1
|
Ansaripour S, Yazdchi K, Sadeghi MR, Nasseri N, Karimi A, Ataei M, Madadi N, Jalalinejad F, Rahimi F. Comparison of ultra-long gonadotropin releasing hormone agonist versus standard downregulation in women with adenomyosis undergoing frozen-thawed embryo transfer: a randomized clinical trial. Contracept Reprod Med 2024; 9:44. [PMID: 39256889 PMCID: PMC11385168 DOI: 10.1186/s40834-024-00304-9] [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: 06/09/2024] [Accepted: 08/20/2024] [Indexed: 09/12/2024] Open
Abstract
BACKGROUND Adenomyosis can lead to infertility and failure of in vitro fertilization. Limited evidence suggests that the use of long-term treatment with gonadotropin-releasing hormone (GnRH) agonists followed by frozen-thawed embryo transfer (FET) may be the preferred approach for women with adenomyosis. OBJECTIVE The aim of this randomized controlled trial is to compare the efficacy of an ultra-long GnRH agonist with standard downregulation in women with adenomyosis undergoing FET. MATERIALS AND METHODS This randomized controlled trial enrolled 72 women with adenomyosis diagnosed by sonographic criteria who underwent FET cycles at the Avicenna Infertility Center. These women were randomly assigned to two equal groups: one received GnRH agonist treatment for three months before the FET cycle and the other served as the standard downregulation group. Results were reported as chemical and clinical pregnancy rates. RESULTS The two groups were similar in age, body mass index, anti-Müllerian hormone levels, number of previous pregnancies and miscarriages, presence of uterine myomas, and endometriosis. However, the total dose of estradiol used until embryo transfer was significantly higher in the ultra-long GnRH agonist group than in the standard group (96.14 mg vs. 80.52 mg, p-value = 0.004). Nevertheless, chemical and clinical pregnancy rates did not differ significantly between the two groups. CONCLUSIONS Ultra-long GnRH agonist downregulation did not improve the chemical and clinical pregnancy rate in the FET cycle in women with adenomyosis compared with standard GnRH agonist downregulation in the other words, ultra-long GnRH agonist downregulation is not superior to standard protocol. In women with adenomyosis (without history of endometriosis), downregulation of standard GnRH agonists prior to frozen-thawed embryo transfer may be the preferred embryo transfer protocol to gain higher clinical/chemical pregnancy rate. TRIAL REGISTRATION Clinical trial registry: IRCT20160717028967N9, available at: https://irct.behdasht.gov.ir/trial/36103 .
Collapse
Affiliation(s)
- Soheila Ansaripour
- Reproductive Biotechnology Research Centre, Avicenna Research Institute (ARI), Academic Centre for Education, Culture and Research (ACECR), Tehran, Iran
| | - Katayoun Yazdchi
- Reproductive Biotechnology Research Centre, Avicenna Research Institute (ARI), Academic Centre for Education, Culture and Research (ACECR), Tehran, Iran.
| | - Mohammad Reza Sadeghi
- Reproductive Biotechnology Research Centre, Avicenna Research Institute (ARI), Academic Centre for Education, Culture and Research (ACECR), Tehran, Iran
| | - Nasim Nasseri
- Reproductive Biotechnology Research Centre, Avicenna Research Institute (ARI), Academic Centre for Education, Culture and Research (ACECR), Tehran, Iran
| | - Atousa Karimi
- Reproductive Biotechnology Research Centre, Avicenna Research Institute (ARI), Academic Centre for Education, Culture and Research (ACECR), Tehran, Iran
| | - Mina Ataei
- Department of Obstetrics and Gynecology, Research Center, School of Medical Sciences, Social Determinants of Health, Alborz University of Medical Sciences, Karaj, Iran
| | - Narges Madadi
- Reproductive Biotechnology Research Centre, Avicenna Research Institute (ARI), Academic Centre for Education, Culture and Research (ACECR), Tehran, Iran
| | - Fateme Jalalinejad
- Reproductive Biotechnology Research Centre, Avicenna Research Institute (ARI), Academic Centre for Education, Culture and Research (ACECR), Tehran, Iran
| | - Fahimeh Rahimi
- Reproductive Biotechnology Research Centre, Avicenna Research Institute (ARI), Academic Centre for Education, Culture and Research (ACECR), Tehran, Iran
| |
Collapse
|
2
|
Hoffmann-Dishon N, Barnett-Itzhaki Z, Zalko D, Hemi R, Farzam N, Hauser R, Racowsky C, Baccarelli AA, Machtinger R. Endocrine-disrupting chemical concentrations in follicular fluid and follicular reproductive hormone levels. J Assist Reprod Genet 2024; 41:1637-1642. [PMID: 38557803 PMCID: PMC11224170 DOI: 10.1007/s10815-024-03101-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 03/15/2024] [Indexed: 04/04/2024] Open
Abstract
PURPOSE To determine correlations between chemicals in follicular fluid (FF) and follicular reproductive hormone levels. METHODS The analysis was part of a larger cohort study to determine associations between exposure to EDCs and in vitro fertilization (IVF) outcomes. FF was aspirated from a single leading follicle per participant. Demographics and data on exposure to EDCs were self-reported by the participants using a questionnaire. The concentrations of estradiol (E2), progesterone (PG), anti-Mullerian hormone (AMH), and inhibin B, as well as that of 12 phthalate metabolites and 12 phenolic chemicals were measured in each FF sample. Multivariate linear regression model was used to identify the drivers of hormone levels based on participant's age, BMI, smoking status, and chemical exposure for the monitored chemicals detected in more than 50% of the samples. Benjamini-Hochberg false discovery rate (FDR) correction was applied on the resulting p values (q value). RESULTS FF samples were obtained from 72 women (mean age 30.9 years). Most of the phthalates and phenolic substances monitored (21/24, 88%) were identified in FF. Ten compounds (7 phthalate metabolites, 3 phenols) were found in more than 50% of samples. In addition, there were positive associations between E2 levels and mono-n-butyl phthalate (MnBP) (beta = 0.01) and mono-isobutyl phthalate (MiBP) (beta = 0.03) levels (q value < 0.05). CONCLUSION Higher concentrations of several phthalate metabolites, present among others in personal care products, were associated with increased E2 levels in FF. The results emphasize the need to further investigate the mechanisms of action of such EDCs on hormonal cyclicity and fertility in women.
Collapse
Affiliation(s)
- Nathalie Hoffmann-Dishon
- Infertility and IVF Unit, Department of Obstetrics and Gynecology, Division of IVF, Sheba Medical Center, Ramat-Gan 5262000, Israel
| | - Zohar Barnett-Itzhaki
- Public Health Services, Ministry of Health, 9446724, Jerusalem, Israel
- Faculty of Engineering, Ruppin Academic Center, 4025000, Emek Hefer, Israel
- Ruppin Research Group in Environmental and Social Sustainability, Ruppin Academic Center, 4025000, Emek Hefer, Israel
| | - Daniel Zalko
- UMR1331 Toxalim (Research Center in Food Toxicology), Université de Toulouse, INRAE, ENVT, INP-Purpan, UPS, Toulouse, France
| | - Rina Hemi
- Division of Endocrinology, Diabetes and Metabolism, Sheba Medical Center, Ramat-Gan 5262000, Israel
| | - Nahid Farzam
- Division of Endocrinology, Diabetes and Metabolism, Sheba Medical Center, Ramat-Gan 5262000, Israel
| | - Russ Hauser
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Catherine Racowsky
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hospital Foch, Suresnes, France
| | - Andrea A Baccarelli
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Ronit Machtinger
- Infertility and IVF Unit, Department of Obstetrics and Gynecology, Division of IVF, Sheba Medical Center, Ramat-Gan 5262000, Israel.
- School of Medicine, Tel-Aviv University, 6997801, Tel Aviv, Israel.
| |
Collapse
|
3
|
Borna MR, Sepehri MM, Maleki B. An artificial intelligence algorithm to select most viable embryos considering current process in IVF labs. Front Artif Intell 2024; 7:1375474. [PMID: 38881952 PMCID: PMC11177761 DOI: 10.3389/frai.2024.1375474] [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: 01/23/2024] [Accepted: 05/16/2024] [Indexed: 06/18/2024] Open
Abstract
Background The most common Assisted Reproductive Technology is In-Vitro Fertilization (IVF). During IVF, embryologists commonly perform a morphological assessment to evaluate embryo quality and choose the best embryo for transferring to the uterus. However, embryo selection through morphological assessment is subjective, so various embryologists obtain different conclusions. Furthermore, humans can consider only a limited number of visual parameters resulting in a poor IVF success rate. Artificial intelligence (AI) for embryo selection is objective and can include many parameters, leading to better IVF outcomes. Objectives This study sought to use AI to (1) predict pregnancy results based on embryo images, (2) assess using more than one image of the embryo in the prediction of pregnancy but based on the current process in IVF labs, and (3) compare results of AI-Based methods and embryologist experts in predicting pregnancy. Methods A data set including 252 Time-lapse Videos of embryos related to IVF performed between 2017 and 2020 was collected. Frames related to 19 ± 1, 43 ± 1, and 67 ± 1 h post-insemination were extracted. Well-Known CNN architectures with transfer learning have been applied to these images. The results have been compared with an algorithm that only uses the final image of embryos. Furthermore, the results have been compared with five experienced embryologists. Results To predict the pregnancy outcome, we applied five well-known CNN architectures (AlexNet, ResNet18, ResNet34, Inception V3, and DenseNet121). DeepEmbryo, using three images, predicts pregnancy better than the algorithm that only uses one final image. It also can predict pregnancy better than all embryologists. Different well-known architectures can successfully predict pregnancy chances with up to 75.0% accuracy using Transfer Learning. Conclusion We have developed DeepEmbryo, an AI-based tool that uses three static images to predict pregnancy. Additionally, DeepEmbryo uses images that can be obtained in the current IVF process in almost all IVF labs. AI-based tools have great potential for predicting pregnancy and can be used as a proper tool in the future.
Collapse
Affiliation(s)
- Mahdi-Reza Borna
- Department of IT Engineering, Faculty of Industrial and Systems Engineering, Tarbiat Modares University, Tehran, Iran
| | - Mohammad Mehdi Sepehri
- Department of IT Engineering, Faculty of Industrial and Systems Engineering, Tarbiat Modares University, Tehran, Iran
| | - Behnam Maleki
- Infertility Center, Department of Obstetrics and Gynecology, Mazandaran University of Medical Sciences, Sari, Iran
- Research and Clinical Center for Infertility, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| |
Collapse
|
4
|
Guo D, Pang C, Wang K. Comparison of pregnancy outcomes in women with normal ovarian response to the gonadotropin-releasing hormone agonist protocol using different trigger methods: a single-center retrospective cohort study based on propensity score matching. Arch Gynecol Obstet 2024; 309:2153-2165. [PMID: 38494512 DOI: 10.1007/s00404-024-07404-6] [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: 11/15/2023] [Accepted: 01/28/2024] [Indexed: 03/19/2024]
Abstract
PURPOSE To investigate whether gonadotropin-releasing hormone agonist (GnRH-a) combined with human chorionic gonadotropin (HCG) can improve pregnancy outcomes in patients with normal ovarian response (NOR). METHODS In this retrospective cohort study, data of 404 NOR patients undergoing fresh embryo transfer (ET) from 2018 to 2022 were studied. Patients were divided into HCG group and HCG plus GnRH-a group according to trigger methods. After confounding factors were controlled by propensity score matching, 67 cases were included in HCG group and HCG plus GnRH-a group, respectively, and pregnancy outcomes were assessed. Basal data, ovarian stimulation, embryological data and pregnancy outcomes were compared. The effect of trigger methods on pregnancy outcomes was analyzed by binary logistic regression. RESULTS There was no statistically significant differences in embryological data, embryo implantation rate, clinical pregnancy rate, live birth rate of ET, number of fresh embryos transferred and total number of embryos transferred after one cycle of oocyte retrieval. While, cumulative live birth rate (CLBR) was better in the dual-trigger group than in the HCG group. The binary logistic regression analysis indicated that the trigger methods had an independent influence on embryo implantation and cumulative live birth. CONCLUSIONS During IVF/ICSI, dual-trigger could potentially play a role in improving oocyte quality, ensuring embryo implantation rate, clinical pregnancy rate, live birth rate of ET and cumulative live birth rate at the end of one ovum pick-up (OPU) cycle, and reducing the physical, temporal and financial negative consequences due to repeated OPU cycle.
Collapse
Affiliation(s)
- Danyang Guo
- The First Clinical College, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Conghui Pang
- The First Clinical College, Shandong University of Traditional Chinese Medicine, Jinan, China
- Reproductive and Genetic Center of Integrative Medicine, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Kehua Wang
- Reproductive and Genetic Center of Integrative Medicine, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China.
| |
Collapse
|
5
|
Cimadomo D, Innocenti F, Taggi M, Saturno G, Campitiello MR, Guido M, Vaiarelli A, Ubaldi FM, Rienzi L. How should the best human embryo in vitro be? Current and future challenges for embryo selection. Minerva Obstet Gynecol 2024; 76:159-173. [PMID: 37326354 DOI: 10.23736/s2724-606x.23.05296-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
In-vitro fertilization (IVF) aims at overcoming the causes of infertility and lead to a healthy live birth. To maximize IVF efficiency, it is critical to identify and transfer the most competent embryo within a cohort produced by a couple during a cycle. Conventional static embryo morphological assessment involves sequential observations under a light microscope at specific timepoints. The introduction of time-lapse technology enhanced morphological evaluation via the continuous monitoring of embryo preimplantation in vitro development, thereby unveiling features otherwise undetectable via multiple static assessments. Although an association exists, blastocyst morphology poorly predicts chromosomal competence. In fact, the only reliable approach currently available to diagnose the embryonic karyotype is trophectoderm biopsy and comprehensive chromosome testing to assess non-mosaic aneuploidies, namely preimplantation genetic testing for aneuploidies (PGT-A). Lately, the focus is shifting towards the fine-tuning of non-invasive technologies, such as "omic" analyses of waste products of IVF (e.g., spent culture media) and/or artificial intelligence-powered morphologic/morphodynamic evaluations. This review summarizes the main tools currently available to assess (or predict) embryo developmental, chromosomal, and reproductive competence, their strengths, the limitations, and the most probable future challenges.
Collapse
Affiliation(s)
- Danilo Cimadomo
- IVIRMA Global Research Alliance, GENERA, Clinica Valle Giulia, Rome, Italy -
| | - Federica Innocenti
- IVIRMA Global Research Alliance, GENERA, Clinica Valle Giulia, Rome, Italy
| | - Marilena Taggi
- IVIRMA Global Research Alliance, GENERA, Clinica Valle Giulia, Rome, Italy
- Lazzaro Spallanzani Department of Biology and Biotechnology, University of Pavia, Pavia, Italy
| | - Gaia Saturno
- IVIRMA Global Research Alliance, GENERA, Clinica Valle Giulia, Rome, Italy
- Lazzaro Spallanzani Department of Biology and Biotechnology, University of Pavia, Pavia, Italy
| | - Maria R Campitiello
- Department of Obstetrics and Gynecology and Physiopathology of Human Reproduction, ASL Salerno, Salerno, Italy
| | - Maurizio Guido
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Alberto Vaiarelli
- IVIRMA Global Research Alliance, GENERA, Clinica Valle Giulia, Rome, Italy
| | - Filippo M Ubaldi
- IVIRMA Global Research Alliance, GENERA, Clinica Valle Giulia, Rome, Italy
| | - Laura Rienzi
- IVIRMA Global Research Alliance, GENERA, Clinica Valle Giulia, Rome, Italy
- Department of Biomolecular Sciences, Carlo Bo University of Urbino, Urbino, Italy
| |
Collapse
|
6
|
Zhu M, Dong Q, Zhu Y, Le Y, Wang T, Zhou Y, Yang S. Developmental potential of non- and mono-pronuclear zygotes and associated clinical outcomes in IVF cycles. Front Endocrinol (Lausanne) 2024; 15:1361734. [PMID: 38532894 PMCID: PMC10964251 DOI: 10.3389/fendo.2024.1361734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 02/19/2024] [Indexed: 03/28/2024] Open
Abstract
Purpose This study aims to evaluate the developmental potential of 0PN, 1PN, and 2PN zygotes in IVF cycles and compare their clinical outcomes. Methods We conducted a retrospective cohort study involving IVF patients. Blastocyst formation rates were assessed with 0PN, 1PN, and 2PN zygotes. Subsequently, we collected clinical outcome data following the transfer of these zygotes. Results The overall blastulation rate was similar between 0PN (29.6%) and 2PN (32.1%) zygotes, but 1PN zygotes exhibited a significantly lower blastulation rate (17.0%) compared to both 0PN and 2PN zygotes. Similarly, the overall rate of good-quality blastulation was comparable between 0PN (15.3%) and 2PN (17.5%) zygotes, while 1PN zygotes showed a significantly lower rate (7.0%) compared to both 0PN and 2PN. Clinical pregnancy, ectopic pregnancy, implantation, and live birth rates were similar among single blastocyst frozen embryo transfers (FET) of 0PN, 1PN, and 2PN. Additionally, no significant differences were observed between single- and double-blastocyst FET of 0PN and 2PN. Conclusions Our findings suggest that 0PN and 2PN zygotes have comparable developmental potential, while 1PN embryos exhibit lower developmental potential. Blastocyst FET outcomes appear similar among 0PN, 1PN, and 2PN zygotes.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Sheng Yang
- Department of Assisted Reproduction, Huzhou Maternity & Child Health Care Hospital, Huzhou, Zhejiang, China
| |
Collapse
|
7
|
Goswami N, Winston N, Choi W, Lai NZE, Arcanjo RB, Chen X, Sobh N, Nowak RA, Anastasio MA, Popescu G. EVATOM: an optical, label-free, machine learning assisted embryo health assessment tool. Commun Biol 2024; 7:268. [PMID: 38443460 PMCID: PMC10915136 DOI: 10.1038/s42003-024-05960-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 02/22/2024] [Indexed: 03/07/2024] Open
Abstract
The combination of a good quality embryo and proper maternal health factors promise higher chances of a successful in vitro fertilization (IVF) procedure leading to clinical pregnancy and live birth. Of these two factors, selection of a good embryo is a controllable aspect. The current gold standard in clinical practice is visual assessment of an embryo based on its morphological appearance by trained embryologists. More recently, machine learning has been incorporated into embryo selection "packages". Here, we report EVATOM: a machine-learning assisted embryo health assessment tool utilizing an optical quantitative phase imaging technique called artificial confocal microscopy (ACM). We present a label-free nucleus detection method with, to the best of our knowledge, novel quantitative embryo health biomarkers. Two viability assessment models are presented for grading embryos into two classes: healthy/intermediate (H/I) or sick (S) class. The models achieve a weighted F1 score of 1.0 and 0.99 respectively on the in-distribution test set of 72 fixed embryos and a weighted F1 score of 0.9 and 0.95 respectively on the out-of-distribution test dataset of 19 time-instances from 8 live embryos.
