1
|
Valera MÁ, Garg A, Bori L, Meseguer F, de Los Santos JM, Meseguer M. Undisturbed culture: a clinical examination of this culture strategy on embryo in vitro development and clinical outcomes. Fertil Steril 2024:S0015-0282(24)00614-9. [PMID: 39048020 DOI: 10.1016/j.fertnstert.2024.07.018] [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: 03/03/2024] [Revised: 07/12/2024] [Accepted: 07/14/2024] [Indexed: 07/27/2024]
Abstract
OBJECTIVE To compare the effect of a fully undisturbed culture strategy over a sequential one on embryo in vitro development and clinical outcomes in intracytoplasmic sperm injection (ICSI) cycles. DESIGN Retrospective cohort study. SETTING University-affiliated private IVF center. PATIENT(S) This study included 4,564 ICSI cycles performed over 5 years, including autologous and oocyte donation treatments with extended embryo culture until blastocyst in one of the two defined culture strategies. INTERVENTION(S) Embryo cohorts were cultured in one of two culture systems: a fully undisturbed culture, including an incubator with integrated time-lapse technology, a one-step culture medium and embryo selection assisted by semi-automatic tools on the basis of embryo morphokinetics, or a sequential culture, using a conventional benchtop incubator, sequential media and traditional morphological evaluation under optical microscope. The effect of the culture strategies on embryo development and clinical outcomes was quantified by generalized estimated equations, controlling for possible confounders through the inverse probability of the treatment weighting method. MAIN OUTCOME MEASURE(S) Weighted odds ratios (ORs) and 95% confidence intervals (CIs) for live birth rate after fresh single embryo transfer and the cumulative live birth rate. In addition, blastocyst development and morphology and other intermediate outcomes were also assessed. RESULT(S) A significant positive association was found between the employment of undisturbed embryo culture and higher live birth rate in the first embryo transfer in both autologous (OR, 1.617; 95% CI, 1.074-2.435) and oocyte donation cycles (OR, 1.316; 95% CI, 1.036-1.672). Cumulative live birth rate after 1-year follow-up was also positively associated with the undisturbed culture strategy in oocyte donation cycles (OR, 1.5; 95% CI, 1.179-1.909), but not in autologous cycles (OR, 1.051; 95% CI, 0.777-1.423). Similarly, blastocyst rate, good morphology blastocyst rate, and utilization rate were positively associated with the employment of undisturbed culture in oocyte donation cycles, but not in autologous cycles. CONCLUSION(S) These findings imply that a culture system combining integrated time-lapse incubators with a one-step culture medium may enhance the success rates of patients undergoing ICSI treatment by increasing the production of higher quality blastocysts and improving embryo selection while streamlining laboratory procedures and workflow.
Collapse
Affiliation(s)
- María Ángeles Valera
- IVI Foundation-Instituo de Investigación Sanitaria (IIS) La Fe, Research and Innovation, IVF Laboratory, Valencia, Spain; IVI-RMA Valencia, IVF Laboratory, Valencia, Spain.
| | - Akhil Garg
- IVI-RMA Valencia, IVF Laboratory, Valencia, Spain
| | - Lorena Bori
- IVI Foundation-Instituo de Investigación Sanitaria (IIS) La Fe, Research and Innovation, IVF Laboratory, Valencia, Spain; IVI-RMA Valencia, IVF Laboratory, Valencia, Spain
| | - Fernando Meseguer
- IVI Foundation-Instituo de Investigación Sanitaria (IIS) La Fe, Research and Innovation, IVF Laboratory, Valencia, Spain; IVI-RMA Valencia, IVF Laboratory, Valencia, Spain
| | | | - Marcos Meseguer
- IVI Foundation-Instituo de Investigación Sanitaria (IIS) La Fe, Research and Innovation, IVF Laboratory, Valencia, Spain; IVI-RMA Valencia, IVF Laboratory, Valencia, Spain
| |
Collapse
|
2
|
Bhide P, Chan DYL, Lanz D, Alqawasmeh O, Barry E, Baxter D, Gonzalez Carreras F, Choudhury Y, Cheong Y, Chung JPW, Collins B, Cong L, Doidge S, Heighway J, Patel D, Pardo MC, Rattos A, Wright A, Dodds J, Perez T, Khan KS, Thangaratinam S. Clinical effectiveness and safety of time-lapse imaging systems for embryo incubation and selection in in-vitro fertilisation treatment (TILT): a multicentre, three-parallel-group, double-blind, randomised controlled trial. Lancet 2024; 404:256-265. [PMID: 39033010 DOI: 10.1016/s0140-6736(24)00816-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 03/29/2024] [Accepted: 04/17/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND Time-lapse imaging systems for embryo incubation and selection might improve outcomes of in-vitro fertilisation (IVF) and intracytoplasmic sperm injection (ICSI) treatment due to undisturbed embryo culture conditions, improved embryo selection, or both. However, the benefit remains uncertain. We aimed to evaluate the effectiveness of time-lapse imaging systems providing undisturbed culture and embryo selection, and time-lapse imaging systems providing only undisturbed culture, and compared each with standard care without time-lapse imaging. METHODS We conducted a multicentre, three-parallel-group, double-blind, randomised controlled trial in participants undergoing IVF or ICSI at seven IVF centres in the UK and Hong Kong. Embryologists randomly assigned participants using a web-based system, stratified by clinic in a 1:1:1 ratio to the time-lapse imaging system for undisturbed culture and embryo selection (time-lapse imaging group), time-lapse imaging system for undisturbed culture alone (undisturbed culture group), and standard care without time-lapse imaging (control group). Women were required to be aged 18-42 years and men (ie, their partners) 18 years or older. Couples had to be receiving their first, second, or third IVF or ICSI treatment and could not participate if using donor gametes. Participants and trial staff were masked to group assignment, embryologists were not. The primary outcome was live birth. We performed analyses using the intention-to-treat principle and reported the main analysis in participants with primary outcome data available (full analysis set). The trial is registered on the International Trials Registry (ISRCTN17792989) and is now closed. FINDINGS 1575 participants were randomly assigned to treatment groups (525 participants per group) between June 21, 2018, and Sept 30, 2022. The live birth rates were 33·7% (175/520) in the time-lapse imaging group, 36·6% (189/516) in the undisturbed culture group, and 33·0% (172/522) in the standard care group. The adjusted odds ratio was 1·04 (97·5% CI 0·73 to 1·47) for time-lapse imaging arm versus control and 1·20 (0·85 to 1·70) for undisturbed culture versus control. The risk reduction for the absolute difference was 0·7 percentage points (97·5% CI -5·85 to 7·25) between the time-lapse imaging and standard care groups and 3·6 percentage points (-3·02 to 10·22) between the undisturbed culture and standard care groups. 79 serious adverse events unrelated to the trial were reported (n=28 in time-lapse imaging, n=27 in undisturbed culture, and n=24 in standard care). INTERPRETATION In women undergoing IVF or ICSI treatment, the use of time-lapse imaging systems for embryo culture and selection does not significantly increase the odds of live birth compared with standard care without time-lapse imaging. FUNDING Barts Charity, Pharmasure Pharmaceuticals, Hong Kong OG Trust Fund, Hong Kong Health and Medical Research Fund, Hong Kong Matching Fund.
Collapse
Affiliation(s)
- Priya Bhide
- Women's Health Research Unit, Wolfson Institute of Population Health, Queen Mary University of London, London, UK; Homerton Fertility Centre, Homerton Healthcare NHS Foundation Trust, London, UK.
| | - David Y L Chan
- Assisted Reproductive Technology Unit, Department of Obstetrics and Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Doris Lanz
- Institute of Cancer Research, Clinical Trials and Statistics Unit, Sutton, UK
| | | | - Eleanor Barry
- Women's Health Research Unit, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Dominic Baxter
- Women's Health Research Unit, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | | | - Yasmin Choudhury
- Women's Health Research Unit, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Ying Cheong
- Human Development and Health, Institute of Life Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Jacqueline Pui Wah Chung
- Assisted Reproductive Technology Unit, Department of Obstetrics and Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Bonnie Collins
- The Centre for Reproductive Medicine, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Luping Cong
- Assisted Reproductive Technology Unit, Department of Obstetrics and Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Sally Doidge
- Centre for Reproduction and Gynaecology Wales and the West, Plymouth, UK
| | - James Heighway
- Coalition for Epidemic Preparedness Innovations (CEPI), London, UK
| | - Deepali Patel
- Women's Health Research Unit, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - M Carmen Pardo
- Department of Statistics and OR, Complutense University of Madrid, Madrid, Spain
| | - Annabel Rattos
- Wolfson Fertility Centre, Hammersmith Hospital, Imperial College NHS Trust, London, UK
| | - Annie Wright
- Imperial Clinical Trials Unit, Imperial College, London, UK
| | - Julie Dodds
- Women's Health Research Unit, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Teresa Perez
- Department of Statistics and Data Science, Complutense University of Madrid, Madrid, Spain
| | - Khalid S Khan
- Department of Preventative Medicine and Public Health, University of Granada, Granada, Spain
| | - Shakila Thangaratinam
- Institute of Life Course and Medical Sciences, University of Liverpool, UK; Liverpool Women's NHS Foundation Trust, Liverpool, UK
| |
Collapse
|
3
|
Bartolacci A, Marzanati D, Barbagallo BM, Solano Narduche L, D’Alessandro G, Esposito S, Vanni VS, Masciangelo R, Gentilini D, Papaleo E, Pagliardini L. To Assess or Not to Assess: Reconsidering Day 3 Embryo Quality in Planned Freeze-All Blastocyst Cycles. J Pers Med 2024; 14:624. [PMID: 38929846 PMCID: PMC11204659 DOI: 10.3390/jpm14060624] [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: 05/07/2024] [Revised: 05/31/2024] [Accepted: 06/07/2024] [Indexed: 06/28/2024] Open
Abstract
Day 3 embryo quality is a predictor of in vitro fertilization (IVF) success rates in cleavage-stage embryo transfer. However, the association between day 3 embryo quality and clinical outcomes in blastocyst transfer policy is largely unknown. This retrospective study included 1074 frozen-thawed single day 5/6 blastocyst transfers between January 2019 and December 2022. Three groups were assessed depending on whether the transferred blastocyst derived from a top-quality, good-quality, or poor-quality embryo at day 3. The analysis was conducted independently for each blastocyst quality group (top, good, and poor) using multivariable logistic regression. We applied a Factorial Analysis of Mixed Data (FAMD) to reduce the potential collinearity between the covariates used in the model. All the blastocysts included in this study were obtained from the first ICSI freeze-all cycles. The cleavage and blastocysts stages were assessed between 67 ± 0.5 (day 3), 115 ± 0.5 (day 5), and 139 ± 0.5 (day 6) hours post-insemination (hpi), respectively. After adjusting for the day of transfer (day 5 or day 6) and FAMD dimensions, no statistical differences in a β-HCG, clinical pregnancy, and live birth were observed among the same-quality blastocysts derived from different day 3 embryo quality groups (top = A, good = B, and poor = C). Our findings showed that a day 3 embryo quality assessment may be unnecessary in planned freeze-all blastocyst cycles.
Collapse
Affiliation(s)
- Alessandro Bartolacci
- Obstetrics and Gynaecology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132 Milan, Italy; (B.M.B.); (G.D.); (S.E.); (V.S.V.); (R.M.); (E.P.); (L.P.)
| | - Daria Marzanati
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy; (D.M.); (D.G.)
- Reproductive Sciences Laboratory, Obstetrics and Gynaecology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy;
| | - Beatrice Maria Barbagallo
- Obstetrics and Gynaecology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132 Milan, Italy; (B.M.B.); (G.D.); (S.E.); (V.S.V.); (R.M.); (E.P.); (L.P.)
| | - Lisett Solano Narduche
- Reproductive Sciences Laboratory, Obstetrics and Gynaecology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy;
| | - Giulia D’Alessandro
- Obstetrics and Gynaecology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132 Milan, Italy; (B.M.B.); (G.D.); (S.E.); (V.S.V.); (R.M.); (E.P.); (L.P.)
| | - Stefania Esposito
- Obstetrics and Gynaecology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132 Milan, Italy; (B.M.B.); (G.D.); (S.E.); (V.S.V.); (R.M.); (E.P.); (L.P.)
| | - Valeria Stella Vanni
- Obstetrics and Gynaecology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132 Milan, Italy; (B.M.B.); (G.D.); (S.E.); (V.S.V.); (R.M.); (E.P.); (L.P.)
| | - Rossella Masciangelo
- Obstetrics and Gynaecology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132 Milan, Italy; (B.M.B.); (G.D.); (S.E.); (V.S.V.); (R.M.); (E.P.); (L.P.)
| | - Davide Gentilini
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy; (D.M.); (D.G.)
