parameters, are discussed alongside the reference start point for the timing system, and types of datasets used for developing and validating time-lapse algorithms. Considering these factors, alternative future research directions which could potentially solve current issues are proposed.
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Affiliation(s)
- Yanhe Liu
- Reproductive Medicine Center, Tianjin United Family Hospital, Tianjin, China.,School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
| | | | - Masoud Afnan
- Reproductive Medicine Center, Tianjin United Family Hospital, Tianjin, China
| | - Phillip Matson
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia.,Joondalup Private Hospital, Fertility North, Joondalup, Australia
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A comparison of morphokinetic markers predicting blastocyst formation and implantation potential from two large clinical data sets. J Assist Reprod Genet 2019; 36:637-646. [PMID: 30671702 DOI: 10.1007/s10815-018-1396-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 12/18/2018] [Indexed: 12/22/2022] Open
Abstract
PURPOSE To demonstrate whether the standard morphokinetic markers used for embryo selection have a similar relationship to blastocyst formation and implantation in two large clinical data sets. METHODS This is a retrospective cohort analysis striving to answer two distinct questions utilizing data sets from two large IVF clinics. Blastocysts (BL) and implanted blastocysts (I) in both clinics, IVI-Valencia (BL = 11,414, I = 479) and WMC (BL = 15,902; I = 337), were cultured in a time-lapse system (EmbryoScope, Vitrolife, Sweden). The study was designed to assess the relationship between early morphokinetic hallmarks and BL development, with a secondary analysis of implantation rates following single-embryo day 3 and day 5 transfers. RESULTS We performed a detailed graphical analysis for t3, t5, duration of the second cell cycle (cc2) (t3-t2), and the ratio (t5-t3)/(t5-t2). The t5 timing was not affected between the clinics. However, Weill Cornell Medicine's (WCM) proportions were significantly affected by having BL vs. not. A significant decrease of blastocysts with longer t5 in WCM data, while t5 was more informative in the IVI data set for the implantation rate. CONCLUSIONS Morphokinetic intervals for early cleavages were distributed differently between the clinics. Incorporation of embryo-selection algorithms depends on the individual clinic's selected developmental hallmarks, all of which must be validated before incorporation into clinical practice.
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Prediction of implantation after blastocyst transfer in in vitro fertilization: a machine-learning perspective. Fertil Steril 2019; 111:318-326. [PMID: 30611557 DOI: 10.1016/j.fertnstert.2018.10.030] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 10/06/2018] [Accepted: 10/29/2018] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To develop a random forest model (RFM) to predict implantation potential of a transferred embryo and compare it with a multivariate logistic regression model (MvLRM), based on data from a large cohort including in vitro fertilization (IVF) patients treated with the use of single-embryo transfer (SET) of blastocyst-stage embryos. DESIGN Retrospective study of a 2-year single-center cohort of women undergoing IVF or intracytoplasmatic sperm injection (ICSI). SETTING Academic hospital. PATIENT(S) Data from 1,052 women who underwent fresh SET in IVF or ICSI cycles were included. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) The performance of both RFM and MvLRM to predict pregnancy was quantified in terms of the area under the receiver operating characteristic (ROC) curve (AUC), classification accuracy, specificity, and sensitivity. RESULT(S) ROC analysis resulted in an AUC of 0.74 ± 0.03 for the proposed RFM and 0.66 ± 0.05 for the MvLRM for the prediction of ongoing pregnancies of ≥11 weeks. This RFM approach and the MvLRM yielded, respectively, sensitivities of 0.84 ± 0.07 and 0.66 ± 0.08 and specificities of 0.48 ± 0.07 and 0.58 ± 0.08. CONCLUSION(S) The performance to predict ongoing implantation will significantly improve with the use of an RFM approach compared with MvLRM.
