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Capodanno F, Anastasi A, Cinti M, Bonesi F, Gallinelli A. Current and future methods for embryo selection: on a quest for reliable strategies to reduce time to pregnancy. Minerva Obstet Gynecol 2024; 76:80-88. [PMID: 37162493 DOI: 10.23736/s2724-606x.23.05257-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
INTRODUCTION The aim of this study was to analyze the usefulness of the principal embryological strategies to reduce time to pregnancy. EVIDENCE ACQUISITION A systematic search of publications in the PubMed/MEDLINE, Embase and Scopus databases from inception to present including "IVF," "blastocyst," "embryo colture," "competent embryo," "time to pregnancy," "aneuploid," "euploid," "vitrification," "preimplantation genetic," "IVF strategies" and "embryo selection" alone or in combinations has been done. EVIDENCE SYNTHESIS We have selected 230 articles and 9 of them have been included in this mini-review. CONCLUSIONS Several embryological strategies aimed to select the most competent embryo and reduce time to pregnancy have been proposed, even if few publications on this specific topic are available. preimplantation genetic testing (PGT-A) represents the unique method able to assess the embryonic chromosomal status, but this does not mean that PGT-A is a reliable strategy to reduce time to pregnancy. There is no consensus on a specific method to reduce time to pregnancy, nevertheless this final goal could be probably reached through a harmonious combination of procedures. Thus, a reliable strategy to reduce time to pregnancy could be achieved when embryo culture, embryo cryopreservation and PGT-A are perfectly integrated and appropriately offered to selected patients.
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Affiliation(s)
- Francesco Capodanno
- Center of Physiopathology of Human Reproduction, "Delta" Hospital, AUSL Ferrara, Ferrara, Italy
| | - Attilio Anastasi
- Center of Physiopathology of Human Reproduction, "Delta" Hospital, AUSL Ferrara, Ferrara, Italy -
| | - Marialuisa Cinti
- Center of Physiopathology of Human Reproduction, "Delta" Hospital, AUSL Ferrara, Ferrara, Italy
| | - Francesca Bonesi
- Center of Physiopathology of Human Reproduction, "Delta" Hospital, AUSL Ferrara, Ferrara, Italy
| | - Andrea Gallinelli
- Center of Physiopathology of Human Reproduction, "Delta" Hospital, AUSL Ferrara, Ferrara, Italy
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Aslih N, Dekel BZ, Malonek D, Michaeli M, Polotov D, Shalom-Paz E. Non-invasive evaluation of embryos using mid-infrared attenuated total reflection spectrometry of incubation medium: a preliminary study. Reprod Biomed Online 2022; 46:793-801. [PMID: 36925364 DOI: 10.1016/j.rbmo.2022.12.009] [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: 07/25/2022] [Revised: 11/27/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022]
Abstract
RESEARCH QUESTION Can mid-infrared attenuated total reflection (MIR ATR) spectroscopy combined with machine learning methods be used as an additional tool to predict embryo quality and IVF treatment outcomes? DESIGN Spent culture media was collected and analysed. MIR ATR absorbance spectra were measured using an ALPHA II spectrometer equipped with an attenuated total reflection (ATR) spectrometry accessory. Patient and treatment data and results were collected and analysed in combination with machine learning techniques to identify possible correlations. The main outcome measures were to define the characteristics of absorbance spectra of spent culture media and to distinguish the difference in absorbance between top- and low-quality embryos, day 3 and day 5 embryos and implanting embryos versus non-implanting embryos. RESULTS Spent culture media of 227 embryos was collected and analysed. Absorbance peaks in the culture media were different between day 3 and day 5 embryos. Moreover, significant differences in P-values, spanning from 0.014 to 0.044 in absorbance peaks for day 3 embryos and 0.024 up to 0.04 for day 5 embryos, were seen between implanting and non-implanting embryos. Machine learning techniques offered a pregnancy prediction value of 84.6% for day 3 embryos. CONCLUSIONS MIR ATR may offer an additional parameter for better selection of embryos based on the spectrometric absorbance and secretions of metabolites in the culture media.
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Affiliation(s)
- Nardin Aslih
- IVF Unit, Hillel Yaffe Medical Center, Hadera, Israel.