- Bioinformatics and Statistical Genomics Unit, Istituto Auxologico Italiano IRCCS, 20095 Milan, Italy
| | - Enrico Papaleo
- Obstetrics and Gynaecology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132 Milan, Italy; (B.M.B.); (G.D.); (S.E.); (V.S.V.); (R.M.); (E.P.); (L.P.)
| | - Luca Pagliardini
- Obstetrics and Gynaecology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132 Milan, Italy; (B.M.B.); (G.D.); (S.E.); (V.S.V.); (R.M.); (E.P.); (L.P.)
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy; (D.M.); (D.G.)
- Reproductive Sciences Laboratory, Obstetrics and Gynaecology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy;
| |
Collapse
|
4
|
Tvrdonova K, Belaskova S, Rumpikova T, Rumpik D, Myslivcova Fucikova A, Malir F. Prediction of live birth - selection of embryos using morphokinetic parameters. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2024; 168:74-80. [PMID: 36622075 DOI: 10.5507/bp.2022.052] [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: 08/18/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022] Open
Abstract
BACKROUND The goal of assisted reproduction is for a couple treated with IVF techniques to end the treatment by giving birth to a healthy baby. A neccessary presumption for success is the identification of the best embryo with high implantation and developmental potential. One option is to select an euploid embryo by invasive preimplantaion genetic testing for aneuploidy (PGT-A) or it is possible to select the best embryo by non-invasive time-lapse monitoring (TLM), specifically based on morphokinetic parameters and morphological markers that are able to identify an embryo with high developmental potential. MATERIALS AND METHODS The study involved a total of 1060 embryos (585 euploid and 475 aneuploid embryos after PGT-A) with good morphology from 329 patients in the period 01/2016-10/2021. All embryos were cultured in a time-lapse incubator, trophectoderm (TE) cells biopsies for PGT-A examination were performed on day 5 (D5) or day 6 (D6) of culture. During the study period, 225 frozen embryo transfers (FET) of one euploid embryo were performed. Based on the treatment outcome, the embryos were divided into 2 groups - euploid embryos, which led to the birth of a healthy child, and euploid embryos that did not show fetal heartbeat (FHB) after FET. RESULTS Based on the statistical analysis of the embryos without implantation and the embryos with live birth, it is clear that the morphokinetic parameters t5 (time of division into 5 cells) and tSB (time of start of blastulation) are significantly different. CONCLUSION The results suggest that of the morphokinetic parameters tSB and t5 are predictive indicators for selecting an embryo with high developmental potential and with a high probability of achieving the birth of a healthy child.
Collapse
Affiliation(s)
- Katerina Tvrdonova
- Department of Biology, Faculty of Sciences, University Hradec Kralove, 500 03 Hradec Kralove, Czech Republic
- Clinic of Reproductive Medicine and Gynecology Zlin, U Lomu 638, 760 01 Zlin, Czech Republic
| | - Silvie Belaskova
- Institute of Mathematics and Statistics, Faculty of Science, Masaryk University, 611 37 Brno, Czech Republic
- International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic
| | - Tatana Rumpikova
- Clinic of Reproductive Medicine and Gynecology Zlin, U Lomu 638, 760 01 Zlin, Czech Republic
| | - David Rumpik
- Clinic of Reproductive Medicine and Gynecology Zlin, U Lomu 638, 760 01 Zlin, Czech Republic
| | - Alena Myslivcova Fucikova
- Department of Biology, Faculty of Sciences, University Hradec Kralove, 500 03 Hradec Kralove, Czech Republic
| | - Frantisek Malir
- Department of Biology, Faculty of Sciences, University Hradec Kralove, 500 03 Hradec Kralove, Czech Republic
| |
Collapse
|
5
|
Kikuchi Y, Ito D, Wakayama S, Ooga M, Wakayama T. Time-lapse observation of mouse preimplantation embryos using a simple closed glass capillary method. Sci Rep 2023; 13:19893. [PMID: 37963931 PMCID: PMC10646084 DOI: 10.1038/s41598-023-47017-8] [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: 06/09/2023] [Accepted: 11/08/2023] [Indexed: 11/16/2023] Open
Abstract
Time-lapse observation is a popular method for analyzing mammalian preimplantation embryos, but it often requires expensive equipment and skilled techniques. We previously developed a simply and costly embryo-culture system in a sealed tube that does not require a CO2 incubator. In the present study, we developed a new time-lapse observation system using our previous culture method and a glass capillary. Zygotes were placed in a glass capillary and sunk in oil for observation under a stereomicroscope. Warming the capillary using a thermoplate enabled most of the zygotes to develop into blastocysts and produce healthy offspring. This time-lapse observation system captured images every 30 min for up to 5 days, which confirmed that the developmental speed and quality of the embryos were not affected, even with fluorescence. Overall, this new system is a simple time-lapse observation method for preimplantation embryos that does not require dedicated machines and advanced techniques.
Collapse
Affiliation(s)
- Yasuyuki Kikuchi
- Faculty of Life and Environmental Science, University of Yamanashi, Kofu, 400-8510, Japan
| | - Daiyu Ito
- Faculty of Life and Environmental Science, University of Yamanashi, Kofu, 400-8510, Japan
| | - Sayaka Wakayama
- Advanced Biotechnology Center, University of Yamanashi, Kofu, 400-8510, Japan
| | - Masatoshi Ooga
- Faculty of Life and Environmental Science, University of Yamanashi, Kofu, 400-8510, Japan
- Department of Animal Science and Biotechnology, School of Veterinary Medicine, Azabu University, Fuchinobe, Chuo-ku, Sagamihara, 252-5201, Japan
| | - Teruhiko Wakayama
- Advanced Biotechnology Center, University of Yamanashi, Kofu, 400-8510, Japan.
| |
Collapse
|
6
|
Pons MC, Carrasco B, Rives N, Delgado A, Martínez-Moro A, Martínez-Granados L, Rodriguez I, Cairó O, Cuevas-Saiz I. Predicting the likelihood of live birth: an objective and user-friendly blastocyst grading system. Reprod Biomed Online 2023; 47:103243. [PMID: 37473718 DOI: 10.1016/j.rbmo.2023.05.015] [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: 02/07/2023] [Revised: 05/10/2023] [Accepted: 05/31/2023] [Indexed: 07/22/2023]
Abstract
RESEARCH QUESTION Can day-5 blastocysts be ranked according to their likelihood of live birth using an objective and user-friendly grading system? DESIGN A retrospective multicentre study conducted between 2017 and 2019, including 1044 day-5 blastocysts. Blastocyst expansion degree, trophectoderm and inner cell mass quality were assessed morphologically and morphometrically. Several analyses were conducted: the association between the qualitative and quantitative assessment for the blastocyst expansion degree and the number of trophectoderm cells; the effect of the embryo quality on day 3 and the contribution of the three blastocyst parameters to live birth, with logistic regression; and a decision tree with the most significant variables to create the new scoring system. RESULTS Cut-off points were found to discriminate between expanding and expanded blastocysts (165 µm for blastocyst diameter) and between trophectoderm grades (A: ≥14 cells; B: 11-13 cells; C: ≤10 cells). When the embryos reached the blastocyst stage, their quality on day 3 did not add predictive value for implantation and live birth. In the logistic regression analysis, the only parameter capable of significantly predicting the live birth likelihood was the trophectoderm grade: A versus C (OR 1.95, 95% CI 1.26 to 3.0); B versus C (OR 1.71, 95% CI 1.22 to 2.4). The decision tree supported the finding that the trophectoderm grade had the highest predictive value for a live birth, followed by the blastocyst expansion degree in a second step. CONCLUSIONS This new method makes objective blastocyst assessment feasible, allowing for standardization and exportation to other laboratories worldwide.
Collapse
Affiliation(s)
- Maria Carme Pons
- Dexeus Mujer- Hospital Universitari Dexeus, Reproductive Medicine Service, Gran, Via Carles III, 71-75. 08028 Barcelona, Spain.
| | - Beatriz Carrasco
- Dexeus Mujer- Hospital Universitari Dexeus, Reproductive Medicine Service, Gran, Via Carles III, 71-75. 08028 Barcelona, Spain
| | - Natalia Rives
- Barcelona IVF, Escoles Pies, 103. 08017 Barcelona, Spain
| | - Arantza Delgado
- Institut Universitari IVI Valencia, Plaza Policía local, 3. 46015 Valencia, Spain
| | - Alvaro Martínez-Moro
- IVF Spain Madrid, Calle Manuel de Falla, 6-8. 28036 Madrid, Spain; Animal Reproduction Department, INIA-CSIC, Avda. Puerta del Hierro, 18. 28040, Madrid, Spain
| | - Luís Martínez-Granados
- Hospital Universitario Príncipe de Asturias, Unidad de Reproducción Humana, Carretera de Alcalá-Meco s/n. 28805 Alcalá de Henares, Spain
| | - Ignacio Rodriguez
- Dexeus Mujer- Hospital Universitari Dexeus, Reproductive Medicine Service, Gran, Via Carles III, 71-75. 08028 Barcelona, Spain
| | - Olga Cairó
- Centro de Infertilidad y Reproducción Humana (CIRH), Plaza Eguilaz, 14 bajos. 08017 Barcelona, Spain
| | - Irene Cuevas-Saiz
- Hospital General Universitario de Valencia, Unidad de Medicina Reproductiva, Avenida Tres Cruces, 2. 46014 Valencia, Spain
| |
Collapse
|
7
|
Huayhua C, Rodríguez M, Vega J, Briones M, Rodriguez-Alvarez L, Mellisho E. Blastulation time measured with time-lapse system can predict in vitro viability of bovine blastocysts. PLoS One 2023; 18:e0289751. [PMID: 37561791 PMCID: PMC10414680 DOI: 10.1371/journal.pone.0289751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 07/26/2023] [Indexed: 08/12/2023] Open
Abstract
The objective of this study was to evaluate the time of blastulation monitored by time-lapse technology to predict in vitro viability of bovine blastocysts. This technology can be a powerful tool for bovine embryos selection with higher implantation capacity and competence. Also, in humans an early blastulation is associated with higher quality and pregnancy rate. Cumulus oocyte complexes (COCs) were matured for 20 to 22 h and then fertilized by co-incubation of COCs and spermatozoa (10,000 sperm per oocyte) for 18 h. Presumptive zygotes were placed individually in microwells, in droplets of commercial culture medium. The Primo Vision TL system (EVO+; Vitrolife) captured digital images of developing embryos every 15 minutes. The time frame from IVF to the start of blastulation (tSB) and to blastocyst development (tB) was recorded. After day 7.5, the blastocysts were in vitro culture for 48 h until day 9.5 after IVF to evaluate post hatching development. In vitro viability was evaluated at day 9.5: those with a diameter greater than 200 μm and a total cell count greater than 180 were classified as viable (value 1), while the rest were classified as non in vitro viable (value 0). The area under the ROC curve (AUC) was estimated to determine the predictive power of in vitro viability through blastulation time. In addition, binary logistic regression analysis was used to generate a mathematical model with morphokinetic variables that allow the best prediction of in vitro viability. In 13 sessions, the blastocyst production rate was 46.2% (96/208). The cut-off time to discriminate early or late blastulation was 149.8 h. The post-hatching development of the embryos with early blastulation was 63.3% (31/49), being statistically superior (p = 0.001) than the late blastulation group 14.9% (7/47). Likewise, the time of blastulation showed an accuracy of 90.8% (p < 0.001) in predicting in vitro viability of bovine blastocysts. In conclusion, the selection of blastocysts based on blastulation time (< 155 h) and blastocyst diameter measured on day 7.5 after IVF (> 180 μm) maximizes the in vitro viability.