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Simopoulou M, Sfakianoudis K, Rapani A, Giannelou P, Anifandis G, Bolaris S, Pantou A, Lambropoulou M, Pappas A, Deligeoroglou E, Pantos K, Koutsilieris M. Considerations Regarding Embryo Culture Conditions: From Media to Epigenetics. ACTA ACUST UNITED AC 2018; 32:451-460. [PMID: 29695546 DOI: 10.21873/invivo.11261] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 03/13/2018] [Accepted: 03/20/2018] [Indexed: 02/05/2023]
Abstract
There are numerous reports on embryo culture media and conditions in the laboratory, as the subject is multifaceted and complex, reflecting the variation in practice. In this scoping review, we attempt to approach the topic of culture media and conditions from the practitioners' perspective aiming to highlight, in a comprehensive fashion, important aspects regarding the options available, introduce points of debate and controversy, while maintaining the viewpoint of the practicing embryologist's concerns.
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Affiliation(s)
- Mara Simopoulou
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece .,Assisted Conception Unit, 2nd Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Anna Rapani
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Polina Giannelou
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Centre for Human Reproduction, Genesis Athens Clinic, Athens, Greece
| | - George Anifandis
- Department of Histology and Embryology, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Stamatis Bolaris
- Assisted Conception Unit, Elena Venizelou General-Maternity District Hospital, Athens, Greece
| | - Agni Pantou
- Centre for Human Reproduction, Genesis Athens Clinic, Athens, Greece
| | - Maria Lambropoulou
- Department of Histology and Embryology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Athanasios Pappas
- Centre for Human Reproduction, Genesis Athens Clinic, Athens, Greece
| | - Efthimios Deligeoroglou
- Assisted Conception Unit, 2nd Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Michael Koutsilieris
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Boueilh T, Reignier A, Barriere P, Freour T. Time-lapse imaging systems in IVF laboratories: a French national survey. J Assist Reprod Genet 2018; 35:2181-2186. [PMID: 30187427 DOI: 10.1007/s10815-018-1302-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 08/30/2018] [Indexed: 10/28/2022] Open
Abstract
PURPOSE Although the clinical value of time-lapse imaging (TLI) systems in in vitro fertilization (IVF) cycles is still debated, its prevalence worldwide seems to be expanding. The situation of TLI in the USA has been recently surveyed, but these results might not be transposable to other countries with different IVF regulation and funding such as France. This study evaluated the TLI situation in French IVF laboratories. METHODS An anonymous online cross-sectional survey was sent by email to 210 embryologists in September and October 2017. Laboratories, demographics, TLI clinical use, purchasing plan, and embryologists' opinions were analyzed using logistic regression to calculate odds ratio. RESULTS Of the 210 lab directors surveyed, 78 responded (37.1%), 43 (55%) working in private IVF laboratories and 35 (45%) in public hospitals. Thirty (38.5%) were TLI users. The odds of TLI possession were not statistically different according to laboratory sector or size. Most embryologists (n = 21, 70%) used TLI for unselected patients. Cost was the main reason given by non-users for not implementing TLI (n = 24, 50%). Most respondents were convinced that TLI is superior to standard morphology (n = 52, 73.2%) and that TLI improves culture conditions (n = 62, 84.9%). However, half (n = 39, 54.9%) indicated that evidence was still lacking to assert TLI clinical usefulness. CONCLUSION The prevalence of TLI systems and embryologists' opinion in France was slightly different from the American situation. The different regulation and funding policy might account for some differences in terms of TLI use and perception.
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Affiliation(s)
- Thomas Boueilh
- Service de biologie et médecine de la reproduction, CHU Nantes, 38 boulevard Jean Monnet, 44093, Nantes, France.,Centre d'Assistance Médicale à la Procréation-CECOS, CHU Grenoble-Alpes, Grenoble, France
| | - Arnaud Reignier
- Service de biologie et médecine de la reproduction, CHU Nantes, 38 boulevard Jean Monnet, 44093, Nantes, France.,Faculté de médecine, Université de Nantes, Nantes, France.,Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, Nantes, France
| | - Paul Barriere
- Service de biologie et médecine de la reproduction, CHU Nantes, 38 boulevard Jean Monnet, 44093, Nantes, France.,Faculté de médecine, Université de Nantes, Nantes, France.,Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, Nantes, France
| | - Thomas Freour
- Service de biologie et médecine de la reproduction, CHU Nantes, 38 boulevard Jean Monnet, 44093, Nantes, France. .,Faculté de médecine, Université de Nantes, Nantes, France. .,Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, Nantes, France.
