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Griesinger G, Larsson P. Conventional outcome reporting per IVF cycle/embryo transfer may systematically underestimate chances of success for women undergoing ART: relevant biases in registries, epidemiological studies, and guidelines. Hum Reprod Open 2023; 2023:hoad018. [PMID: 37250429 PMCID: PMC10214861 DOI: 10.1093/hropen/hoad018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 03/14/2023] [Indexed: 05/31/2023] Open
Abstract
Pre-conception counselling and management of expectations about chance of success of IVF/ICSI treatments is an integral part of fertility care. Registry data are usually used to inform patients about expected success rates of IVF/ICSI treatment, as these data should best represent real-world populations and clinical practice. In registries, the success rate of IVF/ICSI treatments is conventionally reported per treatment cycle or per embryo transfer and estimated from data for which several treatment attempts per subject have been pooled (e.g. repetitive IVF/ICSI attempts or repetitive attempts of cryotransfer). This, however, may underestimate the true mean chance of success per treatment attempt, because treatment attempts of women with a poor prognosis will usually be over-represented in a pool of treatment cycle data compared to treatment events of women with a good prognosis. Of note, this phenomenon is also a source of potential bias when comparing outcomes between fresh transfers and cryotransfers, since women can undergo a maximum of only one fresh transfer after each IVF/ICSI treatment, but potentially several cryotransfers. Herein, we use a trial dataset from 619 women, who underwent one cycle of ovarian stimulation and ICSI, a Day 5 fresh transfer and/or subsequent cryotransfers (follow-up of all cryotransfers up to 1 year after the start of stimulation), to exemplify the underestimation of the live birth rate, when not accounting for repeated transfers in the same woman. Using mixed-effect logistic regression modelling, we show that the mean live birth rate per transfer per woman in cryocycles is underestimated by the factor 0.69 (e.g. live birth rate per cryotransfer of 36% after adjustment versus 25% unadjusted). We conclude that the average chance of success of treatment cycles of women of a given age, treated in a given centre, etc., when conventionally calculated per cycle or per embryo transfer from a pool of treatment events, do not apply to an individual woman. We suggest that patients are, especially at the outset of treatment, systematically confronted with mean estimates of success per attempt that are too low. Live birth rates per transfer from datasets encompassing multiple transfers from single individuals could be more accurately reported using statistical models accounting for the correlation between cycle outcomes within women.
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Affiliation(s)
- Georg Griesinger
- Correspondence address. University of Luebeck and University Hospital of Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538 Luebeck. Germany. Tel: +49-451-505-778-212; Fax: +49-451-505-778-210; E-mail: https://orcid.org/0000-0002-0606-5804
| | - Per Larsson
- Global Biometrics, Global Clinical Development, Ferring Pharmaceuticals, Kastrup, Denmark
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2
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Perrotta M, Geampana A. Enacting evidence-based medicine in fertility care: Tensions between commercialisation and knowledge standardisation. SOCIOLOGY OF HEALTH & ILLNESS 2021; 43:2015-2030. [PMID: 34564881 DOI: 10.1111/1467-9566.13381] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 07/21/2021] [Accepted: 08/31/2021] [Indexed: 06/13/2023]
Abstract
In this article we explore the recent enactment of evidence-based medicine (EBM) in the field of fertility care. We aim to contribute to the medical sociology literature through an analysis of how evidence is produced, interpreted and institutionalised in a relatively new medical field such as in vitro fertilisation (IVF), characterised by high uncertainty due to limited knowledge and high levels of commercialisation. Drawing on extensive ethnographic research conducted in England, this article explores the challenges IVF professionals encounter in producing credible data on the effectiveness of additional treatments, offering novel insights on the tensions between commercialisation and standardisation in the enactment of EBM. Extant medical sociology and Science and Technology Studies literature has shown the hidden professional work required to enact randomised control trials in practice. Our analysis shows that this hidden work is not enough when there is a broader lack of standardisation in both clinical and research practices, as producing 'good quality' evidence requires high levels of standardisation of knowledge production.