Collapse
Affiliation(s)
- Carmen Huayhua
- Centro de Investigación en Tecnología de Embriones (CIETE), Animal Improvement Program, Universidad Nacional Agraria La Molina, Lima, Perú
| | - Misael Rodríguez
- Centro de Investigación en Tecnología de Embriones (CIETE), Animal Improvement Program, Universidad Nacional Agraria La Molina, Lima, Perú
| | - Jhorjhi Vega
- Centro de Investigación en Tecnología de Embriones (CIETE), Animal Improvement Program, Universidad Nacional Agraria La Molina, Lima, Perú
| | - Mario Briones
- Department of Animal Science, Faculty of Veterinary Sciences, Universidad de Concepción, Chillán, Concepción, Chile
| | - Lleretny Rodriguez-Alvarez
- Department of Animal Science, Faculty of Veterinary Sciences, Universidad de Concepción, Chillán, Concepción, Chile
| | - Edwin Mellisho
- Centro de Investigación en Tecnología de Embriones (CIETE), Animal Improvement Program, Universidad Nacional Agraria La Molina, Lima, Perú
| |
Collapse
|
8
|
Rauchfuss LK, Zhao Y, Walker D, Galantis T, Fredrickson J, Barud K, Shenoy C. Optimal Embryo Selection: The Irreplaceable Role of the Embryologist in an Age of Advancing Technology. J Hum Reprod Sci 2023; 16:227-232. [PMID: 38045503 PMCID: PMC10688284 DOI: 10.4103/jhrs.jhrs_98_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 08/26/2023] [Accepted: 09/07/2023] [Indexed: 12/05/2023] Open
Abstract
Background Time-lapse incubators allow for ongoing evaluation of embryos without culture condition disruption. The use of time-lapse incubation has been shown to improve outcomes either by improving overall conditions or providing additional information to aid in embryo selection for transfer. Time-lapse incubators can also utilise morphokinetic models to rank embryos based on morphokinetic parameters. We sought to compare a morphokinetic model for embryo comparison to traditional morphologic evaluation. Aims The aim of the study is to compare a morphokinetic model for embryo comparison to traditional morphologic evaluation. Settings and Design This is a retrospective cohort design. Materials and Methods Embryos cultured in a time-lapse culture system that had traditional morphologic evaluation, morphokinetic modelling and known live birth outcomes were included in this study. Embryos with unknown competence were excluded, including when two embryos were transferred with a single live birth resulted. Statistical Analysis Used Receiver operating characteristic (ROC) curves were determined for both the morphologic analysis and the morphokinetic model on culture day 3 and day 5. Using the ROC-determined cutoff that optimised both sensitivity and specificity, a binary outcome for each test was analysed using agreement statistics to determine if one method of embryo evaluation was superior to the other. Results Morphological and morphokinetic grading were both predictive of embryo competence on days 3 and 5. However, on day 3, morphologic grading was superior to morphokinetic grading with area under the curve (AUC) of 0.66 (P < 0.001) and 0.58 (P = 0.009), respectively. Contrarily, on day 5, the morphokinetic model had a higher AUC of 0.65 (P = 0.03) compared to the morphologic grading, AUC 0.56 (P = 0.02). Conclusion Traditional morphology was noted to be a better diagnostic tool (higher AUC) on culture day 3 while a morphokinetic model was superior on day 5.
Collapse
|
9
|
Sciorio R, Aiello R, Janssens R. Considerations on staffing levels for a modern assisted reproductive laboratory. JBRA Assist Reprod 2023; 27:120-130. [PMID: 36515254 PMCID: PMC10065777 DOI: 10.5935/1518-0557.20220048] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 08/23/2022] [Indexed: 12/12/2022] Open
Abstract
The duties recently performed in the embryology laboratory have deeply increased compared to those realized a couple of decades ago. Currently, procedures include conventional in vitro fertilization (IVF) and ICSI techniques, or processing of surgically retrieved sperm, embryo culture and time-lapse monitoring, blastocyst culture, as well as trophectoderm biopsy for preimplantation genetic testing and cryopreservation. These techniques require not only time, but also high knowledge level and acutely concentration by the embryologist team. The existing data indicate that an IVF laboratory need to have adequate staffing levels to perform the required daily duties, and to work in optimal conditions that are critical to assure a high quality service, as well as avoiding incidents and to provide the best outcomes. As a result, IVF clinics have invested in human resources, but there is still a large discrepancy between IVF centres on the number of embryologists employed. Currently there is no golden standard on the human resource requirements for assisted reproductive technology procedures; therefore, in this review paper we aim to provide arguments to take into account to determine the embryology staffing requirements in an embryology laboratory to assure optimal safety and efficiency of operations.
Collapse
Affiliation(s)
- Romualdo Sciorio
- Edinburgh Assisted Conception Programme, EFREC, Royal Infirmary of
Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Edinburgh, Scotland, EH16
4SA, UK
| | - Raffaele Aiello
- OMNIA Lab S.C.a.R.L, Via Cesare Rosaroll 24, 80139 Naples, Italy
| | | |
Collapse
|
10
|
Gunderson SJ, Snowden N, Field JJ. Embryo Cryopreservation in a Patient with Sickle Cell Disease Utilizing Letrozole and Enoxaparin: A Case Report. Hematol Rep 2023; 15:101-107. [PMID: 36810554 PMCID: PMC9944850 DOI: 10.3390/hematolrep15010011] [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: 09/08/2022] [Revised: 11/15/2022] [Accepted: 02/01/2023] [Indexed: 02/05/2023] Open
Abstract
PURPOSE To describe a patient with sickle cell disease, a prothrombotic disorder, who underwent successful embryo cryopreservation for the purposes of fertility preservation prior to hematopoietic stem cell transplant. METHODS To report a successful case of gonadotropin stimulation and embryo cryopreservation using the aromatase inhibitor letrozole to maintain low serum estradiol to minimize thrombotic risk in a patient with sickle cell disease (SCD) and history of retinal artery thrombosis planning hematopoietic stem cell transplant (HSCT). The patient was given letrozole (5 mg daily) as well as prophylactic enoxaparin while undergoing gonadotropin stimulation with an antagonist protocol to preserve fertility prior to HSCT. After the oocyte retrieval, letrozole was continued for one additional week. RESULTS The patient's peak serum estradiol concentration was 172 pg/mL during gonadotropin stimulation. Ten mature oocytes were retrieved and a total of 10 blastocysts were cryopreserved. The patient required pain medication and intravenous fluids after oocyte retrieval due to pain but had significant improvement at the scheduled post-operative day one follow-up. No embolic events occurred during stimulation or 6 months thereafter. CONCLUSION The utilization of definitive treatment for SCD with stem cell transplant is increasing. We successfully used letrozole to maintain low serum estradiol during gonadotropin stimulation along with prophylactic enoxaparin in a patient with SCD to minimize her risk of thrombosis. This approach will allow patients planning definitive treatment with stem cell transplant the opportunity to preserve their fertility safely.
Collapse
Affiliation(s)
- Stephanie J. Gunderson
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI 53226, USA
- Correspondence:
| | - Nina Snowden
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Joshua J. Field
- Department of Hematology, Medical College of Wisconsin, Milwaukee, WI 53226, USA
- Versiti Blood Center of Wisconsin, Milwaukee, WI 53233, USA
| |
Collapse
|
11
|
Zhu L, Zeng X, Liu W, Han W, Huang G, Li J. Comparison of DNA methylation profiles of human embryos cultured in either uninterrupted or interrupted incubators. J Assist Reprod Genet 2023; 40:113-123. [PMID: 36459262 PMCID: PMC9840733 DOI: 10.1007/s10815-022-02669-9] [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: 07/06/2022] [Accepted: 11/21/2022] [Indexed: 12/04/2022] Open
Abstract
PURPOSE We aimed to compare the DNA methylation profiles of human embryos cultured in uninterrupted or interrupted incubators. METHODS This study included 9 women, ≤ 30 years old (range: 20-30 years), without a history of genetic diseases or smoking, undergoing ICSI treatment, and each woman donated one oocyte. Embryos were randomly assigned to culture in either time-lapse imaging or standard incubators after ICSI. We compared the DNA methylation profiles of human eight-cell embryos cultured in uninterrupted condition using time-lapse imaging (TLI) incubator (EmbryoScope) to those cultured in interrupted culture model using standard incubators (SI, G185 K-System). Nine single-cell whole-genome bisulfite sequencing (WGBS) datasets were analyzed, including four SI-cultured embryos and five TLI-cultured embryos at the eight-cell stage. RESULTS A total of 581,140,020 and 732,348,182 clean reads were generated from the TLI and SI groups, respectively. TLI-cultured embryos had similar genome-wide methylation patterns to SI-cultured embryos. There were no significant differences in the methylation and transcription levels of transposable elements and imprinted control regions. Although a total of 198 differentially methylated genes (DMGs) were identified, only five DMGs had significantly different transcription levels between the two groups. CONCLUSIONS This is the first study to compare the DNA methylation profiles of embryos cultured in TLI and SI and will provide a foundation for evaluating the safety of TLI application in assisted reproductive technologies. However, further study with a larger cohort of samples was needed for the data validation.
Collapse
Affiliation(s)
- Ling Zhu
- Chongqing Key Laboratory of Human Embryo Engineering, Center for Reproductive Medicine, Women and Children's Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Clinical Research Center for Reproductive Medicine, Chongqing Health Center for Women and Children, Chongqing, China
| | - Xi Zeng
- Chongqing Key Laboratory of Human Embryo Engineering, Center for Reproductive Medicine, Women and Children's Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Clinical Research Center for Reproductive Medicine, Chongqing Health Center for Women and Children, Chongqing, China
| | - Weiwei Liu
- Chongqing Key Laboratory of Human Embryo Engineering, Center for Reproductive Medicine, Women and Children's Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Clinical Research Center for Reproductive Medicine, Chongqing Health Center for Women and Children, Chongqing, China
| | - Wei Han
- Chongqing Key Laboratory of Human Embryo Engineering, Center for Reproductive Medicine, Women and Children's Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Clinical Research Center for Reproductive Medicine, Chongqing Health Center for Women and Children, Chongqing, China
| | - Guoning Huang
- Chongqing Key Laboratory of Human Embryo Engineering, Center for Reproductive Medicine, Women and Children's Hospital of Chongqing Medical University, Chongqing, China.
- Chongqing Clinical Research Center for Reproductive Medicine, Chongqing Health Center for Women and Children, Chongqing, China.
| | - Jingyu Li
- Chongqing Key Laboratory of Human Embryo Engineering, Center for Reproductive Medicine, Women and Children's Hospital of Chongqing Medical University, Chongqing, China.
- Chongqing Clinical Research Center for Reproductive Medicine, Chongqing Health Center for Women and Children, Chongqing, China.
| |
Collapse
|
12
|
Yang Mohsin WS, Abdullah Chue NS, Abdul Hamid F, Abu MA, Othman S, Mat Jin N, Woon SY, Abdul Karim AK, Ahmad MF. Comparison of Treatment Outcomes among Sibling Oocytes Using Different Culture Systems-Conventional IVF versus INVOcell Device-And Evaluation of INVOcell User Satisfaction: The INVOcIVF Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12391. [PMID: 36231691 PMCID: PMC9564657 DOI: 10.3390/ijerph191912391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 09/26/2022] [Accepted: 09/27/2022] [Indexed: 06/16/2023]
Abstract
INVOcell is considered an alternative to conventional IVF proposed for intravaginal embryo culture; however, implementation is still low because evidence is scanty regarding its outcome and, most importantly, the device's user satisfaction. Thus, we aim to compare the embryo outcome of sibling oocytes following INVOcell culture with conventional IVF (cIVF) by assessing its clinical outcome (fertilization, blastulation rate, and good embryo quality) and the user satisfaction evaluation based on a local validation questionnaire. A prospective study was done at a university-setting hospital for 12 months (July 2021-2022). The oocytes collected were divided into INVOcell and cIVF groups equally. Inclusion criteria included <40 years old and body mass index (BMI) < 30 kg/m2. The pre- and post-satisfaction questionnaires were assessed. In total, 23 women were included following standard controlled ovarian stimulation (COS). The mean age was 32.9, and the mean BMI was 24.9 kg/m2. Most of them suffered from tubal factors. A total of 252 oocytes were collected and incubated accordingly (cIVF; 138, INVOcell; 114). The blastulation rate was superior in the INVOcell group (p = 0.16); otherwise, the fertilization rate and good embryo quality were not significantly different between both methods (p > 0.05). Overall, women were satisfied with the INVOcell device as they were adequately advised, follow-up was scheduled, and the lowest score was obtained for all side effects of the device. Although both methods produce similar fertilization rates and good-quality embryos, the blastulation rates were better in the INVOcell group. Functionally, it is a user-friendly device and tolerable. Therefore, INVOcell can be used as an alternative method for reproductive treatment in carefully selected patients without jeopardizing the IVF outcomes.