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33
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Time-lapse imaging algorithms rank human preimplantation embryos according to the probability of live birth. Reprod Biomed Online 2018; 37:304-313. [DOI: 10.1016/j.rbmo.2018.05.016] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Revised: 05/15/2018] [Accepted: 05/22/2018] [Indexed: 01/20/2023]
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Are computational applications the "crystal ball" in the IVF laboratory? The evolution from mathematics to artificial intelligence. J Assist Reprod Genet 2018; 35:1545-1557. [PMID: 30054845 DOI: 10.1007/s10815-018-1266-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 07/11/2018] [Indexed: 01/23/2023] Open
Abstract
Mathematics rules the world of science. Innovative technologies based on mathematics have paved the way for implementation of novel strategies in assisted reproduction. Ascertaining efficient embryo selection in order to secure optimal pregnancy rates remains the focus of the in vitro fertilization scientific community and the strongest driver behind innovative approaches. This scoping review aims to describe and analyze complex models based on mathematics for embryo selection, devices, and software most widely employed in the IVF laboratory and algorithms in the service of the cutting-edge technology of artificial intelligence. Despite their promising nature, the practicing embryologist is the one ultimately responsible for the success of the IVF laboratory and thus the one to approve embracing pioneering technologies in routine practice. Applied mathematics and computational biology have already provided significant insight into the selection of the most competent preimplantation embryo. This review describes the leap of evolution from basic mathematics to bioinformatics and investigates the possibility that computational applications may be the means to foretell a promising future for the IVF clinical practice.
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35
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The association between quality of supernumerary embryos in a cohort and implantation potential of the transferred blastocyst. J Assist Reprod Genet 2018; 35:1651-1656. [PMID: 29974298 DOI: 10.1007/s10815-018-1254-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Accepted: 06/26/2018] [Indexed: 10/28/2022] Open
Abstract
PURPOSE Despite studies focused on the association between embryo morphology and implantation potential, it is unknown how the collective quality of the supernumerary embryos in a cohort is associated with the implantation rate (IR) of the transferred embryo. This study tested the hypothesis that a relationship exists between the quality of the supernumerary cohort and IR. METHODS A retrospective cohort study of first fresh autologous IVF cycles from 05/2012 to 09/2016, with ≥ 3 blastocysts, resulting in a single blastocyst transfer (n = 819) was performed. Cohorts were grouped in two ways: by mean priority score (PS; 1 being best) of supernumerary embryos and by percent supernumerary embryos with low implantation potential. The relationship between cohort quality and IR was assessed using logistic regression. RESULTS As mean cohort PS increased, IR of the transferred embryo decreased (test for linear trend, p = 0.05). When ≥ 75% of the supernumerary cohort was predicted to have low implantation potential, IR of the transferred embryo was significantly lower compared to when < 75% of the cohort was predicted to have low implantation potential (OR 0.71; 95% CI (0.53-0.94)). All associations were attenuated when adjusting for PS of the transferred embryo. CONCLUSIONS Our findings suggest that quality of supernumerary embryos is associated with IR of the transferred embryo, among patients with ≥ 3 blastocysts available on day 5. As cohort quality declines and the proportion of low implantation potential embryos increases, the IR of the transferred embryo declines. These associations are attenuated when controlling for quality of the transferred embryo, suggesting that the relationship between embryo cohort quality and implantation is not independent of the transferred embryo quality.