Collapse
Affiliation(s)
- Neha Goswami
- Department of Bioengineering, University of Illinois Urbana-Champaign, Urbana, IL, 61801, USA.
- Beckman Institute of Advanced Science and Technology, University of Illinois Urbana-Champaign, Urbana, IL, 61801, USA.
| | - Nicola Winston
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Illinois at Chicago College of Medicine, Chicago, IL, 60612, USA
| | - Wonho Choi
- Department of Animal Sciences, University of Illinois Urbana-Champaign, Urbana, IL, 61801, USA
| | - Nastasia Z E Lai
- Department of Animal Sciences, University of Illinois Urbana-Champaign, Urbana, IL, 61801, USA
| | - Rachel B Arcanjo
- Department of Animal Sciences, University of Illinois Urbana-Champaign, Urbana, IL, 61801, USA
- Department of Animal Science, University of California, Davis, CA, 95616, USA
| | - Xi Chen
- Beckman Institute of Advanced Science and Technology, University of Illinois Urbana-Champaign, Urbana, IL, 61801, USA
- School of Applied and Engineering Physics, Cornell University, Ithaca, NY, 14850, USA
| | - Nahil Sobh
- NCSA Center for Artificial Intelligence Innovation, University of Illinois Urbana-Champaign, Urbana, IL, 61801, USA
| | - Romana A Nowak
- Department of Animal Sciences, University of Illinois Urbana-Champaign, Urbana, IL, 61801, USA.
| | - Mark A Anastasio
- Department of Bioengineering, University of Illinois Urbana-Champaign, Urbana, IL, 61801, USA.
- Beckman Institute of Advanced Science and Technology, University of Illinois Urbana-Champaign, Urbana, IL, 61801, USA.
- Department of Electrical and Computer Engineering, University of Illinois Urbana-Champaign, Urbana, IL, 61801, USA.
| | - Gabriel Popescu
- Department of Bioengineering, University of Illinois Urbana-Champaign, Urbana, IL, 61801, USA
- Beckman Institute of Advanced Science and Technology, University of Illinois Urbana-Champaign, Urbana, IL, 61801, USA
- Department of Electrical and Computer Engineering, University of Illinois Urbana-Champaign, Urbana, IL, 61801, USA
| |
Collapse
|
8
|
Hillyear LM, Zak LJ, Beckitt T, Griffin DK, Harvey SC, Harvey KE. Morphokinetic Profiling Suggests That Rapid First Cleavage Division Accurately Predicts the Chances of Blastulation in Pig In Vitro Produced Embryos. Animals (Basel) 2024; 14:783. [PMID: 38473168 DOI: 10.3390/ani14050783] [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: 01/23/2024] [Revised: 02/27/2024] [Accepted: 02/28/2024] [Indexed: 03/14/2024] Open
Abstract
The study of pig preimplantation embryo development has several potential uses: from agriculture to the production of medically relevant genetically modified organisms and from rare breed conservation to acting as a physiologically relevant model for progressing human and other (e.g., endangered) species' in vitro fertilisation technology. Despite this, barriers to the widespread adoption of pig embryo in vitro production include lipid-laden cells that are hard to visualise, slow adoption of contemporary technologies such as the use of time-lapse incubators or artificial intelligence, poor blastulation and high polyspermy rates. Here, we employ a commercially available time-lapse incubator to provide a comprehensive overview of the morphokinetics of pig preimplantation development for the first time. We tested the hypotheses that (a) there are differences in developmental timings between blastulating and non-blastulating embryos and (b) embryo developmental morphokinetic features can be used to predict the likelihood of blastulation. The abattoir-derived oocytes fertilised by commercial extended semen produced presumptive zygotes were split into two groups: cavitating/blastulating 144 h post gamete co-incubation and those that were not. The blastulating group reached the 2-cell and morula stages significantly earlier, and the time taken to reach the 2-cell stage was identified to be a predictive marker for blastocyst formation. Reverse cleavage was also associated with poor blastulation. These data demonstrate the potential of morphokinetic analysis in automating and upscaling pig in vitro production through effective embryo selection.
Collapse
Affiliation(s)
- Lucy M Hillyear
- School of Psychology and Life Sciences, Canterbury Christ Church University, Canterbury CT1 1QU, UK
| | - Louisa J Zak
- Topigs Norsvin Research Center, Meerendonkweg 25, 5216 TZ Den Bosch, The Netherlands
| | | | - Darren K Griffin
- School of Biosciences, University of Kent, Canterbury CT2 7NJ, UK
| | - Simon C Harvey
- Faculty of Engineering and Science, University of Greenwich, Medway ME4 4TB, UK
| | - Katie E Harvey
- School of Life, Health and Chemical Sciences, The Open University, Milton Keynes MK7 6AA, UK
| |
Collapse
|
9
|
Wu T, Wu Y, Yan J, Zhang J, Wang S. Microfluidic chip as a promising evaluation method in assisted reproduction: A systematic review. Bioeng Transl Med 2024; 9:e10625. [PMID: 38435817 PMCID: PMC10905557 DOI: 10.1002/btm2.10625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 10/26/2023] [Accepted: 11/09/2023] [Indexed: 03/05/2024] Open
Abstract
The aim of assisted reproductive technology (ART) is to select the high-quality sperm, oocytes, and embryos, and finally achieve a successful pregnancy. However, functional evaluation is hindered by intra- and inter-operator variability. Microfluidic chips emerge as the one of the most powerful tools to analyze biological samples for reduced size, precise control, and flexible extension. Herein, a systematic search was conducted in PubMed, Scopus, Web of Science, ScienceDirect, and IEEE Xplore databases until March 2023. We displayed and prospected all detection strategies based on microfluidics in the ART field. After full-text screening, 71 studies were identified as eligible for inclusion. The percentages of human and mouse studies equaled with 31.5%. The prominent country in terms of publication number was the USA (n = 13). Polydimethylsiloxane (n = 49) and soft lithography (n = 28) were the most commonly used material and fabrication method, respectively. All articles were classified into three types: sperm (n = 38), oocytes (n = 20), and embryos (n = 13). The assessment contents included motility, counting, mechanics, permeability, impedance, secretion, oxygen consumption, and metabolism. Collectively, the microfluidic chip technology facilitates more efficient, accurate, and objective evaluation in ART. It can even be combined with artificial intelligence to assist the daily activities of embryologists. More well-designed clinical studies and affordable integrated microfluidic chips are needed to validate the safety, efficacy, and reproducibility. Trial registration: The protocol was registered in the Open Science Frame REGISTRIES (identification: osf.io/6rv4a).
Collapse
Affiliation(s)
- Tong Wu
- National Clinical Research Center for Obstetrical and Gynecological DiseasesTongji Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhanChina
- Key Laboratory of Cancer Invasion and Metastasis, Ministry of EducationTongji Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhanChina
- Department of Obstetrics and GynecologyTongji Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhanChina
| | - Yangyang Wu
- College of Animal Science and TechnologySichuan Agricultural UniversityYa'anSichuanChina
| | - Jinfeng Yan
- National Clinical Research Center for Obstetrical and Gynecological DiseasesTongji Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhanChina
- Key Laboratory of Cancer Invasion and Metastasis, Ministry of EducationTongji Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhanChina
- Department of Obstetrics and GynecologyTongji Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhanChina
- School of Materials Science and EngineeringHuazhong University of Science and TechnologyWuhanChina
| | - Jinjin Zhang
- National Clinical Research Center for Obstetrical and Gynecological DiseasesTongji Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhanChina
- Key Laboratory of Cancer Invasion and Metastasis, Ministry of EducationTongji Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhanChina
- Department of Obstetrics and GynecologyTongji Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhanChina
| | - Shixuan Wang
- National Clinical Research Center for Obstetrical and Gynecological DiseasesTongji Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhanChina
- Key Laboratory of Cancer Invasion and Metastasis, Ministry of EducationTongji Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhanChina
- Department of Obstetrics and GynecologyTongji Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhanChina
| |
Collapse
|
10
|
Yu C, Bai L, Zhang W, Feng L, Wang X, Chen L, Hu L. Analyzing the dynamic measurement of growth and development in children born after the transplantation of poor quality blastocyst embryos: a propensity matching study. J Psychosom Obstet Gynaecol 2023; 44:2284100. [PMID: 38018521 DOI: 10.1080/0167482x.2023.2284100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 11/11/2023] [Indexed: 11/30/2023] Open
Abstract
OBJECTIVE This study aimed to observe the dynamic measurement of growth and development in children (0-3 years) after transplantation of low-quality frozen-thawed single blastocysts. METHODS This was a retrospective cohort study conducted from January 2016 to December 2019 at a single center. The follow-up data of the children were obtained from the Jiangsu Province Maternal and Child Database. A total of 350 singleton live births were included. Based on the blastocyst score, the live births were divided into good-quality blastocyst embryo (GQE) group (315 live births) and poor-quality blastocyst embryo (PQE) group (35 live births). To improve statistical efficiency and control for potential confounding factors, singletons conceived from PQEs were matched with a 3:1 ratio according to couple ages, BMI, occupation and women AMH levels. Ultimately, 32 children in the PQE group and 95 children (with one missing data) in the GQE group were included in the final analysis. RESULTS After matching for parents' age, BMI, occupation and maternal serum AMH level, there was no significant difference in growth and development of children between the PQE group and GQE group. However, the E2 level on trigger days, the rate of 2PN oocyte, and blastocyst formation rate in the PQE group were significantly lower than in the GQE group (p < .05). The number of embryo transfers (ETs) in the PQE group was higher than in the GQE group (p < .0001). The rate of cesarean section in the PQE group was significantly higher than in the GQE group (p < .05). The height (at 3 months) and head circumference (at 12 months) in the PQE group were lower than in the GQE group (p < .05). CONCLUSIONS Transplantation of PQEs did not affect the growth and development of offspring (0-3 years) compared to good-quality blastocysts. However, the oocyte and embryo development potential was lower in the PQE group than in the GQE group. These results provide clinical reference that the transfer of PQE could be acceptable for patients with only PQE embryos.
Collapse
Affiliation(s)
- Chunmei Yu
- Department of Reproduction, Changzhou Maternity and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, China
| | - Lijing Bai
- Department of Reproduction, Changzhou Maternity and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, China
| | - Wanchao Zhang
- Wuqia County People Hospital, The Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Lin Feng
- Wuqia County People Hospital, The Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Xiaoyu Wang
- Department of Reproduction, Changzhou Maternity and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, China
| | - Li Chen
- Department of Reproduction, Changzhou Maternity and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, China
| | - Lingmin Hu
- Department of Reproduction, Changzhou Maternity and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, China
| |
Collapse
|
11
|
Yang T, Yuan X, Xue Q, Sun L, Xu T, Chen Y, Shi D, Li X. Comparison of symmetrical and asymmetrical cleavage 2-cell embryos of porcine by Smart-seq2. Theriogenology 2023; 210:221-226. [PMID: 37540954 DOI: 10.1016/j.theriogenology.2023.07.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 07/22/2023] [Accepted: 07/22/2023] [Indexed: 08/06/2023]
Abstract
Early cleavage (EC) influences the development of the pre-implantation and post-implantation embryo. Symmetric cleavage (Sym) and asymmetric cleavage (Asy) have been observed in EC, but its molecular mechanism remains unclear. This study was designed to pick out the key candidate genes and signaling pathway between Sym and Asy embryos by applying Smart-seq2 technique. In in-vitro fertilization (IVF) 2-cell embryos, Sym embryos and Asy embryos accounted for 62.55% and 37.45%, respectively. The 2-cell rate, blastocyst rate and total blastocyst cells of Sym group were significantly higher than those of Asy group (31.38% vs 18.79%, 47.55% vs 29.5%, 71.33 vs 33.67, P < 0.05). The 2-cell rate, blastocyst rate and total blastocyst cell number in parthenogenetic activation (PA) embryos in Sym group were significantly higher than those in Asy group (40.61% vs 23.64%, 63.15% vs 30.11%, 50.75 vs 40.5, P < 0.05). A total of 216 differentially expressed genes (DEGs) incorporating 147 genes up-regulated and 69 genes down-regulated genes were screened under the p-value <0.05 and |log2 (fold change)| ≥ 1 when compared with Sym group. Further Gene Ontology (GO) analysis showed that these DEGs were related to the regulation of metabolic process, cell cycle, chromosome segregation, centromeric region and microtubule cytoskeleton. Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis revealed that the DEGs were mainly enriched to oocyte meiosis, cell cycle, p53 and Hippo signaling pathways. We concluded that asymmetric cleavage is a consequence of altered gene expression. Atg4c, Sesn2, Stk11ip, Slc25a6, Cep19 and Cep55 associated with mitochondrial function and cytoskeletal structure were probably the key candidate genesto determine the zygote cleavage pattern.
Collapse
Affiliation(s)
- Ting Yang
- Guangxi Key Laboratory of Animal Breeding and Disease Control, Guangxi University, Nanning, 530005, China
| | - Xi Yuan
- Guangxi Key Laboratory of Animal Breeding and Disease Control, Guangxi University, Nanning, 530005, China
| | - Qingsong Xue
- Guangxi Key Laboratory of Animal Breeding and Disease Control, Guangxi University, Nanning, 530005, China
| | - Le Sun
- Guangxi Key Laboratory of Animal Breeding and Disease Control, Guangxi University, Nanning, 530005, China
| | - Tairan Xu
- Guangxi Key Laboratory of Animal Breeding and Disease Control, Guangxi University, Nanning, 530005, China
| | - Yuan Chen
- Guangxi Key Laboratory of Animal Breeding and Disease Control, Guangxi University, Nanning, 530005, China
| | - Deshun Shi
- Guangxi Key Laboratory of Animal Breeding and Disease Control, Guangxi University, Nanning, 530005, China
| | - Xiangping Li
- Guangxi Key Laboratory of Animal Breeding and Disease Control, Guangxi University, Nanning, 530005, China.
| |
Collapse
|
12
|
Jin H, Yang H, Zheng J, Zhou J, Yu R. Post-trigger luteinizing hormone concentration to positively predict oocyte yield in the antagonist protocol and its association with genetic variants of LHCGR. J Ovarian Res 2023; 16:189. [PMID: 37691102 PMCID: PMC10494325 DOI: 10.1186/s13048-023-01271-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 08/30/2023] [Indexed: 09/12/2023] Open
Abstract
BACKGROUND The concentration of human chorionic gonadotropin (hCG)/ luteinizing hormone (LH) after triggering is generally accepted as a predictor of the normal ovarian response to the trigger, but few studies have explored the distribution model of concentration and its impact on oocyte yield. Genetic variations in LHCGR, known as a receptor for hCG and LH, also play a role in oocyte maturation and retrieval. The objective of the study was to investigate the impact of concentrations of hCG/LH after triggering on oocyte yield and its association with genetic variants of LHCGR. METHODS A retrospective cohort study including 372 antagonist IVF cycles, in which 205 received the recombinant hCG trigger and 167 received the gonadotropin-releasing hormone agonist (GnRH-a) trigger, was conducted. The post-trigger concentrations of hCG/LH and the LHCGR N312S (rs2293275) genotype were evaluated in patients to analyse the impact of these factors on oocyte yield. RESULTS The oocyte retrieval rate (ORR) increased significantly among the low-, medium- and high-hCG-concentration groups (0.91 ± 0.25, 0.99 ± 0.23 and 1.08 ± 0.19, P < 0.001) and among the low-, medium- and high-LH-concentration groups (0.80 ± 0.29, 0.95 ± 0.21 and 1.07 ± 0.19, P < 0.001). The Pearson correlation coefficient between the post-trigger hCG concentration and ORR was 0.242 (P < 0.001), and that between the LH concentration and ORR was 0.454 (P < 0.001). After adjustment for confounding factors, high post-trigger LH concentrations remained associated with the significantly higher ORRs (adjusted R2 = 0.541, P < 0.001). Patients with the AG genotype of LHCGR N312S were more likely to have low post-trigger LH concentrations (46.10 IU/L versus 60.91 IU/L, P < 0.001) and a significantly lower ORR (0.85 versus 0.96, P = 0.042) than patients with the GG genotype after the GnRH-a trigger. CONCLUSIONS The post-trigger LH concentration can positively predict oocyte yield in antagonist IVF cycles, and patients with the AG genotype of LHCGR rs2293275 could have a suboptimal oocyte yield using the GnRH-a trigger.