Collapse
Affiliation(s)
- Wan Syahirah Yang Mohsin
- Advanced Reproductive Centre HCTM Cheras, Kuala Lumpur 56000, Malaysia
- Department of Obstetrics & Gynecology, Hospital Tuanku Azizah (HTA), Kuala Lumpur 50300, Malaysia
| | | | | | | | - Sukhilmi Othman
- Hospital Bersalin Sukhilmi, No. 1-G, Jalan Coco Drive 3, Taman Bandar Senawang, Senawang 70450, Malaysia
| | - Norazilah Mat Jin
- Advanced Reproductive Centre HCTM Cheras, Kuala Lumpur 56000, Malaysia
- Reproductive Unit Faculty of Medicine, Universiti Teknologi MARA, Sg Buloh Campus, Kuala Selangor 45800, Malaysia
| | - Shu Yuan Woon
- Advanced Reproductive Centre HCTM Cheras, Kuala Lumpur 56000, Malaysia
- Hospital Umum Sarawak, Kuching 93586, Malaysia
| | | | - Mohd Faizal Ahmad
- Advanced Reproductive Centre HCTM Cheras, Kuala Lumpur 56000, Malaysia
| |
Collapse
|
13
|
Improved embryonic development and utilization rates with EmbryoScope: a within-subject comparison versus a benchtop incubator. ZYGOTE 2022; 30:633-637. [PMID: 35674243 DOI: 10.1017/s0967199422000077] [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: 11/06/2022]
Abstract
The objective of this study was to investigate whether, in consecutive intracytoplasmic sperm injection (ICSI) cycles, embryonic development in an incubator with a time-lapse imaging (TLI) system is better than the previous one obtained in a benchtop incubator (G-185) with similar cultivation characteristics. The study was of a retrospective within-subject design, in which each cycle served as its own control. Data were obtained via the chart review of patients undergoing ICSI in a private university-affiliated in vitro fertilization (IVF) centre who fulfilled the following criteria: second ICSI attempt in which embryos were cultured in a TLI incubator system (TLI group, n = 71), preceded by a first ICSI attempt in which embryos were cultured in a benchtop incubator (Control group, n = 71). Embryonic development up to the fifth day of development, oocyte utilization rate (OUR; transferred embryos plus frozen embryos per total number of retrieved oocytes) and embryo utilization rate (EUR; transferred embryos plus frozen embryos per normally fertilized oocyte) were compared between the groups. There were significant differences in the day 2 non-cleavage rate, day 5 embryo rate, blastocyst development rate, frozen blastocyst rate, OUR, and EUR, in favour of the TLI group. Embryonic development, frozen blastocyst rate, OUR and EUR in the second ICSI cycle were significantly improved when the culture was performed in the EmbryoScope, compared with those rates obtained with culture in a G-185 in the first ICSI cycle of the same patients. The results may also lead to higher cumulative pregnancy outcomes following embryo thawing and transfer.
Collapse
|
14
|
Zhang XD, Zhang Q, Han W, Liu WW, Shen XL, Yao GD, Shi SL, Hu LL, Wang SS, Wang JX, Zhou JJ, Kang WW, De Zhang H, Luo C, Yu Q, Liu RZ, Sun YP, Sun HX, Wang XH, Quan S, Huang GN. Comparison of embryo implantation potential between time-lapse incubators and standard incubators: A randomized controlled study. Reprod Biomed Online 2022; 45:858-866. [DOI: 10.1016/j.rbmo.2022.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 06/09/2022] [Accepted: 06/20/2022] [Indexed: 11/29/2022]
|
15
|
Fadon P, Gallegos E, Jalota S, Muriel L, Diaz-Garcia C. Time-Lapse Systems: A Comprehensive Analysis on Effectiveness. Semin Reprod Med 2022; 39:e12-e18. [PMID: 35008119 DOI: 10.1055/s-0041-1742149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Time-lapse systems have quickly become a common feature of in vitro fertilization laboratories all over the world. Since being introduced over a decade ago, the alleged benefits of time-lapse technology have continued to grow, from undisturbed culture conditions and round the clock, noninvasive observations to more recent computer-assisted selection of embryos through the development of algorithms. Despite the global uptake of time-lapse technology, its real impact on clinical outcomes is still controversial. This review aims to explore the different features offered by time-lapse technology, discussing incubation, algorithms, artificial intelligence and the regulation of nonessential treatment interventions, while assessing evidence on whether any benefit is offered over conventional technology.
Collapse
Affiliation(s)
| | | | | | | | - Cesar Diaz-Garcia
- IVI London, IVIRMA Global, London, United Kingdom.,EGA Institute for Women's Health, University College London, London, United Kingdom
| |
Collapse
|
16
|
Differences in Morphokinetic Parameters and Incidence of Multinucleations in Human Embryos of Genetically Normal, Abnormal and Euploid Embryos Leading to Clinical Pregnancy. J Clin Med 2021; 10:jcm10215173. [PMID: 34768693 PMCID: PMC8584289 DOI: 10.3390/jcm10215173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 10/26/2021] [Accepted: 11/02/2021] [Indexed: 11/17/2022] Open
Abstract
The selection of the best embryo for embryo transfer (ET) is one of the most important steps in IVF (in vitro fertilisation) treatment. Preimplantation genetic testing (PGT) is an invasive method that can greatly facilitate the decision about the best embryo. An alternative way to select the embryo with the greatest implantation potential is by cultivation in a time-lapse system, which can offer several predictive factors. Non-invasive time-lapse monitoring can be used to select quality embryos with high implantation potential under stable culture conditions. The embryo for ET can then be selected based on the determined morphokinetic parameters and morphological features, which according to our results predict a higher implantation potential. This study included a total of 1027 morphologically high-quality embryos (552 normal and 475 abnormal PGT-tested embryos) from 296 patients (01/2016-06/2021). All embryos were cultivated in a time-lapse incubator and PGT biopsy of trophectoderm cells on D5 or D6 was performed. Significant differences were found in the morphological parameters cc2, t5 and tSB and the occurrence of multinucleations in the stage of two-cell and four-cell embryos between the group of genetically normal embryos and abnormal embryos. At the same time, significant differences in the morphological parameters cc2, t5 and tSB and the occurrence of multinucleations in the two-cell and four-cell embryo stage were found between the group of genetically normal embryos that led to clinical pregnancy after ET and the group of abnormal embryos. From the morphokinetic data found in the PGT-A group of normal embryos leading to clinical pregnancy, time intervals were determined based on statistical analysis, which should predict embryos with high implantation potential. Out of a total of 218 euploid embryos, which were transferred into the uterus after thawing (single frozen embryo transfer), clinical pregnancy was confirmed in 119 embryos (54.6%). Our results show that according to the morphokinetic parameters (cc2, t5, tSB) and the occurrence of multinucleations during the first two cell divisions, the best euploid embryo for ET can be selected with high probability.
Collapse
|
17
|
Shebl O, Trautner PS, Enengl S, Reiter E, Allerstorfer C, Rechberger T, Oppelt P, Ebner T. Ionophore application for artificial oocyte activation and its potential effect on morphokinetics: a sibling oocyte study. J Assist Reprod Genet 2021; 38:3125-3133. [PMID: 34642877 PMCID: PMC8666403 DOI: 10.1007/s10815-021-02338-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 10/01/2021] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To evaluate whether ionophore application at the oocyte stage changes the morphokinetics of the associated embryos in cases of artificial oocyte activation. METHODS In a prospective sibling oocyte approach, 78 ICSI patients with suspected fertilization problems had half of their MII-oocytes treated with a ready-to-use ionophore (calcimycin) immediately following ICSI (study group). Untreated ICSI eggs served as the control group. Primary analyses focused on morphokinetic behavior and the presence of irregular cleavages. The rates of fertilization, utilization, pregnancy, and live birth rate were also evaluated. RESULTS Ionophore-treated oocytes showed a significantly earlier formation of pronuclei (t2PNa) and a better synchronized third cell cycle (s3) (P < .05). The rate of irregular cleavage was unaffected (P > .05). Ionophore treatment significantly improved the overall rates of fertilization (P < .01) and blastocyst utilization (P < .05). CONCLUSION Ionophore application does not negatively affect cleavage timing nor is it associated with irregular cleavage.
Collapse
Affiliation(s)
- Omar Shebl
- Department of Gynecology, Obstetrics, and Gynecological Endocrinology, Kepler University Hospital, MedCampus IV, Krankenhausstr. 26-30, A-4020, Linz, Upper Austria, Austria
| | - Philip Sebastian Trautner
- Department of Gynecology, Obstetrics, and Gynecological Endocrinology, Kepler University Hospital, MedCampus IV, Krankenhausstr. 26-30, A-4020, Linz, Upper Austria, Austria
| | - Sabine Enengl
- Department of Gynecology, Obstetrics, and Gynecological Endocrinology, Kepler University Hospital, MedCampus IV, Krankenhausstr. 26-30, A-4020, Linz, Upper Austria, Austria
| | - Elisabeth Reiter
- Department of Gynecology, Obstetrics, and Gynecological Endocrinology, Kepler University Hospital, MedCampus IV, Krankenhausstr. 26-30, A-4020, Linz, Upper Austria, Austria
| | - Christina Allerstorfer
- Department of Gynecology, Obstetrics, and Gynecological Endocrinology, Kepler University Hospital, MedCampus IV, Krankenhausstr. 26-30, A-4020, Linz, Upper Austria, Austria
| | - Tamara Rechberger
- Department of Gynecology, Obstetrics, and Gynecological Endocrinology, Kepler University Hospital, MedCampus IV, Krankenhausstr. 26-30, A-4020, Linz, Upper Austria, Austria
| | - Peter Oppelt
- Department of Gynecology, Obstetrics, and Gynecological Endocrinology, Kepler University Hospital, MedCampus IV, Krankenhausstr. 26-30, A-4020, Linz, Upper Austria, Austria
| | - Thomas Ebner
- Department of Gynecology, Obstetrics, and Gynecological Endocrinology, Kepler University Hospital, MedCampus IV, Krankenhausstr. 26-30, A-4020, Linz, Upper Austria, Austria.
| |
Collapse
|
18
|
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.
Collapse
Affiliation(s)
- Romualdo Sciorio
- Edinburgh Assisted Conception Programme, EFREC, Royal Infirmary of Edinburgh, UK.
| | | |
Collapse
|
19
|
Toxic effect of light on oocyte and pre-implantation embryo: a systematic review. Arch Toxicol 2021; 95:3161-3169. [PMID: 34448882 DOI: 10.1007/s00204-021-03139-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 08/12/2021] [Indexed: 10/20/2022]
Abstract
In the female reproductive tract, oocytes and embryos are in a dark environment, while during the in vitro fertilization (IVF) they are exposed to various visible and invisible lights such as daylight, microscope, and laminar hood fluorescent lights. Studies have shown that light could damage cellular compartments of oocytes and embryos and consequently decrease rates of fertilization, development, and blastocyst formation. However, due to the lack of consensus about the effects of light on the embryos, and subsequently the inability to make definitive decisions regarding the light exposure management to improve IVF results, in the present study, we systematically reviewed the effect of light with different wavelengths and intensities on pre-implantation embryos. The toxic impact of light depends on the wavelength, intensity, and duration of light exposure and also the stage of embryo. Therefore, reducing the observation time of embryos out of the incubator and also using light filters can alleviate the detrimental effect of light in IVF labs.
Collapse
|
20
|
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.
Collapse
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
| |
Collapse
|
21
|
Nguyen EB, Jacobs EA, Summers KM, Sparks AE, Van Voorhis BJ, Klenov VE, Duran EH. Embryo blastulation and quality between days 5 and 6 of extended embryo culture. J Assist Reprod Genet 2021; 38:2193-2198. [PMID: 33754252 DOI: 10.1007/s10815-021-02156-7] [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: 10/22/2020] [Accepted: 03/16/2021] [Indexed: 11/28/2022] Open
Abstract
PURPOSE This study aims to know what proportion of culture day 5 pre-blastocyst-stage embryos develop into blastocysts by culture day 6 and what patient and cycle characteristics are associated with delayed blastocyst formation. METHODS A retrospective observational cohort analysis was performed including a total of 9886 embryos from 1008 IVF cycles in 835 patients, who underwent treatment between January 1, 2016, and December 31, 2018. Autologous fresh in vitro fertilization (IVF) cycles at a single academic center were included in the analysis. Embryos were group-cultured using single-step culture media. Blastulation was defined as the presence of a new blastocyst. Usable blastulation was defined as the presence of a new good or excellent quality, expanded, hatching, or hatched blastocysts. RESULTS The mean blastulation rate between days 5 and 6 of extended embryo culture was 30.9%. The mean percentage of embryos developing into usable blastocyst-stage embryos was 19.8%. The factors associated with blastulation on day 6 included the total number of embryos and the number of pre-blastocysts on day 5, as well as the use of ICSI. Age, the number of total embryos, those remained in culture and pre-blastocysts, as well as the blastulation rate on day 5 were associated with usable blastulation. CONCLUSION It is important to know the usable blastocyst development rate between culture days 5 and 6 in order to adequately counsel patients debating whether to proceed with fresh ET on day 5 or forego ET with the expectation that embryos will be biopsied for PGT and/or cryopreserved on culture day 6. Our findings provide evidence to help guide patients in this difficult decision.