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Martínez M, Santaló J, Rodríguez A, Vassena R. High reliability of morphokinetic annotations among embryologists. Hum Reprod Open 2018; 2018:hoy009. [PMID: 30895250 PMCID: PMC6276644 DOI: 10.1093/hropen/hoy009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 04/10/2018] [Accepted: 05/03/2018] [Indexed: 12/16/2022] Open
Abstract
STUDY QUESTION Are morphokinetic measurements of time lapse-videos of human embryos comparable among operators? SUMMARY ANSWER There is little variation among morphokinetic measurements taken by different operators when analyzing the same time lapse-videos of human embryos. WHAT IS KNOWN ALREADY Morphokinetic analysis of preimplantation embryo development is a complementary method of embryo assessment increasingly used in IVF laboratories. Time-lapse videos of embryo development are normally viewed by trained embryologists and annotated with the times when specific developmental events occur. Such annotations form the basis of embryo selection algorithms, used to rank the embryos for transfer. It is unknown whether the reliability of morphokinetic annotations is related to the morphological characteristics of the analyzed embryo or to the ability of the embryologists performing the annotation. One study so far reported the reliability of morphokinetic annotations among three embryologists using the time-lapse system (TLS), but larger studies with different setups are needed to address this issue further. STUDY DESIGN SIZE DURATION A prospective study was carried out between October 2015 and June 2016. Six embryologists with various degrees of experience in static, morphology-based evaluation, individually annotated the same 93 videos of preimplantation development, corresponding to 18 IVF/ICSI cycles, recorded with a TLS. PARTICIPANTS/MATERIALS SETTING METHODS Times of second polar body extrusion, appearance and disappearance of pronuclei, and embryo cleavages (times from 2-cell to 5-cell stage: t2, t3, t4, t5) were annotated. Each embryologist was blinded to the annotations of the others. Intra- and inter-observer agreement was evaluated by computing intra-class correlation coefficients (ICCs). MAIN RESULTS AND THE ROLE OF CHANCE In the inter-observer analysis, most ICCs obtained were higher than 0.80, indicating a high level of agreement: t2: 0.93; t3: 0.80; t4: 0.89; t5: 0.89; disappearance of two pronuclei: 0.98. However, the ICCs obtained for second polar body extrusion and the appearance of two pronuclei annotations was lower: 0.51 and 0.63, respectively, indicating an average level of agreement. The ICCs obtained from the intra-observer analysis were also higher than 0.80 (t2: 0.96; t3: 0.89; t4: 0.88; t5: 0.86; disappearance of two pronuclei: 0.96). The ICCs obtained from second polar body extrusion and the appearance of two pronuclei annotations were 0.77 and 0.66, respectively. These results indicate that developmental timings, annotated in time-lapse videos, are highly reliable both within and among observers. LIMITATIONS REASONS FOR CAUTION The events at the developmental stages from 6-cells to blastocyst were not evaluated; since some morphokinetic algorithms use times past the 6-cell stage in their calculations, further studies should be carried out to understand the variations among observers in these cases. WIDER IMPLICATIONS OF THE FINDINGS Time-lapse measurement should be as objective as possible, especially for the first embryo cleavages, because they are often measured to define algorithms to assess the embryonic implantation potential. Our results show that measurements using this particular TLS are consistent and reliable both within and among operators. STUDY FUNDING/COMPETING INTERESTS None. TRIAL REGISTRATION NUMBER Not applicable.
