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Kakulavarapu R, Stensen MH, Jahanlu D, Haugen TB, Delbarre E. Altered morphokinetics and differential reproductive outcomes associated with cell exclusion events in human embryos. Reprod Biomed Online 2023; 47:103285. [PMID: 37573752 DOI: 10.1016/j.rbmo.2023.103285] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 06/19/2023] [Accepted: 07/05/2023] [Indexed: 08/15/2023]
Abstract
RESEARCH QUESTION Can embryos harbouring cell exclusion and their reproductive outcomes be classified based on morphokinetic profiles? DESIGN A total of 469 time-lapse videos of embryos transferred between 2013 and 2019 from a single clinic were analysed. Videos were assessed and grouped according to the presence or absence of one or more excluded cells before compaction. Cell division timings, intervals between subsequent cell divisions and dynamic intervals were analysed to determine the morphokinetic profiles of embryos with cell exclusion (CE+), compared with fully compacted embryos without cell exclusion or extrusion (CE-). RESULTS Transfer of CE+ embryos resulted in lower proportions of fetal heartbeat (FHB) and live birth compared with CE- embryos (both, P < 0.001). CE+ embryos were associated with delays in t2 (P = 0.030), t6 (P = 0.018), t7 (P < 0.001), t8 (P = 0.001), tSC (P < 0.001) and tM (P < 0.001). Earlier timings for t3 (P = 0.014) and t5 (P < 0.001) were positively associated with CE+; CE+ embryos indicated prolonged S2, S3, ECC3, cc2 and cc4. Logistic regression analysis revealed that t5, tM, S2 and ECC3 were the strongest predictive indicators of cell exclusion. Timings for S2 and ECC3 were useful in identifying increased odds of FHB when a cell exclusion event was present. CONCLUSION Embryos harbouring cell exclusion indicated altered morphokinetic profiles. Their overall lower reproductive success was associated with two morphokinetic parameters. Morphokinetic profiles could be used as adjunct indicators for reproductive success during cycles producing few, low-quality embryos. This may allow more objective identification of cell exclusion and refinement of embryo ranking procedures before transfer.
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Affiliation(s)
- Radhika Kakulavarapu
- Department of Life Sciences and Health, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway..
| | | | - David Jahanlu
- Department of Life Sciences and Health, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Trine B Haugen
- Department of Life Sciences and Health, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Erwan Delbarre
- Department of Life Sciences and Health, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway..
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2
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Wu C, Fu L, Tian Z, Liu J, Song J, Guo W, Zhao Y, Zheng D, Jin Y, Yi D, Jiang X. LWMA-Net: Light-weighted morphology attention learning for human embryo grading. Comput Biol Med 2022; 151:106242. [PMID: 36436483 DOI: 10.1016/j.compbiomed.2022.106242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 09/23/2022] [Accepted: 10/22/2022] [Indexed: 11/16/2022]
Abstract
Visual inspection of embryo morphology is routinely used in embryo assessment and selection. However, due to the complexity of morphologies and large inter- and intra-observer variances among embryologists, manual evaluations remain to be subjective and time-consuming. Thus, we proposed a light-weighted morphology attention learning network (LWMA-Net) for automatic assistance on embryo grading. The LWMA-Net integrated a morphology attention module (MAM) to seek the informative features and their locations and a multiscale fusion module (MFM) to increase the features flowing in the model. The LWMA-Net was trained with a primary set of 3599 embryos from 2318 couples that were clinically enrolled between Sep. 2016 and Dec. 2018, and generated area under the receiver operating characteristic curves (AUCs) of 96.88% and 97.58% on 4- and 3-category gradings, respectively. An independent test set comprises 691 embryos from 321 couples between Jan. 2019 and Jan. 2021 were used to test the assisted fertility values on the embryo grading. Five experienced embryologists were invited to regrade the embryos in the independent set with and without the aid of the LWMA-Net three months apart. Embryologists aided by our LWMA-Net significantly improved their grading capabilities with average AUCs improved by 4.98%-5.32% on 4- and 3-category grading tasks, respectively, which suggests good potential of our LWMA-Net on assisted human reproduction.
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Affiliation(s)
- Chongwei Wu
- Department of Biomedical Engineering, School of Intelligent Medicine, China Medical University, Shenyang, 110122, China
| | - Langyuan Fu
- Department of Biomedical Engineering, School of Intelligent Medicine, China Medical University, Shenyang, 110122, China
| | - Zhiying Tian
- Key Laboratory of Reproductive Health and Medical Genetics, National Health and Family Planning Commission, Liaoning Research Institute of Family Planning, Shenyang, 110031, China
| | - Jiao Liu
- Department of Reproductive Medicine, Dalian Municipal Women and Children's Medical Center (Group), Dalian, 116083, China
| | - Jiangdian Song
- School of Medical Informatics, China Medical University, Shenyang, 110122, China
| | - Wei Guo
- College of Computer Science, Shenyang Aerospace University, Shenyang, 110136, China
| | - Yu Zhao
- Department of Reproductive Medicine, Dalian Municipal Women and Children's Medical Center (Group), Dalian, 116083, China
| | - Duo Zheng
- Department of Biomedical Engineering, School of Intelligent Medicine, China Medical University, Shenyang, 110122, China
| | - Ying Jin
- Key Laboratory of Reproductive Health and Medical Genetics, National Health and Family Planning Commission, Liaoning Research Institute of Family Planning, Shenyang, 110031, China
| | - Dongxu Yi
- Key Laboratory of Reproductive Health and Medical Genetics, National Health and Family Planning Commission, Liaoning Research Institute of Family Planning, Shenyang, 110031, China
| | - Xiran Jiang
- Department of Biomedical Engineering, School of Intelligent Medicine, China Medical University, Shenyang, 110122, China.
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3
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Kim J, Lee J, Jun JH. Non-invasive evaluation of embryo quality for the selection of transferable embryos in human in vitro fertilization-embryo transfer. Clin Exp Reprod Med 2022; 49:225-238. [PMID: 36482497 PMCID: PMC9732075 DOI: 10.5653/cerm.2022.05575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 11/09/2022] [Accepted: 11/10/2022] [Indexed: 07/28/2023] Open
Abstract
The ultimate goal of human assisted reproductive technology is to achieve a healthy pregnancy and birth, ideally from the selection and transfer of a single competent embryo. Recently, techniques for efficiently evaluating the state and quality of preimplantation embryos using time-lapse imaging systems have been applied. Artificial intelligence programs based on deep learning technology and big data analysis of time-lapse monitoring system during in vitro culture of preimplantation embryos have also been rapidly developed. In addition, several molecular markers of the secretome have been successfully analyzed in spent embryo culture media, which could easily be obtained during in vitro embryo culture. It is also possible to analyze small amounts of cell-free nucleic acids, mitochondrial nucleic acids, miRNA, and long non-coding RNA derived from embryos using real-time polymerase chain reaction (PCR) or digital PCR, as well as next-generation sequencing. Various efforts are being made to use non-invasive evaluation of embryo quality (NiEEQ) to select the embryo with the best developmental competence. However, each NiEEQ method has some limitations that should be evaluated case by case. Therefore, an integrated analysis strategy fusing several NiEEQ methods should be urgently developed and confirmed by proper clinical trials.
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Affiliation(s)
- Jihyun Kim
- Department of Obstetrics and Gynaecology, Seoul Medical Center, Seoul, Republic of Korea
| | - Jaewang Lee
- Department of Biomedical Laboratory Science, College of Health Science, Eulji University, Seongnam, Republic of Korea
| | - Jin Hyun Jun
- Department of Biomedical Laboratory Science, College of Health Science, Eulji University, Seongnam, Republic of Korea
- Department of Senior Healthcare, Graduate School, Eulji University, Seongnam, Republic of Korea
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Sayed S, Reigstad MM, Petersen BM, Schwennicke A, Hausken JW, Storeng R. Nucleation status of Day 2 pre-implantation embryos, acquired by time-lapse imaging during IVF, is associated with live birth. PLoS One 2022; 17:e0274502. [PMID: 36137104 PMCID: PMC9498959 DOI: 10.1371/journal.pone.0274502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 08/26/2022] [Indexed: 11/19/2022] Open
Abstract
The primary purpose of this time-lapse data analysis was to identify the association between the nucleation status of a Day 2 preimplantation embryo and live births following in vitro fertilization (IVF). The retrospective data analysis was based on 2769 transferred embryos from 1966 treatment cycles and utilised only Known Implantation Data (KID) for live births. Nucleation errors (NE) such as micronucleation, binucleation, multinucleation and minor error groups, were annotated in the time-lapse images which were taken every 15 minutes for a minimum of 44 hours post insemination. Further, factors that may impact NE and the relationship of early morphological attributes and morphokinetic variables with NE occurrence were explored. The frequency of NE among the transferred embryos was 23.8%. The reversibility of NE evidenced by their presence at the two-cell stage, but absence at the four-cell stage was 89.6%. Embryos exhibiting nucleation errors at the two-cell stage had significantly lower live birth rates compared to embryos with no nucleation errors, constituting a significant predictor. A Generalized Additive Mixed Model was used to control for confounders and for controlling clustering effects from dual embryo transfers. Increased incidences of NE were observed with increasing age, with delayed occurrence of cell divisions and in oocytes inseminated with surgically retrieved spermatozoa. NE assessment and their impact on live birth provides valuable markers for early preimplantation embryo selection. In addition, the high incidence of reversibility of NE and their possible impact on live birth suggest that incorporating two-cell nuclear status annotations in embryo selection, alongside morphology and morphokinetics, is of value.