Collapse
Affiliation(s)
- E B Nguyen
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, University of Iowa Hospitals and Clinics, Iowa City, IA, 52242, USA.,Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, 98195, USA
| | - E A Jacobs
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, University of Iowa Hospitals and Clinics, Iowa City, IA, 52242, USA
| | - K M Summers
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, University of Iowa Hospitals and Clinics, Iowa City, IA, 52242, USA
| | - A E Sparks
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, University of Iowa Hospitals and Clinics, Iowa City, IA, 52242, USA
| | - B J Van Voorhis
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, University of Iowa Hospitals and Clinics, Iowa City, IA, 52242, USA
| | - V E Klenov
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, University of Iowa Hospitals and Clinics, Iowa City, IA, 52242, USA
| | - E H Duran
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, University of Iowa Hospitals and Clinics, Iowa City, IA, 52242, USA. .,Department of Obstetrics and Gynecology, 200 Hawkins Drive, 31322 PFP, Iowa City, IA, 52242, USA.
| |
Collapse
|
22
|
Coticchio G, Behr B, Campbell A, Meseguer M, Morbeck DE, Pisaturo V, Plancha CE, Sakkas D, Xu Y, D'Hooghe T, Cottell E, Lundin K. Fertility technologies and how to optimize laboratory performance to support the shortening of time to birth of a healthy singleton: a Delphi consensus. J Assist Reprod Genet 2021; 38:1021-1043. [PMID: 33599923 DOI: 10.1007/s10815-021-02077-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 01/18/2021] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To explore how the assisted reproductive technology (ART) laboratories can be optimized and standardized to enhance embryo culture and selection, to bridge the gap between standard practice and the new concept of shortening time to healthy singleton birth. METHODS A Delphi consensus was conducted (January to July 2018) to assess how the ART laboratory could be optimized, in conjunction with existing guidelines, to reduce the time to a healthy singleton birth. Eight experts plus the coordinator discussed and refined statements proposed by the coordinator. The statements were distributed via an online survey to 29 participants (including the eight experts from step 1), who voted on their agreement/disagreement with each statement. Consensus was reached if ≥ 66% of participants agreed/disagreed with a statement. If consensus was not achieved for any statement, that statement was revised and the process repeated until consensus was achieved. Details of statements achieving consensus were communicated to the participants. RESULTS Consensus was achieved for all 13 statements, which underlined the need for professional guidelines and standardization of lab processes to increase laboratory competency and quality. The most important points identified were the improvement of embryo culture and embryo assessment to shorten time to live birth through the availability of more high-quality embryos, priority selection of the most viable embryos and improved cryosurvival. CONCLUSION The efficiency of the ART laboratory can be improved through professional guidelines on standardized practices and optimized embryo culture environment, assessment, selection and cryopreservation methodologies, thereby reducing the time to a healthy singleton delivery.
Collapse
Affiliation(s)
- Giovanni Coticchio
- 9.baby Family and Fertility Center, Via Dante, 15, 40125, Bologna, Italy.
| | - Barry Behr
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics & Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| | | | | | - Dean E Morbeck
- Fertility Associates, Auckland, New Zealand
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Valerio Pisaturo
- Reproductive Medicine Department, International Evangelical Hospital, Genoa, Italy
| | - Carlos E Plancha
- Inst. Histologia e Biologia do Desenvolvimento, Faculdade de Medicina, Universidade de Lisboa and CEMEARE, Lisbon, Portugal
| | - Denny Sakkas
- Boston IVF, Waltham, MA, USA
- Department of Obstetrics and Gynecology, Yale University, New Haven, CT, USA
| | - Yanwen Xu
- Reproductive Medicine Center, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Thomas D'Hooghe
- Department of Obstetrics and Gynecology, Yale University, New Haven, CT, USA
- Global Medical Affairs Fertility, R&D Biopharma, Merck KGaA, Darmstadt, Germany
- Department of Development and Regeneration, Biomedical Sciences Group, KU Leuven (University of Leuven), Leuven, Belgium
| | - Evelyn Cottell
- Global Medical Affairs Fertility, R&D Biopharma, Merck KGaA, Darmstadt, Germany
| | - Kersti Lundin
- Reproductive Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| |
Collapse
|
23
|
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.
Collapse
|
24
|
Bori L, Paya E, Alegre L, Viloria TA, Remohi JA, Naranjo V, Meseguer M. Novel and conventional embryo parameters as input data for artificial neural networks: an artificial intelligence model applied for prediction of the implantation potential. Fertil Steril 2020; 114:1232-1241. [PMID: 32917380 DOI: 10.1016/j.fertnstert.2020.08.023] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 08/14/2020] [Accepted: 08/19/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To describe novel embryo features capable of predicting implantation potential as input data for an artificial neural network (ANN) model. DESIGN Retrospective cohort study. SETTING University-affiliated private IVF center. PATIENT(S) This study included 637 patients from the oocyte donation program who underwent single-blastocyst transfer during two consecutive years. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) The research was divided into two phases. Phase 1 consisted of the description and analysis of the following embryo features in implanted and nonimplanted embryos: distance and speed of pronuclear migration, blastocyst expanded diameter, inner cell mass area, and trophectoderm cell cycle length. Phase 2 consisted of the development of an ANN algorithm for implantation prediction. Results were obtained for four models fed with different input data. The predictive power was measured with the use of the area under the receiver operating characteristic curve (AUC). RESULT(S) Out of the five novel described parameters, blastocyst expanded diameter and trophectoderm cell cycle length had statistically different values in implanted and nonimplanted embryos. After the ANN models were trained and validated using fivefold cross-validation, they were capable of predicting implantation on testing data with AUCs of 0.64 for ANN1 (conventional morphokinetics), 0.73 for ANN2 (novel morphodynamics), 0.77 for ANN3 (conventional morphokinetics + novel morphodynamics), and 0.68 for ANN4 (discriminatory variables from statistical test). CONCLUSION(S) The novel proposed embryo features affect the implantation potential, and their combination with conventional morphokinetic parameters is effective as input data for a predictive model based on artificial intelligence.
Collapse
Affiliation(s)
| | - Elena Paya
- IVI-RMA Valencia, Valencia, Spain; Instituto de Investigación e Innovación en Bioingeniería, Universitat Politécnica de Valencia, Valencia, Spain
| | | | | | | | - Valery Naranjo
- Instituto de Investigación e Innovación en Bioingeniería, Universitat Politécnica de Valencia, Valencia, Spain
| | - Marcos Meseguer
- IVI-RMA Valencia, Valencia, Spain; Health Research Institute la Fe, Valencia, Spain
| |
Collapse
|
25
|
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.
Collapse
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
| |
Collapse
|
26
|
Jacobs C, Nicolielo M, Erberelli R, Mendez F, Fanelli M, Cremonesi L, Aiello B, Lorenzon AR. Correlation between morphokinetic parameters and standard morphological assessment: what can we predict from early embryo development? A time-lapse-based experiment with 2085 blastocysts. JBRA Assist Reprod 2020; 24:273-277. [PMID: 32293818 PMCID: PMC7365527 DOI: 10.5935/1518-0557.20190088] [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] [Indexed: 11/26/2022] Open
Abstract
Objectives: To evaluate the association between morphology grading and morphokinetic parameters in blastocyst stage embryos cultured in a time-lapse system. Methods: This retrospective cohort study included patients offered fertility treatment with autologous oocytes in our clinic between October 2017 and May 2019 using a time-lapse system. The embryos were morphologically graded according to the criteria developed by Gardner and Schoolcraft and their morphokinetic parameters were recorded. Results: Our results indicated that the time of pronuclei fading (tPNf), time to cleavage into two (t2), four (t4), and eight (t8) cells, and time to start of blastulation (tB) were significantly different according to the morphological quality of the blastocysts formed. In the early development stage, tPNf, t2 and t4 differed between good (AA, AB, BA, BB) and poor (CC) quality potential blastocysts. The 8-cell stage time separated embryos graded as AA blastocysts in terms of morphology from embryos graded as BB. Earlier tB correlated with higher quality embryos (AA, AB, BA). Conclusion: Our results showed that the first kinetic parameters (tPNf, t2, and t4) distinguished top-graded from low-graded blastocysts. Between top-graded blastocysts, t8 separated BB blastocysts from AA blastocysts. And finally, tB also told apart BB blastocysts from AA, AB, and BA blastocysts. These time-related parameters may be applied even in centers without time-lapse systems.
Collapse
Affiliation(s)
- Catherine Jacobs
- Embryology Department - Huntington Medicina Reprodutiva, São Paulo, SP, Brazil
| | - Mariana Nicolielo
- Embryology Department - Huntington Medicina Reprodutiva, São Paulo, SP, Brazil
| | - Renata Erberelli
- Embryology Department - Huntington Medicina Reprodutiva, São Paulo, SP, Brazil
| | - Fabiana Mendez
- Embryology Department - Huntington Medicina Reprodutiva, São Paulo, SP, Brazil
| | - Marina Fanelli
- Embryology Department - Huntington Medicina Reprodutiva, São Paulo, SP, Brazil
| | - Livia Cremonesi
- Embryology Department - Huntington Medicina Reprodutiva, São Paulo, SP, Brazil
| | - Beatriz Aiello
- Embryology Department - Huntington Medicina Reprodutiva, São Paulo, SP, Brazil
| | - Aline R Lorenzon
- Scientific Coordinator - Huntington Medicina Reprodutiva, São Paulo, SP, Brazil
| |
Collapse
|
27
|
Saraeva NV, Spiridonova NV, Tugushev MT, Shurygina OV, Sinitsyna AI, Korchagin AO. Optimization of a single-embryo transfer in patients with good ovarian reserve. BULLETIN OF RUSSIAN STATE MEDICAL UNIVERSITY 2020. [DOI: 10.24075/brsmu.2020.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Due to refinements of assisted reproductive technology, the number of multiple pregnancies has increased substantially. Time-lapse microscopy (TLM) is a tool for selecting quality embryos for transfer. This study aimed to assess the outcomes of single-embryo transfer of autologous oocytes performed on day 5 of embryo incubation in a TLM-equipped system in patients with good ovarian reserve. The study was carried out in 208 infertile women with good ovarian reserve (over 8 oocytes retrieved). Single-embryo transfer following incubation in a TLM-equipped incubator was performed in 95 patients, who formed the main group; the control group consisted of 113 patients undergoing single-embryo transfer following a traditional culture and embryo selection procedure. We assessed the quality of transferred embryos, the rates of clinical pregnancy and pregnancy loss. Two subgroups were identified in each group of the participants: the 5SET subgroup (nonelective single-embryo transfer), which included 45 patients from the main group and 67 controls, and the 5eSET subgroup (elective single-embryo transfer), which consisted of 50 main group patients and 46 controls. The groups did not differ in terms of age, infertility factors and infertility duration. The quality of transferred embryos was excellent or good in all main group patients (100%); in the control group, the quality of transferred embryos was excellent or good in 93.8% of cases (p = 0.037). Clinical pregnancies were achieved in 64.2% of women in the main group and in 60.2% of controls (p = 0.65). Delivery rates were 54% and 51.1% in the 5eSET and 5SET subgroups of the main group, respectively (p = 0.940). For the control group, delivery rates were 54.4% and 34.3% in the 5eSET and 5SET subgroups, respectively (p = 0.052, Fisher exact test). Elective single-embryo transfer (5eSET) and the use of TLM increased the chance of pregnancy 2.17-fold (p = 0.01).