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Affiliation(s)
- Manuela Perrotta
- Department of People and Organisations, Queen Mary University of London, London, UK
| | - Alina Geampana
- Department of Sociology and Policy, Aston University, Birmingham, UK
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3
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Large randomized controlled trials in infertility. Fertil Steril 2020; 113:1093-1099. [DOI: 10.1016/j.fertnstert.2020.04.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 04/15/2020] [Accepted: 04/16/2020] [Indexed: 01/12/2023]
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4
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‘There is only one thing that is truly important in an IVF laboratory: everything’ Cairo Consensus Guidelines on IVF Culture Conditions. Reprod Biomed Online 2020; 40:33-60. [DOI: 10.1016/j.rbmo.2019.10.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 09/22/2019] [Accepted: 10/02/2019] [Indexed: 02/06/2023]
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Wilkinson J, Brison DR, Duffy JMN, Farquhar CM, Lensen S, Mastenbroek S, van Wely M, Vail A. Don’t abandon RCTs in IVF. We don’t even understand them. Hum Reprod 2019. [PMCID: PMC6994932 DOI: 10.1093/humrep/dez199] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
The conclusion of the Human Fertilisation and Embryology Authority that ‘add-on’ therapies in IVF are not supported by high-quality evidence has prompted new questions regarding the role of the randomized controlled trial (RCT) in evaluating infertility treatments. Critics argue that trials are cumbersome tools that provide irrelevant answers. Instead, they argue that greater emphasis should be placed on large observational databases, which can be analysed using powerful algorithms to determine which treatments work and for whom. Although the validity of these arguments rests upon the sciences of statistics and epidemiology, the discussion to date has largely been conducted without reference to these fields. We aim to remedy this omission, by evaluating the arguments against RCTs in IVF from a primarily methodological perspective. We suggest that, while criticism of the status quo is warranted, a retreat from RCTs is more likely to make things worse for patients and clinicians.
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Affiliation(s)
- J Wilkinson
- Centre for Biostatistics, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - D R Brison
- Department of Reproductive Medicine, Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, UK
- Maternal and Fetal Health Research Centre, Faculty of Life Sciences, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - J M N Duffy
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- Balliol College, University of Oxford, Oxford, UK
| | - C M Farquhar
- Cochrane Gynecology and Fertility Group, Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - S Lensen
- Cochrane Gynecology and Fertility Group, Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - S Mastenbroek
- Amsterdam UMC, University of Amsterdam, Center for Reproductive Medicine, Amsterdam Reproduction & Development Research Institute, Amsterdam, Netherlands
| | - M van Wely
- Amsterdam UMC, University of Amsterdam, Center for Reproductive Medicine, Amsterdam Reproduction & Development Research Institute, Amsterdam, Netherlands
| | - A Vail
- Centre for Biostatistics, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
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Wilkinson J, Malpas P, Hammarberg K, Mahoney Tsigdinos P, Lensen S, Jackson E, Harper J, Mol BW. Do à la carte menus serve infertility patients? The ethics and regulation of in vitro fertility add-ons. Fertil Steril 2019; 112:973-977. [PMID: 31703942 DOI: 10.1016/j.fertnstert.2019.09.028] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 09/18/2019] [Accepted: 09/20/2019] [Indexed: 01/08/2023]
Abstract
Add-on treatments are the new black. They are provided (most frequently, sold) to patients undergoing in vitro fertilization on the premise that they will improve the chances of having a baby. However, the regulation of add-ons is consistently minimal, meaning that they are introduced into routine practice before they have been shown to improve the live birth rate. Debate on the adequacy of this light-touch approach rages. Defenders argue that demands for a rigorous approval process are paternalistic, as this would delay access to promising treatments. Critics respond that promising treatments may turn out to have adverse effects on patients and their offspring, contradicting the clinician's responsibility to do no harm. Some add-ons, including earlier versions of preimplantation genetic testing for aneuploidy, might even reduce the live birth rate, raising the prospect of desperate patients paying more to worsen their chances. Informed consent represents a solution in principle, but in practice there is a clear tension between impartial information and direct-to-consumer advertising. Because the effects of a treatment cannot be known until it has been robustly evaluated, we argue that strong evidence should be required before add-ons are introduced to the clinic. In the meantime, there is an imperative to identify methods for communicating the associated risks and uncertainties of add-ons to prospective patients.