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Affiliation(s)
- Shabana Sayed
- Klinikk Hausken, IVF and Gynecology, Haugesund, Norway
| | - Marte Myhre Reigstad
- Norwegian Research Centre on Women’s Health, Oslo University Hospital, Oslo, Norway
| | | | | | | | - Ritsa Storeng
- Norwegian Research Centre on Women’s Health, Oslo University Hospital, Oslo, Norway
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5
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van Duijn L, Rousian M, Kramer CS, van Marion ES, Willemsen SP, Speksnijder JP, Laven JSE, Steegers-Theunissen RPM, Baart EB. The Impact of Culture Medium on Morphokinetics of Cleavage Stage Embryos: An Observational Study. Reprod Sci 2022; 29:2179-2189. [PMID: 35534767 PMCID: PMC9352745 DOI: 10.1007/s43032-022-00962-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 04/27/2022] [Indexed: 11/28/2022]
Abstract
To study the impact of culture media on preimplantation morphokinetics used for predicting clinical outcomes. All IVF and ICSI cycles performed between 2012 and 2017 with time-lapse information available were included. In November 2014, culture medium was changed from Vitrolife G-1 PLUS to SAGE 1-Step. Each embryo was retrospectively assigned a morphokinetic-based KIDScore for prediction of implantation. Clinical outcomes were retrieved from medical records. Linear mixed models were used to study differences in morphokinetic parameters, a proportional odds model for KIDScore ranking and logistic regression for differences in clinical outcomes. All analyses were adjusted for patient and treatment characteristics. In 253 (63.1%) cycles, embryos (n = 671) were cultured in Vitrolife, and in 148 (36.9%) cycles, embryos (n = 517) were cultured in SAGE. All cleavage divisions occurred earlier for SAGE embryos than for Vitrolife embryos (2-cell: -2.28 (95%CI: -3.66, -0.89), 3-cell: -2.34 (95%CI: -4.00, -0.64), 4-cell: -2.41 (95%CI: -4.11, -0.71), 5-cell: -2.54 (95%CI: -4.90, -0.18), 6-cell: -3.58 (95%CI: -6.08, -1.08), 7-cell: -5.62 (95%CI: -8.80, -2.45) and 8-cell: -5.32 (95%CI: -9.21, -1.42) hours, respectively). Significantly more embryos cultured in SAGE classified for the highest KIDScore compared to embryos cultured in Vitrolife (p < 0.001). No differences were observed in clinical outcomes. Our results demonstrate an impact of culture medium on preimplantation embryo developmental kinetics, which affects classification within the KIDScore algorithm, while pregnancy outcomes were comparable between the groups. This study underscores the need to include the type of culture medium in the development of morphokinetic-based embryo selection tools.
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Affiliation(s)
- Linette van Duijn
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Melek Rousian
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Charlotte S Kramer
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, The Netherlands
| | - Eva S van Marion
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 40, Rotterdam, 3015 GD, The Netherlands
| | - Sten P Willemsen
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Biostatistics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jeroen P Speksnijder
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 40, Rotterdam, 3015 GD, The Netherlands
| | - Joop S E Laven
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 40, Rotterdam, 3015 GD, The Netherlands
| | | | - Esther B Baart
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 40, Rotterdam, 3015 GD, The Netherlands. .,Department of Developmental Biology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
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The KIDScore™ D3 scoring system contributes to the prediction of embryonic development potential: A promising tool for screening high-quality embryos. ZYGOTE 2022; 30:528-535. [DOI: 10.1017/s0967199422000016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Summary
Using the KIDScoreTM D3 (KID3) scoring system, day 3 embryos observed by time-lapse imaging (TLI) were scored to explore the predictive value of the KID scoring system on the developmental potential of embryos. The kinetic parameters of 477 normal fertilized embryos from 77 patients who underwent TLI in our hospital from January 2019 to June 2020 were evaluated by KID3, and the embryos were divided into five groups according to the scores for retrospective analysis of blastocyst formation. Additionally, the high-quality blastocyst formation rate, pregnancy rate and early abortion rate were analyzed via KID3 and traditional morphological assessments, and comparisons of differences among different ages were also performed. In the KID3 estimate, the blastocyst or high-quality blastocyst formation rate in the score 5 group was markedly higher than that in the score 1–4 groups. Blastocyst or high-quality blastocyst formation rates in the A group (the results of two evaluation tools indicated they were excellent embryos) and the B group (KID3: excellent embryos, traditional evaluation: not excellent embryos) were evidently increased in comparison with the C or D group (KID3: not excellent embryos, traditional evaluation: excellent embryo or not, respectively). Furthermore, the percentages of score 5 embryos, blastocyst and high-quality blastocyst formation rates for patients ≥ 35 years old were markedly decreased compared with those for patients < 34 years old, while the trends of nondiploid cleavage, multinucleation and asymmetric division were the opposite. Collectively, the KID3 scoring system may be a promising predictive tool for screening embryos with better developmental potential.
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7
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Tartia AP, Wu CQ, Gale J, Shmorgun D, Léveillé MC. Time-lapse KIDScore Day 5 can be used as a primary marker to predict embryo pregnancy potential in fresh and frozen single embryo transfers. Reprod Biomed Online 2022; 45:46-53. [DOI: 10.1016/j.rbmo.2022.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 03/01/2022] [Accepted: 03/22/2022] [Indexed: 10/18/2022]
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Vandame J, Fossard C, Filali M, Benammar A, Ranga S, Pirtea P, Racowsky C, Ayoubi JM, Poulain M. Investigation of the Reliability of Semi-Automatic Annotation by the Geri Time Lapse System. Reprod Biomed Online 2022; 45:35-45. [DOI: 10.1016/j.rbmo.2022.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 01/30/2022] [Accepted: 02/15/2022] [Indexed: 11/16/2022]
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Fadon P, Gallegos E, Jalota S, Muriel L, Diaz-Garcia C. Time-Lapse Systems: A Comprehensive Analysis on Effectiveness. Semin Reprod Med 2022; 39:e12-e18. [PMID: 35008119 DOI: 10.1055/s-0041-1742149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Time-lapse systems have quickly become a common feature of in vitro fertilization laboratories all over the world. Since being introduced over a decade ago, the alleged benefits of time-lapse technology have continued to grow, from undisturbed culture conditions and round the clock, noninvasive observations to more recent computer-assisted selection of embryos through the development of algorithms. Despite the global uptake of time-lapse technology, its real impact on clinical outcomes is still controversial. This review aims to explore the different features offered by time-lapse technology, discussing incubation, algorithms, artificial intelligence and the regulation of nonessential treatment interventions, while assessing evidence on whether any benefit is offered over conventional technology.
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Affiliation(s)
| | | | | | | | - Cesar Diaz-Garcia
- IVI London, IVIRMA Global, London, United Kingdom.,EGA Institute for Women's Health, University College London, London, United Kingdom
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Clua E, Rodríguez I, Arroyo G, Racca A, Martínez F, Polyzos N. Blastocyst transfer increases cumulative-live-birth-rates and reduces time and cost to livebirth compared with cleavage stage in recipients of donated oocytes. A randomized controlled trial. Reprod Biomed Online 2022; 44:995-1004. [DOI: 10.1016/j.rbmo.2022.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 12/17/2021] [Accepted: 01/05/2022] [Indexed: 11/16/2022]
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11
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OUP accepted manuscript. Hum Reprod 2022; 37:1148-1160. [DOI: 10.1093/humrep/deac066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 03/22/2022] [Indexed: 11/14/2022] Open
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Dimitriadis I, Zaninovic N, Badiola AC, Bormann CL. Artificial intelligence in the embryology laboratory: a review. Reprod Biomed Online 2021; 44:435-448. [PMID: 35027326 DOI: 10.1016/j.rbmo.2021.11.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 10/07/2021] [Accepted: 11/04/2021] [Indexed: 02/03/2023]
Abstract
The goal of an IVF cycle is a healthy live-born baby. Despite the many advances in the field of assisted reproductive technologies, accurately predicting the outcome of an IVF cycle has yet to be achieved. One reason for this is the method of selecting an embryo for transfer. Morphological assessment of embryos is the traditional method of evaluating embryo quality and selecting which embryo to transfer. However, this subjective method of assessing embryos leads to inter- and intra-observer variability, resulting in less than optimal IVF success rates. To overcome this, it is common practice to transfer more than one embryo, potentially resulting in high-risk multiple pregnancies. Although time-lapse incubators and preimplantation genetic testing for aneuploidy have been introduced to help increase the chances of live birth, the outcomes remain less than ideal. Utilization of artificial intelligence (AI) has become increasingly popular in the medical field and is increasingly being leveraged in the embryology laboratory to help improve IVF outcomes. Many studies have been published investigating the use of AI as an unbiased, automated approach to embryo assessment. This review summarizes recent AI advancements in the embryology laboratory.
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Affiliation(s)
- Irene Dimitriadis
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston MA, USA
| | - Nikica Zaninovic
- The Ronald O Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York NY, USA
| | - Alejandro Chavez Badiola
- New Hope Fertility Center, Av. Prado Norte 135, Lomas de Chapultepec, Mexico City, Mexico; IVF 2.0 LTD, 1 Liverpool Rd, Maghull, Merseyside, UK; School of Biosciences, University of Kent Kent, UK
| | - Charles L Bormann
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston MA, USA.