Collapse
Affiliation(s)
- NV Saraeva
- Samara State Medical University, Samara, Russia; IDK Medical Company, the Mother and Child group, Samara, Russia
| | | | - MT Tugushev
- Samara State Medical University, Samara, Russia
| | | | | | - AO Korchagin
- IDK Medical Company, the Mother and Child group, Samara, Russia
| |
Collapse
|
28
|
Sciorio R, Herrer Saura R, Thong KJ, Esbert Algam M, Pickering SJ, Meseguer M. Blastocyst collapse as an embryo marker of low implantation potential: a time-lapse multicentre study. ZYGOTE 2020; 28:1-9. [PMID: 31928572 DOI: 10.1017/s0967199419000819] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Spontaneous blastocyst collapse during in vitro embryo development has been suggested as a novel marker of embryo quality. Therefore, the aim of this multicentre study was to carry out a retrospective multicentre analysis to investigate the correlation between blastocyst collapse and pregnancy outcome. Here, 1297 intracytoplasmic sperm injection (ICSI)/in vitro fertilization (IVF) fresh cycles, with an elective single blastocyst transfer (eSET) were included in this study. Embryos were cultured individually in 6.0% CO2, 5.0% O2, 89.0% N2, using single step medium (GTLTM VitroLife, Sweden) or sequential medium (CookTM, Cook Medical, Australia) and selected for transfer using standard morphological criteria. With the use of time-lapse monitoring (TLM), blastocysts were analyzed by measuring the maximum volume reduction and defined as having collapsed, if there was ≥ 50% volume reduction from the expanded blastocyst and the collapse event. Following embryo replacement, each blastocyst was retrospectively allocated to one of two groups (collapsed or not collapsed). Here, 259 blastocysts collapsed once or more during development (19.9%) and the remaining 1038 either contracted minimally or not collapsed (80.1%). A significantly higher ongoing pregnancy rate (OPR) of 51.9% (95% CI 48.9-59.9%) was observed when blastocysts that had not collapsed were replaced compared with cycles in which collapsed blastocysts were transferred 37.5% (95% CI 31.6-43.4%). This study suggests that human blastocysts that collapse spontaneously during development are less likely to implant and generate a pregnancy compared with embryos that do not. Although this is a retrospective study, the results demonstrated the utility of collapse episodes as new marker of embryo selection following eSET at blastocyst stage.
Collapse
Affiliation(s)
- Romualdo Sciorio
- Edinburgh Assisted Conception Programme, EFREC, Royal Infirmary of Edinburgh, UK
| | | | - K Joo Thong
- Edinburgh Assisted Conception Programme, EFREC, Royal Infirmary of Edinburgh, UK
| | | | - Susan Jane Pickering
- Edinburgh Assisted Conception Programme, EFREC, Royal Infirmary of Edinburgh, UK
| | | |
Collapse
|
29
|
Abstract
BACKGROUND 'Infertility' is defined as the failure to achieve pregnancy after 12 months or more of regular unprotected sexual intercourse. One in six couples experience a delay in becoming pregnant. In vitro fertilisation (IVF) is one of the assisted reproductive techniques used to enable couples to achieve a live birth. One of the processes involved in IVF is embryo culture in an incubator, where a stable environment is created and maintained. The incubators are set at approximately 37°C, which is based on the human core body temperature, although several studies have shown that this temperature may in fact be lower in the female reproductive tract and that this could be beneficial. In this review we have included randomised controlled trials which compared different temperatures of embryo culture. OBJECTIVES To assess different temperatures of embryo culture for human assisted reproduction, which may lead to higher live birth rates. SEARCH METHODS We searched the following databases and trial registers: the Cochrane Gynaecology and Fertility (CGF) Group Specialised Register of Controlled Trials, the Cochrane Central Register of Studies Online, MEDLINE, Embase, PsycINFO, CINAHL, clinicaltrials.gov, The World Health Organization International Trials Registry Platform search portal, DARE, Web of Knowledge, OpenGrey, LILACS database, PubMed and Google Scholar. Furthermore, we manually searched the references of relevant articles and contacted experts in the field to obtain additional data. We did not restrict the search by language or publication status. We performed the last search on 6 March 2019. SELECTION CRITERIA Two review authors independently screened the titles and abstracts of articles retrieved by the search. Full texts of potentially eligible randomised controlled trials (RCTs) were obtained and screened. We included all RCTs which compared different temperatures of embryo culture in IVF or intracytoplasmic sperm injection (ICSI), with a minimum difference in temperature between the two incubators of ≥ 0.5°C. The search process is shown in the PRISMA flow chart. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial eligibility and risk of bias and extracted data from the included studies; the third review author resolved any disagreements. We contacted trial authors to provide additional data. The primary review outcomes were live birth and miscarriage. Clinical pregnancy, ongoing pregnancy, multiple pregnancy and adverse events were secondary outcomes. All extracted data were dichotomous outcomes, and odds ratios (OR) were calculated with 95% confidence intervals (CIs) on an intention-to-treat basis. We assessed the overall quality of the evidence for the main comparisons using GRADE methods. MAIN RESULTS We included three RCTs, with a total of 563 women, that compared incubation of embryos at 37.0°C or 37.1°C with a lower incubator temperature (37.0°C versus 36.6°C, 37.1°C versus 36.0°C, 37.0° versus 36.5°C). Live birth, miscarriage, clinical pregnancy, ongoing pregnancy and multiple pregnancy were reported. After additional information from the authors, we confirmed one study as having no adverse events; the other two studies did not report adverse events. We did not perform a meta-analysis as there were not enough studies included per outcome. Live birth was not graded since there were no data of interest available. The evidence for the primary outcome, miscarriage, was of very low quality. The evidence for the secondary outcomes, clinical pregnancy, ongoing pregnancy and multiple pregnancy was also of very low quality. We downgraded the evidence because of high risk of bias (for performance bias) and imprecision due to limited included studies and wide CIs.Only one study reported the primary outcome, live birth (n = 52). They performed randomisation at the level of oocytes and not per woman, and used a paired design whereby two embryos, one from 36.0°C and one from 37.0°C, were transferred. The data from this study were not interpretable in a meaningful way and therefore not presented. Only one study reported miscarriage. We are uncertain whether incubation at a lower temperature decreases the miscarriage (odds ratio (OR) 0.90, 95% CI 0.52 to 1.55; 1 study, N = 412; very low-quality evidence).Of the two studies that reported clinical pregnancy, only one of them performed randomisation per woman. We are uncertain whether a lower temperature improves clinical pregnancy compared to 37°C for embryo incubation (OR 1.08, 95% CI 0.73 to 1.60; 1 study, N = 412; very low-quality evidence). For the outcome, ongoing pregnancy, we are uncertain if a lower temperature is better than 37°C (OR 1.10, 95% CI 0.75 to 1.62; 1 study, N = 412; very low quality-evidence). Multiple pregnancy was reported by two studies, one of which used a paired design, which made it impossible to report the data per temperature. We are uncertain if a temperature lower than 37°C reduces multiple pregnancy (OR 0.80, 95% CI 0.31 to 2.07; 1 study, N = 412; very low-quality evidence). There was insufficient evidence to make a conclusion regarding adverse events, as no studies reported data suitable for analysis. AUTHORS' CONCLUSIONS This review evaluated different temperatures for embryo culture during IVF. There is a lack of evidence for the majority of outcomes in this review. Based on very low-quality evidence, we are uncertain if incubating at a lower temperature than 37°C improves pregnancy outcomes. More RCTs are needed for comparing different temperatures of embryo culture which require reporting of clinical outcomes as live birth, miscarriage, clinical pregnancy and adverse events.
Collapse
Affiliation(s)
- Nora A Baak
- University of GroningenHanzeplein 1GroningenNetherlands9713 GZ
| | - Astrid EP Cantineau
- University Medical CentreDepartment of Obstetrics and GynaecologyHanzeplein 1GroningenNetherlands9700 RB
| | - Cindy Farquhar
- University of AucklandDepartment of Obstetrics and GynaecologyFMHS Park RoadGraftonAucklandNew Zealand1003
| | - Daniel R Brison
- Manchester University NHS Foundation TrustDepartment of Reproductive MedicineSt. Mary's HospitalOxford RdManchesterUKM13 9WL
| | | |
Collapse
|
30
|
A Strength, Weaknesses, Opportunities and Threats analysis on time lapse. Curr Opin Obstet Gynecol 2019; 31:148-155. [DOI: 10.1097/gco.0000000000000534] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
31
|
Influence of human embryo cultivation in a classic CO2 incubator with 20% oxygen versus benchtop incubator with 5% oxygen on live births: the randomized prospective trial. ZYGOTE 2019; 27:131-136. [PMID: 31072414 DOI: 10.1017/s0967199418000618] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
SummaryOur objective was to assess the effect of benchtop incubators with low oxygen concentrations on the clinical and embryological parameters of our patients. We conducted a prospective, randomized, opened controlled trial on infertile patients in stimulated cycles. In total, 738 infertile patients were assessed for eligibility and, after final exclusions, 230 patients were allocated either to a 5% O2 group (benchtop incubator) or a 20% O2 group (classic incubator). Finally, 198 patients in the 5% O2 group and 195 in the 20% O2 group were analysed. The outcomes measured were fertilization rate, clinical pregnancy rate, and live birth rate. The primary outcome - live birth rate per all transfers - did not show any improvement in the 5% oxygen group over the 20% oxygen group (25.3% versus 22.6%, P=0.531), but the number of day 5 blastocysts was significantly higher (P=0.009). Fertilization rate did not show any beneficial effect of reduced oxygen (5%) (73.4%±22.4% versus 74.6%±24.0%, P=0.606) per all transfers but there was statistically significant difference in the day 5 SET subgroup (85.3±15.1 versus 75.1±17.5; P=0.004). Clinical pregnancy rate showed results in favour of the 5% oxygen group for all subgroups (day 3: 23.7% versus 21.1%, P=0.701; day 5 SET: 35.0% versus 30.6%. P=0.569) but showed statistical significance only in the day 5 SET subgroup (51.1% versus 29.8%; P=0.038). Culturing of embryos in benchtop incubators under low oxygen produced more blastocysts and therefore was a better alternative for embryo selection, which resulted in higher pregnancy rates. To achieve higher live birth rates, embryo quality is not the only factor.
Collapse
|
32
|
Ueno S, Ito M, Uchiyama K, Okimura T, Yabuuchi A, Kobayashi T, Kato K. Closed embryo culture system improved embryological and clinical outcome for single vitrified-warmed blastocyst transfer: A single-center large cohort study. Reprod Biol 2019; 19:139-144. [PMID: 30948345 DOI: 10.1016/j.repbio.2019.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 03/11/2019] [Accepted: 03/27/2019] [Indexed: 11/28/2022]
Abstract
While some studies have shown that the closed embryo culture system (CCS) is a possible improvement over standard embryo culture systems (STS) in terms of early embryonic development, information on clinical outcomes of culturing blastocysts following single vitrified-warmed blastocyst transfer (SVBT) in the CCS and STS remains limited. Therefore, the objective of this single-center, large-cohort, retrospective study was to compare embryonic development until the blastocyst stage and clinical outcomes following SVBT between CCS and STS. From May 2017 to October 2018, 2420 oocytes from 1402 patients who underwent in vitro fertilization and blastocyst culture after minimal stimulation were divided into two groups (CCS and STS). The main outcome measures in the two groups were embryological (blastocyst formation rates and utilized blastocyst rates) and clinical outcomes (ongoing pregnancy rates) after a single vitrified-warmed blastocyst transfer (SVBT). There were no significant differences in the blastocyst formation rates between the CCS and STS groups (59.6% versus 59.1%, p = 0.81). However, there were significant differences in utilized blastocyst rates (51.0% versus 46.6%, p < 0.05). Ongoing pregnancy rates per SVBT cycle were significantly higher in the CCS group than in the STS group (41.4% versus 34.4%, p < 0.05). Moreover, after applying multivariable logistic regression analysis, the type of embryo culture system (CCS to STS, adjusted odds ratios: 1.41, 95% CI: 1.04-1.91) was correlated with ongoing pregnancy. Our study suggests that compared to STS, CCS could improve utilized blastocyst rates and ongoing pregnancy rates to a greater extent, following SVBT.
