Utilization of high-security straws for embryo freezing in an in vitro fertilization program: a prospective, randomized study

Outcomes of neonates born following transfers of frozen-thawed cleavage-stage embryos with blastomere loss: a prospective, multicenter, cohort study

BACKGROUND

Despite limited information on neonatal safety, the transfer of frozen-thawed cleavage-stage embryos with blastomere loss is common in women undergoing in vitro fertilization. We aimed to evaluate the pregnancy outcomes and safety of frozen-thawed cleavage-stage embryos with blastomere loss.

METHODS

This prospective, multicenter, cohort study included all frozen-thawed cleavage-stage embryo transfer (FET) cycles between 2002 and 2012. Pregnancy outcomes and subsequent neonatal outcomes were compared between FET cycles with intact embryos and those with blastomere loss.

RESULTS

A total of 12,105 FET cycles were included in the analysis (2259 cycles in the blastomere loss group and 9846 cycles in the intact embryo group). The blastomere loss group showed significantly poorer outcomes with respect to implantation, pregnancy, and live birth rates than the intact embryo group. However, following embryo implantation, the two groups were similar with respect to live birth rates per clinical pregnancy. Among multiple pregnancies (4229 neonates), neonates from the blastomere loss group were at an increased risk of being small for gestational age (aOR = 1.50, 95% CI 1.00-2.25) compared to those from the intact group. A similar trend was observed among singletons (aOR = 1.84, 95% CI 0.99-3.37). No associations were found between blastomere loss and the subsequent occurrence of congenital anomalies or neonatal mortality. However, neonates from the blastomere loss group were at an increased risk of transient tachypnea of the newborn (aOR = 5.21, 95% CI 2.42-11.22).

CONCLUSIONS

The transfer of embryos with blastomere loss is associated with reduced conception rates. Once the damaged embryos have implanted, pregnancies appear to have the same probability of progressing to live birth but with an increased risk of small for gestational age neonates and transient tachypnea of the newborn.

STUDY REGISTRATION

This study was retrospectively registered at Chinese Clinical Trial Registry. Registration number: ChiCTR-OOC-16007753 . Registration date: 13 January 2016.

Incidence of transmissible diseases in a network of assisted reproduction clinics throughout Queensland

In assisted reproduction, knowledge of the presence of transmissible disease assists diagnosis and permits appropriate risk minimisation. The overall incidence was lowest in the Brisbane full-cost clinic and highest in the Springwood low-cost clinic. Male partners predominated over females, particularly in the low-cost clinic. Hepatitis C was the most commonly detected infection with the highest incidence in the low-cost clinic. HIV was the least commonly detected infection amongst those tested.

Large-volume vitrification of human biopsied and non-biopsied blastocysts: a simple, robust technique for cryopreservation

PURPOSE

To evaluate the transition from a proven slow-cooling cryopreservation method to a commercial large-volume vitrification system for human blastocysts.

METHODS

Retrospective analysis of de-identified laboratory and clinical data from January 2012 to present date for all frozen embryo replacement (FET) cycles was undertaken. Cryopreservation of trophectoderm-biopsied or non-biopsied blastocysts utilized during this time period was logged as either slow-cooling, small-volume vitrification, or large-volume vitrification. Blastocyst survival post-warm or post-thaw, clinical pregnancy following FET, and implantation rates were identified for each respective cryopreservation method.

RESULTS

Embryo survival was highest for large-volume vitrification compared to micro-volume vitrification and slow-cooling; 187/193 (96.9 %), 27/32 (84.4 %), and 244/272 (89.7 %), respectively. Survival of biopsied and non-biopsied blastocysts vitrified using the large-volume system was 105/109 (96.3 %) and 82/84 (97.6 %), respectively. Survival for micro-volume biopsied and non-biopsied blastocysts was 16/30 (83.3 %) and 2/2 (100.0 %) respectively. Slow-cooling post-thaw embryo survival was 272/244 (89.7 %). Clinical pregnancy and implantation rates outcomes for non-biopsied embryos were similar between large-volume and slow-cooling cryopreservation methods, 18/39 (46.2 %) clinical pregnancy and 24/82 (29.3 %) implantation/embryo, and 52/116 (44.8 %) clinical pregnancy and 67/244 (27.5 %) implantation/embryo, respectively. Comparing outcomes for biopsied embryos, clinical pregnancy and implantation rates were 39/67 (58.2 %) clinical pregnancy and 50/105 (47.6 %) implantation/embryo and 4/16 (25 %) clinical pregnancy and 6/25 (24.0 %) implantation/embryo, respectively.

CONCLUSIONS

The LifeGlobal large-volume vitrification system proved to be very reliable, simple to learn and implement in the laboratory. Clinically large-volume vitrification was as, or more effective compared to slow-cooling cryopreservation in terms of recovery of viable embryos in this laboratory.