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Neonatal Outcomes of Embryos Cultured in a Time-Lapse Incubation System: an Analysis of More Than 15,000 Fresh Transfer Cycles. Reprod Sci 2021; 29:1524-1530. [PMID: 34406638 DOI: 10.1007/s43032-021-00714-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 08/05/2021] [Indexed: 10/20/2022]
Abstract
In the past 5 years, the time-lapse culture system (TLS) has gradually been applied to the field of assisted reproduction. However, there are few reports on the comparison between this system and the conventional culture system (CS) on the outcome of newborns. As a new model in embryo culture, we should pay attention to its neonatal outcomes. We examined 15,252 fresh transfer cycles processed between January 2016 and December 2019. After propensity score matching, embryos in two groups, TLS and CS, had similar rates of miscarriages, ectopic pregnancy, and live delivery (P > 0.05). Embryos in the TLS group achieved higher clinical pregnancy and implantation rates (P < 0.05). Of the perinatal and neonatal outcomes, singletons and twins were analyzed separately. No significant differences were observed in gestational age, preterm deliveries, birth weight, and sex ratio (P > 0.05). Incidences of malformations of babies delivered from CS and TLS groups were also similar between the two groups. Embryos cultured in a TLS are as safe as CS with regard to neonatal outcomes, including congenital malformations.
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Mizuno S, Matsumoto H, Hashimoto S, Brahmajosyula M, Ohgaki A, Tarui S, Matoba M, Satoh M, Fukuda A, Morimoto Y. A novel embryo quality scoring system to compare groups of embryos at different developmental stages. J Assist Reprod Genet 2021; 38:1123-1132. [PMID: 33646470 PMCID: PMC8190420 DOI: 10.1007/s10815-021-02117-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 02/15/2021] [Indexed: 10/22/2022] Open
Abstract
PURPOSE To construct a new embryonic quality scoring system to compare groups of embryos at different developmental stages. METHODS Based on a hypothesis that the implantation potential of any embryo in an ovum pickup (OPU) cycle remains the same at any stage of development, be it day 2, 3, or 5, a new embryo quality scoring (EQS) system was designed. It was based on the analysis of the clinical results of 1610 single embryo transfers. We validated this scoring system in the comparison of embryonic quality between groups by evaluating the mean scores calculated at day 2, day 3, and day 5 for 957 embryos (150 cycles) from 3 different groups. We then compared EQSs of patients with pregnancy favorable factors (group A) such as young age and high AMH levels, with the patients with contra features (group B). RESULTS We confirmed that each mean EQS assessed at different stages of embryonic development within the same group was similar. The mean EQSs on day 3 and day 5 in group A were significantly higher than the mean EQSs on days 2, 3, and 5 in group B. CONCLUSION The novel EQS system proposed by us enables embryonic quality comparison between groups of embryos at different developmental stages.
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Affiliation(s)
- Satoshi Mizuno
- IVF Osaka Clinic, Higashi-Osaka, Osaka, 577-0012, Japan.
| | | | - Shu Hashimoto
- IVF Namba Clinic, Osaka, 550-0015, Japan
- Graduate School of Medicine, Osaka City University, Osaka, 545-8585, Japan
| | | | - Aya Ohgaki
- IVF Osaka Clinic, Higashi-Osaka, Osaka, 577-0012, Japan
| | - Sachiyo Tarui
- IVF Osaka Clinic, Higashi-Osaka, Osaka, 577-0012, Japan
| | - Mari Matoba
- HORAC Grand Front Osaka Clinic, Osaka, 530-0011, Japan
| | | | - Aisaku Fukuda
- IVF Osaka Clinic, Higashi-Osaka, Osaka, 577-0012, Japan
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Ferrick L, Lee YSL, Gardner DK. Metabolic activity of human blastocysts correlates with their morphokinetics, morphological grade, KIDScore and artificial intelligence ranking. Hum Reprod 2021; 35:2004-2016. [PMID: 32829415 DOI: 10.1093/humrep/deaa181] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/18/2020] [Indexed: 01/15/2023] Open
Abstract
STUDY QUESTION Is there a relationship between blastocyst metabolism and biomarkers of embryo viability? SUMMARY ANSWER Blastocysts with higher developmental potential and a higher probability of resulting in a viable pregnancy consume higher levels of glucose and exhibit distinct amino acid profiles. WHAT IS KNOWN ALREADY Morphological and morphokinetic analyses utilized in embryo selection provide insight into developmental potential, but alone are unable to provide a direct measure of embryo physiology and inherent health. Glucose uptake is a physiological biomarker of viability and amino acid utilization is different between embryos of varying qualities. STUDY DESIGN, SIZE, DURATION Two hundred and nine human preimplantation embryos from 50 patients were cultured in a time-lapse incubator system in both freeze all and fresh transfer cycles. A retrospective analysis of morphokinetics, morphology (Gardner grade), KIDScore, artificial intelligence grade (EmbryoScore), glucose and amino acid metabolism, and clinical pregnancies was conducted. PARTICIPANTS/MATERIALS, SETTING, METHODS ICSI was conducted in all patients, who were aged ≤37 years and previously had no more than two IVF cycles. Embryos were individually cultured in a time-lapse incubator system, and those reaching the blastocyst stage had their morphokinetics annotated and were each assigned a Gardner grade, KIDScore and EmbryoScore. Glucose and amino acid metabolism were measured. Clinical pregnancies were confirmed by the presence of a fetal heartbeat at 6 weeks of gestation. MAIN RESULTS AND THE ROLE OF CHANCE Glucose consumption was at least 40% higher in blastocysts deemed of high developmental potential using either the Gardner grade (P < 0.01, n = 209), KIDScore (P < 0.05, n = 207) or EmbryoScore (P < 0.05, n = 184), compared to less viable blastocysts and in blastocysts that resulted in a clinical pregnancy compared to those that failed to implant (P < 0.05, n = 37). Additionally, duration of cavitation was inversely related to glucose consumption (P < 0.05, n = 200). Total amino acid consumption was significantly higher in blastocysts with an EmbryoScore higher than the cohort median score (P < 0.01, n = 185). Furthermore, the production of amino acids was significantly lower in blastocysts with a high Gardner grade (P < 0.05, n = 209), KIDScore (P < 0.05, n = 207) and EmbryoScore (P < 0.01, n = 184). LIMITATIONS, REASONS FOR CAUTION Samples were collected from patients who had ICSI treatment and from only one clinic. WIDER IMPLICATIONS OF THE FINDINGS These results confirm that metabolites, such as glucose and amino acids, are valid biomarkers of embryo viability and could therefore be used in conjunction with other systems to aid in the selection of a healthy embryo. STUDY FUNDING/COMPETING INTEREST(S) Work was supported by Virtus Health. D.K.G is contracted with Virtus Health. The other authors have no conflict of interest to declare. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Laura Ferrick
- School of BioSciences, University of Melbourne, Melbourne, VIC 3010, Australia
| | | | - David K Gardner
- School of BioSciences, University of Melbourne, Melbourne, VIC 3010, Australia.,Melbourne IVF, East Melbourne, Melbourne, VIC 3002, Australia
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Zmuidinaite R, Sharara FI, Iles RK. Current Advancements in Noninvasive Profiling of the Embryo Culture Media Secretome. Int J Mol Sci 2021; 22:ijms22052513. [PMID: 33802374 PMCID: PMC7959312 DOI: 10.3390/ijms22052513] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 02/24/2021] [Accepted: 02/25/2021] [Indexed: 12/18/2022] Open
Abstract
There have been over 8 million babies born through in vitro fertilization (IVF) and this number continues to grow. There is a global trend to perform elective single embryo transfers, avoiding risks associated with multiple pregnancies. It is therefore important to understand where current research of noninvasive testing for embryos stands, and what are the most promising techniques currently used. Furthermore, it is important to identify the potential to translate research and development into clinically applicable methods that ultimately improve live birth and reduce time to pregnancy. The current focus in the field of human reproductive medicine is to develop a more rapid, quantitative, and noninvasive test. Some of the most promising fields of research for noninvasive assays comprise cell-free DNA analysis, microscopy techniques coupled with artificial intelligence (AI) and omics analysis of the spent blastocyst media. High-throughput proteomics and metabolomics technologies are valuable tools for noninvasive embryo analysis. The biggest advantages of such technology are that it can differentiate between the embryos that appear morphologically identical and has the potential to identify the ploidy status noninvasively prior to transfer in a fresh cycle or before vitrification for a later frozen embryo transfer.