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Affiliation(s)
- Jack Wilkinson
- Centre for Biostatistics, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom.
| | - Phillipa Malpas
- Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Karin Hammarberg
- Jean Hailes Research Unit, School of Public Health and Preventative Medicine, Monash University, Clayton, Victoria, Australia
| | | | - Sarah Lensen
- Cochrane Gynecology and Fertility Group, University of Auckland, Auckland, New Zealand
| | - Emily Jackson
- Law Department, London School of Economics and Political Science, London, United Kingdom
| | - Joyce Harper
- Department of Reproductive Health, Institute for Women's Health, University College London, London, United Kingdom
| | - Ben W Mol
- Evidence-based Women's Health Care Research Group, Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
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Tannus S, Cohen Y, Henderson S, Son WY, Tulandi T. The Effect of Assisted Hatching on Live Birth Rate Following Fresh Embryo Transfer in Advanced Maternal Age. Reprod Sci 2018; 26:806-811. [PMID: 30213229 DOI: 10.1177/1933719118799192] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Assisted hatching (AH) was introduced 3 decades ago as an adjunct method to in vitro fertilization (IVF) and embryo transfer (ET) to improve embryo implantation rate. Limited data are available on the effect of AH on live birth rate (LBR) in advanced maternal age. The objective of this study is to investigate the effect of AH on LBR in women aged 40 years and older. MATERIALS AND METHODS A retrospective study conducted at a single academic reproductive center. Women aged ≥40 years, who were undergoing their first IVF cycle were included. Laser-assisted hatching was the method used for AH and single or double embryos were transferred. Embryo transfer was performed at the cleavage or blastocyst stage. Separate analysis was performed on each ET stage. Live birth rate was the primary outcome. RESULTS A total of 892 patients were included. Of these, 681 women underwent cleavage ET and 211 underwent blastocyst ET. The clinical pregnancy rate in the entire group was 15.3% and the LBR was 10.2%. Baseline and cycle parameters between the AH group and the control group were comparable. Assisted hatching in the cleavage stage was associated with lower clinical pregnancy rate (odds ratio [OR], 0.52; confidence interval [CI], 0.31-0.86; P = .012) and lower LBR (OR, 0.36; CI, 0.19-0.68; P = .001). Assisted hatching did not have any effect on outcomes in blastocyst ET. CONCLUSION Assisted hatching does not improve the reproductive outcomes in advanced maternal age. Performing routine AH for the sole indication of advanced maternal age is not clinically justified.
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Affiliation(s)
- Samer Tannus
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, McGill University Health Centre, 1001 Decarie Blvd, Montreal, Québec, Canada, H4A 3J1.
| | - Yoni Cohen
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, McGill University Health Centre, 1001 Decarie Blvd, Montreal, Québec, Canada, H4A 3J1
| | - Sara Henderson
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, McGill University Health Centre, 1001 Decarie Blvd, Montreal, Québec, Canada, H4A 3J1
| | - Weon-Young Son
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, McGill University Health Centre, 1001 Decarie Blvd, Montreal, Québec, Canada, H4A 3J1
| | - Togas Tulandi
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, McGill University Health Centre, 1001 Decarie Blvd, Montreal, Québec, Canada, H4A 3J1
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8
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Le MT, Nguyen TTA, Nguyen TTT, Nguyen VT, Le DD, Nguyen VQH, Cao NT, Aints A, Salumets A. Thinning and drilling laser-assisted hatching in thawed embryo transfer: A randomized controlled trial. Clin Exp Reprod Med 2018; 45:129-134. [PMID: 30202743 PMCID: PMC6125152 DOI: 10.5653/cerm.2018.45.3.129] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 06/19/2018] [Accepted: 07/04/2018] [Indexed: 11/06/2022] Open
Abstract
Objective In frozen and thawed embryos, the zona pellucida (ZP) can be damaged due to hardening. Laser-assisted hatching (LAH) of embryos can increase the pregnancy rate. This study compared thinning and drilling of the ZP before frozen embryo transfer (FET). Methods Patients were randomly allocated into two groups for LAH using thinning or drilling on day 2 after thawing. Twenty-five percent of the ZP circumference and 50% of the ZP thickness was removed in the thinning group, and a hole 40 µm in diameter was made in the drilling group. Results A total of 171 in vitro fertilization/intracytoplasmic sperm injection FET cycles, including 85 cycles with drilling LAH and 86 cycles with thinning LAH, were carried out. The thinning group had a similar β-human chorionic gonadotropin-positive rate (38.4% vs. 29.4%), implantation rate (16.5% vs. 14.4%), clinical pregnancy rate (36.0% vs. 25.9%), miscarriage rate (5.8% vs. 2.4%), ongoing pregnancy rate (30.2% vs. 23.5%), and multiple pregnancy rate (7.0% vs. 10.6%) to the drilling LAH group. There were no significant differences in pregnancy outcomes between subgroups defined based on age (older or younger than 35 years) or ZP thickness (greater or less than 17 µm) according to the LAH method. Conclusion The present study demonstrated that partial ZP thinning or drilling resulted in similar outcomes in implantation and pregnancy rates using thawed embryos, irrespective of women's age or ZP thickness.