Collapse
Affiliation(s)
- Hao Jin
- The Urological Surgical Department, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Haiyan Yang
- The Reproductive Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China, No. 96, Fuxue Road, Lucheng District
| | - Jiujia Zheng
- The Reproductive Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China, No. 96, Fuxue Road, Lucheng District
| | - Jiechun Zhou
- The Reproductive Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China, No. 96, Fuxue Road, Lucheng District
| | - Rong Yu
- The Reproductive Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China, No. 96, Fuxue Road, Lucheng District.
| |
Collapse
|
13
|
Goswami N, Winston N, Choi W, Lai NZE, Arcanjo RB, Chen X, Sobh N, Nowak RA, Anastasio MA, Popescu G. Machine learning assisted health viability assay for mouse embryos with artificial confocal microscopy (ACM). BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.07.30.550591. [PMID: 37547014 PMCID: PMC10402120 DOI: 10.1101/2023.07.30.550591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
The combination of a good quality embryo and proper maternal health factors promise higher chances of a successful in vitro fertilization (IVF) procedure leading to clinical pregnancy and live birth. Of these two factors, selection of a good embryo is a controllable aspect. The current gold standard in clinical practice is visual assessment of an embryo based on its morphological appearance by trained embryologists. More recently, machine learning has been incorporated into embryo selection "packages". Here, we report a machine-learning assisted embryo health assessment tool utilizing a quantitative phase imaging technique called artificial confocal microscopy (ACM). We present a label-free nucleus detection method with novel quantitative embryo health biomarkers. Two viability assessment models are presented for grading embryos into two classes: healthy/intermediate (H/I) or sick (S) class. The models achieve a weighted F1 score of 1.0 and 0.99 respectively on the in-distribution test set of 72 fixed embryos and a weighted F1 score of 0.9 and 0.95 respectively on the out-of-distribution test dataset of 19 time-instances from 8 live embryos.
Collapse
|
14
|
Jin H, Yang H, Zheng J, Zhou J, Yu R. Risk factors for low oocyte retrieval in patients with polycystic ovarian syndrome undergoing in vitro fertilization. Reprod Biol Endocrinol 2023; 21:66. [PMID: 37468927 DOI: 10.1186/s12958-023-01118-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 07/09/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND The number of oocytes retrieved does not always coincide with the number of follicles aspirated in in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) treatment. Patients with high expectation of retrieval sometimes obtain few oocytes, which may be induced by improper operation or therapeutic factors. The purpose of this study was to evaluate the distribution data of oocyte retrieval rate (ORR) and to explore the risk factors for low ORR in patients with polycystic ovary syndrome (PCOS) undergoing IVF/ICSI. METHODS A total of 2478 patients with PCOS undergoing IVF/ICSI were involved in this retrospective case-control study from March 2016 to October 2021. The oocyte retrieval rate was calculated as the ratio of the number of obtained oocytes to the number of follicles (≥ 12 mm) on the trigger day. Patients were divided into a low ORR and a normal ORR group with the boundary of one standard deviation from the mean value of ORR. The patient characteristics, treatment protocols, serum hormone levels, and embryonic and pregnancy outcomes were analyzed. RESULTS The ORR exhibited a non-normal distribution, with a median of 0.818. The incidence of complete empty follicle syndrome was 0.12% (3/2478). The proportion of patients in the low ORR group who received the progestin-primed protocol was significantly higher than that in the normal ORR group (30.30% vs. 17.69%). A logistic regression analysis showed that the serum estradiol level/follicle (≥ 12 mm) ratio (OR: 0.600 (0.545-0.661)) and progesterone level (OR: 0.783 (0.720-0.853)) on the trigger day were significant factors in the development of a low ORR, with optimal cutoff values of 172.85 pg/ml and 0.83 ng/ml, respectively, as determined by receiver operating curve. Fewer high-quality embryos (2 vs. 5) and more cycles with no available embryos (5.42% vs. 0.43%) were found in the low ORR group. CONCLUSIONS For patients with PCOS, low estradiol levels/follicles (≥ 12 mm) and progesterone levels on the trigger day and the use of the progestin-primed protocol could be risk factors for low ORR, which leads to a limited number of embryos and more cycle cancellations.
Collapse
Affiliation(s)
- Hao Jin
- The Urological Surgical Department, The First Affiliated Hospital of Wenzhou Medical University, No. 96, Fuxue Road, Lucheng District, Wenzhou, China
| | - Haiyan Yang
- The Reproductive Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jiujia Zheng
- The Reproductive Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jiechun Zhou
- The Reproductive Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Rong Yu
- The Reproductive Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
| |
Collapse
|
15
|
Li D, Parmegiani L, Yang D, Vajta G, Li R. Expert consensus on the morphological evaluation of human cleavage-stage embryos and blastocysts. Chin Med J (Engl) 2023; 136:1009-1011. [PMID: 37185360 PMCID: PMC10228470 DOI: 10.1097/cm9.0000000000002609] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Indexed: 05/17/2023] Open
Affiliation(s)
- Da Li
- Center of Reproductive Medicine, Shengjing Hospital of China Medical University, Key Laboratory of Reproductive and Genetic Medicine (China Medical University), National Health Commission, Shenyang, Liaoning 110004, China
| | | | - Dalei Yang
- Center of Reproductive Medicine, Shengjing Hospital of China Medical University, Key Laboratory of Reproductive and Genetic Medicine (China Medical University), National Health Commission, Shenyang, Liaoning 110004, China
| | | | - Rong Li
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, National Clinical Research Center for Obstetrics and Gynecology (Peking University Third Hospital), Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing 100084, China
| |
Collapse
|
16
|
Serrano-Novillo C, Uroz L, Márquez C. Novel Time-Lapse Parameters Correlate with Embryo Ploidy and Suggest an Improvement in Non-Invasive Embryo Selection. J Clin Med 2023; 12:jcm12082983. [PMID: 37109319 PMCID: PMC10146271 DOI: 10.3390/jcm12082983] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/12/2023] [Accepted: 04/19/2023] [Indexed: 04/29/2023] Open
Abstract
Selecting the best embryo for transfer is key to success in assisted reproduction. The use of algorithms or artificial intelligence can already predict blastulation or implantation with good results. However, ploidy predictions still rely on invasive techniques. Embryologists are still essential, and improving their evaluation tools can enhance clinical outcomes. This study analyzed 374 blastocysts from preimplantation genetic testing cycles. Embryos were cultured in time-lapse incubators and tested for aneuploidies; images were then studied for morphokinetic parameters. We present a new parameter, "st2, start of t2", detected at the beginning of the first cell cleavage, as strongly implicated in ploidy status. We describe specific cytoplasmic movement patterns associated with ploidy status. Aneuploid embryos also present slower developmental rates (t3, t5, tSB, tB, cc3, and t5-t2). Our analysis demonstrates a positive correlation among them for euploid embryos, while aneuploids present non-sequential behaviors. A logistic regression study confirmed the implications of the described parameters, showing a ROC value of 0.69 for ploidy prediction (95% confidence interval (CI), 0.62 to 0.76). Our results show that optimizing the relevant indicators to select the most suitable blastocyst, such as by including st2, could reduce the time until the pregnancy of a euploid baby while avoiding invasive and expensive methods.
Collapse
Affiliation(s)
| | - Laia Uroz
- Gravida, Hospital de Barcelona, 08034 Barcelona, Spain
| | | |
Collapse
|
17
|
Liu J, Zhou Y, Tong L, Wang X, Li Y, Wang H. Developmental potential of different embryos on day 3: a retrospective study. J OBSTET GYNAECOL 2022; 42:3322-3327. [PMID: 36149236 DOI: 10.1080/01443615.2022.2125291] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
To investigate how different quality of day 3 (D3) embryos affect blastocyst formation and clinical outcomes. This retrospective study analysed 699 patients undergoing assisted reproductive technology (ART) between January 2017 and February 2021. A total of 2517 D3 embryos were transferred to blastocyst medium for extended culture. D3 embryos were divided into five groups. Grade A, 6-10 cells, symmetrical blastomeres and <20% fragmentation; grade B, 6-10 cells, uneven blastomeres and ≥20% fragmentation; grade C, >10 cells, symmetrical blastomeres and <20% fragmentation; grade D, >10 cells, uneven blastomeres and ≥20% fragmentation; grade E, <6 cells. Status of day 5 (D5) and day 6 (D6) blastocysts and the clinical outcomes (blastocyst transfer) of each D3 embryo were recorded. The grade C group showed a higher D5 blastocyst formation rate and a high-quality blastocyst rate than other groups (p<.05). However, the clinical pregnancy rates in the grade A group were higher than other groups (p<.05). Embryos with low speed of development (grade E group) showed considerable clinical outcomes that were still worth investigating. D3 embryos with less fragmentation and ≥6 symmetrical blastomeres revealed a higher developmental potential, while embryos with 6-10 blastomeres showed the ideal clinical outcomes.Impact StatementWhat is already known on this subject? Accurate embryo evaluation can effectively reflect the developmental potential of different embryos. The number of blastomeres, proportion of fragmentation, and blastomere symmetry are three important and popular morphologic parameters used for evaluating day 3 (D3) embryos. However, in existing reports, combining these three parameters for embryo evaluation often results in different results. This is because different researchers have chosen different criteria for these three parameters.What do the results of this study add? In this retrospective study, we summarised the medical records of our reproductive centre in the past three years, redefined the evaluation method of the D3 embryos, and analysed the corresponding developmental potential and clinical outcomes. We conclude that although the embryonic development potential of grade C embryos (>10 cells, symmetrical blastomeres and/or <20% fragmentation) is relatively good, the results of grade A embryos (6-10 cells, symmetrical blastomeres and/or <20% fragmentation) are better in terms of clinical outcomes.What are the implications of these findings for clinical practice and/or further research? We believe this is meaningful for embryologists to choose embryos for transfer and predict the clinical outcome of IVF cycles.
Collapse
Affiliation(s)
- Ji Liu
- Center of Reproductive Medicine, The Affiliated Weihai Second Municipal Hospital of Qingdao University, Weihai, China.,Center of Reproductive Medicine, Weihai Maternal and Child Health Hospital, Weihai, China
| | - Yanhua Zhou
- Center of Reproductive Medicine, The Affiliated Weihai Second Municipal Hospital of Qingdao University, Weihai, China.,Center of Reproductive Medicine, Weihai Maternal and Child Health Hospital, Weihai, China
| | - Lingxi Tong
- Center of Reproductive Medicine, The Affiliated Weihai Second Municipal Hospital of Qingdao University, Weihai, China.,Center of Reproductive Medicine, Weihai Maternal and Child Health Hospital, Weihai, China
| | - Xiaoxiao Wang
- Center of Reproductive Medicine, The Affiliated Weihai Second Municipal Hospital of Qingdao University, Weihai, China.,Center of Reproductive Medicine, Weihai Maternal and Child Health Hospital, Weihai, China
| | - Yanhong Li
- Center of Reproductive Medicine, The Affiliated Weihai Second Municipal Hospital of Qingdao University, Weihai, China.,Center of Reproductive Medicine, Weihai Maternal and Child Health Hospital, Weihai, China
| | - Honghui Wang
- Center of Reproductive Medicine, The Affiliated Weihai Second Municipal Hospital of Qingdao University, Weihai, China.,Center of Reproductive Medicine, Weihai Maternal and Child Health Hospital, Weihai, China
| |
Collapse
|
18
|
Jiang T, Hu Y, He S, Jiang R, Yao Y, Jin Z, Shen J, Tao F, Ji Y, Liang C. Exposure to multiple toxic metals and the risk of early embryonic arrest among women undergoing assisted reproductive techniques. ENVIRONMENTAL RESEARCH 2022; 211:113072. [PMID: 35283078 DOI: 10.1016/j.envres.2022.113072] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 02/27/2022] [Accepted: 03/01/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Early embryonic arrest is a great challenge for in vitro fertilization. Whether exposure to toxic metals is associated with an increased risk of early embryonic arrest warrants investigation. OBJECTIVES Here, we conducted a case-control study in infertile women to estimate the associations between blood barium (Ba), arsenic (As), mercury (Hg), and lead (Pb) exposure levels and the risk of early embryonic arrest. METHODS Ba, As, Hg, and Pb exposure levels in fasting blood collected from 74 infertile women (123 cycles) with early embryonic arrest and 157 infertile women (180 cycles) without early embryonic arrest were measured by ICP-MS. Bayesian kernel machine regression (BKMR) was used to assess the association of exposure level of toxic metals mixture with the risk of early embryonic arrest as well as to evaluate which metal playing a leading role in the association, and then generalized estimating equations (GEEs) were used to evaluate the relationship between the selected harmful metal and the risk of early embryonic arrest. Finally, the potential causes of early embryonic arrest originating from the harmful metal exposure were explored. RESULTS Blood Ba levels were significantly higher in the case group than that in the control group (p = 0.009) rather than As, Pb and Hg. Results from BKMR showed that exposure to toxic metals mixture increased the risk of early embryonic arrest, with Ba playing a leading role (PIP = 0.9612). GEE analysis showed that high Ba exposure level was related with the increased risk of early embryonic arrest (p < 0.05) and it impacted on the oogenesis significantly. CONCLUSIONS Our study found that exposure to toxic metals mixture was associated with the increased risk of early embryonic arrest, and Ba contributed most to the increased risk. Higher Ba exposure in whole blood corresponds to a higher risk of early embryonic arrest and impacted on the oogenesis significantly.
Collapse
Affiliation(s)
- Tingting Jiang
- School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Yuan Hu
- School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Shitao He
- School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Rui Jiang
- School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Yuyou Yao
- School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei, 230032, Anhui, China; Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei, 230032, Anhui, China; Anhui Provincial Key Laboratory of Population Health and Aristogenics / Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Anhui Medical University; No 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Zhongxiu Jin
- School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei, 230032, Anhui, China; Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei, 230032, Anhui, China; Anhui Provincial Key Laboratory of Population Health and Aristogenics / Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Anhui Medical University; No 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Juan Shen
- School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Fangbiao Tao
- School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei, 230032, Anhui, China; Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei, 230032, Anhui, China; Anhui Provincial Key Laboratory of Population Health and Aristogenics / Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Anhui Medical University; No 81 Meishan Road, Hefei, 230032, Anhui, China.
| | - Yanli Ji
- School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei, 230032, Anhui, China; Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei, 230032, Anhui, China; Anhui Provincial Key Laboratory of Population Health and Aristogenics / Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Anhui Medical University; No 81 Meishan Road, Hefei, 230032, Anhui, China.
| | - Chunmei Liang
- School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei, 230032, Anhui, China; Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, No 218 Jixi Road, Hefei, 230022, Anhui, China; Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei, 230032, Anhui, China; Anhui Provincial Key Laboratory of Population Health and Aristogenics / Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Anhui Medical University; No 81 Meishan Road, Hefei, 230032, Anhui, China.
| |
Collapse
|
19
|
Song X, Li T, Xiong X, Shan H, Feng T, Cui K, Shi D, Liu Q, Li Z. RNA-Seq Reveals the Underlying Molecular Mechanism of First Cleavage Time Affecting Porcine Embryo Development. Genes (Basel) 2022; 13:genes13071251. [PMID: 35886034 PMCID: PMC9320770 DOI: 10.3390/genes13071251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/12/2022] [Accepted: 07/13/2022] [Indexed: 02/01/2023] Open
Abstract
The selection and evaluation of high-quality embryos are the key factors affecting in vitro embryo development and pregnancy outcome. The timing of first embryonic cleavage has been considered a positive indicator of the in vitro developmental potential of embryos, while the underlying molecular mechanism is still not fully understood. In this study, the embryos generated by parthenogenetic activation (PA) or in vitro fertilization (IVF) were monitored and recorded every 2 h and divided into two groups (early cleavage or late cleavage) based on the cleavage rate and blastocyst formation data. RNA sequencing was used to analyze the gene expression pattern of the embryos. We identified 667 and 71 different expression genes (DEGs) in early cleavage and late cleavage porcine PA and IVF embryos, respectively. Further Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses showed that the DEGs are mainly enriched in pathways concerning the proteasome, DNA repair, cell cycle arrest, autophagy, and apoptosis, suggesting that severe endoplasmic reticulum stress (ERS) and DNA damage may be the key factors that led to the low development potential of late cleavage embryos. This study provides a theoretical basis for the following application and offers important information about the understanding of the timely manner of porcine embryo development.