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Affiliation(s)
- Raminta Zmuidinaite
- MAP Sciences Ltd., The iLab, Stannard Way, Priory Business Park, Bedford MK44 3RZ, UK;
| | - Fady I. Sharara
- Virginia Center for Reproductive Medicine, Reston, VA 20190, USA;
| | - Ray K. Iles
- MAP Sciences Ltd., The iLab, Stannard Way, Priory Business Park, Bedford MK44 3RZ, UK;
- NISAD (Lund), Medicon Village, SE-223 81 Lund, Sweden
- Correspondence:
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Khalife D, Abu-Musa A, Khalil A, Ghazeeri G. Towards the selection of embryos with the greatest implantation potential. J OBSTET GYNAECOL 2021; 41:1010-1015. [PMID: 33432866 DOI: 10.1080/01443615.2020.1835842] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Choosing the most suitable embryo remains challenging as the standard approach to select top-quality embryos for transfer rely on static morphological assessment. It is completed after fertilisation, on days 3 and 5 post oocyte retrieval and evaluates the size and number of blastomeres, presence of nucleation and percentage of fragmentation for cleavage stage embryos. Because of the limited number of observations during the morphological assessment, morphokinetic development of embryos has been implemented. It shows a broader image of embryo behaviour with precise evaluation of the timing of events. Yet, studies are inconsistent and debatable in predicting the parameters to identify chromosomal abnormalities. Pre-implantation genetic testing detects dysmorphic embryos and correlate their developmental potential to the assessed morphology. However, the clinical utility of PGT-aneuploidy remains controversial. The future relies on newly described scoring systems such as artificial intelligence and non-invasive PGT, yet their application and actual success rate still lacks supportive evidence.
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Affiliation(s)
- Dalia Khalife
- Department of Obstetrics and Gynecology, Jumeirah American Clinic, Dubai, UAE
| | - Antoine Abu-Musa
- Reproductive Endocrinology and Infertility Unit, Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ali Khalil
- Division of Gynecologic Oncology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ghina Ghazeeri
- Reproductive Endocrinology and Infertility Unit, Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
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Li M, Wang M, Xue X, Shi J. Day 3 time lapse selection is beneficial for the patients with no good-quality embryos. Gynecol Endocrinol 2021; 37:31-34. [PMID: 32252570 DOI: 10.1080/09513590.2020.1750002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
We aimed to evaluate whether or not time lapse selection was beneficial for the cleavage-stage embryo transfers. The study included 838 infertile women with good ovarian reserve (obtaining more than 8 oocytes) from January 2018 to August 2019. Based on the transferred embryos with different grades (grade I, II and III), the patients were divided into day 3 selection with conventional morphology (CM) and day 3 selection with time lapse (TL) groups. For the grade I and II embryos, we observed that CM and TL had similar implantation, clinical pregnancy and ongoing pregnancy (p > .05) rates. For the grade III embryos, we observed that CM group showed slightly lower implantation (36.74 versus 41.03%, p = .261) and clinical pregnancy (56.82 versus 64.10%, p = .182) rates than TL group. CM group showed significantly lower ongoing pregnancy (47.35 versus 59.83%, p = .025) rate than TL group. And we observed that CM group had significantly higher blastulation (38.93 versus 26.61%, p = .019) rate than TL group. We concluded that TL selection was beneficial to the patients with no good-quality embryos in the first cleavage-stage embryo transfers.
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Affiliation(s)
- Mingzhao Li
- The ART Center, Northwest Women and Children's Hospital, Xi'an, China
| | - Min Wang
- The ART Center, Northwest Women and Children's Hospital, Xi'an, China
| | - Xia Xue
- The ART Center, Northwest Women and Children's Hospital, Xi'an, China
| | - Juanzi Shi
- The ART Center, Northwest Women and Children's Hospital, Xi'an, China
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Li MZ, Bai HY, Xue X, Shi JZ. Preimplantation genetic testing for a new abnormal cleavage behavior. Asian J Androl 2021; 23:227-228. [PMID: 32643631 PMCID: PMC7991823 DOI: 10.4103/aja.aja_26_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Ming-Zhao Li
- The ART Center, Northwest Women and Children's Hospital, Xi'an 710003, China
| | - Hai-Yan Bai
- The ART Center, Northwest Women and Children's Hospital, Xi'an 710003, China
| | - Xia Xue
- The ART Center, Northwest Women and Children's Hospital, Xi'an 710003, China
| | - Juan-Zi Shi
- The ART Center, Northwest Women and Children's Hospital, Xi'an 710003, China
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21
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Minasi MG, Greco P, Varricchio MT, Barillari P, Greco E. The clinical use of time-lapse in human-assisted reproduction. Ther Adv Reprod Health 2020; 14:2633494120976921. [PMID: 33336190 PMCID: PMC7724395 DOI: 10.1177/2633494120976921] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 11/04/2020] [Indexed: 11/18/2022] Open
Abstract
A major challenge in the assisted reproduction laboratory is to set up
reproducible and efficient criteria to identify the embryo with the
highest developmental potential. Over the years, several methods have
been used worldwide with this purpose. Initially, standard morphology
assessment was the only available strategy. It is now universally
recognized that besides being a very subjective embryo selection
strategy, morphology evaluation alone has a very poor prognostic
value. More recently, the availability of time-lapse incubators
allowed a continuous monitoring of human embryo development. This
technology has spread quickly and many fertility clinics over the
world produced a remarkable amount of data. To date, however, a
general consensus on which variables, or combination of variables,
should play a central role in embryo selection is still lacking. Many
confounding factors, concerning both patient features and clinical and
biological procedures, have been observed to influence embryo
development. In addition, several studies have reported unexpected
positive outcomes, even in the presence of abnormal developmental
criteria. While it does not seem that time-lapse technology is ready
to entirely replace the more invasive preimplantation genetic testing
in identifying the embryo with the highest implantation potential, it
is certainly true that its application is rapidly growing, becoming
progressively more accurate. Studies involving artificial intelligence
and deep-learning models as well as combining morphokinetic with other
non-invasive markers of embryo development, are currently ongoing,
raising hopes for its successful applicability for clinical purpose in
the near future. The present review mainly focuses on data published
starting from the first decade of 2000, when time-lapse technology was
introduced as a routine clinical practice in the infertility
centers.
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Affiliation(s)
| | | | | | - Paolo Barillari
- Center for Reproductive Medicine,
Villa Mafalda, Rome, Italy
| | - Ermanno Greco
- Center for Reproductive Medicine,
Villa Mafalda, Rome, Italy
- Saint Camillus International
University of Health and Medical Sciences (UniCamillus), Rome,
Italy
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22
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Sayed S, Reigstad MM, Petersen BM, Schwennicke A, Wegner Hausken J, Storeng R. Time-lapse imaging derived morphokinetic variables reveal association with implantation and live birth following in vitro fertilization: A retrospective study using data from transferred human embryos. PLoS One 2020; 15:e0242377. [PMID: 33211770 PMCID: PMC7676704 DOI: 10.1371/journal.pone.0242377] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 11/01/2020] [Indexed: 01/03/2023] Open
Abstract
The purpose of this retrospective time-lapse data analysis from transferred preimplantation human embryos was to identify early morphokinetic cleavage variables that are related to implantation and live birth following in vitro fertilization (IVF). All embryos were monitored from fertilization check until embryo transfer for a minimum of 44 hours. The study was designed to assess the association between day 2 embryo morphokinetic variables with implantation and live birth based on Known Implantation Data (KID). The kinetic variables were subjected to quartile-based analysis. The predictive ability for implantation and live birth was studied using receiver operator characteristic (ROC) curves. Three morphokinetic variables, time to 2-cells (t2), duration of second cell cycle (cc2) below one threshold and cc2 above another threshold had the highest predictive value with regards to implantation and live birth following IVF treatment. The predictive pre-transfer information has little divergence between fetal heartbeat and live birth data and therefore, at least for early morphokinetic variables up to the four-cell stage (t4), conclusions and models based on fetal heartbeat data can be expected to be valid for live birth datasets as well. The three above mentioned variables (t2, cc2 below one threshold and cc2 above another threshold) may supplement morphological evaluation in embryo selection and thereby improve the outcome of in vitro fertilization treatments.
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Affiliation(s)
- Shabana Sayed
- Klinikk Hausken, IVF and Gynecology, Haugesund, Norway
| | - Marte Myhre Reigstad
- Norwegian National Advisory Unit on Women's Health, Oslo University Hospital, Oslo, Norway
| | | | | | | | - Ritsa Storeng
- Norwegian National Advisory Unit on Women's Health, Oslo University Hospital, Oslo, Norway
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Fryc K, Nowak A, Kij B, Kochan J, Bartlewski PM, Murawski M. Timing of cleavage divisions determined with time-lapse imaging is linked to blastocyst formation rates and quality of in vitro-produced ovine embryos. Theriogenology 2020; 159:147-152. [PMID: 33157452 DOI: 10.1016/j.theriogenology.2020.10.031] [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: 06/26/2020] [Revised: 10/21/2020] [Accepted: 10/24/2020] [Indexed: 10/23/2022]
Abstract
Time-lapse (TL) imaging provides a practical and safe tool to constantly monitor the development of in vitro-derived embryos. TL may help develop novel methods of predicting the timing of embryo cleavage that will lead to optimizing blastocyst cryopreservation or transfer. The primary objective of the present study was to employ TL imaging to examine associations among the division kinetics of ovine embryos, their quality and rates of development to the blastocyst stage. Oocytes were collected by ovary scarification from 78 Longwool ewes slaughtered in the breeding season (November-March). Cumulus oocyte complexes (COCs) were matured for 24 h in TCM 199 media containing 0.1 IU/mL LH/FSH and 10% FBS. In-vitro fertilization was carried out by co-incubation of semen and COCs for 19 h. Presumptive zygotes were placed in microwells, in droplets of Cult medium (Gynemed, Lensahn, Germany). Digital images of developing embryos were captured every 10 min by Primo Vision TL system (EVO+; Vitrolife, Göteburg, Sweden). The following time intervals were recorded: from IVF to the attainment of two-cell (t2), three-cells (t3) or four-cell (t4) stage, to morula detection (tM), blastulation (tSB) and blastocyst formation (tB). Lastly, the duration of the second cell cycle (cc2; t3-t2) and complete synchronous cell division (s2; t4-t3) were calculated, and the incidence of developmental anomalies noted. Out of 147 embryos selected for TL observations, 55 (37.4%) developed to the blastocyst stage (normally developing embryos, NE) and 92 (62.6%) failed to reach the blastocyst stage (arrested embryos, AE; P < 0.05). Mean t2, tM, s2 and cc2 were all less (P ≤ 0.02) in NE compared with AE. Approximately 61.9% of embryos exhibited developmental anomalies (35.5% in the NE group and 78.2% in the AE group; P < 0.05) and AE exceeded (P < 0.05) NE in the proportion of FRG (blastomeric fragmentation), IRR (blastomeres of irregular size after cleavage), DC (direct cleavage) and MA (multi-morphological aberrations). Of all NE, 63.6% were classified as good quality and 36.4% as poor quality blastocysts (P < 0.05). Good quality ovine blastocysts attained t2, t3, t4, tSB and tB stages earlier (P ≤ 0.03) than poor quality blastocysts and none of the poor quality blastocysts was seen to hatch. To recapitulate, the present results indicate that the kinetics of early ovine embryo development are significant predictors of their potential to develop to the blastocyst stage and the markers of blastocyst quality. Time-lapse imaging may serve as a useful technique for predicting the outcome and enhancing efficacy of in vitro embryo production in sheep.