Collapse
Affiliation(s)
- Satoshi Ueno
- Kato Ladies Clinic, 7-20-3, Nishi-shinjuku, Shinjuku, Tokyo 160-0023, Japan
| | - Motoki Ito
- Kato Ladies Clinic, 7-20-3, Nishi-shinjuku, Shinjuku, Tokyo 160-0023, Japan
| | - Kazuo Uchiyama
- Kato Ladies Clinic, 7-20-3, Nishi-shinjuku, Shinjuku, Tokyo 160-0023, Japan
| | - Tadashi Okimura
- Kato Ladies Clinic, 7-20-3, Nishi-shinjuku, Shinjuku, Tokyo 160-0023, Japan
| | - Akiko Yabuuchi
- Kato Ladies Clinic, 7-20-3, Nishi-shinjuku, Shinjuku, Tokyo 160-0023, Japan
| | - Tamotsu Kobayashi
- Kato Ladies Clinic, 7-20-3, Nishi-shinjuku, Shinjuku, Tokyo 160-0023, Japan
| | - Keiichi Kato
- Kato Ladies Clinic, 7-20-3, Nishi-shinjuku, Shinjuku, Tokyo 160-0023, Japan.
| |
Collapse
|
33
|
Stojić I, Vukosavljević J, Maričić S, Vuković M, Stojanoski S, Trninić-Pjević A. Preimplantation genetic screening of embryos in the process of in vitro fertilization: Pilot study. MEDICINSKI PODMLADAK 2019. [DOI: 10.5937/mp70-21735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
|
34
|
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]
|
35
|
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]
|
36
|
Alhelou Y, Mat Adenan NA, Ali J. Embryo culture conditions are significantly improved during uninterrupted incubation: A randomized controlled trial. Reprod Biol 2017; 18:40-45. [PMID: 29279181 DOI: 10.1016/j.repbio.2017.12.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Revised: 12/04/2017] [Accepted: 12/06/2017] [Indexed: 10/18/2022]
Abstract
A parallel group superiority prospective randomised controlled trial was devised to compare the culture characteristics of human pre-implantation stage embryos during uninterrupted culture in a time lapse incubator (TLI) versus the conventional model of interrupted culture in a standard incubator (SI) under low oxygen tension using a single step medium. 221 patients aged 35-and-under, 124 patients aged between 36 and 39 and 86 patients aged 40-and-over years were randomised and cultured either in a SI or in a TLI. Patients in the three age groups were distributed between the TLI and SI in a 1:1 ratio. The development of embryos on days 2, 3 and 5, and the clinical pregnancy and implantation rates were recorded. The fertilisation rate, development of day 2 and clinical pregnancy rates were similar in both treatments but the 8-cell development rate in all age groups combined (p = 0.016), blastocyst development rate (p = 0.0022) and the implantation rate (p = 0.0022) was significantly higher for the uninterrupted culture. These findings demonstrated significant differences between the two incubation groups. It also indicated less efficacious embryonic development with age in both treatments which appeared more pronounced in the conventional incubator. In conclusion uninterrupted culture is superior compared to the interrupted incubation culture system.
Collapse
Affiliation(s)
- Yousef Alhelou
- Fakih IVF, Sh Haza Bin Zayed st, Abu Dhabi, United Arab Emirates; IVF Lab, Deparment of Obstetrics and Gynaecology, KKWK, UMMC, Faculty of Medicine, University of Malaya, K. Lumpur, Malaysia
| | - Noor Azmi Mat Adenan
- IVF Lab, Deparment of Obstetrics and Gynaecology, KKWK, UMMC, Faculty of Medicine, University of Malaya, K. Lumpur, Malaysia
| | - Jaffar Ali
- IVF Lab, Deparment of Obstetrics and Gynaecology, KKWK, UMMC, Faculty of Medicine, University of Malaya, K. Lumpur, Malaysia.
| |
Collapse
|
37
|
Comparison of the development of human embryos cultured in either an EmbryoScope or benchtop incubator. J Assist Reprod Genet 2017; 35:515-522. [PMID: 29243141 DOI: 10.1007/s10815-017-1100-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 12/05/2017] [Indexed: 01/04/2023] Open
Abstract
PURPOSE In this current study, our main goal was to establish that EmbryoScope incubation environment is comparable to standard incubation. METHODS The development of sibling human zygotes was compared after culture in either a benchtop incubator (SI) or an EmbryoScope time-lapse incubator (ES). Between May 2015 to April 2016, a total of 581 normally fertilized 2PN, pronuclear-stage embryos, from 47 patients were allocated to culture in either a benchtop incubator (SI) or an EmbryoScope incubator (ES). RESULTS The development of embryos to cleavage (up to day 3) and blastocyst stages (day 5/6) was compared between the two different incubators. The proportion of good quality embryos was higher in the ES group compared to the SI on day 2 (66.8 vs. 50.5%, P = 0.014) and on day 3 (75.1 vs. 56.0%, P = 0.006). Those differences were statistically significant. A higher proportion of embryos developed to good quality blastocysts when cultured in the EmbryoScope compared to the benchtop (49.4 vs. 42.0%, P = 0.24), but this was not significant. Finally, no significant differences were noted with the proportion of blastocysts chosen for cryopreservation on day 5/6 in the two incubators. CONCLUSIONS The findings support the view that the EmbryoScope incubator supports at least equivalent in vitro development of human embryos compared to other standard incubation methods and may promote improved development during early cleavage stages.
Collapse
|
38
|
Herbemont C, Sarandi S, Boujenah J, Cedrin-Durnerin I, Sermondade N, Vivot A, Poncelet C, Grynberg M, Sifer C. Should we consider day-2 and day-3 embryo morphology before day-5 transfer when blastocysts reach a similar good quality? Reprod Biomed Online 2017; 35:521-528. [DOI: 10.1016/j.rbmo.2017.07.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 07/06/2017] [Accepted: 07/25/2017] [Indexed: 10/19/2022]
|
39
|
Abstract
The phenotype of the human embryo conceived through in vitro fertilization (IVF), that is its morphology, developmental kinetics, physiology and metabolism, can be affected by numerous components of the laboratory and embryo culture system (which comprise the laboratory environment). The culture media formulation is important in determining embryo phenotype, but this exists within a culture system that includes oxygen, temperature, pH and whether an embryo is cultured individually or in a group, all of which can influence embryo development. Significantly, exposure of an embryo to one suboptimal component of the culture system of laboratory typically predisposes the embryo to become more vulnerable to a second stressor, as has been well documented for atmospheric oxygen and individual culture, as well as for oxygen and ammonium. Furthermore, the inherent viability of the human embryo is derived from the quality of the gametes from which it is created. Patient age, aetiology, genetics, lifestyle (as well as ovarian stimulation in women) are all known to affect the developmental potential of gametes and hence the embryo. Thus, as well as considering the impact of the IVF laboratory environment, one needs to be aware of the status of the infertile couple, as this impacts how their gametes and embryos will respond to an in vitro environment. Although far from straight forward, analysing the interactions that exist between the human embryo and its environment will facilitate the creation of more effective and safer treatments for the infertile couple.
Collapse
|
40
|
Wu L, Han W, Wang J, Zhang X, Liu W, Xiong S, Han S, Liu J, Gao Y, Huang G. Embryo culture using a time-lapse monitoring system improves live birth rates compared with a conventional culture system: a prospective cohort study. HUM FERTIL 2017; 21:255-262. [DOI: 10.1080/14647273.2017.1335886] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Lihong Wu
- Chongqing Reproductive and Genetics Institute, Chongqing, China
| | - Wei Han
- Chongqing Reproductive and Genetics Institute, Chongqing, China
| | - Jiang Wang
- Chongqing Reproductive and Genetics Institute, Chongqing, China
| | - Xiaodong Zhang
- Chongqing Reproductive and Genetics Institute, Chongqing, China
| | - Weiwei Liu
- Chongqing Reproductive and Genetics Institute, Chongqing, China
| | - Shun Xiong
- Chongqing Reproductive and Genetics Institute, Chongqing, China
| | - Shubiao Han
- Chongqing Reproductive and Genetics Institute, Chongqing, China
| | - Junxia Liu
- Chongqing Reproductive and Genetics Institute, Chongqing, China
| | - Yang Gao
- Chongqing Reproductive and Genetics Institute, Chongqing, China
| | - Guoning Huang
- Chongqing Reproductive and Genetics Institute, Chongqing, China
| |
Collapse
|
41
|
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.
Collapse
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
| |
Collapse
|
42
|
Holschbach V, Weigert J, Dietrich JE, Roesner S, Montag M, Strowitzki T, Toth B. Pregnancy rates of day 4 and day 5 embryos after culture in an integrated time-lapse incubator. Reprod Biol Endocrinol 2017; 15:37. [PMID: 28482910 PMCID: PMC5422939 DOI: 10.1186/s12958-017-0253-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 04/24/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study was to compare pregnancy rates in patients undergoing IVF/ICSI with embryo transfer after 4 and 5 days of culture in a closed incubation system with integrated time-lapse imaging. METHODS Out of n = 2207 in vitro fertilization (IVF)/ intracytoplasmic sperm injection (ICSI) cycles performed between January 2011 and April 2016 at a tertiary referral university hospital, a total of n = 599 IVF/ICSI cycles with prolonged embryo culture in an integrated time-lapse system (EmbryoScope© (Vitrolife)) until day 4 or 5 were retrospectively analyzed with regard to embryo morphology and pregnancy rates. RESULTS A transfer on day 5 compared to a transfer on day 4 did not result in higher implantation and clinical pregnancy rates (IR 29.4% on day 4 versus 33.0% on day 5, p = 0.310; CPR 45.2% on day 4 versus 45.7% on day 5, p = 1.0). The percentage of ideal embryos transferred on day 4 was comparable to the rate of ideal embryos transferred on day 5 (41.6% versus 44.1%, p = 0.508). However, on day 4 a significantly higher number of embryos was transferred (1.92 on day 4 versus 1.84 on day 5, p = 0.023), which did not result in higher rates of multiple pregnancies. CONCLUSIONS Pregnancy rates in IVF/ICSI cycles with integrated time-lapse incubation and transfer on day 4 and 5 are comparable. This finding provides the clinician, IVF laboratory and patient with more flexibility. TRIAL REGISTRATION This study was retrospectively registered by the local ethics committee of the University of Heidelberg on December 19, 2016 (registration number S-649/2016).
Collapse
Affiliation(s)
- Verena Holschbach
- 0000 0001 2190 4373grid.7700.0Department of Gynaecological Endocrinology and Fertility Disorders, Ruprecht- Karls University Heidelberg, Im Neuenheimer Feld 440, 69120 Heidelberg, Germany
| | - Julia Weigert
- 0000 0001 2190 4373grid.7700.0Department of Gynaecological Endocrinology and Fertility Disorders, Ruprecht- Karls University Heidelberg, Im Neuenheimer Feld 440, 69120 Heidelberg, Germany
| | - Jens Erik Dietrich
- 0000 0001 2190 4373grid.7700.0Department of Gynaecological Endocrinology and Fertility Disorders, Ruprecht- Karls University Heidelberg, Im Neuenheimer Feld 440, 69120 Heidelberg, Germany
| | - Sabine Roesner
- 0000 0001 2190 4373grid.7700.0Department of Gynaecological Endocrinology and Fertility Disorders, Ruprecht- Karls University Heidelberg, Im Neuenheimer Feld 440, 69120 Heidelberg, Germany
| | - Markus Montag
- ilabcomm GmbH, Eisenachstr. 34, 53757 Sankt Augustin, Germany
| | - Thomas Strowitzki
- 0000 0001 2190 4373grid.7700.0Department of Gynaecological Endocrinology and Fertility Disorders, Ruprecht- Karls University Heidelberg, Im Neuenheimer Feld 440, 69120 Heidelberg, Germany
| | - Bettina Toth
- 0000 0001 2151 8122grid.5771.4Gynecological Endocrinology and Reproductive Medicine, University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| |
Collapse
|
43
|
Kirkegaard K, Dyrlund TF, Ingerslev HJ. Clinical Application of Methods to Select In VitroFertilized Embryos. Hum Reprod 2016. [DOI: 10.1002/9781118849613.ch7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Kirstine Kirkegaard
- Department of Medical Biochemistry; Aarhus University Hospital; Aarhus Denmark
| | - Thomas F. Dyrlund
- Department of Molecular Biology and Genetics; Aarhus University; Aarhus Denmark
| | | |
Collapse
|
44
|
Cedillo L, Ocampo-Bárcenas A, Maldonado I, Valdez-Morales FJ, Camargo F, López-Bayghen E. A simple, less invasive stripper micropipetter-based technique for day 3 embryo biopsy. FERTILITY RESEARCH AND PRACTICE 2016; 2:13. [PMID: 28620540 PMCID: PMC5424395 DOI: 10.1186/s40738-016-0027-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 11/04/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Preimplantation genetic screening (PGS) is an important procedure for in vitro fertilization (IVF). A key step of PGS, blastomere removal, is abundant with many technical issues. The aim of this study was to compare a more simple procedure based on the Stipper Micropipetter, named S-biopsy, to the conventional aspiration method. METHODS On Day 3, 368 high-quality embryos (>7 cells on Day3 with <10% fragmentation) were collected from 38 women. For each patient, their embryos were equally separated between the conventional method (n = 188) and S-biopsy method (n = 180). The conventional method was performed using a standardized protocol. For the S-biopsy method, a laser was used to remove a significantly smaller portion of the zona pellucida. Afterwards, the complete embryo was aspirated with a Stripper Micropipetter, forcing the removal of the blastomere. Selected blastomeres went to PGS using CGH microarrays. Embryo integrity and blastocyst formation were assessed on Day 5. Differences between groups were assessed by either the Mann-Whitney test or Fisher Exact test. RESULTS Both methods resulted in the removal of only one blastomere. The S-biopsy and the conventional method did not differ in terms of affecting embryo integrity (95.0% vs. 95.7%) or blastocyst formation (72.7% vs. 70.7%). PGS analysis indicated that aneuploidy rate were similar between the two methods (63.1% vs. 65.2%). However, the time required to perform the S-biopsy method (179.2 ± 17.5 s) was significantly shorter (5-fold) than the conventional method. CONCLUSION The S-biopsy method is comparable to the conventional method that is used to remove a blastomere for PGS, but requires less time. Furthermore, due to the simplicity of the S-biopsy technique, this method is more ideal for IVF laboratories.