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Affiliation(s)
- Minh Tam Le
- Center for Reproductive Endocrinology and Infertility (HUECREI), Hue University of Medicine and Pharmacy, Hue, Vietnam.,Department of Obstetrics and Gynecology, Hue University of Medicine and Pharmacy, Hue, Vietnam
| | - Thi Tam An Nguyen
- Center for Reproductive Endocrinology and Infertility (HUECREI), Hue University of Medicine and Pharmacy, Hue, Vietnam
| | - Thi Thai Thanh Nguyen
- Center for Reproductive Endocrinology and Infertility (HUECREI), Hue University of Medicine and Pharmacy, Hue, Vietnam
| | - Van Trung Nguyen
- Center for Reproductive Endocrinology and Infertility (HUECREI), Hue University of Medicine and Pharmacy, Hue, Vietnam
| | - Dinh Duong Le
- Department of Public Health, Hue University of Medicine and Pharmacy, Hue, Vietnam
| | - Vu Quoc Huy Nguyen
- Department of Obstetrics and Gynecology, Hue University of Medicine and Pharmacy, Hue, Vietnam
| | - Ngoc Thanh Cao
- Center for Reproductive Endocrinology and Infertility (HUECREI), Hue University of Medicine and Pharmacy, Hue, Vietnam.,Department of Obstetrics and Gynecology, Hue University of Medicine and Pharmacy, Hue, Vietnam
| | - Alar Aints
- Institute of Clinical Medicine, Department of Obstetrics and Gynecology, University of Tartu, Tartu, Estonia
| | - Andres Salumets
- Institute of Clinical Medicine, Department of Obstetrics and Gynecology, University of Tartu, Tartu, Estonia.,Competence Centre on Health Technologies, Tartu, Estonia.,Institute of Biomedicine and Translational Medicine, University of Tartu, Tartu, Estonia.,Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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9
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Defining the appropriate laboratory environment for fostering healthy embryogenesis in humans: a place for consensus. Reprod Biomed Online 2018; 36:605-606. [PMID: 29860980 DOI: 10.1016/j.rbmo.2018.04.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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10
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Nada AM, El-Noury A, Al-Inany H, Bibars M, Taha T, Salama S, Hassan F, Zein E. Effect of laser-assisted zona thinning, during assisted reproduction, on pregnancy outcome in women with endometriosis: randomized controlled trial. Arch Gynecol Obstet 2018; 297:521-528. [PMID: 29214348 DOI: 10.1007/s00404-017-4604-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 11/15/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To compare the ICSI-ET outcomes in patients with endometriosis with or without laser-assisted zona pellucida thinning. DESIGN Randomized controlled trial. SETTING The study was conducted in the Obstetrics & Gynecology Department, Cairo University hospital, and two private IVF centers in Cairo & Beni-Suif from July 2015 to January 2017 upon infertile and known endometriosis patients who planned to do ICSI-ET. INTERVENTIONS Before randomization, all patients received the same ovarian stimulation preparation, oocyte retrieval procedures, and the same intracytoplasmic sperm injection procedures. After randomization, laser-assisted hatching was performed only for embryos of 158 patients, while the other group (n = 150) no laser-assisted hatching was made. The verification of pregnancy was achieved by the serum hCG concentration 14 days after the embryo transfer, and the clinical pregnancy was confirmed 2 weeks later by the presence of gestational sac with pulsating fetal pole on vaginal ultrasonography. MEASUREMENTS The main outcome measures were the clinical pregnancy rate and the clinical implantation rate. MAIN RESULTS Both groups were comparable