A randomized controlled study of human Day 3 embryo cryopreservation by slow freezing or vitrification: vitrification is associated with higher survival, metabolism and blastocyst formation

BACKGROUND

The aim of this study was to compare two methods of cryopreservation for the cleavage-stage human embryo: slow freezing and vitrification.

METHODS

A total of 466 Day 3 embryos, donated with consent, underwent cryopreservation by either slow freezing in straws or vitrification using the cryoloop. The vitrification procedure did not include dimethyl sulfoxide, but rather employed ethylene glycol and 1,2-propanediol as the cryoprotectants. Survival, embryonic metabolism and subsequent development to the blastocyst were used to determine the efficacy of the two procedures.

RESULTS

Significantly, more embryos survived the vitrification procedure (222/234, 94.8%) than slow freezing (206/232, 88.7%; P < 0.05). Consistent with this observation, pyruvate uptake was significantly greater in the vitrification group, reflecting a higher metabolic rate. Development to the blastocyst was also higher following vitrification (134/222, 60.3%) than following freezing (106/206, 49.5%; P < 0.05). In a separate cohort of 73 patients who had their supernumerary embryos cyropreserved with vitrification, the resulting implantation rate and clinical pregnancy rate were 30 and 49%, respectively.

CONCLUSIONS

Analysis of metabolism revealed that vitrification had less impact on the metabolic rate of the embryo than freezing, which was reflected in higher survival rate and subsequent development in vitro. Excellent pregnancy outcomes followed the warming and transfer of vitrified cleavage-stage embryos. These data provide further evidence that vitrification imparts less trauma to cells and is, therefore, a more effective means of cryopreserving the human embryo than conventional slow freezing. Clinicaltrials.gov identifier: NCT00608010.

Severe cytoplasmic abnormalities of the oocyte decrease cryosurvival and subsequent embryonic development of cryopreserved embryos

BACKGROUND

Abnormalities of oocyte morphology affect embryo quality and viability. Whether morphological abnormalities of the oocyte influence cryosurvival and further development of derived embryos is not known. The aim of this study was to compare cryosurvival and progression to the blastocyst stage of frozen-thawed embryos derived from normal and abnormal oocytes.

METHODS

A total of 5292 Grade 1 and 2 embryos from 964 women were frozen, thawed and subsequently cultured up to the blastocyst stage. The study was performed on excess embryos from patients who did not opt for cryopreservation. Cryosurvival, progression to the blastocyst stage and hatching were correlated with morphological characteristics of the oocytes that embryos were derived from.

RESULTS

Presence of a cytoplasmic abnormality of the oocyte significantly decreased cryosurvival. This detrimental effect was more pronounced in embryos derived from oocytes with vacuolar cytoplasm or with central granulation. Furthermore, these embryos did not have the potential to develop into good quality blastocysts or reach the hatching stage. On the other hand, presence of a single extracytoplasmic abnormality of the oocyte did not affect cryosurvival and the potential to develop into good quality blastocysts. Grade 2 embryos derived from oocytes with irregular shape or a large perivitelline space had decreased cryosurvival. However when these embryos survived cryopreservation, their potential to develop good quality blastocysts or to reach hatching stage was unaffected.

CONCLUSIONS

Embryos derived from oocytes with vacuolar cytoplasm or central granulation do not seem to bear the potential to develop good quality blastocysts or to reach hatching stage after cryopreservation. The presence of extracytoplasmic abnormalities alone does not affect blastocyst development despite decreasing cryosurvival.

Dual renin-angiotensin blockage and total embryo cryopreservation is not a risk-free strategy in patients at high risk for ovarian hyperstimulation syndrome

OBJECTIVE

To evaluate the effectiveness and safety of dual renin-angiotensin system (RAS) blockage together with total embryo cryopreservation for prevention of ovarian hyperstimulation syndrome (OHSS) in overstimulated patients undergoing IVF.

DESIGN

Retrospective case series.

SETTING

A private tertiary care hospital assisted reproduction program.

PATIENT(S)

Ten women at high risk for OHSS (mean E(2) level 9401 +/- 585 pg/mL on the day of hCG administration).

INTERVENTION(S)

Cancellation of ET and dual RAS blockage with an angiotensin receptor blocker (candesartan cilexetil) and an angiotensin-converting enzyme inhibitor (enalapril) starting from day 1 after oocyte retrieval. Embryos were cryopreserved and transferred in subsequent cycles.

MAIN OUTCOME MEASURE(S)

Development of OHSS and pregnancy and live birth rates after frozen-thawed ETs.

RESULT(S)

While eight women did not develop OHSS, two women (20%) developed severe OHSS requiring hospitalization. Subsequent frozen-thawed ETs resulted in an 80% clinical pregnancy rate and 40% live birth rate.

CONCLUSION(S)

Dual RAS blockage with total embryo cryopreservation is a relatively new strategy that was proposed for use in patients at high risk for OHSS. It should be stressed that complete elimination of the syndrome is not possible with this treatment. Subsequent pregnancy rates with the transfer of frozen-thawed embryos are high.