Collapse
Affiliation(s)
- Xinhui Song
- State Key Laboratory for Conservation and Utilization of Subtropical Agro-Bioresources, Guangxi University, Nanning 530004, China; (X.S.); (H.S.); (T.F.); (K.C.); (D.S.)
| | - Tiantian Li
- Guangdong-Hong Kong-Macao Central Nervous Research Institute, Medical School, Jinan University, Guangzhou 510632, China; (T.L.); (X.X.)
| | - Xin Xiong
- Guangdong-Hong Kong-Macao Central Nervous Research Institute, Medical School, Jinan University, Guangzhou 510632, China; (T.L.); (X.X.)
| | - Huiquan Shan
- State Key Laboratory for Conservation and Utilization of Subtropical Agro-Bioresources, Guangxi University, Nanning 530004, China; (X.S.); (H.S.); (T.F.); (K.C.); (D.S.)
| | - Tong Feng
- State Key Laboratory for Conservation and Utilization of Subtropical Agro-Bioresources, Guangxi University, Nanning 530004, China; (X.S.); (H.S.); (T.F.); (K.C.); (D.S.)
| | - Kuiqing Cui
- State Key Laboratory for Conservation and Utilization of Subtropical Agro-Bioresources, Guangxi University, Nanning 530004, China; (X.S.); (H.S.); (T.F.); (K.C.); (D.S.)
| | - Deshun Shi
- State Key Laboratory for Conservation and Utilization of Subtropical Agro-Bioresources, Guangxi University, Nanning 530004, China; (X.S.); (H.S.); (T.F.); (K.C.); (D.S.)
| | - Qingyou Liu
- Guangdong Provincial Key Laboratory of Animal Molecular Design and Precise Breeding, School of Life Science and Engineering, Foshan University, Foshan 528225, China;
| | - Zhipeng Li
- State Key Laboratory for Conservation and Utilization of Subtropical Agro-Bioresources, Guangxi University, Nanning 530004, China; (X.S.); (H.S.); (T.F.); (K.C.); (D.S.)
- Correspondence: ; Tel.: +86-185-0136-1752
| |
Collapse
|
20
|
Kanaka V, Proikakis S, Drakakis P, Loutradis D, Tsangaris GT. Implementing a preimplantation proteomic approach to advance assisted reproduction technologies in the framework of predictive, preventive, and personalized medicine. EPMA J 2022; 13:237-260. [PMID: 35719135 PMCID: PMC9203609 DOI: 10.1007/s13167-022-00282-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 05/05/2022] [Indexed: 10/28/2022]
Abstract
The evolution of the field of assisted reproduction technology (ART) in the last 40 years has significantly contributed to the management of global infertility. Despite the great numbers of live births that have been achieved through ART, there is still potential for increasing the success rates. As a result, there is a need to create optimum conditions in order to increase ART efficacy. The selection of the best sperm, oocyte, and embryo, as well as the achievement of optimal endometrial receptivity, through the contribution of new diagnostic and treatment methods, based on a personalized proteomic approach, may assist in the attainment of this goal. Proteomics represent a powerful new technological development, which seeks for protein biomarkers in human tissues. These biomarkers may aid to predict the outcome, prevent failure, and monitor in a personalized manner in vitro fertilization (IVF) cycles. In this review, we will present data from studies that have been conducted in the search for such biomarkers in order to identify proteins related to good sperm, oocyte, and embryo quality, as well as optimal endometrial receptivity, which may later lead to greater results and the desirable ART outcome.
Collapse
Affiliation(s)
- Vasiliki Kanaka
- First Department of Obstetrics and Gynecology, School of Medicine, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece
- Proteomics Research Unit, Biomedical Research Foundation, Academy of Athens, Athens, Greece
| | - Stavros Proikakis
- Proteomics Research Unit, Biomedical Research Foundation, Academy of Athens, Athens, Greece
| | - Petros Drakakis
- Third Department of Obstetrics and Gynecology, School of Medicine, National and Kapodistrian University of Athens, Attikon Hospital, Athens, Greece
| | - Dimitrios Loutradis
- First Department of Obstetrics and Gynecology, School of Medicine, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece
| | - George Th. Tsangaris
- Proteomics Research Unit, Biomedical Research Foundation, Academy of Athens, Athens, Greece
| |
Collapse
|
21
|
Tola EN, Aslan Koşar P, Nal Sahin E, Sancer O. The association between age-related infertility and deoxyribonucleic acid (DNA) integrity parameters of granulosa cells and lymphocytes. J OBSTET GYNAECOL 2022; 42:2373-2380. [PMID: 35611871 DOI: 10.1080/01443615.2022.2054689] [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: 10/18/2022]
Abstract
This study aimed to investigate the association between deoxyribonucleic acid (DNA) integrity parameters and advanced maternal age (AMA)-related infertility. The granulosa cells and the lymphocytes obtained from 119 infertile women were recruited. Patients were divided into two groups: the AMA group (≥35 years, n = 26) and the non-AMA group (<35 years, n = 93). The tail length, tail moment and tail DNA percentage were evaluated as the DNA integrity parameters using comet assay. Infertility duration (p=.001), luteinising hormone (p=.01) and progesterone levels (p<.0001) were higher and smoking was more prevalent in the AMA group (p=.001). AMA group was stimulated with higher gonadotropin doses (p=.04) and had decreased anti-mullerian hormone levels (p<.0001). All of DNA integrity parameters were distributed homogenously between the groups; however, the tail length of lymphocytes was higher (p=.02) in the AMA group. Fertilisation was lower (p=.02), oocyte quality was tended to be poor (p=.03) and blastocyst transfer was lower in the AMA group (p=.03). Embryo quality was distributed homogenously between the groups. Implantation, clinical pregnancy and live birth rates were similar between the groups. Impact StatementWhat is already known on this subject? Advanced maternal age (AMA)-related infertility is associated with diminished ovarian reserve and alteration in follicular environment resulting in poor oocyte quality; however, the exact pathophysiologic mechanism is not clear.What do the results of this study add? Tail length, tail deoxyribonucleic acid (DNA) percentage, tail moment of granulosa cells were nonsignificantly higher in the AMA group compared to younger patients. All of the DNA integrity parameters of lymphocytes were nonsignificantly higher; however, only tail length of lymphocytes was statistically higher in the AMA group than the non-AMA group. A positive correlation was observed between DNA integrity parameters of lymphocytes and body mass index. There were no correlations between DNA integrity parameters of granulosa cells and lymphocyte and infertility duration, gonadotropin dose, duration of ovarian stimulation, oocyte score, embryo score, basal hormone levels and anti-mullerian hormone levels.What are the implications of these findings for clinical practice and/or further research? Our findings offer new insight for further understanding the role of granulosa cells in mediating the poor reproductive outcome of ageing patients. Understanding the mechanisms of ovarian ageing and poor oocyte quality in women with AMA may help to identify specific targets for improving oocyte quality with ageing.
Collapse
Affiliation(s)
- Esra Nur Tola
- Department of Obstetrics and Gynecology, Istanbul Medipol University Faculty of Medicine, Istanbul, Turkey
| | - Pınar Aslan Koşar
- Department of Medical Biology, Suleyman Demirel University Faculty of Medicine, Isparta, Turkey
| | - Esra Nal Sahin
- In Vitro Fertilization Unit, Suleyman Demirel University Hospital, Isparta, Turkey
| | - Okan Sancer
- Department of Medical Biology, Suleyman Demirel University Faculty of Medicine, Isparta, Turkey
| |
Collapse
|
22
|
Fan L, Tang N, Yao C, Wei X, Tang Y, Li J, Huang W. Association Between Fresh Embryo Transfers and Frozen-Thawed Embryo Transfers Regarding Live Birth Rates Among Women Undergoing Long Gonadotropin-Releasing Hormone Antagonist Protocols. Front Cell Dev Biol 2022; 10:884677. [PMID: 35573703 PMCID: PMC9096096 DOI: 10.3389/fcell.2022.884677] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 04/11/2022] [Indexed: 11/30/2022] Open
Abstract
Background: The availability and use of frozen-thawed embryos after controlled ovarian hyperstimulation for assisted reproduction have increased with improvements in vitrification techniques and the rise of gonadotropin-releasing hormone (GnRH) antagonist protocols. Although evidence has shown that frozen-thawed embryo transfers (FETs) result in higher live birth rates than fresh embryo transfers, it is uncertain whether this association exists in cycles employing the GnRH antagonist protocol. Objective: To test the hypothesis that FETs are more likely to result in a live birth than fresh embryo transfers in a GnRH antagonist protocol cycle and to investigate whether frozen blastocyst transfer increases live birth rates compared to fresh blastocyst transfer. Design: A retrospective historical cohort study was conducted using data collected from the Department of Reproductive Medicine of Liuzhou Maternity and Child Healthcare Hospital for 1,437 patients who underwent the GnRH antagonist protocol between 1 January 2015, and 31 December 2020. The primary outcome was the live birth rate, which was compared between fresh embryo transfer and FET, and the secondary outcomes were clinical pregnancy rate and miscarriage rate, which were compared between the two groups. Analyses were adjusted to account for the age of the patient, number of embryo transfers, day of embryo transfer, and type of infertility. Results: Fresh embryo transfers accounted for 1,026 (71.4%) of the 1,437 patients who underwent the GnRH antagonist protocol in our analysis, while FETs accounted for 411 (28.6%). Patients with fresh and frozen-thawed embryos had comparable median body mass index (body mass index; 22.3 [IQR, 24.6-20.0] vs. 22.0 [IQR, 24.5-19.9]). There was a significant difference in the median age of the fresh embryo transfer group (34.0 [IQR, 39.0-30.0]) and the Frozen-thawed embryo transfer group (32.0 [IQR, 37.0-29.0]). Blastocysts were transferred in 14.6% of the fresh embryo transfer cycles and 45.5% of the FET cycles, whereas they account for 10.4% and 13.0% of all patients, respectively. The mean number of embryos transferred was 2 (IQR, 2.0-1.0) for the fresh embryo transfer group and 1 (IQR, 2.0-1.0) for the FET group, with a significant difference in the mean number of embryos transferred. The live birth rate after fresh embryo transfer vs. FET was 28.7% vs. 34.5% (absolute difference, 5.9%; adjusted relative risk [aRR], 1.15 [95% CI, 0.88-1.51]). The clinical pregnancy rates were 39.9% vs. 46.0%, respectively (absolute difference, 6.1%; aRR, 1.10 [95% CI, 0.85-1.43]). The miscarriage rates were 22.5% vs. 23.8%, respectively (absolute difference, 1.3%; aRR, 1.13 [95% CI, 0.75-1.70]). Conclusion: In this retrospective study of women who underwent assisted reproduction using GnRH antagonists, FETs resulted in a higher live birth rates and clinical pregnancy rates than fresh embryo transfers, which parts of these differences were attributable to embryo stage. However, the interpretation of the findings is limited by the possibility of selection and confounding biases.
Collapse
Affiliation(s)
| | | | | | | | | | - Jingjing Li
- Department of Reproductive Medicine, Liuzhou Maternity and Child Healthcare Hospital Affiliated with Women and Children’s Hospital of Guangxi University of Science and Technology, Liuzhou, China
| | - Wenjie Huang
- Department of Reproductive Medicine, Liuzhou Maternity and Child Healthcare Hospital Affiliated with Women and Children’s Hospital of Guangxi University of Science and Technology, Liuzhou, China
| |
Collapse
|
23
|
An Image Processing Protocol to Extract Variables Predictive of Human Embryo Fitness for Assisted Reproduction. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12073531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Despite the use of new techniques on embryo selection and the presence of equipment on the market, such as EmbryoScope® and Geri®, which help in the evaluation of embryo quality, there is still a subjectivity between the embryologist’s classifications, which are subjected to inter- and intra-observer variability, therefore compromising the successful implantation of the embryo. Nonetheless, with the acquisition of images through the time-lapse system, it is possible to perform digital processing of these images, providing a better analysis of the embryo, in addition to enabling the automatic analysis of a large volume of information. An image processing protocol was developed using well-established techniques to segment the image of blastocysts and extract variables of interest. A total of 33 variables were automatically generated by digital image processing, each one representing a different aspect of the embryo and describing a different characteristic of the blastocyst. These variables can be categorized into texture, gray-level average, gray-level standard deviation, modal value, relations, and light level. The automated and directed steps of the proposed processing protocol exclude spurious results, except when image quality (e.g., focus) prevents correct segmentation. The image processing protocol can segment human blastocyst images and automatically extract 33 variables that describe quantitative aspects of the blastocyst’s regions, with potential utility in embryo selection for assisted reproductive technology (ART).
Collapse
|
24
|
Reporting on the Value of Artificial Intelligence in Predicting the Optimal Embryo for Transfer: A Systematic Review including Data Synthesis. Biomedicines 2022; 10:biomedicines10030697. [PMID: 35327499 PMCID: PMC8945147 DOI: 10.3390/biomedicines10030697] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/08/2022] [Accepted: 03/13/2022] [Indexed: 12/04/2022] Open
Abstract
Artificial intelligence (AI) has been gaining support in the field of in vitro fertilization (IVF). Despite the promising existing data, AI cannot yet claim gold-standard status, which serves as the rationale for this study. This systematic review and data synthesis aims to evaluate and report on the predictive capabilities of AI-based prediction models regarding IVF outcome. The study has been registered in PROSPERO (CRD42021242097). Following a systematic search of the literature in Pubmed/Medline, Embase, and Cochrane Central Library, 18 studies were identified as eligible for inclusion. Regarding live-birth, the Area Under the Curve (AUC) of the Summary Receiver Operating Characteristics (SROC) was 0.905, while the partial AUC (pAUC) was 0.755. The Observed: Expected ratio was 1.12 (95%CI: 0.26–2.37; 95%PI: 0.02–6.54). Regarding clinical pregnancy with fetal heartbeat, the AUC of the SROC was 0.722, while the pAUC was 0.774. The O:E ratio was 0.77 (95%CI: 0.54–1.05; 95%PI: 0.21–1.62). According to this data synthesis, the majority of the AI-based prediction models are successful in accurately predicting the IVF outcome regarding live birth, clinical pregnancy, clinical pregnancy with fetal heartbeat, and ploidy status. This review attempted to compare between AI and human prediction capabilities, and although studies do not allow for a meta-analysis, this systematic review indicates that the AI-based prediction models perform rather similarly to the embryologists’ evaluations. While AI models appear marginally more effective, they still have some way to go before they can claim to significantly surpass the clinical embryologists’ predictive competence.