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Affiliation(s)
- Karolina Fryc
- Department of Animal Nutrition and Biotechnology, and Fisheries, University of Agriculture in Kraków, 24/28 Mickiewicza Ave., 30-059, Cracow, Poland.
| | - Agnieszka Nowak
- Department of Animal Reproduction, Anatomy and Genomics, University of Agriculture in Kraków, 24/28 Mickiewicza Ave., 30-059, Cracow, Poland
| | - Barbara Kij
- Department of Animal Reproduction, Anatomy and Genomics, University of Agriculture in Kraków, 24/28 Mickiewicza Ave., 30-059, Cracow, Poland
| | - Joanna Kochan
- Department of Animal Reproduction, Anatomy and Genomics, University of Agriculture in Kraków, 24/28 Mickiewicza Ave., 30-059, Cracow, Poland
| | - Pawel M Bartlewski
- Department of Biomedical Sciences, Ontario Veterinary College, University of Guelph, 50 Stone Rd., Guelph, ON N1G 2W1, Canada
| | - Maciej Murawski
- Department of Animal Nutrition and Biotechnology, and Fisheries, University of Agriculture in Kraków, 24/28 Mickiewicza Ave., 30-059, Cracow, Poland
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24
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Assessment of embryo implantation potential with a cloud-based automatic software. Reprod Biomed Online 2020; 42:66-74. [PMID: 33189576 DOI: 10.1016/j.rbmo.2020.09.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 09/04/2020] [Accepted: 09/30/2020] [Indexed: 11/23/2022]
Abstract
RESEARCH QUESTION Is embryo selection by Dana (automatic software for embryo evaluation) associated with a higher implantation rate in IVF treatments? DESIGN A three-phase study for Dana system's validation: creation of a data-cloud of known implantation data (KID) embryos from 1676 transferred embryos; embryo evaluation by Dana considering manual annotations and embryo development videos (389 transferred embryos); and validation of Dana automatic selection, without embryologist's intervention (147 transferred embryos); RESULTS: The implantation rate of the 1021 KID embryos from phase 1 served to set four grades of embryos referring to implantation rate: A = 34%, B = 25%, C = 24%, and D = 19%. Phase 2: a classification ranking according to the unit average distance (UAD) and implantation potential was established: top (UAD ≤0.50), high (UAD = 0.51-0.66), medium (UAD = 0.67-1.03) and low (UAD >1.03). Pregnancy rates were 59%, 46%, 36% and 28%, respectively (P < 0.001). Phase 3: embryos were automatically categorized according to Dana's classification ranking. Most implanted embryos were found in groups top, high and medium (UAD ≤1.03), whereas the implantation rate in group low (UAD >1.03) was significantly lower: 46% versus 25%, respectively (P = 0.037). The twin gestation rate was higher when number of top embryos (UAD ≤0.5) transferred were two (52%) versus one (25%) (P < 0.001). CONCLUSIONS Embryo selection based on Dana ranking increases the success of IVF treatments at least in oocyte donation programmes. The multicentre nature of the study supports its applicability at different clinics, standardizing the embryo development's interpretation. Dana's innovation is that the system increases its accuracy as the database grows.
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Bori L, Paya E, Alegre L, Viloria TA, Remohi JA, Naranjo V, Meseguer M. Novel and conventional embryo parameters as input data for artificial neural networks: an artificial intelligence model applied for prediction of the implantation potential. Fertil Steril 2020; 114:1232-1241. [PMID: 32917380 DOI: 10.1016/j.fertnstert.2020.08.023] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 08/14/2020] [Accepted: 08/19/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To describe novel embryo features capable of predicting implantation potential as input data for an artificial neural network (ANN) model. DESIGN Retrospective cohort study. SETTING University-affiliated private IVF center. PATIENT(S) This study included 637 patients from the oocyte donation program who underwent single-blastocyst transfer during two consecutive years. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) The research was divided into two phases. Phase 1 consisted of the description and analysis of the following embryo features in implanted and nonimplanted embryos: distance and speed of pronuclear migration, blastocyst expanded diameter, inner cell mass area, and trophectoderm cell cycle length. Phase 2 consisted of the development of an ANN algorithm for implantation prediction. Results were obtained for four models fed with different input data. The predictive power was measured with the use of the area under the receiver operating characteristic curve (AUC). RESULT(S) Out of the five novel described parameters, blastocyst expanded diameter and trophectoderm cell cycle length had statistically different values in implanted and nonimplanted embryos. After the ANN models were trained and validated using fivefold cross-validation, they were capable of predicting implantation on testing data with AUCs of 0.64 for ANN1 (conventional morphokinetics), 0.73 for ANN2 (novel morphodynamics), 0.77 for ANN3 (conventional morphokinetics + novel morphodynamics), and 0.68 for ANN4 (discriminatory variables from statistical test). CONCLUSION(S) The novel proposed embryo features affect the implantation potential, and their combination with conventional morphokinetic parameters is effective as input data for a predictive model based on artificial intelligence.
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Affiliation(s)
| | - Elena Paya
- IVI-RMA Valencia, Valencia, Spain; Instituto de Investigación e Innovación en Bioingeniería, Universitat Politécnica de Valencia, Valencia, Spain
| | | | | | | | - Valery Naranjo
- Instituto de Investigación e Innovación en Bioingeniería, Universitat Politécnica de Valencia, Valencia, Spain
| | - Marcos Meseguer
- IVI-RMA Valencia, Valencia, Spain; Health Research Institute la Fe, Valencia, Spain
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Gallego RD, Remohí J, Meseguer M. Time-lapse imaging: the state of the art†. Biol Reprod 2020; 101:1146-1154. [PMID: 30810735 DOI: 10.1093/biolre/ioz035] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 02/12/2019] [Accepted: 02/26/2019] [Indexed: 12/12/2022] Open
Abstract
The introduction of time-lapse imaging to clinical in vitro fertilization practice enabled the undisturbed monitoring of embryos throughout the entire culture period. Initially, the main objective was to achieve a better embryo development. However, this technology also provided an insight into the novel concept of morphokinetics, parameters regarding embryo cell dynamics. The vast amount of data obtained defined the optimal ranges in the cell-cycle lengths at different stages of embryo development. This added valuable information to embryo assessment prior to transfer. Kinetic markers became part of embryo evaluation strategies with the potential to increase the chances of clinical success. However, none of them has been established as an international standard. The present work aims at describing new approaches into time-lapse: progress to date, challenges, and possible future directions.