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Affiliation(s)
- M Martínez
- Clínica Eugin, Travessera de les Corts 322, Barcelona 08029, Spain
| | - J Santaló
- Departamento de Biología Celular, Fisiología en Inmunología, Facultad de Biociencias, Universidad Autónoma de Barcelona, Bellaterra 08193, Cerdanyola del Vallès, Barcelona
| | - A Rodríguez
- Clínica Eugin, Travessera de les Corts 322, Barcelona 08029, Spain
| | - R Vassena
- Clínica Eugin, Travessera de les Corts 322, Barcelona 08029, Spain
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Time-lapse imaging: clearly useful to both laboratory personnel and patient outcomes versus just because we can doesn't mean we should. Fertil Steril 2018; 109:584-591. [DOI: 10.1016/j.fertnstert.2018.01.042] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 01/29/2018] [Indexed: 11/20/2022]
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38
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Barberet J, Chammas J, Bruno C, Valot E, Vuillemin C, Jonval L, Choux C, Sagot P, Soudry A, Fauque P. Randomized controlled trial comparing embryo culture in two incubator systems: G185 K-System versus EmbryoScope. Fertil Steril 2018; 109:302-309.e1. [DOI: 10.1016/j.fertnstert.2017.10.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 09/22/2017] [Accepted: 10/04/2017] [Indexed: 10/18/2022]
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39
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Liu Y, Feenan K, Chapple V, Matson P. Assessing efficacy of day 3 embryo time-lapse algorithms retrospectively: impacts of dataset type and confounding factors. HUM FERTIL 2018; 22:182-190. [PMID: 29338469 DOI: 10.1080/14647273.2018.1425919] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
This study investigated the efficacy of four published day 3 embryo time-lapse algorithms based on different types of datasets (known implantation data [KID] and single embryo transfer [SET]), and the confounding effect of female age and conventional embryo morphology. Four algorithms were retrospectively applied to three types of datasets generated at Fertility North between February 2013 and December 2014: (a) KID dataset (n = 270), (b) a subset of SET (n = 144, end-point = implantation), and (c) SET (n = 144, end-point = live birth), respectively. All four algorithms showed progressively reduced predictive power (expressed as area under the receiver operating characteristics curve and 95% confidence interval [CI]) after application to the three datasets (a-c): Liu (0.762 [0.701-0.824] vs. 0.724 [0.641-0.807] vs. 0.707 [0.620-0.793]), KIDScore (0.614 [0.539-0.688] vs. 0.548 [0.451-0.645] vs. 0.536 [0.434-0.637]), Meseguer (0.585 [0.508-0.663] vs. 0.56 [0.462-0.658] vs. 0.549 [0.445-0.652]), and Basile (0.582 [0.505-0.659] vs. 0.519 [0.421-0.618] vs. 0.509 [0.406-0.612]). Furthermore, using KID dataset, the association (expressed as odds ratio and 95% CI) between time-lapse algorithms and implantation outcomes lost statistical significance after adjusting for conventional embryo morphology and female age in 3 of the 4 algorithms (KIDScore 1.832 [1.118-3.004] vs. 1.063 [0.659-1.715], Meseguer 1.150 [1.021-1.295] vs. 1.122 [0.981-1.284] and Basile 1.122 [1.008-1.249] vs. 1.038 [0.919-1.172]). In conclusion, SET is a preferred dataset to KID when developing or validating time-lapse algorithms, and day 3 conventional embryo morphology and female age should be considered as confounding factors.
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Affiliation(s)
- Yanhe Liu
- a Fertility North , Joondalup , Australia.,b School of Medical and Health Sciences, Edith Cowan University , Joondalup , Australia
| | | | | | - Phillip Matson
- a Fertility North , Joondalup , Australia.,b School of Medical and Health Sciences, Edith Cowan University , Joondalup , Australia
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40
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Caujolle S, Cernat R, Silvestri G, Marques MJ, Bradu A, Feuchter T, Robinson G, Griffin DK, Podoleanu A. Speckle variance OCT for depth resolved assessment of the viability of bovine embryos. BIOMEDICAL OPTICS EXPRESS 2017; 8:5139-5150. [PMID: 29188109 PMCID: PMC5695959 DOI: 10.1364/boe.8.005139] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 09/14/2017] [Accepted: 09/24/2017] [Indexed: 06/07/2023]
Abstract
The morphology of embryos produced by in vitro fertilization (IVF) is commonly used to estimate their viability. However, imaging by standard microscopy is subjective and unable to assess the embryo on a cellular scale after compaction. Optical coherence tomography is an imaging technique that can produce a depth-resolved profile of a sample and can be coupled with speckle variance (SV) to detect motion on a micron scale. In this study, day 7 post-IVF bovine embryos were observed either short-term (10 minutes) or long-term (over 18 hours) and analyzed by swept source OCT and SV to resolve their depth profile and characterize micron-scale movements potentially associated with viability. The percentage of en face images showing movement at any given time was calculated as a method to detect the vital status of the embryo. This method could be used to measure the levels of damage sustained by an embryo, for example after cryopreservation, in a rapid and non-invasive way.