Collapse
|
25
|
Chen C, Li W, Yin M, Li M, Wu L, Si J, Zhao L, Li B, Yan Z, Lyu Q. Does the cell number of 0PN embryos on day 3 affect pregnancy and neonatal outcomes following single blastocyst transfer? BMC Pregnancy Childbirth 2022; 22:200. [PMID: 35279109 PMCID: PMC8918324 DOI: 10.1186/s12884-022-04492-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 02/17/2022] [Indexed: 11/30/2022] Open
Abstract
Background 0PN zygotes have a low cleavage rate, and the clinical outcomes of cleavage-stage embryo transfers are unsatisfactory. Blastocyst culturing is used to screen 0PN embryos, but whether the cell number of 0PN embryos on day 3 affects the clinical outcomes following single blastocyst transfer is unknown and would be helpful in evaluating the clinical value of these embryos. Methods This retrospective study compared 46,804 0PN zygotes, 242 0PN frozen-thawed single blastocyst transfers, and 92 corresponding 0PN singletons with 232,441 2PN zygotes, 3563 2PN frozen-thawed single blastocyst transfers, and 1250 2PN singletons from January 2015 to October 2019 at a tertiary-care academic medical centre. The 0PN and 2PN embryos were divided into two groups: the group with < 6 cells on day 3 and that with ≥ 6 cells. Embryo development, subsequent pregnancy and neonatal outcomes were compared between the two groups. Results The cleavage and available blastocyst rates of the 0PN zygotes were much lower than those of the 2PN zygotes (25.9% vs. 97.4%, P < 0.001; 13.9% vs. 23.4%, P < 0.001). In the < 6 cells group, the available blastocyst rate of the cleaved 0PN embryos was significantly lower than that of the 2PN embryos (2.5% vs. 12.7%, P < 0.001). However, in the ≥ 6 cells group, the available blastocyst rate of the 0PN cleaved embryos significantly improved, although it was slightly lower than that of the 2PN embryos (33.9% vs. 35.7%, P = 0.014). Importantly, compared to those of the 2PN single blastocyst transfers, the clinical pregnancy rate, live birth rate, Z-score and malformation rate of the 0PN single blastocyst transfers were not significantly different in either the < 6 cells group (30.4% vs. 39.8%, P = 0.362; 30.4% vs. 31.3%, P = 0.932; 0.89 ± 0.90 vs. 0.42 ± 1.02, P = 0.161; 0% vs. 2.6%, P = 1.000) or the ≥ 6 cells group (50.7% vs. 46.6%, P = 0.246; 39.7% vs. 38.3%, P = 0.677; 0.50 ± 1.23 vs. 0.47 ± 1.11, P = 0.861; 2.4% vs. 1.8%, P = 1.000). Conclusions The cell number on day 3 of 0PN embryos affected the subsequent formation of blastocysts but did not influence the subsequent pregnancy and neonatal outcomes of 0PN single blastocyst transfers, which may be beneficial to clinicians counselling patients on the clinical value of 0PN embryos. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04492-7.
Collapse
|
26
|
Cambiasso MY, Gotfryd L, Stinson MG, Birolo S, Salamone G, Romanato M, Calvo JC, Fontana VA. Paternal alcohol consumption has intergenerational consequences in male offspring. J Assist Reprod Genet 2022; 39:441-459. [PMID: 35307778 PMCID: PMC8956782 DOI: 10.1007/s10815-021-02373-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 12/01/2021] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Alcoholism is a heterogeneous set of disorders caused by ethanol intake. Harmful effects of paternal consumption on the offspring are poorly explored and not fully understood. We analyzed the effect of paternal alcohol consumption on both their own reproductive capacity and that of their male offspring. METHODS We used a model of ethanol consumption (15% v/v in drinking water) for 12 days in adult CF-1 male mice. DNA integrity and post-translational modifications of histones were assessed in sperm; testicular weight, histology, and DNA fragmentation were analyzed. Treated or untreated male mice were mated with non-treated females to obtain two cell embryos that were cultured for 7 days; morphology and embryonic cell death were evaluated. Males of both groups were mated with non-treated females. Adult male offspring was euthanized, and sperm and testicular parameters determined. RESULTS Paternal ethanol consumption caused histological and epigenetic changes, as well as damage in DNA integrity in the testicular germline and sperm. These alterations gave rise to deleterious effects on embryonic development and to testicular and spermatic changes in the offspring. CONCLUSION This study provides critical information on reproductive disturbances brought about by paternal alcohol consumption and the profound impact these could have on the male progeny. The need to explore the effects of paternal alcohol consumption in detail and warn about the importance of controlling alcohol intake for the well-being of future generations should not be underscored.
Collapse
Affiliation(s)
- Maite Yael Cambiasso
- CONICET, Instituto de Biología Y Medicina Experimental (IByME), Buenos Aires, Argentina
| | - Lucila Gotfryd
- CONICET, Instituto de Química Biológica de La Facultad de Ciencias Exactas Y Naturales IQUIBICEN, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Marcelo Gabriel Stinson
- CONICET, Instituto de Química Biológica de La Facultad de Ciencias Exactas Y Naturales IQUIBICEN, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Sol Birolo
- Departamento de Química Biológica, Facultad de Ciencias Exactas Y Naturales (UBA), Buenos Aires, Argentina
| | - Gabriela Salamone
- Instituto de Medicina Experimental (IMEX), CONICET Academia Nacional de Medicina, Buenos Aires, Argentina
| | - Marina Romanato
- CONICET, Instituto de Biología Y Medicina Experimental (IByME), Buenos Aires, Argentina
| | - Juan Carlos Calvo
- CONICET, Instituto de Biología Y Medicina Experimental (IByME), Buenos Aires, Argentina
- Departamento de Química Biológica, Facultad de Ciencias Exactas Y Naturales (UBA), Buenos Aires, Argentina
| | - Vanina Andrea Fontana
- CONICET, Instituto de Química Biológica de La Facultad de Ciencias Exactas Y Naturales IQUIBICEN, Universidad de Buenos Aires, Buenos Aires, Argentina.
| |
Collapse
|
27
|
Peng Y, Ma S, Hu L, Wang X, Xiong Y, Yao M, Tan J, Gong F. Effectiveness and Safety of Two Consecutive Cycles of Single Embryo Transfer Compared With One Cycle of Double Embryo Transfer: A Systematic Review and Meta-Analysis. Front Endocrinol (Lausanne) 2022; 13:920973. [PMID: 35846284 PMCID: PMC9279578 DOI: 10.3389/fendo.2022.920973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 05/23/2022] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To date, evidence regarding the effectiveness and safety of two consecutive cycles of single embryo transfer (2SETs) compared with one cycle of double embryo transfer (DET) has been inadequate, particularly considering infertile women with different prognostic factors. This study aimed to comprehensively summarize the evidence by comparing 2SETs with DET. METHODS PubMed, Embase, Cochrane Library databases, ClinicalTrails.gov, and the WHO International Clinical Trials Registry Platform were searched up to March 22, 2022. Peer-reviewed, English-language randomized controlled trials (RCTs) and observational studies (OS) comparing the outcomes of 2SETs with DET in infertile women with their own oocytes and embryos were included. Two authors independently conducted study selection, data extraction, and bias assessment. The Mantel-Haenszel random-effects model was used for pooling RCTs, and a Bayesian design-adjusted model was conducted to synthesize the results from both RCTs and OS. MAIN RESULTS Twelve studies were finally included. Compared with the DET, 2SETs were associated with a similar cumulative live birth rate (LBR; 48.24% vs. 48.91%; OR, 0.97; 95% credible interval (CrI), 0.89-1.13, τ2 = 0.1796; four RCTs and six observational studies; 197,968 women) and a notable lower cumulative multiple birth rate (MBR; 0.87% vs. 17.72%; OR, 0.05; 95% CrI, 0.02-0.10, τ2 = 0.1036; four RCTs and five observational studies; 197,804 women). Subgroup analyses revealed a significant increase in cumulative LBR (OR, 1.33; 95% CrI, 1.29-1.38, τ2 = 0) after two consecutive cycles of single blastocyst transfer compared with one cycle of double blastocyst transfer. Moreover, a lower risk of cesarean section, antepartum hemorrhage, preterm birth, low birth weight, and neonatal intensive care unit admission but a higher gestational age at birth and birth weight were found in the 2SETs group. CONCLUSION Compared to the DET strategy, 2SETs result in a similar LBR while simultaneously reducing the MBR and improving maternal and neonatal adverse outcomes. The 2SETs strategy appears to be especially beneficial for women aged ≤35 years and for blastocyst transfers.
Collapse
Affiliation(s)
- Yangqin Peng
- Reproductive and Genetic Hospital of CITIC-Xiangya, Clinical Research Center for Reproduction and Genetics in Hunan Province, Changsha City, China
| | - Shujuan Ma
- Reproductive and Genetic Hospital of CITIC-Xiangya, Clinical Research Center for Reproduction and Genetics in Hunan Province, Changsha City, China
| | - Liang Hu
- Reproductive and Genetic Hospital of CITIC-Xiangya, Clinical Research Center for Reproduction and Genetics in Hunan Province, Changsha City, China
| | - Xiaojuan Wang
- Reproductive and Genetic Hospital of CITIC-Xiangya, Clinical Research Center for Reproduction and Genetics in Hunan Province, Changsha City, China
| | - Yiquan Xiong
- Chinese Evidence-Based Medicine Center and CREAT Group, West China Hospital, Sichuan University, Chengdu, China
| | - Minghong Yao
- Chinese Evidence-Based Medicine Center and CREAT Group, West China Hospital, Sichuan University, Chengdu, China
| | - Jing Tan
- Chinese Evidence-Based Medicine Center and CREAT Group, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Jing Tan, ; Fei Gong,
| | - Fei Gong
- Reproductive and Genetic Hospital of CITIC-Xiangya, Clinical Research Center for Reproduction and Genetics in Hunan Province, Changsha City, China
- *Correspondence: Jing Tan, ; Fei Gong,
| |
Collapse
|
28
|
Türkkanı A, Seymen CM, Kahyaoğlu İ, Kaplanoğlu İ, İlhan AŞ, Elmas Ç, Dilbaz S. The relationship between good quality embryo rates and IVF outcomes/embryo transfer policies in extended embryo culture. J OBSTET GYNAECOL 2021; 42:1388-1395. [PMID: 34907859 DOI: 10.1080/01443615.2021.1981268] [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: 10/19/2022]
Abstract
This study aims to investigate which parameters affect the change in good quality embryo rates during the cleavage stage and whether they have any effect on embryo transfer policies and IVF results. We analysed changes in good quality embryo (grades 1 and 2) rates during the period on days 2, 3 and 5; patients with five or fewer embryos (group 1), 6-10 embryos (group 2) and more than 10 embryos (group 3). The good quality embryo rates decreased in all groups on day 5. When the infertility reasons are studied among all of the groups, ovulatory dysfunction is found to be significantly higher in group 2 compared to group 1 and unexplained infertility was found to be significantly higher in group 2 compared to group 1 and group 3. Total antral follicle, mature oocyte and total oocyte counts were found to be significantly lower in group 1. However, there is no significant difference found among all of the groups for β-HCG levels and clinical pregnancies. Changes in good quality embryo rates at the cleavage stage in extended embryo culture do not have an impact on IVF results.IMPACT STATEMENTWhat is already known on this subject? The number and quality of embryos in the cleavage stage are important parameters affecting the embryo transfer decision on day 5. There is still insufficient knowledge concerning changes in the percentage of increased good quality embryo transfers associated with IVF outcomes during the second to the third day, and the third to the fifth day.What do the results of this study add? Day 5 embryo transfer is possible in patients with a low number of embryos, according to our results. The good quality embryo rates of patients with a low number of embryos at the cleavage stage are more promising compared to patients having more than five embryos.What are the implications of these findings for clinical practice and/or further research? An extended embryo culture option can be used on patients with a low number of embryos for clinical practice.
Collapse
Affiliation(s)
- Ayten Türkkanı
- Department of Histology and Embryology, Gülhane Medical School, Sağlık Bilimleri University, Ankara, Turkey
| | - Cemile Merve Seymen
- Department of Histology and Embryology, Gazi University Medical School, Ankara, Turkey
| | - İnci Kahyaoğlu
- Sağlık Bilimleri University Ankara Bilkent City Hospital IVF Center, Ankara, Turkey
| | - İskender Kaplanoğlu
- Sağlık Bilimleri University Etlik Zübeyde Hanım Maternity Hospital and IVF Center, Ankara, Turkey
| | - A Şebnem İlhan
- Department of Physiology, Gülhane Medical School, Sağlık Bilimleri University, Ankara, Turkey
| | - Çiğdem Elmas
- Department of Histology and Embryology, Gazi University Medical School, Ankara, Turkey
| | - Serdar Dilbaz
- Sağlık Bilimleri University Etlik Zübeyde Hanım Maternity Hospital and IVF Center, Ankara, Turkey
| |
Collapse
|
29
|
Şentürk R, Tola EN, Bozkurt M, Doğuç DK. The role of oxidant status on the etiopathogenesis of unexplained infertility and intracytoplasmic sperm injection - embryo transfer success: a case-control study. J OBSTET GYNAECOL 2021; 42:1312-1318. [PMID: 34842027 DOI: 10.1080/01443615.2021.1960294] [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: 10/19/2022]
Abstract
The present study aims to evaluate the role of follicular fluid (FF) and serum (s) total oxidant status (TOS), total antioxidant status (TAS) and oxidative stress index (OSI) on the etiopathogenesis of unexplained infertility (UI) and intracytoplasmic sperm injection-embryo transfer (ICSI-ET) success. Twenty UI patients and 20 controls with male factor undergoing an ICSI-ET cycle were recruited. FF samples aspirated from mature follicles and blood samples collected just before the oocyte retrieval were stored until analysis. Embriyo quality and implantation, clinical pregnancy and living birth rates were evaluated.FF-TOS and FF-OSI of the UI patients were higher than the control group. s-TOS and s-OSI were significantly increased in the UI group compared to the control group. However, only s-TOS was positively associated with UI diagnosis after age-adjustment. FF-OSI was negatively associated with embryo quality in the UI group (but not in the whole group) after age-adjustment. No significant effect of TAS, TOS, and OSI on implantation, clinical pregnancy and live birth rate was observed. In conclusion, especially s-TOS can have a partial role in the etiopathogenesis of UI. High FF-OSI can decrease the quality of embryo in patients with UI.Impact statementWhat is already known? Total oxidant status (TOS), total antioxidant status (TAS), and oxidative stress index (OSI), which is the ratio of TOS to TAS, provide a broad overview of redox status.What do the results of this study add? An elevated serum TOS (s-TOS) was associated with UI after age-adjustment. Follicular fluid OSI (FF-OSI) was negatively associated with embryo quality and embryo score in the UI group (but not in the whole group) after age-adjustment. No significant effect of TAS, TOS, and OSI was observed on implantation, clinical pregnancy, and live birth rate.What are the implications of these findings for clinical practice and/or further research? Evaluation of FF-OSI in women with unexplained infertility can be considered to predict embryo quality. Further studies that evaluate antioxidant agents to decrease oxidative stress in UI and its' clinical implications are warranted.
Collapse
Affiliation(s)
- Raziye Şentürk
- Department of Obstetrics and Gynaecology, Suleyman Demirel University Faculty of Medicine, Isparta, Turkey
| | - Esra Nur Tola
- Department of Obstetrics and Gynaecology, Istanbul Medipol University Faculty of Medicine, Istanbul, Turkey
| | - Mustafa Bozkurt
- Department of Biochemistry, Suleyman Demirel University Faculty of Medicine, Isparta, Turkey
| | - Duygu Kumbul Doğuç
- Department of Biochemistry, Suleyman Demirel University Faculty of Medicine, Isparta, Turkey
| |
Collapse
|
30
|
Nguyen DP, Pham QT, Tran TL, Vuong LN, Ho TM. Blastocyst Prediction of Day-3 Cleavage-Stage Embryos Using Machine Learning. FERTILITY & REPRODUCTION 2021. [DOI: 10.1142/s266131822150016x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: Embryo selection plays an important role in the success of in vitro fertilization (IVF). However, morphological embryo assessment has a number of limitations, including the time required, lack of accuracy, and inconsistency. This study determined whether a machine learning-based model could predict blastocyst formation using day-3 embryo images. Methods: Day-3 embryo images from IVF/intracytoplasmic sperm injection (ICSI) cycles performed at My Duc Phu Nhuan Hospital between August 2018 and June 2019 were retrospectively analyzed to inform model development. Day-3 embryo images derived from two-pronuclear (2PN) zygotes with known blastocyst formation data were extracted from the CCM-iBIS time-lapse incubator (Astec, Japan) at 67 hours post ICSI, and labeled as blastocyst/non-blastocyst based on results at 116 hours post ICSI. Images were used as the input dataset to train (85%) and validate (15%) the convolutional neural network (CNN) model, then model accuracy was determined using the training and validation dataset. The performance of 13 experienced embryologists for predicting blastocyst formation based on 100 day-3 embryo images was also evaluated. Results: A total of 1,135 images were allocated into training ([Formula: see text] 967) and validation ([Formula: see text] 168) sets, with an even distribution for blastocyst formation outcome. The accuracy of the final model for blastocyst formation was 97.72% in the training dataset and 76.19% in the validation dataset. The final model predicted blastocyst formation from day-3 embryo images in the validation dataset with an area under the curve of 0.75 (95% confidence interval [CI] 0.69–0.81). Embryologists predicted blastocyst formation with the accuracy of 70.07% (95% CI 68.12%–72.03%), sensitivity of 87.04% (95% CI 82.56%–91.52%), and specificity of 30.93% (95% CI 29.35%–32.51%). Conclusions: The CNN-based machine learning model using day-3 embryo images predicted blastocyst formation more accurately than experienced embryologists. The CNN-based model is a potential tool to predict additional IVF outcomes.