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Barberet J, Bruno C, Valot E, Antunes-Nunes C, Jonval L, Chammas J, Choux C, Ginod P, Sagot P, Soudry-Faure A, Fauque P. Can novel early non-invasive biomarkers of embryo quality be identified with time-lapse imaging to predict live birth? Hum Reprod 2020; 34:1439-1449. [PMID: 31287145 PMCID: PMC6688874 DOI: 10.1093/humrep/dez085] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 04/24/2019] [Accepted: 05/07/2019] [Indexed: 01/31/2023] Open
Abstract
STUDY QUESTION Can time-lapse imaging systems make it possible to identify novel early non-invasive biomarkers to predict live birth? SUMMARY ANSWER From mostly high-grade embryos, out of 35 morphometric, morphologic and morphokinetic variables, only pronuclei (PN) position at time of PN juxtaposition and the absence of multinucleated blastomeres at the 2-cell stage (MNB2cell), were potentially associated with live birth. WHAT IS KNOWN ALREADY Previous studies indicate that some kinetic markers may be predictive of blastocyst development and embryonic implantation. Certain teams have suggested including some of them in decisional algorithms for embryo transfers. STUDY DESIGN, SIZE, DURATION Using a time-lapse incubator (EmbryoScope, Unisense FertiliTech), we retrospectively explored the associations between the morphometric, morphologic and morphokinetic parameters of oocytes, zygotes and embryos, and their associations with live birth. This study assessed 232 embryos from single embryo transfers after ICSI cycles performed between January 2014 and December 2017. PARTICIPANTS/MATERIALS, SETTING, METHODS The morphometric, morphologic and morphokinetic parameters (18, 4 and 13, respectively) of oocytes, zygotes and early embryos were studied retrospectively. The associations between these parameters were examined using a Spearman's correlation, Mann-Whitney or chi-squared test as appropriate. We examined whether these parameters were associated with outcomes in univariate and multivariate logistic regression analyses. MAIN RESULTS AND THE ROLE OF CHANCE Central PN juxtaposition was associated with a 2-fold increase in the odds of live birth (OR = 2.20; 95% CI, [1.26-3.89]; P = 0.006), while the presence of MNB2cell was associated with half the odds of live birth (OR = 0.51; 95% CI, [0.27-0.95]; P = 0.035). These two parameters were independent of embryo kinetics. The 33 remaining parameters had no significant association with the capacity of transferred embryos to develop to term. LIMITATIONS, REASONS FOR CAUTION Even though the population size was relatively small, our analyses were based on homogeneous cycles, i.e. young women whose transferred embryos were found to be high-grade according to conventional morphology evaluation. In addition, our conclusions were established from a specific, highly selected population, so other study populations, such as women in an older age bracket, may yield different results. Finally, because we assessed day 2/3 transfers, our findings cannot be generalized to embryos cultured up to the blastocyst stage. WIDER IMPLICATIONS OF THE FINDINGS It would be interesting to explore, prospectively, whether PN localisation is a relevant measure to predict embryo development when added into further algorithms and whether this parameter could be suitable for use in other IVF clinics. Further studies are needed, notably to explore the added value of timing evaluation in cohorts of embryos with low or intermediate morphology grade, as well as in other maternal populations (i.e. older women). STUDY FUNDING/COMPETING INTEREST(S) No external funding was used for this study. P. Sagot received funding from the following commercial companies: Merck Serono, Finox Biotech, Ferring, MSD France SAS, Teva Sante ́ SAS, Allergan France, Gedeon Richter France, Effik S.A., Karl Storz Endoscopie France, GE Medical Systems SCS, Laboratoires Genevrier, H.A.C. Pharma and Ipsen.All the authors confirm that none of this funding was used to support the research in this study. There are no patents, products in development or marketed products to declare. This does not alter the authors' adherence to all the journal policies on sharing data and materials.
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Affiliation(s)
- J Barberet
- Laboratoire de Biologie de la Reproduction, Hôpital François Mitterrand, Université de Bourgogne, Dijon, France.,INSERM UMR1231, Université de Bourgogne Franche comté, Dijon, France
| | - C Bruno
- Laboratoire de Biologie de la Reproduction, Hôpital François Mitterrand, Université de Bourgogne, Dijon, France.,INSERM UMR1231, Université de Bourgogne Franche comté, Dijon, France
| | - E Valot
- Laboratoire de Biologie de la Reproduction, Hôpital François Mitterrand, Université de Bourgogne, Dijon, France
| | - C Antunes-Nunes
- Laboratoire de Biologie de la Reproduction, Hôpital François Mitterrand, Université de Bourgogne, Dijon, France
| | - L Jonval
- USMR, Dijon University Hospital, France
| | - J Chammas
- Laboratoire de Biologie de la Reproduction, Hôpital François Mitterrand, Université de Bourgogne, Dijon, France
| | - C Choux
- Service de Gynécologie-Obstétrique, Hôpital François Mitterrand, Université de Bourgogne, Dijon, France
| | - P Ginod
- Service de Gynécologie-Obstétrique, Hôpital François Mitterrand, Université de Bourgogne, Dijon, France
| | - P Sagot
- Service de Gynécologie-Obstétrique, Hôpital François Mitterrand, Université de Bourgogne, Dijon, France
| | | | - P Fauque
- Laboratoire de Biologie de la Reproduction, Hôpital François Mitterrand, Université de Bourgogne, Dijon, France.,INSERM UMR1231, Université de Bourgogne Franche comté, Dijon, France
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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.
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Saraeva NV, Spiridonova NV, Tugushev MT, Shurygina OV, Sinitsyna AI, Korchagin AO. Optimization of a single-embryo transfer in patients with good ovarian reserve. BULLETIN OF RUSSIAN STATE MEDICAL UNIVERSITY 2020. [DOI: 10.24075/brsmu.2020.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Due to refinements of assisted reproductive technology, the number of multiple pregnancies has increased substantially. Time-lapse microscopy (TLM) is a tool for selecting quality embryos for transfer. This study aimed to assess the outcomes of single-embryo transfer of autologous oocytes performed on day 5 of embryo incubation in a TLM-equipped system in patients with good ovarian reserve. The study was carried out in 208 infertile women with good ovarian reserve (over 8 oocytes retrieved). Single-embryo transfer following incubation in a TLM-equipped incubator was performed in 95 patients, who formed the main group; the control group consisted of 113 patients undergoing single-embryo transfer following a traditional culture and embryo selection procedure. We assessed the quality of transferred embryos, the rates of clinical pregnancy and pregnancy loss. Two subgroups were identified in each group of the participants: the 5SET subgroup (nonelective single-embryo transfer), which included 45 patients from the main group and 67 controls, and the 5eSET subgroup (elective single-embryo transfer), which consisted of 50 main group patients and 46 controls. The groups did not differ in terms of age, infertility factors and infertility duration. The quality of transferred embryos was excellent or good in all main group patients (100%); in the control group, the quality of transferred embryos was excellent or good in 93.8% of cases (p = 0.037). Clinical pregnancies were achieved in 64.2% of women in the main group and in 60.2% of controls (p = 0.65). Delivery rates were 54% and 51.1% in the 5eSET and 5SET subgroups of the main group, respectively (p = 0.940). For the control group, delivery rates were 54.4% and 34.3% in the 5eSET and 5SET subgroups, respectively (p = 0.052, Fisher exact test). Elective single-embryo transfer (5eSET) and the use of TLM increased the chance of pregnancy 2.17-fold (p = 0.01).
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Affiliation(s)
- NV Saraeva
- Samara State Medical University, Samara, Russia; IDK Medical Company, the Mother and Child group, Samara, Russia
| | | | - MT Tugushev
- Samara State Medical University, Samara, Russia
| | | | | | - AO Korchagin
- IDK Medical Company, the Mother and Child group, Samara, Russia
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30
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Gazzo E, Peña F, Valdéz F, Chung A, Velit M, Ascenzo M, Escudero E. Blastocyst contractions are strongly related with aneuploidy, lower implantation rates, and slow-cleaving embryos: a time lapse study. JBRA Assist Reprod 2020; 24:77-81. [PMID: 31524340 PMCID: PMC6993166 DOI: 10.5935/1518-0557.20190053] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Accepted: 09/02/2019] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES This study aimed to identify human blastocyst contraction patterns and their correlations with ploidy status (PGT-A analysis), the time it took for embryos to reach the blastocyst stage, and pregnancy rates. METHODS The study included 912 embryos from 270 patients seen in our center. All embryos were cultivated in an Embryoscope incubator. An NGS platform was used to test 778 of the 912 embryos initially included in the study for aneuploidy at a reference laboratory. Blastocyst contractions were evaluated using the embryo drawing tool to compute percent contraction. A total of 182 single-embryo transfers were performed. The mean age of the included patients was 30.44 years (24-39 years). RESULTS The embryos were divided into two groups, the first with embryos that contracted (CT group) and the second with embryos that did not contract, herein referred to as expanding-only embryos or solo expanding (SE group). In terms of ploidy status, 58.33% of the embryos in the SE group were euploid, while 53.58% of embryos in the CT group were aneuploid. The difference between the groups was statistically significant (p=0.029), showing that embryos that do not contract have a higher chance of being euploid than embryos that contract. Pregnancy rates were also significantly higher among embryos in the SE group than in the CT group (63.10% vs. 46.67%; p=0.012). Finally, we saw that embryos in the CT group took significantly longer to reach the blastocyst stage compared to embryos in the SE group (p=0.004). Patient age was not significantly different between the CT and SE groups, indicating that age might not be a factor in embryo contraction. CONCLUSION Two of the traits for which the embryos included in this study were compared were statistically different. Embryos in the CT group had lower implantation rates, took longer to reach the blastocyst stage, and had a higher chance of being aneuploid, regardless of maternal age. Therefore, embryo contraction might be a useful parameter in the selection of embryos for transfer.
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Magdi Y, Samy A, Abbas AM, Ibrahim MA, Edris Y, El-Gohary A, Fathi AM, Fawzy M. Effect of embryo selection based morphokinetics on IVF/ICSI outcomes: evidence from a systematic review and meta-analysis of randomized controlled trials. Arch Gynecol Obstet 2019; 300:1479-1490. [PMID: 31667608 DOI: 10.1007/s00404-019-05335-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 10/15/2019] [Indexed: 12/14/2022]
Abstract
PURPOSE Debate exists for the optimal tool to select embryos for transfer in assisted reproductive technology (ART). Time-lapse monitoring (TLM) is a noninvasive tool suggested where each embryo can be captured every 5-20 min. Given the inconsistency in the existing studies, we conducted this meta-analysis of RCTs to summarize the evidence available concerning the predictive ability of morphokinetics compared with the routine assessment of embryo development in ART. METHODS The primary databases MEDLINE, EMBASE, Cochrane, NHS, WHO, and Other Non-Indexed Citations were consulted for RCTs that have been published until November 2018, with no language restriction. RESULTS AND CONCLUSION Our review includes 6 RCTs (n = 2057 patients). The data showed an improvement (~ 9%) in live birth TLM (OR 1.43; 95% CI 1.10-1.85; P = 0.007), with low-quality evidence. There was no evidence of a significant difference between both groups concerning ongoing pregnancy, clinical pregnancy and implantation rates. The data further showed that morphokinetics is associated with decreased early pregnancy loss rate. These estimates must be interpreted with caution owing to the statistical and clinical heterogeneities and the consequent difficulty in drawing any meaningful conclusion.