with regard their baseline characteristics, baseline hormonal profile, the ovarian stimulation characteristics, and the ovulation characteristics. The mean number of embryos developed per patient and the mean transferred number of embryos per patient were comparable between groups (p value > 0.05). The implantation rate was significantly higher (p value 0.002) in the study group than the control group with an odds ratio of 1.86 (CI 95% 1.24-2.80) and NNT 13.81 (CI 95% 8.35-39.94). The clinical pregnancy rate, was significantly (p value 0.022) higher in the study group than in the control group with an odds ratio of 1.79 (CI 95% 1.05-3.06) and NNT 9.57 (CI 95% 5.03-98.99). CONCLUSION That laser-assisted hatching by thinning of the zona pellucida may be a suitable method to improve the ICSI-ET outcomes, in term of the implantation and the pregnancy rates, in cases of endometriosis. CLINICAL TRIAL REGISTRATION Pan African Clinical Trials Registry (PACTR), http://www.pactr.org/ATMWeb/appmanager/atm/atmregistry?dar=true&tNo=PACTR201502001022393 , PACTR201602001467322.
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Affiliation(s)
- Adel Mohamed Nada
- Department of Gynecology and Obstetrics, Faculty of Medicine, Cairo University, 4A/19 Division 3-Zahraa Almaady, 11555, Cairo, Egypt.
| | - Amr El-Noury
- Obstetrics and Gynecology, National Laser Institute (NLI), Cairo University, Cairo, Egypt
| | - Hesham Al-Inany
- Department of Gynecology and Obstetrics, Faculty of Medicine, Cairo University, 4A/19 Division 3-Zahraa Almaady, 11555, Cairo, Egypt
| | | | - Tamer Taha
- National Research Center (NRC), Cairo, Egypt
| | | | | | - Eman Zein
- Department of Gynecology and Obstetrics, Faculty of Medicine, BeniSuif University, Beni Suef, Egypt
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11
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Pribenszky C, Nilselid AM, Montag M. Time-lapse culture with morphokinetic embryo selection improves pregnancy and live birth chances and reduces early pregnancy loss: a meta-analysis. Reprod Biomed Online 2017; 35:511-520. [DOI: 10.1016/j.rbmo.2017.06.022] [Citation(s) in RCA: 106] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 06/30/2017] [Accepted: 06/30/2017] [Indexed: 11/30/2022]
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Abstract
The aim was to identify cell and genetic predictors of human blastocyst hatching success in assisted reproduction programmes via a prospective case-control study. Blastocysts, donated by couples in assisted reproduction programmes were used. Hatching success assessment was performed after 144-146 h post-fertilization. The mRNA expression levels of cathepsin V (CTSV), GATA-binding protein 3 (GATA3) and human chorionic gonadotropin beta subunit 3, 5, 7 and 8 (CGB) genes were detected by quantitative real-time polymerase chain reaction. The odds ratio (OR) of hatching due to zona pellucida (ZP) thickness, oocyte and sperm quality, embryo quality and mRNA expression of CTSV, GATA3 and CGB genes in blastocysts was determined. From 62 blastocysts included in the study, 47 (75.8%) were unable to hatch spontaneously. The ZP thickening, and oocyte and sperm quality did not affect human blastocyst ability to hatch, except the combination of cytoplasmic and extracytoplasmic oocyte dysmorphisms (OR = 1.25; 95% confidence interval = 1.08, 1.45). Hatching-capable blastocysts had higher Gardner scale grade and mRNA expression of CTSV, GATA3 and CGB genes than hatching-incapable blastocysts. The human blastocyst hatching success depends on the blastocyst Gardner grade, but not on ZP and gamete quality. Blastocyst development was regulated by CTSV, GATA3 and CGB gene expression.