Collapse
Affiliation(s)
- Dung P. Nguyen
- IVFMD PN, My Duc Phu Nhuan Hospital, Ho Chi Minh City, Vietnam
- HOPE Research Center, My Duc Hospital, Ho Chi Minh City, Vietnam
| | - Quan T. Pham
- HOPE Research Center, My Duc Hospital, Ho Chi Minh City, Vietnam
| | - Thanh L. Tran
- IVFMD PN, My Duc Phu Nhuan Hospital, Ho Chi Minh City, Vietnam
- HOPE Research Center, My Duc Hospital, Ho Chi Minh City, Vietnam
| | - Lan N. Vuong
- HOPE Research Center, My Duc Hospital, Ho Chi Minh City, Vietnam
- IVFMD, My Duc Hospital, Ho Chi Minh City, Vietnam
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam
| | - Tuong M. Ho
- HOPE Research Center, My Duc Hospital, Ho Chi Minh City, Vietnam
- IVFMD, My Duc Hospital, Ho Chi Minh City, Vietnam
| |
Collapse
|
31
|
Cimadomo D, Sosa Fernandez L, Soscia D, Fabozzi G, Benini F, Cesana A, Dal Canto MB, Maggiulli R, Muzzì S, Scarica C, Rienzi L, De Santis L. Inter-centre reliability in embryo grading across several IVF clinics is limited: implications for embryo selection. Reprod Biomed Online 2021; 44:39-48. [PMID: 34819249 DOI: 10.1016/j.rbmo.2021.09.022] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 09/01/2021] [Accepted: 09/26/2021] [Indexed: 12/26/2022]
Abstract
RESEARCH QUESTION What is the intra- and inter-centre reliability in embryo grading performed according to the Istanbul Consensus across several IVF clinics? DESIGN Forty Day 3 embryos and 40 blastocysts were photographed on three focal planes. Senior and junior embryologists from 65 clinics were invited to grade them according to the Istanbul Consensus (Study Phase I). All participants then attended interactive training where a panel of experts graded the same embryos (Study Phase II). Finally, a second set of pictures was sent to both embryologists and experts for a blinded evaluation (Study Phase III). Intra-centre reliability was reported for Study Phase I as Cohen's kappa between senior and junior embryologists; inter-centre reliability was instead calculated between senior/junior embryologists and experts in Study Phase I versus III to outline improvements after training (i.e. upgrade of Cohen's kappa category according to Landis and Koch). RESULTS Thirty-six embryologists from 18 centres participated (28% participation rate). The intra-centre reliability was (i) substantial (0.63) for blastomere symmetry (range -0.02 to 1.0), (ii) substantial (0.72) for fragmentation (range 0.29-1.0), (iii) substantial (0.66) for blastocyst expansion (range 0.19-1.0), (iv) moderate (0.59) for inner cell mass quality (range 0.07-0.92), (v) moderate (0.56) for trophectoderm quality (range 0.01-0.97). The inter-centre reliability showed an overall improvement from Study Phase I to III, from fair (0.21-0.4) to moderate (0.41-0.6) for all parameters under analysis, except for blastomere fragmentation among senior embryologists, which was already moderate before training. CONCLUSIONS Intra-centre reliability was generally moderate/substantial, while inter-centre reliability was just fair. The interactive training improved it to moderate, hence this workflow was deemed helpful. The establishment of external quality assessment services (e.g. UK NEQAS) and the avant-garde of artificial intelligence might further improve the reliability of this key practice for embryo selection.
Collapse
Affiliation(s)
| | | | - Daria Soscia
- GeneraLife IVF, Clinica Valle Giulia, Rome, Italy
| | | | | | - Amalia Cesana
- Humanitas Clinical and Research Center-IRCCS, Rozzano, Italy
| | | | | | | | - Catello Scarica
- European Hospital, Center for Reproductive Medicine, Rome, Italy
| | - Laura Rienzi
- GeneraLife IVF, Clinica Valle Giulia, Rome, Italy
| | - Lucia De Santis
- Centro Scienze Natalità, Dept Ob/Gyn, IRCCS San Raffaele Scientific Institute, Milan, Italy
| |
Collapse
|
32
|
REPRODUCTIVE OUTCOMES FOLLOWING FROZEN-THAWED EMBRYO TRANSFER IS SUPERIOR WITH THE TRANSFER OF BLASTOCYSTS EXPANDED ON DAY 5 THAN ON DAY 6. INTERNATIONAL JOURNAL OF HEALTH SERVICES RESEARCH AND POLICY 2021. [DOI: 10.33457/ijhsrp.867448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
33
|
Barnett-Itzhaki Z, Knapp S, Avraham C, Racowsky C, Hauser R, Bollati V, Baccarelli AA, Machtinger R. Association between follicular fluid phthalate concentrations and extracellular vesicle microRNAs expression. Hum Reprod 2021; 36:1590-1599. [PMID: 33885134 PMCID: PMC8599830 DOI: 10.1093/humrep/deab063] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 02/24/2021] [Indexed: 12/12/2022] Open
Abstract
STUDY QUESTION Are phthalate metabolite concentrations in follicular fluid (FF) associated with the expression of extracellular vesicle microRNAs (EV-miRNAs)? SUMMARY ANSWER Phthalate metabolite concentrations are associated with the expression of EV-miRNA and their associated pathways in FFs. WHAT IS KNOWN ALREADY Phthalate metabolites were recently detected in FF. Urinary phthalate metabolite concentrations alter the expression of EV-miRNAs in FF. STUDY DESIGN, SIZE, DURATION Prospective study including 105 women recruited between January 2014 and August 2016 in a tertiary university-affiliated hospital. PARTICIPANTS/MATERIALS, SETTING, METHODS We assessed FF concentrations of 12 phthalate metabolites. EV-miRNAs were isolated from aliquots of the same FF, and their expression profiles were measured using a human miRNA panel. Associations between EV-miRNAs that were present in >50% of the samples and phthalate metabolites that were measured in >74% of the FF samples were tested. Genes regulated by EV-miRNAs that were found to be significantly (false discovery rate q-value < 0.1) correlated with FF-phthalates were analyzed for pathways linked with female fertility using miRWalk2.0 Targetscan database, DAVID Bioinformatics Resources and Kyoto Encyclopedia of Genes and Genomes (KEGG). MAIN RESULTS AND THE ROLE OF CHANCE Of 12 phthalate metabolites, 11 were measured in at least one FF sample. Mono (6-COOH-2-methylheptyl) phthalate (MCOMHP), mono-2-ethyl-5-carboxypentyl phthalate (mECPP), mono-n-butyl phthalate (MnBP), monobenzyl phthalate (MBzP), mono-isobutyl phthalate (MiBP), monoethyl phthalate (MEP) and mono (7-COOH-2-methyloctyl) phthalate (MCOMOP) were detected in more than 74% of the samples. Of 754 EV-miRNAs tested, 39 were significantly associated either with MEP, MBzP, MCOMOP, MCOMHP and/or with mECPP, after adjusting for multiple testing (P < 0.05). KEGG-based pathway enrichment analysis of the genes regulated by these miRNAs showed that these EV-miRNAs may be involved in pathways related to ovary or oocyte development, maturation and fertilization. LIMITATIONS, REASONS FOR CAUTION The use of miRNA panel array limits the number of potential relevant miRNAs. Moreover, several of the phthalate metabolites examined may be biased due to internal (enzymatic activity) or external (contamination in medical interventions) causes. WIDER IMPLICATIONS OF THE FINDINGS Phthalate metabolites may alter follicular EV-miRNAs profile and thus impair pathways that are involved with oocyte development, maturation and fertilization. Our results contribute to understanding of possible mechanism(s) in which endocrine disruptor chemicals interfere with female fertility. STUDY FUNDING/COMPETING INTERESTS This work was supported by the National Institutes of Environmental Health Sciences [Grant R21-ES024236]; and Environmental Health Fund, Israel [Grant 1301], no competing interests. TRIAL REGISTRATION NUMBER N/A.
Collapse
Affiliation(s)
- Zohar Barnett-Itzhaki
- Public Health Services, Ministry of Health, Jerusalem, Israel
- School of Engineering, Ruppin Academic Center, Emek Hefer, Israel
- Research Center for Health Informatics, Ruppin Academic Center, Emek Hefer, Israel
| | - Sarah Knapp
- Bioinformatics Department, School of Life and Health Science, Jerusalem College of Technology, Jerusalem, Israel
| | - Chaya Avraham
- Bioinformatics Department, School of Life and Health Science, Jerusalem College of Technology, Jerusalem, Israel
| | - Catherine Racowsky
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hopital Foch, Suresnes, France
| | - Russ Hauser
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Valentina Bollati
- EPIGET Lab, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Andrea A Baccarelli
- Laboratory of Precision Environmental Biosciences, Department of Environmental Health Sciences, Columbia Mailman School of Public Health, New York, NY, USA
| | - Ronit Machtinger
- Department of Obstetrics and Gynecology, Sheba Medical Center, Ramat-Gan and Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| |
Collapse
|
34
|
When using donor oocytes, does embryo stage matter? An analysis of blastocyst versus cleavage stage embryo transfers using a cryopreserved donor oocyte bank. J Assist Reprod Genet 2021; 38:1777-1786. [PMID: 33821428 DOI: 10.1007/s10815-021-02183-4] [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: 01/08/2021] [Accepted: 03/29/2021] [Indexed: 10/21/2022] Open
Abstract
PURPOSE Oocyte donor in vitro fertilization (IVF) represents an ideal model to study the effects of embryo stage on reproductive success, as embryos come from young women with high-quality oocytes. Our study aimed to determine if embryo transfer stage affected outcomes in oocyte donor IVF, including the common scenario where only a limited number of quality embryos are available after culture. METHODS This retrospective cohort analyzed anonymous vitrified donor oocyte cycles at a single clinic between 2008 and 2015. Overall, 983 recipients underwent 1178 warming cycles resulting in fresh transfer of one-to-two embryos. Our primary outcome was live birth; secondary outcomes included multiple birth, birthweight, and gestational age. Log binomial regression with cluster-weighted generalized estimating equations were used to calculate adjusted risk ratios (aRR) accounting for recipient age, race, and transfer year. RESULTS Among 132 cleavage and 1046 blastocyst transfer cycles, cleavage transfers were associated with lower probability of live birth (aRR 0.72, 95% CI 0.59-0.88). Subgroup analysis focused on cycles with a limited number of quality embryos 3 days post-fertilization (≤2), as clinically these women were most likely to be considered for cleavage transfers. Among these cycles (120 cleavage, 371 blastocyst), cleavage transfers were still associated with lower live birth rates compared to blastocyst (aRR 0.66, 95% CI 0.51-0.87) CONCLUSIONS: Even in a donor oocyte model with high-quality oocytes, there was a benefit to extended culture and blastocyst transfer, including when only one-to-two quality embryos were available after early culture. This is possibly owed to improved uterine synchronicity or decreased contractility.
Collapse
|
35
|
Alyafee Y, Alam Q, Tuwaijri AA, Umair M, Haddad S, Alharbi M, Alrabiah H, Al-Ghuraibi M, Al-Showaier S, Alfadhel M. Next-Generation Sequencing-Based Pre-Implantation Genetic Testing for Aneuploidy (PGT-A): First Report from Saudi Arabia. Genes (Basel) 2021; 12:461. [PMID: 33804821 PMCID: PMC8063787 DOI: 10.3390/genes12040461] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 03/12/2021] [Accepted: 03/17/2021] [Indexed: 11/25/2022] Open
Abstract
Recently, high-throughput next-generation sequencing (NGS)-based preimplantation genetic testing for aneuploidies techniques came into use. This technique is essential for successful embryo transfer and accomplishing pregnancy, thus reducing the time and cost of additional cycles. In this study, we describe our first experience in introducing an NGS-based preimplantation genetic testing for aneuploidy (PGT-A) service using next-generation sequencing in King Abdulaziz Medical City located in Riyadh, Saudi Arabia. Our main goal was to report the successful implementation of this new technology in clinical practice and highlight the factors that may affect the results. In total, 200 blastomere biopsies were obtained from 36 in vitro fertilization (IVF) cycles from Saudi couples suffering from prolonged infertility or recurrent embryo transfer failure. NGS-based PGT-A was performed in all embryos. The results were analyzed in five age groups, showing that aneuploidy rates increased with maternal age. Moreover, the results also showed that complex abnormal embryos with (2-5) aneuploidy are the most common type of embryos. Additionally, our data showed that chromosome 16-related abnormality was the most frequent abnormality detected among all reported abnormalities. In conclusion, our study suggests that NGS-based PGT-A is an applicable and reliable technique for routine-based embryo screening, especially for couples suffering from recurrent miscarriages or multiple embryo transfer failures.
Collapse
Affiliation(s)
- Yusra Alyafee
- King Abdullah International Medical Research Center (KAIMRC), Medical Genomics Research Department, King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Ministry of National Guard Health Affairs (MNG-HA), Riyadh 11426, Saudi Arabia; (Y.A.); (Q.A.); (A.A.T.); (M.U.); (S.H.); (M.A.)
| | - Qamre Alam
- King Abdullah International Medical Research Center (KAIMRC), Medical Genomics Research Department, King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Ministry of National Guard Health Affairs (MNG-HA), Riyadh 11426, Saudi Arabia; (Y.A.); (Q.A.); (A.A.T.); (M.U.); (S.H.); (M.A.)
| | - Abeer Al Tuwaijri
- King Abdullah International Medical Research Center (KAIMRC), Medical Genomics Research Department, King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Ministry of National Guard Health Affairs (MNG-HA), Riyadh 11426, Saudi Arabia; (Y.A.); (Q.A.); (A.A.T.); (M.U.); (S.H.); (M.A.)
| | - Muhammad Umair
- King Abdullah International Medical Research Center (KAIMRC), Medical Genomics Research Department, King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Ministry of National Guard Health Affairs (MNG-HA), Riyadh 11426, Saudi Arabia; (Y.A.); (Q.A.); (A.A.T.); (M.U.); (S.H.); (M.A.)
| | - Shahad Haddad
- King Abdullah International Medical Research Center (KAIMRC), Medical Genomics Research Department, King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Ministry of National Guard Health Affairs (MNG-HA), Riyadh 11426, Saudi Arabia; (Y.A.); (Q.A.); (A.A.T.); (M.U.); (S.H.); (M.A.)
| | - Meshael Alharbi
- King Abdullah International Medical Research Center (KAIMRC), Medical Genomics Research Department, King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Ministry of National Guard Health Affairs (MNG-HA), Riyadh 11426, Saudi Arabia; (Y.A.); (Q.A.); (A.A.T.); (M.U.); (S.H.); (M.A.)
| | - Hayat Alrabiah
- Reproductive Endocrinology and Infertility Unit, King Abdulaziz Medical City, Ministry of National Guard Health Affairs (MNG-HA), Riyadh 11426, Saudi Arabia; (H.A.); (M.A.-G.); (S.A.-S.)
| | - Maha Al-Ghuraibi
- Reproductive Endocrinology and Infertility Unit, King Abdulaziz Medical City, Ministry of National Guard Health Affairs (MNG-HA), Riyadh 11426, Saudi Arabia; (H.A.); (M.A.-G.); (S.A.-S.)
| | - Sahar Al-Showaier
- Reproductive Endocrinology and Infertility Unit, King Abdulaziz Medical City, Ministry of National Guard Health Affairs (MNG-HA), Riyadh 11426, Saudi Arabia; (H.A.); (M.A.-G.); (S.A.-S.)
| | - Majid Alfadhel
- King Abdullah International Medical Research Center (KAIMRC), Medical Genomics Research Department, King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Ministry of National Guard Health Affairs (MNG-HA), Riyadh 11426, Saudi Arabia; (Y.A.); (Q.A.); (A.A.T.); (M.U.); (S.H.); (M.A.)
- Genetics and Precision Medicine Department (GPM), King Abdullah Specialized Children’s Hospital, King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Ministry of National Guard Health Affairs (MNG-HA), Riyadh 11426, Saudi Arabia
| |
Collapse
|
36
|
(Pro)renin Receptor Is Present in Human Sperm and It Adversely Affects Sperm Fertility Ability. Int J Mol Sci 2021; 22:ijms22063215. [PMID: 33809946 PMCID: PMC8004193 DOI: 10.3390/ijms22063215] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/14/2021] [Accepted: 03/17/2021] [Indexed: 12/18/2022] Open
Abstract
Sperm fertility ability may be modulated by different molecular systems, such as the renin-angiotensin system (RAS). Although renin is one of its most relevant peptides, the presence and role of the (pro)renin receptor (PRR) is completely unknown. We have proved for the first time the existence of PRR and its transcript in human sperm by western blot and RT-PCR. Immunofluorescence studies showed that this receptor is mainly located in the apical region over the acrosome and in the postacrosomal region of the sperm head and along the sperm tail. In addition, this prospective cohort study also proves that semen samples with higher percentages of PRR-positive spermatozoa are associated with poor sperm motility, worse blastocyst development and no-viable blastocysts. Our results provide insight into how PRR play a negative role in sperm physiology that it may condition human embryo quality and development. An in-depth understanding of the role of PRR in sperm fertility can help elucidate its role in male infertility, as well as establish biomarkers for the diagnosis or selection of sperm to use during assisted reproductive techniques.