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Affiliation(s)
- Yasmin Magdi
- Al-Yasmeen Fertility and Gynecology Center, 5 Farid Nada Street, Benha, 13511, Qalubyia, Egypt.
| | - Ahmed Samy
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed M Abbas
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Mohamed Ahmed Ibrahim
- Department of Obstetrics and Gynecology, Faculty of Medicine, Benha University, Benha, Egypt
| | - Yehia Edris
- Department of Obstetrics and Gynecology, Faculty of Medicine, Benha University, Benha, Egypt
| | - Ayman El-Gohary
- Department of Obstetrics and Gynecology, Faculty of Medicine, Benha University, Benha, Egypt
| | - Ahmed M Fathi
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kafrelsheikh University, Kafr El-Sheikh, Egypt
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Lunenfeld B, Bilger W, Longobardi S, Kirsten J, D'Hooghe T, Sunkara SK. Decision points for individualized hormonal stimulation with recombinant gonadotropins for treatment of women with infertility. Gynecol Endocrinol 2019; 35:1027-1036. [PMID: 31392906 DOI: 10.1080/09513590.2019.1650345] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
It is essential that fertility treatment is individualized based on a thorough diagnostic work-up, with treatment tailored to the patients' requirements. This individualization should be kept in mind during the main decision points that occur before and during treatment. Treatment customization must include consideration of both the woman and her partner involved in the process together, including their collective treatment goals. Once treatment goals have been agreed and diagnostic evaluations performed, personalization based on patient characteristics, together with an understanding of treatment goals and patient preferences, enables the selection of appropriate treatments, protocols, products and their dosing. Following treatment initiation, monitoring and adaptation of product and dose can then ensure optimal outcomes. Currently, it is not possible to base treatment decisions on every characteristic of the patient and personalization is based on biomarkers that have been identified as the most relevant. However, in the future, the use of artificial intelligence coupled with continuous monitoring should enable greater individualization and improve outcomes. This review considers the current state-of-the-art related to decision points during individualized treatment of female infertility, before looking at future developments that might further assist in making individualized treatment decisions, including the use of computer-assisted decision making.
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Affiliation(s)
- Bruno Lunenfeld
- Faculty of Life Sciences, Bar-Ilan University, Ramat Gan, Israel
| | - Wilma Bilger
- Medical Affairs Fertility, Endocrinology & General Medicine, Merck Serono GmbH, Darmstadt, Germany
| | | | - Jan Kirsten
- Business Franchise Fertility, Merck KGaA, Darmstadt, Germany
| | - Thomas D'Hooghe
- Global Medical Affairs Fertility, Merck KGaA, Darmstadt, Germany
- Department of Development and Regeneration, Organ Systems, Group Biomedical Sciences, KU Leuven (University of Leuven), Leuven, Belgium
- Department of Obstetrics and Gynecology, Yale University, New Haven, CT, USA
| | - Sesh K Sunkara
- Assisted Conception Unit, King's College London, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Reignier A, Girard JM, Lammers J, Chtourou S, Lefebvre T, Barriere P, Freour T. Performance of Day 5 KIDScore™ morphokinetic prediction models of implantation and live birth after single blastocyst transfer. J Assist Reprod Genet 2019; 36:2279-2285. [PMID: 31444634 DOI: 10.1007/s10815-019-01567-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 08/15/2019] [Indexed: 11/25/2022] Open
Abstract
PURPOSE While several studies reported the association between morphokinetic parameters and implantation, few predictive models were developed to predict implantation after day 5 embryo transfer, generally without external validation. The objective of this study was to evaluate the respective performance of 2 commercially available morphokinetic-based models (KIDScore™ Day 5 versions 1 and 2) for the prediction of implantation and live birth after day 5 single blastocyst transfer. METHODS This monocentric retrospective study was conducted on 210 ICSI cycles with single day 5 embryo transfer performed with a time-lapse imaging (TLI) system between 2013 and 2016. The association between both KIDScore™ and the observed implantation and live birth rates was calculated, as well as the agreement between embryologist's choice for transfer and embryo ranking by the models. RESULTS Implantation and live birth rate were both 35.7%. A significant positive correlation was found between both models and implantation rate (r = 0.96 and r = 0.90, p = 0.01) respectively. Both models had statistically significant but limited predictive power for implantation (AUC 0.60). There was a fair agreement between the embryologists' choice and both models (78% and 61% respectively), with minor differences in case of discrepancies. CONCLUSIONS KIDScore™ Day 5 predictive models are significantly associated with implantation rates after day 5 single blastocyst transfer. However, their predictive performance remains perfectible. The use of these predictive models holds promises as decision-making tools to help the embryologist select the best embryo, ultimately facilitating the implementation of SET policy. However, embryologists' expertise remains absolutely necessary to make the final decision.
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Affiliation(s)
- Arnaud Reignier
- Service de biologie et médecine de la reproduction, CHU Nantes, 38 boulevard Jean Monnet, 44093, Nantes, France.,Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, Nantes, France.,Faculté de médecine, Université de Nantes, Nantes, France
| | | | - Jenna Lammers
- Service de biologie et médecine de la reproduction, CHU Nantes, 38 boulevard Jean Monnet, 44093, Nantes, France
| | - Sana Chtourou
- Service de biologie et médecine de la reproduction, CHU Nantes, 38 boulevard Jean Monnet, 44093, Nantes, France.,Laboratoire de biologie de la reproduction et de cytogénétique, Hôpital Aziza Othmana, Tunis, Tunisia
| | - Tiphaine Lefebvre
- Service de biologie et médecine de la reproduction, CHU Nantes, 38 boulevard Jean Monnet, 44093, Nantes, France.,Faculté de médecine, Université de Nantes, Nantes, France
| | - Paul Barriere
- Service de biologie et médecine de la reproduction, CHU Nantes, 38 boulevard Jean Monnet, 44093, Nantes, France.,Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, Nantes, France.,Faculté de médecine, Université de Nantes, Nantes, France
| | - Thomas Freour
- Service de biologie et médecine de la reproduction, CHU Nantes, 38 boulevard Jean Monnet, 44093, Nantes, France. .,Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, Nantes, France. .,Faculté de médecine, Université de Nantes, Nantes, France.
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Revelli A, Canosa S, Carosso A, Filippini C, Paschero C, Gennarelli G, Delle Piane L, Benedetto C. Impact of the addition of Early Embryo Viability Assessment to morphological evaluation on the accuracy of embryo selection on day 3 or day 5: a retrospective analysis. J Ovarian Res 2019; 12:73. [PMID: 31399038 PMCID: PMC6688364 DOI: 10.1186/s13048-019-0547-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 07/29/2019] [Indexed: 11/13/2022] Open
Abstract
In this study we aimed at retrospectively assessing in a homogeneous group of IVF patients whether the addition of Early Embryo Viability Assessment (Eeva™) to standard morphology increases the accuracy of embryo selection in case of double embryo transfer (DET) on day 3 or single embryo transfer (SET) on day 5. Eeva™ is an algorhythm aimed at indicating on day 3, according to morphokinetic parameters observed in the first three days of embryo growth, which embryos are more likely to develop into viable blastocysts and implant. A total number of 328 patients were included in the study; IVF or ICSI were performed and 428 embryos were transferred, either with DET on day 5, or (when at least four top scored embryos were available on day 3) with SET of day 5. Four groups were considered: (a) patients receiving day 3 DET with embryos selected by standard morphology (DET-3 M, n = 106, receiving 212 embryos), (b) patients receiving day 3 DET with embryos selected by morphology plus Eeva™ (DET-3 ME group, n = 48, receiving 96 embryos), (c) patients receiving day 5 SET with a blastocyst selected by standard morphology (SET-5 M group, n = 126, receiving 126 embryos), and (d) patients receiving day 5 SET with a blastocyst selected by morphology plus Eeva™ (SET-5 ME group, n = 48, receiving 48 embryos). Overall, a clinical pregnancy rate of 49.1%, implantation rate of 40%, and ongoing pregnancy rate of 43.6% were observed. The implantation rate was significantly higher in DET-3 ME group than in DET-3 M group (44.8% vs. 30.2%, p < 0.02), whereas it was comparable in groups DET-3 ME, SET-5 M and SET-5 ME. Differently, the ultrasound-verified clinical pregnancy rate and the ongoing pregnancy rate at 12 weeks did not significantly differ in all four groups. Overall, our findings suggest that Eeva™ algorhythm can improve embryo selection accuracy of standard morphology when ET on day 3 is scheduled, leading to a higher implantation rate, but its impact on ongoing pregnancy and live birth needs to be further clarified.