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Swain JE, Carrell D, Cobo A, Meseguer M, Rubio C, Smith GD. Optimizing the culture environment and embryo manipulation to help maintain embryo developmental potential. Fertil Steril 2016; 105:571-587. [PMID: 26851765 DOI: 10.1016/j.fertnstert.2016.01.035] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 01/25/2016] [Accepted: 01/26/2016] [Indexed: 12/30/2022]
Abstract
With increased use of comprehensive chromosome screening (CCS), the question remains as to why some practices do not experience the same high levels of clinical success after implementation of the approach. Indeed, the debate surrounding the efficacy and usefulness of blastocyst biopsy and CCS continues. Importantly, several variables impact the success of an assisted reproductive technology cycle. Transfer of a euploid embryo is but one factor in an intricate system that requires numerous steps to occur successfully. Certainly, the culture environment and the manipulations of the embryo during its time in the laboratory can impact its reproductive potential. Environmental stressors ranging from culture media to culture conditions and even culture platform can impact biochemical, metabolic, and epigenetic patterns that can affect the developing cell independent of chromosome number. Furthermore, accompanying procedures, such as biopsy and vitrification, are complex and, when performed improperly, can negatively impact embryo quality. These are areas that likely still carry room for improvement within the IVF laboratory.
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Affiliation(s)
| | - Doug Carrell
- Department of Surgery (Urology) and Human Genetics, University of Utah School of Medicine, Salt Lake City, Utah
| | - Ana Cobo
- Instituto Valenciano de Infertilidad, Valencia, Spain
| | | | | | - Gary D Smith
- Department of Molecular and Integrative Physiology, Ob/Gyn, Urology, University of Michigan, Ann Arbor, Michigan
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14
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Palini S, De Stefani S, Primiterra M, Galluzzi L. Pre-implantation genetic diagnosis and screening: now and the future. Gynecol Endocrinol 2015; 31:755-9. [PMID: 26291813 DOI: 10.3109/09513590.2015.1068752] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Since 1989, the year of the first pre-implantation genetic diagnosis (PGD), many developments occurred both in assisted reproduction techniques and in molecular tools. While PGD is a well-established and documented application, pre-implantation genetic screening (PGS) for the detection of aneuploid embryos is still debated due to the presence of mosaicism in the embryo, but especially to the knowledge of the limits that label an embryo as healthy or as appropriate to the life. The aim of this review is to present the state-of-the-art in the field of PGD and PGS, illustrating its benefits and limitations, along with biopsy techniques and the use of new high-throughput technologies.
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Affiliation(s)
- Simone Palini
- a IVF Unit, "Cervesi" Hospital Cattolica , Cattolica , Province of Rimini , Italy and
| | - Silvia De Stefani
- a IVF Unit, "Cervesi" Hospital Cattolica , Cattolica , Province of Rimini , Italy and
| | - Mariangela Primiterra
- a IVF Unit, "Cervesi" Hospital Cattolica , Cattolica , Province of Rimini , Italy and
| | - Luca Galluzzi
- b Department of Biomolecular Sciences , University of Urbino , Urbino , Province of Pesaro e Urbino , Italy
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15
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Elder K, Johnson MH. The Oldham Notebooks: an analysis of the development of IVF 1969-1978. III. Variations in procedures. REPRODUCTIVE BIOMEDICINE & SOCIETY ONLINE 2015; 1:19-33. [PMID: 28299362 PMCID: PMC5341287 DOI: 10.1016/j.rbms.2015.04.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
A survey is presented of the various technical and scientific challenges that had to be met during the 10-year period before the first successful live birth after IVF and embryo transfer was achieved, and the approaches used to meet these challenges is discussed. Records dated from January 1969 to July 1978 indicate that a minimum of 282 women were involved in 495 cycles scheduled for laparoscopic oocyte recovery, of which 457 cycles (92%) proceeded to attempted egg collection. A total of 1361 eggs were recovered over 388 cycles, of which 1237 (91%) are recorded as having been inseminated in 331 (85%) of these cycles. Approximately 221 embryos were described in 165 (43%) of the 388 cycles. A total of 112 embryo transfers were attempted, which resulted in five clinical pregnancies with two live births. This paper discusses the ways in which hormonal stimulation of follicle growth to the pre-ovulatory stage was varied, and the endocrine monitoring of these variations in blood, urine and follicular fluid, as well as their influence on egg recovery and fertilization rates. Variations in media composition and preparation are also described. It is concluded that, whilst driven by scientific reasoning, the approach adopted in trying to achieve successful IVF was empirical rather than evidence-driven.