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Affiliation(s)
- S. Caujolle
- Applied Optics Group, School of Physical Sciences, University of Kent, Canterbury, CT2 7NH, UK
- NKT Photonics A/S, Blokken 84, 3460 Birkerød, Zealand, Denmark
- contributed equally to this work
| | - R. Cernat
- Applied Optics Group, School of Physical Sciences, University of Kent, Canterbury, CT2 7NH, UK
- contributed equally to this work
| | - G. Silvestri
- School of Biosciences, University of Kent, Canterbury, CT2 7AF, UK
- contributed equally to this work
| | - M. J. Marques
- Applied Optics Group, School of Physical Sciences, University of Kent, Canterbury, CT2 7NH, UK
| | - A. Bradu
- Applied Optics Group, School of Physical Sciences, University of Kent, Canterbury, CT2 7NH, UK
| | - T. Feuchter
- NKT Photonics A/S, Blokken 84, 3460 Birkerød, Zealand, Denmark
| | - G. Robinson
- School of Biosciences, University of Kent, Canterbury, CT2 7AF, UK
| | - D. K. Griffin
- School of Biosciences, University of Kent, Canterbury, CT2 7AF, UK
| | - A. Podoleanu
- Applied Optics Group, School of Physical Sciences, University of Kent, Canterbury, CT2 7NH, UK
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Pribenszky C, Nilselid AM, Montag M. Time-lapse culture with morphokinetic embryo selection improves pregnancy and live birth chances and reduces early pregnancy loss: a meta-analysis. Reprod Biomed Online 2017; 35:511-520. [DOI: 10.1016/j.rbmo.2017.06.022] [Citation(s) in RCA: 106] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 06/30/2017] [Accepted: 06/30/2017] [Indexed: 11/30/2022]
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Zaninovic N, Irani M, Meseguer M. Assessment of embryo morphology and developmental dynamics by time-lapse microscopy: is there a relation to implantation and ploidy? Fertil Steril 2017; 108:722-729. [DOI: 10.1016/j.fertnstert.2017.10.002] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 10/02/2017] [Indexed: 12/27/2022]
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Milewski R, Szpila M, Ajduk A. Dynamics of cytoplasm and cleavage divisions correlates with preimplantation embryo development. Reproduction 2017; 155:1-14. [PMID: 28993454 DOI: 10.1530/rep-17-0230] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 10/04/2017] [Accepted: 10/09/2017] [Indexed: 01/27/2023]
Abstract
In vitro fertilization has become increasingly popular as an infertility treatment. In order to improve efficiency of this procedure, there is a strong need for a refinement of existing embryo assessment methods and development of novel, robust and non-invasive selection protocols. Studies conducted on animal models can be extremely helpful here, as they allow for more extensive research on the potential biomarkers of embryo quality. In the present paper, we subjected mouse embryos to non-invasive time-lapse imaging and combined the Particle Image Velocimetry analysis of cytoplasmic dynamics in freshly fertilized oocytes with the morphokinetic analysis of recordings covering 5 days of preimplantation development. Our results indicate that parameters describing cytoplasmic dynamics and cleavage divisions independently correspond to mouse embryo's capacity to form a high-quality blastocyst. We also showed for the first time that these parameters are associated with the percentage of abnormal embryonic cells with fragmented nuclei and with embryo's ability to form primitive endoderm, one of the cell lineages differentiated during preimplantation development. Finally, we present a model that links selected cytoplasmic and morphokinetic parameters reflecting frequency of fertilization-induced Ca2+-oscillations and timing of 4-cell stage and compaction with viability of the embryo assessed as the total number of cells at the end of its preimplantation development. Our results indicate that a combined analysis of cytoplasmic dynamics and morphokinetics may facilitate the assessment of embryo's ability to form high-quality blastocysts.