Collapse
|
37
|
Thirumalaraju P, Kanakasabapathy MK, Bormann CL, Gupta R, Pooniwala R, Kandula H, Souter I, Dimitriadis I, Shafiee H. Evaluation of deep convolutional neural networks in classifying human embryo images based on their morphological quality. Heliyon 2021; 7:e06298. [PMID: 33665450 PMCID: PMC7907476 DOI: 10.1016/j.heliyon.2021.e06298] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 11/08/2020] [Accepted: 02/11/2021] [Indexed: 01/14/2023] Open
Abstract
A critical factor that influences the success of an in-vitro fertilization (IVF) treatment cycle is the quality of the transferred embryo. Embryo morphology assessments, conventionally performed through manual microscopic analysis suffer from disparities in practice, selection criteria, and subjectivity due to the experience of the embryologist. Convolutional neural networks (CNNs) are powerful, promising algorithms with significant potential for accurate classifications across many object categories. Network architectures and hyper-parameters affect the efficiency of CNNs for any given task. Here, we evaluate multi-layered CNNs developed from scratch and popular deep-learning architectures such as Inception v3, ResNET-50, Inception-ResNET-v2, NASNetLarge, ResNeXt-101, ResNeXt-50, and Xception in differentiating between embryos based on their morphological quality at 113 h post insemination (hpi). Xception performed the best in differentiating between the embryos based on their morphological quality.
Collapse
Affiliation(s)
- Prudhvi Thirumalaraju
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Manoj Kumar Kanakasabapathy
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Charles L Bormann
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics & Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Raghav Gupta
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Rohan Pooniwala
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Hemanth Kandula
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Irene Souter
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics & Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Irene Dimitriadis
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics & Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Hadi Shafiee
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
38
|
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
|
39
|
Cimadomo D, Capalbo A, Scarica C, Sosa Fernandez L, Rienzi L, Ciriminna R, Minasi MG, Novelli A, De Santis L, Zuccarello D. When embryology meets genetics: the definition of developmentally incompetent preimplantation embryos (DIPE)-the consensus of two Italian scientific societies. J Assist Reprod Genet 2021; 38:319-331. [PMID: 33236289 PMCID: PMC7884494 DOI: 10.1007/s10815-020-02015-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 11/12/2020] [Indexed: 02/06/2023] Open
Abstract
A clear definition of developmentally incompetent preimplantation embryo (DIPE) in literature is still missing, while several scientific societies are discussing this challenging topic. From both a clinical and scientific perspective, the identification of embryos unfit for reproductive purpose is crucial. This aim should be pursued in light of all diagnostic technologies for embryo evaluation, encompassing also genetic analyses, of recent implementation in IVF. The Italian context is characterized by an unusual scenario: embryos can be discarded only if not viable and cannot be used for research purposes either. Therefore, thousands of embryos, diagnosed as affected and/or aneuploid as resulting from preimplantation genetic testing (PGT) and clinically not utilizable, are cryopreserved and stored indefinitely, with important psychological, legal, and financial implications. With the aim of updating the definition of DIPE, also on the basis of the embryo genetic status, the Italian Society of Embryology, Reproduction and Research (SIERR) and the Italian Society of Human Genetic (SIGU) reviewed the literature on this topic, found a consensus, and produced a list of relevant criteria.
Collapse
Affiliation(s)
- Danilo Cimadomo
- GeneraLife IVF centers, Clinica Valle Giulia, via G. de Notaris 2b, 00197, Rome, Italy.
| | | | - Catello Scarica
- Center for Reproductive Medicine, Casa di Cura Villa Salaria in Partnership with Institut Marques, Rome, Italy
| | | | - Laura Rienzi
- GeneraLife IVF centers, Clinica Valle Giulia, via G. de Notaris 2b, 00197, Rome, Italy
| | | | | | - Antonio Novelli
- Laboratory of Medical Genetics, IRCCS-Bambino Gesù Children's Hospital, Rome, Italy
| | - Lucia De Santis
- Department of Obstetrics & Gynecology, IVF Unit, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | | |
Collapse
|
40
|
Bormann CL, Kanakasabapathy MK, Thirumalaraju P, Gupta R, Pooniwala R, Kandula H, Hariton E, Souter I, Dimitriadis I, Ramirez LB, Curchoe CL, Swain J, Boehnlein LM, Shafiee H. Performance of a deep learning based neural network in the selection of human blastocysts for implantation. eLife 2020; 9:e55301. [PMID: 32930094 PMCID: PMC7527234 DOI: 10.7554/elife.55301] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 09/01/2020] [Indexed: 11/13/2022] Open
Abstract
Deep learning in in vitro fertilization is currently being evaluated in the development of assistive tools for the determination of transfer order and implantation potential using time-lapse data collected through expensive imaging hardware. Assistive tools and algorithms that can work with static images, however, can help in improving the access to care by enabling their use with images acquired from traditional microscopes that are available to virtually all fertility centers. Here, we evaluated the use of a deep convolutional neural network (CNN), trained using single timepoint images of embryos collected at 113 hr post-insemination, in embryo selection amongst 97 clinical patient cohorts (742 embryos) and observed an accuracy of 90% in choosing the highest quality embryo available. Furthermore, a CNN trained to assess an embryo's implantation potential directly using a set of 97 euploid embryos capable of implantation outperformed 15 trained embryologists (75.26% vs. 67.35%, p<0.0001) from five different fertility centers.
Collapse
Affiliation(s)
- Charles L Bormann
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical SchoolBostonUnited States
- Harvard Medical SchoolBostonUnited States
| | - Manoj Kumar Kanakasabapathy
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical SchoolBostonUnited States
| | - Prudhvi Thirumalaraju
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical SchoolBostonUnited States
| | - Raghav Gupta
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical SchoolBostonUnited States
| | - Rohan Pooniwala
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical SchoolBostonUnited States
| | - Hemanth Kandula
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical SchoolBostonUnited States
| | - Eduardo Hariton
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical SchoolBostonUnited States
| | - Irene Souter
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical SchoolBostonUnited States
- Harvard Medical SchoolBostonUnited States
| | - Irene Dimitriadis
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical SchoolBostonUnited States
- Harvard Medical SchoolBostonUnited States
| | | | - Carol L Curchoe
- San Diego Fertility CenterSan DiegoUnited States
- Colorado Center for Reproductive Medicine IVF Laboratory NetworkEnglewoodUnited States
| | - Jason Swain
- Colorado Center for Reproductive Medicine IVF Laboratory NetworkEnglewoodUnited States
| | - Lynn M Boehnlein
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of WisconsinMadisonUnited States
| | - Hadi Shafiee
- Harvard Medical SchoolBostonUnited States
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical SchoolBostonUnited States
| |
Collapse
|
41
|
Time of morulation and trophectoderm quality are predictors of a live birth after euploid blastocyst transfer: a multicenter study. Fertil Steril 2020; 112:1080-1093.e1. [PMID: 31843084 DOI: 10.1016/j.fertnstert.2019.07.1322] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 07/11/2019] [Accepted: 07/22/2019] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To investigate whether the morphodynamic characterization of a euploid blastocyst's development allows a higher prediction of a live birth after single-embryo-transfer (SET). DESIGN Observational cohort study conducted in two phases: training and validation. SETTING Private in vitro fertilization centers. PATIENT(S) Euploid blastocysts: 511 and 319 first vitrified-warmed SETs from 868 and 546 patients undergoing preimplantation genetic testing for aneuploidies (PGT-A) in the training and validation phase, respectively. INTERVENTION(S) Data collected from time of polar body extrusion to time of starting blastulation, and trophectoderm and inner-cell-mass static morphology in all embryos cultured in a specific time-lapse incubator with a continuous medium. Logistic regressions conducted to outline the variables showing a statistically significant association with live birth. In the validation phase, these variables were tested in an independent data set. MAIN OUTCOME MEASURE(S) Live births per SET. RESULT(S) The average live birth rate (LBR) in the training set was 40% (N = 207/511). Only time of morulation (tM) and trophectoderm quality were outlined as putative predictors of live birth at two IVF centers. In the validation set, the euploid blastocysts characterized by tM <80 hours and high-quality trophectoderm resulted in a LBR of 55.2% (n = 37/67), while those with tM ≥ 80 hours and a low-quality trophectoderm resulted in a LBR of 25.5% (N = 13/51). CONCLUSION(S) Time of morulation and trophectoderm quality are better predictors of a euploid blastocyst's reproductive competence. Our evidence was reproducible across different centers under specific culture conditions. These data support the crucial role of morulation for embryo development, a stage that involves massive morphologic, cellular, and molecular changes and deserves more investigation.
Collapse
|
42
|
Blastocyst-stage embryos provide better frozen-thawed embryo transfer outcomes for young patients with previous fresh embryo transfer failure. Aging (Albany NY) 2020; 12:6981-6989. [PMID: 32294624 PMCID: PMC7202481 DOI: 10.18632/aging.103055] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 03/29/2020] [Indexed: 02/05/2023]
Abstract
Older patients or patients with a reduced ovarian response have a low number of embryos, which limits the opportunity for embryo selection. However, for young patients undergoing frozen-thawed embryo transfer (ET), it remains unclear whether embryo stage affects pregnancy outcomes. In the present study, a total of 2952 patients undergoing their first frozen-thawed ET were divided into two groups: patients who had experienced one failed fresh ET (Group A) and patients who had not received fresh ET because of the high risk of ovarian hyperstimulation syndrome (OHSS) (Group B). Our results show that Group B patients had a significantly higher clinical pregnancy rate (CPR) and live birth rate (LBR) than Group A patients. However, Group A patients who underwent blastocyst-stage frozen-thawed ET had a significantly higher CPR and LBR and a lower ectopic pregnancy rate (ePR) than did those who underwent cleavage-stage frozen-thawed ET. In Group B, CPR, ePR, LBR and spontaneous abortion rate (sAR) were similar with blastocyst-stage and cleavage-stage frozen-thawed ET. These results suggest that blastocyst-stage frozen-thawed ET is more appropriate for young patients who had previously undergone one failed fresh ET cycle.
Collapse
|
43
|
Toft CLF, Ingerslev HJ, Kesmodel US, Diemer T, Degn B, Ernst A, Okkels H, Kjartansdóttir KR, Pedersen IS. A systematic review on concurrent aneuploidy screening and preimplantation genetic testing for hereditary disorders: What is the prevalence of aneuploidy and is there a clinical effect from aneuploidy screening? Acta Obstet Gynecol Scand 2020; 99:696-706. [PMID: 32039470 DOI: 10.1111/aogs.13823] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 01/23/2020] [Accepted: 02/05/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION In assisted reproductive technology, aneuploidy is considered a primary cause of failed embryo implantation. This has led to the implementation of preimplantation genetic testing for aneuploidy in some clinics. The prevalence of aneuploidy and the use of aneuploidy screening during preimplantation genetic testing for inherited disorders has not previously been reviewed. Here, we systematically review the literature to investigate the prevalence of aneuploidy in blastocysts derived from patients carrying or affected by an inherited disorder, and whether screening for aneuploidy improves clinical outcomes. MATERIAL AND METHODS PubMed and Embase were searched for articles describing preimplantation genetic testing for monogenic disorders and/or structural rearrangements in combination with preimplantation genetic testing for aneuploidy. Original articles reporting aneuploidy rates at the blastocyst stage and/or clinical outcomes (positive human chorionic gonadotropin, gestational sacs/implantation rate, fetal heartbeat/clinical pregnancy, ongoing pregnancy, miscarriage, or live birth/delivery rate on a per transfer basis) were included. Case studies were excluded. RESULTS Of the 26 identified studies, none were randomized controlled trials, three were historical cohort studies with a reference group not receiving aneuploidy screening, and the remaining were case series. In weighted analysis, 34.1% of 7749 blastocysts were aneuploid. Screening for aneuploidy reduced the proportion of embryos suitable for transfer, thereby increasing the risk of experiencing a cycle without transferable embryos. In pooled analysis the percentage of embryos suitable for transfer was reduced from 57.5% to 37.2% following screening for aneuploidy. Among historical cohort studies, one reported significantly improved pregnancy and birth rates but did not control for confounding, one did not report any statistically significant difference between groups, and one properly designed study concluded that preimplantation genetic testing for aneuploidy enhanced the chance of achieving a pregnancy while simultaneously reducing the chance of miscarriage following single embryo transfer. CONCLUSIONS On average, aneuploidy is detected in 34% of embryos when performing a single blastocyst biopsy derived from patients carrying or affected by an inherited disorder. Accordingly, when screening for aneuploidy, the risk of experiencing a cycle with no transferable embryos increases. Current available data on the clinical effect of preimplantation genetic testing for aneuploidy performed concurrently with preimplantation genetic testing for inherited disorders are sparse, rendering the clinical effect from preimplantation genetic testing for aneuploidy difficult to access.
Collapse
Affiliation(s)
- Christian Liebst Frisk Toft
- Department of Molecular Diagnostics, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | | | - Ulrik Schiøler Kesmodel
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Fertility Unit, Aalborg University Hospital, Aalborg, Denmark
| | - Tue Diemer
- Department of Clinical Genetics, Aalborg University Hospital, Aalborg, Denmark
| | - Birte Degn
- Department of Molecular Diagnostics, Aalborg University Hospital, Aalborg, Denmark
| | - Anja Ernst
- Department of Molecular Diagnostics, Aalborg University Hospital, Aalborg, Denmark
| | - Henrik Okkels
- Department of Molecular Diagnostics, Aalborg University Hospital, Aalborg, Denmark
| | | | - Inge Søkilde Pedersen
- Department of Molecular Diagnostics, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| |
Collapse
|
44
|
McLennan HJ, Saini A, Dunning KR, Thompson JG. Oocyte and embryo evaluation by AI and multi-spectral auto-fluorescence imaging: Livestock embryology needs to catch-up to clinical practice. Theriogenology 2020; 150:255-262. [PMID: 32088032 DOI: 10.1016/j.theriogenology.2020.01.061] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 01/28/2020] [Indexed: 02/08/2023]
Abstract
A highly accurate 'non-invasive quantitative embryo assessment for pregnancy' (NQEAP) technique that determines embryo quality has been an elusive goal. If developed, NQEAP would transform the selection of embryos from both Multiple Ovulation and Embryo Transfer (MOET), and even more so, in vitro produced (IVP) embryos for livestock breeding. The area where this concept is already having impact is in the field of clinical embryology, where great strides have been taken in the application of morphokinetics and artificial intelligence (AI); while both are already in practice, rigorous and robust evidence of efficacy is still required. Even the translation of advances in the qualitative scoring of human IVF embryos have yet to be translated to the livestock IVP industry, which remains dependent on the MOET-standardised 3-point scoring system. Furthermore, there are new ways to interrogate the biochemistry of individual embryonic cells by using new, light-based methodologies, such as FLIM and hyperspectral microscopy. Combinations of these technologies, in particular combining new imaging systems with AI, will lead to very accurate NQEAP predictive tools, improving embryo selection and recipient pregnancy success.