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Affiliation(s)
- Kay Elder
- Bourn Hall Clinic, Bourn, Cambridge CB23 2TN, UK
| | - Martin H. Johnson
- Anatomy School and Centre for Trophoblast Research, Department of Physiology, Development and Neuroscience, Downing Street, Cambridge CB2 3DY, UK
- Corresponding author.
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Schimmel T, Cohen J, Saunders H, Alikani M. Laser-assisted zona pellucida thinning does not facilitate hatching and may disrupt the in vitro hatching process: a morphokinetic study in the mouse. Hum Reprod 2014; 29:2670-9. [PMID: 25267786 PMCID: PMC4227580 DOI: 10.1093/humrep/deu245] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
STUDY QUESTION Does laser-assisted zona thinning of cleavage stage mouse embryos facilitate hatching in vitro? SUMMARY ANSWER No, unlike laser zona opening, zona thinning does not facilitate embryo hatching. WHAT IS KNOWN ALREADY Artificial opening of the zona pellucida facilitates hatching of mouse and human embryos. Laser-assisted zona thinning has also been used for the purpose of assisted hatching of human embryos but it has not been properly investigated in an animal model; thinning methods have produced inconsistent clinical results. STUDY DESIGN, SIZE, DURATION Time-lapse microscopy was used to study the hatching process in the mouse after zona opening and zona thinning; a control group of embryos was not zona-manipulated but exposed to the same laser energy. PARTICIPANTS/MATERIALS, SETTING, METHODS Eight-cell CB6F1/J mouse embryos were pooled and allocated to three groups (n = 56 per group): A control group of embryos that were exposed to a dose of laser energy focused outside the zona pellucida (zona intact); one experimental group of embryos in which the zona pellucida was opened by complete ablation using the same total number of pulses as the control group; a second experimental group of embryos in which the zona pellucida was thinned to establish a smooth lased area using the same number of pulses as used in the other two groups. The width of the zona opening was 25 μm and width of the thinned area was 35 μm. Development was monitored by time-lapse microscopy. Overall treatment differences for continuous variables were analyzed by analysis of variance and pairwise comparisons using the Student t-test allowing for unequal variances, while for categorical data, a standard chi-squared test was utilized for all pairwise comparisons. MAIN RESULTS AND THE ROLE OF CHANCE The frequency of complete hatching was 33.9% in the control group, 94.4% after zona opening, and 39.3% after zona thinning (overall group comparison, P < 0.0001). Overall, 60.7% of the zona-thinned embryos did not complete the hatching process and remained trapped within the zona; when they did hatch, they did not necessarily hatch from the zona-thinned area. Hatching in about one-third of the zona-intact embryos began with breaches at multiple sites by small groups of cells. Likewise, 53.6% of zona-thinned embryos had multiple breaches, always involving an area outside the thinned zone. Zona opening decreased multiple breaching and led to blastocyst escape an average of 14 h earlier than zona-thinned embryos and 5.5 h before control embryos (P = 0.0003). LIMITATIONS, REASONS FOR CAUTION The experiments presented here were limited to in vitro experiments performed in the mouse. Whether human embryos would behave the same way under similar circumstances is unknown. We postulate that zona thinning is not beneficial in human embryos. WIDER IMPLICATIONS OF THE FINDINGS The experiments demonstrate that zona thinning is not equivalent to zona opening for assisted hatching. The study provides reason for systematic reviews of assisted hatching trials to take the method of assisted hatching into consideration and not combine the results of zona thinning and zona opening procedures. STUDY FUNDING/COMPETING INTEREST(S) Institutional funds were used for the study. No competing interests are declared.
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Affiliation(s)
- Tim Schimmel
- Tyho-Galileo Research Laboratories, ART Institute of Washington, 3 Regent Street, Suite 301, Livingston, NJ 07039, USA
| | - Jacques Cohen
- Tyho-Galileo Research Laboratories, ART Institute of Washington, 3 Regent Street, Suite 301, Livingston, NJ 07039, USA
| | | | - Mina Alikani
- Center for Human Reproduction, North Shore University Hospital, 300 Community Drive, Manhasset, NY 11030, USA
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