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Affiliation(s)
- Robert Milewski
- Department of Statistics and Medical InformaticsMedical University of Bialystok, Bialystok, Poland
| | - Marcin Szpila
- Department of EmbryologyFaculty of Biology, University of Warsaw, Warsaw, Poland
| | - Anna Ajduk
- Department of EmbryologyFaculty of Biology, University of Warsaw, Warsaw, Poland
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Insua MF, Cobo AC, Larreategui Z, Ferrando M, Serra V, Meseguer M. Obstetric and perinatal outcomes of pregnancies conceived with embryos cultured in a time-lapse monitoring system. Fertil Steril 2017; 108:498-504. [DOI: 10.1016/j.fertnstert.2017.06.031] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 06/16/2017] [Accepted: 06/26/2017] [Indexed: 01/06/2023]
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45
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Racowsky C, Martins WP. Effectiveness and safety of time-lapse imaging for embryo culture and selection: it is still too early for any conclusions? Fertil Steril 2017; 108:450-452. [DOI: 10.1016/j.fertnstert.2017.07.1156] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 07/25/2017] [Indexed: 11/15/2022]
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46
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Fawzy M, AbdelRahman MY, Zidan MH, Abdel Hafez FF, Abdelghafar H, Al-Inany H, Bedaiwy MA. Humid versus dry incubator: a prospective, randomized, controlled trial. Fertil Steril 2017; 108:277-283. [DOI: 10.1016/j.fertnstert.2017.05.036] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 05/20/2017] [Accepted: 05/24/2017] [Indexed: 11/17/2022]
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47
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Dolinko AV, Farland LV, Kaser DJ, Missmer SA, Racowsky C. National survey on use of time-lapse imaging systems in IVF laboratories. J Assist Reprod Genet 2017; 34:1167-1172. [PMID: 28600620 DOI: 10.1007/s10815-017-0964-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 05/22/2017] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Several time-lapse imaging (TLI) systems for non-invasive continuous monitoring of developing embryos are currently available. The present study explored the prevalence, means of acquisition, and clinical application of TLI systems in USA in vitro fertilization (IVF) laboratories. METHODS An online cross-sectional survey of 294 USA IVF laboratory directors was conducted in February and March 2016. Those directing more than one laboratory were asked to complete the survey for their home program and for their smallest laboratory by number of IVF/intracytoplasmic sperm injection (ICSI) cycle starts. Use of TLI was analyzed using logistic regression to calculate odds ratios (OR). RESULTS Of 294 directors surveyed, 162 (55%) reported data on 204 laboratories. Thirty-five laboratories (17%) possessed at least one TLI system (median 2, interquartile range 1-4, total range 1-11). The more oocyte retrievals a laboratory performed annually, the more likely the laboratory was to possess a TLI system. Fifteen laboratories (43%) purchased their own systems, while others leased, loaned, or received donated systems. Twenty-five laboratories (71%) reported using TLI for embryo selection; all used TLI always, or usually, in combination with standard morphology evaluation. Twenty laboratories (80%) offered TLI to all patients. Some laboratories charged patients for TLI. Directors with TLI systems were more inclined to believe that TLI has value for embryo selection in clinical IVF. CONCLUSIONS TLI system possession in USA IVF laboratories is low, although positively associated with the number of retrievals performed and with directors' opinions on the technology's utility. Over 70% of laboratories with TLI systems use them clinically, and less than half purchased their systems.
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Affiliation(s)
- Andrey V Dolinko
- Department of Obstetrics, Gynecology, and Reproductive Biology, Division of Reproductive Endocrinology and Infertility, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, ASB I-3, Boston, MA, 02115, USA. .,Department of Obstetrics and Gynecology, Women & Infants Hospital of Rhode Island, 101 Dudley Street, Providence, RI, 02905, USA.