Collapse
Affiliation(s)
- H J McLennan
- Robinson Research Institute, Adelaide Medical School, The University of Adelaide, Adelaide, SA, 5005, Australia; ARC Centre of Excellence for Nanoscale BioPhotonics & Institute for Photonics and Advanced Sensing, The University of Adelaide, Adelaide, SA, 5005, Australia
| | - A Saini
- Robinson Research Institute, Adelaide Medical School, The University of Adelaide, Adelaide, SA, 5005, Australia; ARC Centre of Excellence for Nanoscale BioPhotonics & Institute for Photonics and Advanced Sensing, The University of Adelaide, Adelaide, SA, 5005, Australia
| | - K R Dunning
- Robinson Research Institute, Adelaide Medical School, The University of Adelaide, Adelaide, SA, 5005, Australia; ARC Centre of Excellence for Nanoscale BioPhotonics & Institute for Photonics and Advanced Sensing, The University of Adelaide, Adelaide, SA, 5005, Australia
| | - J G Thompson
- Robinson Research Institute, Adelaide Medical School, The University of Adelaide, Adelaide, SA, 5005, Australia; ARC Centre of Excellence for Nanoscale BioPhotonics & Institute for Photonics and Advanced Sensing, The University of Adelaide, Adelaide, SA, 5005, Australia.
| |
Collapse
|
45
|
Dietrich JE, Freis A, Beedgen F, von Horn K, Holschbach V, Liebscher J, Strowitzki T, Germeyer A. Intraindividual Embryo Morphokinetics Are Not Affected by a Switch of the Ovarian Stimulation Protocol Between GnRH Agonist vs. Antagonist Regimens in Consecutive Cycles. Front Endocrinol (Lausanne) 2020; 11:246. [PMID: 32411093 PMCID: PMC7198727 DOI: 10.3389/fendo.2020.00246] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 04/03/2020] [Indexed: 11/26/2022] Open
Abstract
Background: The impact of controlled ovarian stimulation (COS) during medically assisted reproduction (MAR) on human embryogenesis is still unclear. Therefore, we investigated if early embryonic development is affected by the type of gonadotropin-releasing hormone (GnRH) analog used to prevent a premature LH surge. We compared embryo morphology and morphokinetics between GnRH agonist and antagonist cycles, both involving human chorionic gonadotropin (hCG)-trigger. To reduce possible confounding factors, we used intraindividual comparison of embryo morphokinetics in consecutive treatment cycles of the same patients that underwent a switch in the COS protocol. Methods: This retrospective cohort study analyzed morphokinetics of embryos from patients (n = 49) undergoing a switch in COS protocols between GnRH agonists followed by GnRH antagonists, or vice versa, after culture in a time-lapse incubator (EmbryoScope®, Vitrolife) in our clinic between 06/2011 and 11/2016 (n = 49 GnRH agonist cycles with n = 172 embryos; n = 49 GnRH antagonist cycles with n = 163 embryos). Among time-lapse cycles we included all embryos of the two consecutive cycles before and after a switch in the type of COS in the same patient. In-vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) was performed and embryos were imaged up to day 5. Data were analyzed using Mann-Whitney U test or Fisher's exact test. The significance level was set to p = 0.05. Patients with preimplantation genetic screening cycles were excluded. Results: The mean age (years ± standard deviation) of patients at the time of treatment was 35.7 ± 4.3 (GnRH agonist) and 35.8 ± 4.0 (GnRH antagonist) (p = 0.94). There was no statistically significant difference in the number of oocytes collected or the fertilization rate. The numbers of top quality embryos (TQE), good-quality embryos (GQE), or poor-quality embryos (PQE) were also not different in GnRH agonist vs. antagonist cycles. We found no statistically significant difference between the analyzed morphokinetic parameters between the study groups. Conclusions: Our finding supports the flexible use of GnRH analogs to optimize patient treatment for COS without affecting embryo morphokinetics.
Collapse
Affiliation(s)
- Jens E. Dietrich
- Department of Gynecologic Endocrinology and Fertility Disorders, Heidelberg University Women's Hospital, Heidelberg, Germany
- *Correspondence: Jens E. Dietrich
| | - Alexander Freis
- Department of Gynecologic Endocrinology and Fertility Disorders, Heidelberg University Women's Hospital, Heidelberg, Germany
| | - Franziska Beedgen
- Department of Gynecologic Endocrinology and Fertility Disorders, Heidelberg University Women's Hospital, Heidelberg, Germany
- Faculty of Veterinary Medicine, Justus-Liebig-University Giessen, Giessen, Germany
| | - Kyra von Horn
- Department of Gynecologic Endocrinology and Fertility Disorders, Heidelberg University Women's Hospital, Heidelberg, Germany
| | - Verena Holschbach
- Department of Gynecologic Endocrinology and Fertility Disorders, Heidelberg University Women's Hospital, Heidelberg, Germany
| | - Julia Liebscher
- Department of Gynecologic Endocrinology and Fertility Disorders, Heidelberg University Women's Hospital, Heidelberg, Germany
| | - Thomas Strowitzki
- Department of Gynecologic Endocrinology and Fertility Disorders, Heidelberg University Women's Hospital, Heidelberg, Germany
| | - Ariane Germeyer
- Department of Gynecologic Endocrinology and Fertility Disorders, Heidelberg University Women's Hospital, Heidelberg, Germany
| |
Collapse
|
46
|
‘There is only one thing that is truly important in an IVF laboratory: everything’ Cairo Consensus Guidelines on IVF Culture Conditions. Reprod Biomed Online 2020; 40:33-60. [DOI: 10.1016/j.rbmo.2019.10.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 09/22/2019] [Accepted: 10/02/2019] [Indexed: 02/06/2023]
|
47
|
Gianzo M, Urizar-Arenaza I, Muñoa-Hoyos I, Larreategui Z, Garrido N, Casis L, Irazusta J, Subirán N. Human sperm testicular angiotensin-converting enzyme helps determine human embryo quality. Asian J Androl 2019; 20:498-504. [PMID: 29873314 PMCID: PMC6116683 DOI: 10.4103/aja.aja_25_18] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Angiotensin-converting enzyme functions in the male reproductive system, but the extent of its function in reproduction is not fully understood. The primary objective of this work was to investigate the relationship between the testicular isoform of angiotensin-converting enzyme present in human spermatozoa and semen parameters, human embryo quality, and assisted reproduction success. A total of 81 semen samples and 635 embryos from couples undergoing oocyte donation cycles at the IVI Bilbao Clinic were analyzed. Semen parameters, embryos quality, and blastocyst development were examined according to the World Health Organization standards and the Spanish Association of Reproduction Biology Studies criteria. The percentage of testicular angiotensin-converting enzyme-positive spermatozoa and the number of molecules per spermatozoon were analyzed by flow cytometry. Both parameters were inversely correlated with human sperm motility. Higher percentages of testicular angiotensin-converting enzyme-positive spermatozoa together with fewer enzyme molecules per spermatozoon were positively correlated with better embryo quality and development. Our results suggest that embryos with a higher implantation potential come from semen samples with higher percentages of testicular angiotensin-converting enzyme-positive cells and fewer enzyme molecules per spermatozoon. Based on these findings, we propose that testicular angiotensin-converting enzyme could be used to aid embryologists in selecting better semen samples for obtaining high-quality blastocysts during in vitro fertilization procedures.
Collapse
Affiliation(s)
- Marta Gianzo
- Department of Physiology, Faculty of Medicine and Nursery, University of the Basque Country (UPV/EHU), Leioa, Biscay 48940, Spain
| | - Itziar Urizar-Arenaza
- Department of Physiology, Faculty of Medicine and Nursery, University of the Basque Country (UPV/EHU), Leioa, Biscay 48940, Spain
| | - Iraia Muñoa-Hoyos
- Department of Physiology, Faculty of Medicine and Nursery, University of the Basque Country (UPV/EHU), Leioa, Biscay 48940, Spain
| | - Zaloa Larreategui
- In Vitro Fertilization Laboratory, IVI Bilbao, Landabarri Promenade 1, Leioa, Biscay 48940, Spain
| | - Nicolás Garrido
- IVI Foundation, IVI Valencia, Local Police Square 3, Valencia 46015, Spain
| | - Luis Casis
- Department of Physiology, Faculty of Medicine and Nursery, University of the Basque Country (UPV/EHU), Leioa, Biscay 48940, Spain
| | - Jon Irazusta
- Department of Physiology, Faculty of Medicine and Nursery, University of the Basque Country (UPV/EHU), Leioa, Biscay 48940, Spain
| | - Nerea Subirán
- Department of Physiology, Faculty of Medicine and Nursery, University of the Basque Country (UPV/EHU), Leioa, Biscay 48940, Spain
| |
Collapse
|
48
|
Fang R, Yang W, Zhao X, Xiong F, Guo C, Xiao J, Chen L, Song X, Wang H, Chen J, Xiao X, Yao B, Cai LY. Chromosome screening using culture medium of embryos fertilised in vitro: a pilot clinical study. J Transl Med 2019; 17:73. [PMID: 30849973 PMCID: PMC6408780 DOI: 10.1186/s12967-019-1827-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 03/01/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Previous studies from this as well as other research groups suggested that non-invasive chromosome screening (NICS) with embryo culture medium can be used to identify chromosomal ploidy and chromosomal abnormalities. We here report a series of clinical cases utilizing the technology. METHODS A total of 45 couples underwent in vitro fertilisation during a period between February 2016 and February 2017. Karyotyping revealed normal chromosomes in both partners in 23 couples, and chromosomal rearrangements in at least one partner in 22 couples. Intracytoplasmic sperm injection (ICSI) was used for fertilization. NICS was carried out using embryo culture medium at the blastocyst stage via multiple annealing and looping-based amplification cycles, whole-genome amplification and next-generation sequencing. RESULTS A total of 413 embryos were obtained; 170 blastocysts were subjected to NICS. The screening showed euploidy in 79 embryos, aneuploidy in 52 embryos, and mosaic ploidy for 33 embryos. The rate of euploidy was comparable in couples with normal karyotype (50.7%; 38/75) vs. chromosomal rearrangement (43.2%; 41/95). A total of 52 euploid embryos (50 oocyte retrieval cycles) were transferred in 43 women. Biochemical pregnancy rate was 72.0% (36/50). Clinical pregnancy rate was 58.0% (29/50). The rate of spontaneous miscarriage was 3/29 (none with chromosomal aneuploidy). A total of 27 healthy babies were delivered. CONCLUSIONS NICS could identify embryo chromosomal abnormalities in couples either with or without chromosomal rearrangement, with satisfying clinical outcomes.
Collapse
Affiliation(s)
- Rui Fang
- Centre for Reproductive Medicine, Wuxi Maternity and Child Health Hospital Affiliated to Nanjing Medical University, Wuxi, 214002 Jiangsu China
| | - Weimin Yang
- Centre for Reproductive Medicine, Hebei Maternity and Reproductive Hospital, Shijiazhuang, 050090 Hebei China
| | - Xin Zhao
- Wuxi Maternity and Child Health Hospital Affiliated to Nanjing Medical University, Wuxi, 214002 Jiangsu China
| | - Fang Xiong
- Centre for Reproductive Medicine, Wuxi Maternity and Child Health Hospital Affiliated to Nanjing Medical University, Wuxi, 214002 Jiangsu China
| | - Caiqing Guo
- Wuxi Maternity and Child Health Hospital Affiliated to Nanjing Medical University, Wuxi, 214002 Jiangsu China
| | - Jianping Xiao
- Centre for Reproductive Medicine, Wuxi Maternity and Child Health Hospital Affiliated to Nanjing Medical University, Wuxi, 214002 Jiangsu China
| | - Li Chen
- Reproductive Medical Center of Nanjing Jinling Hospital and the Collaborative Innovation Platform for Reproductive Biology and Technology, Nanjing University School of Medicine, Nanjing, 210002 Jiangsu China
| | - Xiaoqing Song
- Centre for Reproductive Medicine, Wuxi Maternity and Child Health Hospital Affiliated to Nanjing Medical University, Wuxi, 214002 Jiangsu China
| | - Honghua Wang
- Centre for Reproductive Medicine, Wuxi Maternity and Child Health Hospital Affiliated to Nanjing Medical University, Wuxi, 214002 Jiangsu China
| | - Jie Chen
- Centre for Reproductive Medicine, Wuxi Maternity and Child Health Hospital Affiliated to Nanjing Medical University, Wuxi, 214002 Jiangsu China
| | - Xiao Xiao
- Centre for Reproductive Medicine, Wuxi Maternity and Child Health Hospital Affiliated to Nanjing Medical University, Wuxi, 214002 Jiangsu China
| | - Bing Yao
- Reproductive Medical Center of Nanjing Jinling Hospital and the Collaborative Innovation Platform for Reproductive Biology and Technology, Nanjing University School of Medicine, Nanjing, 210002 Jiangsu China
| | - Li-Yi Cai
- Centre for Reproductive Medicine, Wuxi Maternity and Child Health Hospital Affiliated to Nanjing Medical University, Wuxi, 214002 Jiangsu China
- Centre for Reproductive Medicine, Hebei Maternity and Reproductive Hospital, Shijiazhuang, 050090 Hebei China
| |
Collapse
|
49
|
Tola EN, Koşar PA, Karatopuk DU, Sancer O, Oral B. Effect of DNA damage of cumulus oophorus cells and lymphocytes analyzed by alkaline comet assay on oocyte quality and intracytoplasmic sperm injection success among patients with polycystic ovary syndrome. J Obstet Gynaecol Res 2018; 45:609-618. [PMID: 30515934 DOI: 10.1111/jog.13868] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 11/02/2018] [Indexed: 11/29/2022]
Abstract
AIM Cumulus oophorus cells (COC) exhibit a close relationship with the oocytes. We aimed to determine the role of the DNA integrity of COC and lymphocytes on the oocyte and embryo quality and intracytoplasmic sperm injection (ICSI) success. METHODS The COC obtained with the mechanical denudation of each oocyte and the lymphocytes obtained on oocyte retrieval day from 69 infertile polycystic ovary syndrome (PCOS) patients were used. The tail length, tail moment and tail DNA percentage were evaluated using an alkaline comet assay. The oocytes and embryos were graded. Clinical pregnancy was defined as the presence of a gestational sac with a beating heart. RESULTS All of the DNA integrity parameters of the COC and lymphocytes were similar between the good and poor quality oocytes and between the good and poor quality embryos. There was no relationship between the DNA damage parameters and the fertilization and clinical pregnancy. The day 2 hormone levels, body mass index and age were negatively correlated with the DNA integrity parameters. No links were found between the embryo and oocyte scores and the DNA damage parameters. CONCLUSION The DNA integrity of the COC and lymphocytes did not seem to be related to the oocyte and embryo quality and ICSI success.
Collapse
Affiliation(s)
- Esra N Tola
- Department of Obstetrics and Gynaecology, in vitro Fertilization Unit, Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey
| | - Pınar A Koşar
- Department of Medical Biology and Genetics, Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey
| | - Dilek U Karatopuk
- Department of Histology and Embryology, Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey
| | - Okan Sancer
- Department of Medical Biology and Genetics, Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey
| | - Baha Oral
- Department of Obstetrics and Gynaecology, in vitro Fertilization Unit, Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey
| |
Collapse
|
50
|
Martinez RM, Liang L, Racowsky C, Dioni L, Mansur A, Adir M, Bollati V, Baccarelli AA, Hauser R, Machtinger R. Extracellular microRNAs profile in human follicular fluid and IVF outcomes. Sci Rep 2018; 8:17036. [PMID: 30451969 PMCID: PMC6242846 DOI: 10.1038/s41598-018-35379-3] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 11/05/2018] [Indexed: 12/21/2022] Open
Abstract
Encapsulated microRNAs (i.e., miRNAs within the extracellular vesicles, i.e., EV-miRNAs) have been detected in follicular fluid in both animal and human studies and different profiles have been associated with IVF cycle characteristics. However, limited studies to date have investigated other IVF outcomes, including fertilization status and embryo quality on day three". In this cohort, we performed a cross-sectional analysis on 126 women who contributed follicular fluid from a single follicle during a single IVF cycle. One hundred and ninety-two EV-miRNAs were assessed by univariable fold-change and multivariable logistic regression analyses. Hsa-miR-92a and hsa-miR-130b, were over-expressed in follicular fluid samples from oocytes that failed to fertilize compared to those that were normally fertilized. Additionally, hsa-miR-888 was over-expressed and hsa-miR-214 and hsa-miR-454 were under-expressed in samples that resulted in impaired day-3 embryo quality compared to top-quality day-3 embryos. After adjusting for confounders as BMI, smoking and total motile sperm, associations of these EV-miRNAs remained significant. In-silico KEGG pathway analyses assigned the identified EV-miRNAs to pathways of follicular growth and development, cellular signaling, oocyte meiosis, and ovarian function. Our findings suggest that EV-miRNAs may play a role in pathways of ovarian function and follicle development, which could be essential for understanding the molecular mechanisms that could lead to a successful pregnancy and birth.
Collapse
Affiliation(s)
- Rosie M Martinez
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, 02115, USA
- Laboratory of Precision Environmental Biosciences, Department of Environmental Health Sciences, Columbia Mailman School of Public Health, New York, New York, 10032, USA
| | - Liming Liang
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, 02115, USA
| | - Catherine Racowsky
- Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, 02115, USA
| | - Laura Dioni
- EPIGET - Epidemiology, Epigenetics and Toxicology Lab, Department of Clinical Sciences and Community Health, University of Milan, 20122, Milano, Italy
| | - Abdallah Mansur
- Department of Obstetrics and Gynecology, Sheba Medical Center, Ramat-Gan, 52561, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Michal Adir
- Department of Obstetrics and Gynecology, Sheba Medical Center, Ramat-Gan, 52561, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Valentina Bollati
- EPIGET - Epidemiology, Epigenetics and Toxicology Lab, Department of Clinical Sciences and Community Health, University of Milan, 20122, Milano, Italy
| | - Andrea A Baccarelli
- Laboratory of Precision Environmental Biosciences, Department of Environmental Health Sciences, Columbia Mailman School of Public Health, New York, New York, 10032, USA
| | - Russ Hauser
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, 02115, USA
| | - Ronit Machtinger
- Department of Obstetrics and Gynecology, Sheba Medical Center, Ramat-Gan, 52561, Israel.
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| |
Collapse
|