Collapse
Affiliation(s)
- Luciano Cedillo
- Laboratorio de Fertilización In Vitro and Laboratorio de Investigación y Diagnóstico Molecular, Instituto de Infertilidad y Genética, Ingenes México, Carretera México-Toluca No. 5420, Piso 6, Ofna 602 Col. El Yaqui, Del. Cuajimalpa, 05320 Mexico City, Mexico
| | - Azucena Ocampo-Bárcenas
- Laboratorio de Fertilización In Vitro and Laboratorio de Investigación y Diagnóstico Molecular, Instituto de Infertilidad y Genética, Ingenes México, Carretera México-Toluca No. 5420, Piso 6, Ofna 602 Col. El Yaqui, Del. Cuajimalpa, 05320 Mexico City, Mexico
| | - Israel Maldonado
- Laboratorio de Fertilización In Vitro and Laboratorio de Investigación y Diagnóstico Molecular, Instituto de Infertilidad y Genética, Ingenes México, Carretera México-Toluca No. 5420, Piso 6, Ofna 602 Col. El Yaqui, Del. Cuajimalpa, 05320 Mexico City, Mexico
| | - Francisco J. Valdez-Morales
- Facultad de Química, Universidad Nacional Autónoma de México, Ciudad Universitaria, Mexico City, 04510 Mexico
| | - Felipe Camargo
- Laboratorio de Fertilización In Vitro and Laboratorio de Investigación y Diagnóstico Molecular, Instituto de Infertilidad y Genética, Ingenes México, Carretera México-Toluca No. 5420, Piso 6, Ofna 602 Col. El Yaqui, Del. Cuajimalpa, 05320 Mexico City, Mexico
| | - Esther López-Bayghen
- Laboratorio de Fertilización In Vitro and Laboratorio de Investigación y Diagnóstico Molecular, Instituto de Infertilidad y Genética, Ingenes México, Carretera México-Toluca No. 5420, Piso 6, Ofna 602 Col. El Yaqui, Del. Cuajimalpa, 05320 Mexico City, Mexico
- Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional, Departamento de Toxicología, Av. IPN 2508 San Pedro Zac., 07380 Mexico City, Mexico
| |
Collapse
|
45
|
Wu YG, Lazzaroni-Tealdi E, Wang Q, Zhang L, Barad DH, Kushnir VA, Darmon SK, Albertini DF, Gleicher N. Different effectiveness of closed embryo culture system with time-lapse imaging (EmbryoScope(TM)) in comparison to standard manual embryology in good and poor prognosis patients: a prospectively randomized pilot study. Reprod Biol Endocrinol 2016; 14:49. [PMID: 27553622 PMCID: PMC4995783 DOI: 10.1186/s12958-016-0181-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 08/04/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Previously manual human embryology in many in vitro fertilization (IVF) centers is rapidly being replaced by closed embryo incubation systems with time-lapse imaging. Whether such systems perform comparably to manual embryology in different IVF patient populations has, however, never before been investigated. We, therefore, prospectively compared embryo quality following closed system culture with time-lapse photography (EmbryoScope™) and standard embryology. We performed a two-part prospectively randomized study in IVF (clinical trial # NCT92256309). Part A involved 31 infertile poor prognosis patients prospectively randomized to EmbryoScope™ and standard embryology. Part B involved embryos from 17 egg donor-recipient cycles resulting in large egg/embryo numbers, thus permitting prospectively alternative embryo assignments to EmbryoScope™ and standard embryology. We then compared pregnancy rates and embryo quality on day-3 after fertilization and embryologist time utilized per processed embryo. RESULTS Part A revealed in poor prognosis patients no differences in day-3 embryo scores, implantation and clinical pregnancy rates between EmbryoScope™ and standard embryology. The EmbryoScope™, however, more than doubled embryology staff time (P < 0.0001). In Part B, embryos grown in the EmbyoScope™ demonstrated significantly poorer day-3 quality (depending on embryo parameter between P = 0.005 and P = 0.01). Suspicion that conical culture dishes of the EmbryoScope™ (EmbryoSlide™) may be the cause was disproven when standard culture dishes demonstrated no outcome difference in standard incubation. CONCLUSIONS Though due to small patient numbers preliminary, this study raises concerns about the mostly uncontrolled introduction of closed incubation systems with time lapse imaging into routine clinical embryology. Appropriately designed and powered prospectively randomized studies appear urgently needed in well-defined patient populations before the uncontrolled utilization of these instruments further expands. TRIAL REGISTRATION NCT02246309 Registered September 18, 2014.
Collapse
Affiliation(s)
- Yan-Guang Wu
- The Center for Human Reproduction, 21 East 69th Street, New York, NY 10021 USA
| | | | - Qi Wang
- The Center for Human Reproduction, 21 East 69th Street, New York, NY 10021 USA
| | - Lin Zhang
- The Center for Human Reproduction, 21 East 69th Street, New York, NY 10021 USA
| | - David H. Barad
- The Center for Human Reproduction, 21 East 69th Street, New York, NY 10021 USA
- The Foundation for Reproductive Medicine, New York, NY 10021 USA
- Department of Obstetrics and Gynecology, Albert Einstein College of Medicine, Bronx, NY 10461 USA
| | - Vitaly A. Kushnir
- The Center for Human Reproduction, 21 East 69th Street, New York, NY 10021 USA
- Department of Obstetrics and Gynecology, Wake Forest University, Winston Salem, NC 27106 USA
| | - Sarah K. Darmon
- The Center for Human Reproduction, 21 East 69th Street, New York, NY 10021 USA
| | - David F. Albertini
- The Center for Human Reproduction, 21 East 69th Street, New York, NY 10021 USA
- Department of Molecular and Integrative Physiology, The University of Kansas School of Medicine, Wichita, KS 64109 USA
| | - Norbert Gleicher
- The Center for Human Reproduction, 21 East 69th Street, New York, NY 10021 USA
- The Foundation for Reproductive Medicine, New York, NY 10021 USA
- Stem Cell Biology and Molecular Embryology Laboratory, The Rockefeller University, New York, NY 10065 USA
| |
Collapse
|
46
|
Koustas G, Sjoblom C. Minute changes to the culture environment of mouse pre-implantation embryos affect the health of the conceptus. ASIAN PACIFIC JOURNAL OF REPRODUCTION 2016. [DOI: 10.1016/j.apjr.2016.06.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
47
|
Cassuto NG. [Is it useful to observe the embryo in the early stages of development when prolonged cultivation is carried out? No]. GYNECOLOGIE, OBSTETRIQUE & FERTILITE 2016; 44:444-445. [PMID: 27451067 DOI: 10.1016/j.gyobfe.2016.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 05/24/2016] [Indexed: 06/06/2023]
Affiliation(s)
- N G Cassuto
- Unité AMP Drouot, 21, rue Drouot, 75009 Paris, France.
| |
Collapse
|
48
|
Sifer C. [Culture to blastocyst-stage: Is it valid to observe cleaved embryos? Yes]. GYNECOLOGIE, OBSTETRIQUE & FERTILITE 2016; 44:441-443. [PMID: 27451062 DOI: 10.1016/j.gyobfe.2016.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 05/29/2016] [Indexed: 06/06/2023]
Affiliation(s)
- C Sifer
- Service d'histologie-embryologie-cytogénétique, CECOS, CHU Jean-Verdier, AP-HP, avenue du 14-Juillet, 93143 Bondy, France.
| |
Collapse
|
49
|
Baak NA, Cantineau AEP, Farquhar C, Brison D. Temperature of embryo culture for assisted reproduction. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2016. [DOI: 10.1002/14651858.cd012192] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Nora A Baak
- University of Groningen; Hanzeplein 1 Groningen Netherlands 9713 GZ
| | - Astrid EP Cantineau
- University Medical Centre; Department of Obstetrics and Gynaecology; Hanzeplein 1 Groningen Netherlands 9700 RB
| | - Cindy Farquhar
- University of Auckland; Department of Obstetrics and Gynaecology; FMHS Park Road Grafton Auckland New Zealand 1003
| | - Daniel Brison
- Central Manchester University Hospitals NHS Foundation Trust; Department of Reproductive Medicine; St. Mary's Hospital Oxford Rd Manchester UK M13 9WL
| |
Collapse
|
50
|
Doody KJ, Broome EJ, Doody KM. Comparing blastocyst quality and live birth rates of intravaginal culture using INVOcell™ to traditional in vitro incubation in a randomized open-label prospective controlled trial. J Assist Reprod Genet 2016; 33:495-500. [PMID: 26843390 PMCID: PMC4818641 DOI: 10.1007/s10815-016-0661-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 01/13/2016] [Indexed: 10/27/2022] Open
Abstract
PURPOSE The purpose of this study is to to compare the efficacy of intravaginal culture (IVC) of embryos in INVOcell™ (INVO Bioscience, MA, USA) to traditional in vitro fertilization (IVF) incubators in a laboratory setting using a mild pre-determined stimulation regimen based solely on anti-mullerian hormone (AMH) and body weight with minimal ultrasound monitoring. The primary endpoint examined was total quality blastocysts expressed as a percentage of total oocytes placed in incubation. Secondary endpoints included percentage of quality blastocysts transferred, pregnancy, and live birth rates. METHODS In this prospective randomized open-label controlled single-center study, 40 women aged <38 years of age with a body mass index (BMI) of <36 and an AMH of 1-3 ng/mL were randomized prior to trigger to receive either IVC or IVF. Controlled ovarian stimulation was administered with human menopausal gonadotropin (hMG) in a fixed gonadotropin-releasing hormone (GnRH) agonist cycle based solely on AMH and body weight. A single ultrasound-monitoring visit was performed on the 10th day of stimulation. One or two embryos were transferred following 5 days of culture. RESULTS IVF produced a greater percentage of total quality embryos as compared to IVC (50.6 vs. 30.7 %, p = 0.0007, respectively). There was no significant difference between in IVF and IVC in the percentage of quality blastocysts transferred (97.5 vs. 84.9 %, p = 0.09) or live birth rate (60 % IVF, 55 % IVC). CONCLUSIONS IVF was shown to be superior to IVC in creating quality blastocysts. However, both IVF and IVC produced identical blastocysts for transfer resulting in similar live birth rates. IVC using INVOcell™ is effective and may broaden access to fertility care in selected patient populations by ameliorating the need for a traditional IVF laboratory setting. Further studies will help elucidate the potential physiological, psychological, geographic, and financial impact of IVC on the delivery of fertility care.
Collapse
Affiliation(s)
- Kevin J Doody
- Center for Assisted Reproduction, 1701 Park Place Ave, Bedford, TX, 76022, USA.
| | | | - Kathleen M Doody
- Center for Assisted Reproduction, 1701 Park Place Ave, Bedford, TX, 76022, USA
| |
Collapse
|