| | - L V Farland
- Department of Obstetrics, Gynecology, and Reproductive Biology, Division of Reproductive Endocrinology and Infertility, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, ASB I-3, Boston, MA, 02115, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA
| | - D J Kaser
- Department of Obstetrics, Gynecology, and Reproductive Biology, Division of Reproductive Endocrinology and Infertility, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, ASB I-3, Boston, MA, 02115, USA
| | - S A Missmer
- Department of Obstetrics, Gynecology, and Reproductive Biology, Division of Reproductive Endocrinology and Infertility, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, ASB I-3, Boston, MA, 02115, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, 181 Longwood Avenue, Boston, MA, 02115, USA
| | - C Racowsky
- Department of Obstetrics, Gynecology, and Reproductive Biology, Division of Reproductive Endocrinology and Infertility, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, ASB I-3, Boston, MA, 02115, USA
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Faramarzi A, Khalili MA, Micara G, Agha- Rahimi A. Revealing the secret life of pre-implantation embryos by time-lapse monitoring: A review. Int J Reprod Biomed 2017. [DOI: 10.29252/ijrm.15.5.257] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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49
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Chen M, Wei S, Hu J, Yuan J, Liu F. Does time-lapse imaging have favorable results for embryo incubation and selection compared with conventional methods in clinical in vitro fertilization? A meta-analysis and systematic review of randomized controlled trials. PLoS One 2017; 12:e0178720. [PMID: 28570713 PMCID: PMC5453598 DOI: 10.1371/journal.pone.0178720] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Accepted: 05/17/2017] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE The present study aimed to undertake a review of available evidence assessing whether time-lapse imaging (TLI) has favorable outcomes for embryo incubation and selection compared with conventional methods in clinical in vitro fertilization (IVF). METHODS Using PubMed, EMBASE, Cochrane library and ClinicalTrial.gov up to February 2017 to search for randomized controlled trials (RCTs) comparing TLI versus conventional methods. Both studies randomized women and oocytes were included. For studies randomized women, the primary outcomes were live birth and ongoing pregnancy, the secondary outcomes were clinical pregnancy and miscarriage; for studies randomized oocytes, the primary outcome was blastocyst rate, the secondary outcome was good quality embryo on Day 2/3. Subgroup analysis was conducted based on different incubation and embryo selection between groups. RESULTS Ten RCTs were included, four randomized oocytes and six randomized women. For oocyte-based review, the pool-analysis observed no significant difference between TLI group and control group for blastocyst rate [relative risk (RR) 1.08, 95% CI 0.94-1.25, I2 = 0%, two studies, including 1154 embryos]. The quality of evidence was moderate for all outcomes in oocyte-based review. For woman-based review, only one study provided live birth rate (RR 1,23, 95% CI 1.06-1.44,I2 N/A, one study, including 842 women), the pooled result showed no significant difference in ongoing pregnancy rate (RR 1.04, 95% CI 0.80-1.36, I2 = 59%, four studies, including 1403 women) between two groups. The quality of the evidence was low or very low for all outcomes in woman-based review. CONCLUSIONS Currently there is insufficient evidence to support that TLI is superior to conventional methods for human embryo incubation and selection. In consideration of the limitations and flaws of included studies, more well designed RCTs are still in need to comprehensively evaluate the effectiveness of clinical TLI use.
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Affiliation(s)
- Minghao Chen
- Reproductive Center, Guangdong Women and Children Hospital, Guangzhou, China
| | - Shiyou Wei
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Junyan Hu
- Department of Emergency, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jing Yuan
- School of Traditional Chinese Medicine, Jinan University, Guangzhou, China
| | - Fenghua Liu
- Reproductive Center, Guangdong Women and Children Hospital, Guangzhou, China
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50
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OMIDI MARJAN, FARAMARZI AZITA, AGHARAHIMI AZAM, KHALILI MOHAMMADALI. Noninvasive imaging systems for gametes and embryo selection in IVF programs: a review. J Microsc 2017; 267:253-264. [DOI: 10.1111/jmi.12573] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 03/14/2017] [Accepted: 03/29/2017] [Indexed: 12/30/2022]
Affiliation(s)
- MARJAN OMIDI
- Research and Clinical Center for Infertility; Shahid Sadoughi University of Medical Sciences; Yazd Iran
| | - AZITA FARAMARZI
- Research and Clinical Center for Infertility; Shahid Sadoughi University of Medical Sciences; Yazd Iran
| | - AZAM AGHARAHIMI
- Research and Clinical Center for Infertility; Shahid Sadoughi University of Medical Sciences; Yazd Iran
| | - MOHAMMAD ALI KHALILI
- Research and Clinical Center for Infertility; Shahid Sadoughi University of Medical Sciences; Yazd Iran
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