| | - Ben Zion Dekel
- Department of Electrical and Computer Engineering, Ruppin Academic Center, Emek Hefer, Israel
| | - Dov Malonek
- Department of Electrical and Computer Engineering, Ruppin Academic Center, Emek Hefer, Israel
| | | | - Diana Polotov
- IVF Unit, Hillel Yaffe Medical Center, Hadera, Israel
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Clua E, Rodríguez I, Arroyo G, Racca A, Martínez F, Polyzos N. Blastocyst transfer increases cumulative-live-birth-rates and reduces time and cost to livebirth compared with cleavage stage in recipients of donated oocytes. A randomized controlled trial. Reprod Biomed Online 2022; 44:995-1004. [DOI: 10.1016/j.rbmo.2022.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 12/17/2021] [Accepted: 01/05/2022] [Indexed: 11/16/2022]
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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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Minasi MG, Greco P, Varricchio MT, Barillari P, Greco E. The clinical use of time-lapse in human-assisted reproduction. Ther Adv Reprod Health 2020; 14:2633494120976921. [PMID: 33336190 PMCID: PMC7724395 DOI: 10.1177/2633494120976921] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 11/04/2020] [Indexed: 11/18/2022] Open
Abstract
A major challenge in the assisted reproduction laboratory is to set up
reproducible and efficient criteria to identify the embryo with the
highest developmental potential. Over the years, several methods have
been used worldwide with this purpose. Initially, standard morphology
assessment was the only available strategy. It is now universally
recognized that besides being a very subjective embryo selection
strategy, morphology evaluation alone has a very poor prognostic
value. More recently, the availability of time-lapse incubators
allowed a continuous monitoring of human embryo development. This
technology has spread quickly and many fertility clinics over the
world produced a remarkable amount of data. To date, however, a
general consensus on which variables, or combination of variables,
should play a central role in embryo selection is still lacking. Many
confounding factors, concerning both patient features and clinical and
biological procedures, have been observed to influence embryo
development. In addition, several studies have reported unexpected
positive outcomes, even in the presence of abnormal developmental
criteria. While it does not seem that time-lapse technology is ready
to entirely replace the more invasive preimplantation genetic testing
in identifying the embryo with the highest implantation potential, it
is certainly true that its application is rapidly growing, becoming
progressively more accurate. Studies involving artificial intelligence
and deep-learning models as well as combining morphokinetic with other
non-invasive markers of embryo development, are currently ongoing,
raising hopes for its successful applicability for clinical purpose in
the near future. The present review mainly focuses on data published
starting from the first decade of 2000, when time-lapse technology was
introduced as a routine clinical practice in the infertility
centers.
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Affiliation(s)
| | | | | | - Paolo Barillari
- Center for Reproductive Medicine,
Villa Mafalda, Rome, Italy
| | - Ermanno Greco
- Center for Reproductive Medicine,
Villa Mafalda, Rome, Italy
- Saint Camillus International
University of Health and Medical Sciences (UniCamillus), Rome,
Italy
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Chen M, Wu Y, Huang X, Li W, Sun C, Meng Z, Ai A, Hong L, Tang C, Li K, Fu Y, Chen Z, Kong P, Guo Y, Liu W, Mol BW, Teng X. Embryo incubation by time-lapse systems versus conventional incubators in Chinese women with diminished ovarian reserve undergoing IVF/ICSI: a study protocol for a randomised controlled trial. BMJ Open 2020; 10:e038657. [PMID: 33191252 PMCID: PMC7668367 DOI: 10.1136/bmjopen-2020-038657] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION The time-lapse imaging system (TLS) is a newly developed non-invasive embryo assessment system. Compared with conventional incubators, a TLS provides stable culture conditions and consistent observations of embryo development, thereby potentially improving embryo quality and selection of the best quality embryo. Although TLSs have been routinely used in many in vitro fertilisation (IVF) centres globally, there is insufficient evidence to indicate that TLSs result in higher cumulative live birth rates over conventional incubators. The purpose of this study is to compare the cumulative live birth rates and safety including miscarriage in infertile patients with diminished ovarian reserve (DOR) from both TLSs and conventional incubators. METHODS AND ANALYSIS This study is a double-blind randomised controlled clinical trial (1:1 treatment ratio of TLSs vs conventional incubator). A total of 730 patients with DOR undergoing the first or second cycle of IVF or intracytoplasmic sperm injection (ICSI) will be enrolled and randomised into two parallel groups. Participants will undergo embryo culture in the TLSs (group A) or the conventional incubators (group B), respectively. Embryos are selected for transfer in both groups by the morphological characteristics. The embryo selection algorithm software is not used in the TLSs. The primary outcome is the cumulative live birth rate of the trial IVF/ICSI cycle within 12 months after randomisation. This study is powered to detect an absolute difference of 10% (35% vs 25%) at the significance level of 0.05% and 80% statistical power based on a two-sided test. ETHICS AND DISSEMINATION This trial has been approved by the Institutional Ethical Committee of Shanghai First Maternity and Infant Hospital (KS1958). All participants in the trial will provide written informed consent. The study will be conducted according to the principles outlined in the Declaration of Helsinki and its amendments. Results of this study will be disseminated in peer-reviewed scientific journals. TRIAL REGISTRATION NUMBER Chinese Clinical Trial Registry (ChiCTR1900027746).
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Affiliation(s)
- Miaoxin Chen
- Centre for Reproductive Medicine, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yuanyuan Wu
- Centre for Reproductive Medicine, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xin Huang
- Centre for Reproductive Medicine, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Wentao Li
- Department of Obstetrics and Gynaecology, Monash Medical Centre, Monash University, Melbourne, Victoria, Australia
| | - Chunyan Sun
- Centre for Reproductive Medicine, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Zhenzhen Meng
- Centre for Reproductive Medicine, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ai Ai
- Centre for Reproductive Medicine, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ling Hong
- Centre for Reproductive Medicine, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Chuanling Tang
- Centre for Reproductive Medicine, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Kunming Li
- Centre for Reproductive Medicine, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yonglun Fu
- Centre for Reproductive Medicine, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Zhiqin Chen
- Centre for Reproductive Medicine, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Pengcheng Kong
- Centre for Reproductive Medicine, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yi Guo
- Centre for Reproductive Medicine, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Wenqiang Liu
- Centre for Reproductive Medicine, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ben W Mol
- Department of Obstetrics and Gynaecology, Monash Medical Centre, Monash University, Melbourne, Victoria, Australia
| | - Xiaoming Teng
- Centre for Reproductive Medicine, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
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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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