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Affiliation(s)
- Alberto Revelli
- Department of Surgical Sciences, Gynecology and Obstetrics 1, Physiopathology of Reproduction and IVF Unit, S. Anna Hospital, University of Torino, Via Ventimiglia 3, 10126, Torino, Italy.
| | - Stefano Canosa
- Department of Surgical Sciences, Gynecology and Obstetrics 1, Physiopathology of Reproduction and IVF Unit, S. Anna Hospital, University of Torino, Via Ventimiglia 3, 10126, Torino, Italy
| | - Andrea Carosso
- Department of Surgical Sciences, Gynecology and Obstetrics 1, Physiopathology of Reproduction and IVF Unit, S. Anna Hospital, University of Torino, Via Ventimiglia 3, 10126, Torino, Italy
| | - Claudia Filippini
- Department of Surgical Sciences, Clinical statistics, University of Torino, Corso Bramante, 88, Torino, Italy
| | - Carlotta Paschero
- Department of Surgical Sciences, Gynecology and Obstetrics 1, Physiopathology of Reproduction and IVF Unit, S. Anna Hospital, University of Torino, Via Ventimiglia 3, 10126, Torino, Italy
| | - Gianluca Gennarelli
- Department of Surgical Sciences, Gynecology and Obstetrics 1, Physiopathology of Reproduction and IVF Unit, S. Anna Hospital, University of Torino, Via Ventimiglia 3, 10126, Torino, Italy
| | - Luisa Delle Piane
- Department of Surgical Sciences, Gynecology and Obstetrics 1, Physiopathology of Reproduction and IVF Unit, S. Anna Hospital, University of Torino, Via Ventimiglia 3, 10126, Torino, Italy
| | - Chiara Benedetto
- Department of Surgical Sciences, Gynecology and Obstetrics 1, Physiopathology of Reproduction and IVF Unit, S. Anna Hospital, University of Torino, Via Ventimiglia 3, 10126, Torino, Italy
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Schenk M, Kröpfl JM, Hörmann-Kröpfl M, Weiss G. Endometriosis accelerates synchronization of early embryo cell divisions but does not change morphokinetic dynamics in endometriosis patients. PLoS One 2019; 14:e0220529. [PMID: 31369616 PMCID: PMC6675061 DOI: 10.1371/journal.pone.0220529] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 07/17/2019] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE The pathology of endometriosis and its impact on embryo development is still a black box in reproductive medicine. In this time-lapse study we investigated the influence of endometriosis on morphokinetic parameters of embryo development, taking variables of dynamic monitoring into account. Furthermore we evaluated reproductive medicine treatment outcome such as fetal heartbeat and live birth rate. METHODS 1148 embryos (control: n = 596, endometriosis: n = 552) were retrospectively analyzed. Patients were stimulated with GnRH antagonist protocol. After fertilization, embryos were incubated in a time-lapse system (EmbryoScope). RESULTS The mixed-model analysis revealed a significant main effect of time (p<0.001), with post-hoc tests showing that any time needed to reach a specific developmental stage was significantly different from all the others (all p<0.001). Embryos of endometriosis patients showed the same absolute morphokinetic time parameters as the control group, however, synchronization of early embryo cell divisions (s2) was faster in endometriosis patients compared to the control group. CONCLUSION In general, endometriosis does not induce changes in early embryo morphokinetics. However, observed acceleration in cell cycle synchronization of embryo cleavage patterns might be a missing explanation for contradicting results in literature regarding the impairments in reproductive medicine treatment outcome of endometriosis patients.
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Affiliation(s)
- Michael Schenk
- Das Kinderwunsch Institut Schenk GmbH, Dobl, Austria
- Institute of Human Genetics, Medical University of Graz, Graz, Austria
| | - Julia Maria Kröpfl
- Exercise Physiology Lab, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland
| | | | - Gregor Weiss
- Das Kinderwunsch Institut Schenk GmbH, Dobl, Austria
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36
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Ohata K, Ezoe K, Miki T, Morita H, Tsuchiya R, Kaneko S, Okimura T, Uchiyama K, Yabuuchi A, Kobayashi T, Montag M, Kato K. Blastomere movement post first cell division correlates with embryonic compaction and subsequent blastocyst formation. Reprod Biol Endocrinol 2019; 17:44. [PMID: 31092247 PMCID: PMC6521525 DOI: 10.1186/s12958-019-0488-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 05/09/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Blastomere movement (BMov) occurs after the first cell division in human embryos. This movement has been suggested as a prognostic parameter for pregnancy outcome prediction following cleavage-stage embryo transfer. However, the effect of BMov on preimplantation development and pregnancy outcome after blastocyst transfer remains unclear. Therefore, this study aimed to evaluate whether BMov after the first cell division is correlated with blastocyst formation rate and live birth rate after single vitrified-warmed blastocyst transfer (SVBT). METHODS Nine hundred and sixty-six embryos cultured in the EmbryoScope+® time-lapse system were retrospectively analyzed. The BMov type was categorized into three groups; namely, bouncing, wobbling, and twist-and-crumble. The BMov duration (dBMov) between the first (t2) and second cell division (t3) was monitored, and the ratio of dBMov to the duration of the 2-cell stage was calculated [dBMov/(t3-t2)]. Developmental rates to the 4-cell, 8-cell, morula, blastocyst, and expanded blastocyst stages were assessed, as well as blastocyst morphological grade. The correlations between dBMov and clinical pregnancy, ongoing pregnancy, and live birth rates were evaluated. RESULTS Increased dBMov/(t3-t2) was significantly correlated with decreased developmental rates to the 8-cell, morula, blastocyst, and expanded blastocyst stages, especially from the 4-cell stage to the morula stage. Analysis of different types of BMov revealed that embryos with bouncing movement exhibited significantly higher developmental rates to the 8-cell, morula, blastocyst, and expanded blastocyst stages compared with embryos with twist-and-crumble movement. The morphological quality of blastocyst-stage embryos with twist-and-crumble movement was significantly lower than that of embryos with bouncing and wobbling movements. The rates of clinical pregnancy, ongoing pregnancy, and live birth after SVBT were not correlated with BMov type or duration. CONCLUSIONS Embryonic compaction and subsequent blastocyst formation are adversely affected by twist-and-crumble movement and prolonged movement after the first cell division. Our results indicate that the preimplantation developmental competence of human embryos could be predicted by assessing BMov after the first cell division on day 1.
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Affiliation(s)
- Kazuki Ohata
- Kato Ladies Clinic, 7-20-3 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Kenji Ezoe
- Kato Ladies Clinic, 7-20-3 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.
| | - Tetsuya Miki
- Kato Ladies Clinic, 7-20-3 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Hirofumi Morita
- Kato Ladies Clinic, 7-20-3 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Ryoma Tsuchiya
- Kato Ladies Clinic, 7-20-3 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Shigeru Kaneko
- Kato Ladies Clinic, 7-20-3 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Tadashi Okimura
- Kato Ladies Clinic, 7-20-3 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Kazuo Uchiyama
- Kato Ladies Clinic, 7-20-3 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Akiko Yabuuchi
- Kato Ladies Clinic, 7-20-3 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Tamotsu Kobayashi
- Kato Ladies Clinic, 7-20-3 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Markus Montag
- ilabcomm GmbH, Eisenachstr, 34, 53757, Sankt Augustin, Germany
| | - Keiichi Kato
- Kato Ladies Clinic, 7-20-3 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.
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Liu Y, Sakkas D, Afnan M, Matson P. Time-lapse videography for embryo selection/de-selection: a bright future or fading star? HUM FERTIL 2019; 23:76-82. [PMID: 30963781 DOI: 10.1080/14647273.2019.1598586] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
The recent clinical introduction of time-lapse videography into in vitro fertilization laboratories has offered a novel opportunity for embryologists to explore improved methods for embryo selection. While the concept of uninterrupted culture of embryos provided by such systems is welcomed, the current evidence does not support its full application in routine clinical practice. The issue of whether or not algorithms for embryo selection can be extrapolated between laboratories, which may represent a major hurdle to its wide application, is currently gaining increasing attention amongst embryologists worldwide. In this commentary issues identified in time-lapse embryo selection/de-selection algorithms, such as quantitative versus qualitative parameters, are discussed alongside the reference start point for the timing system, and types of datasets used for developing and validating time-lapse algorithms. Considering these factors, alternative future research directions which could potentially solve current issues are proposed.
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Affiliation(s)
- Yanhe Liu
- Reproductive Medicine Center, Tianjin United Family Hospital, Tianjin, China.,School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
| | | | - Masoud Afnan
- Reproductive Medicine Center, Tianjin United Family Hospital, Tianjin, China
| | - Phillip Matson
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia.,Joondalup Private Hospital, Fertility North, Joondalup, Australia
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Martinez G, Hograindleur JP, Jeammet L, Le Blévec E, Coutton C, Mermillod P, Lambeau G, Schmitt E, Ray PF, Arnoult C. Enzymatic activity of mouse group X-sPLA2 improves in vitro production of preimplantation bovine embryos. Theriogenology 2019; 131:113-122. [PMID: 30959437 DOI: 10.1016/j.theriogenology.2019.03.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 03/27/2019] [Accepted: 03/30/2019] [Indexed: 10/27/2022]
Abstract
Assisted reproductive technologies (ART) are widely used for both humans and domestic animals. In bovine species, in vitro embryo production is increasingly used and significant efforts are being made to optimize media and culture conditions. Phospholipase A2 (PLA2) are lipolytic enzymes that hydrolyze glycerophospholipids to produce free fatty acids and lysophospholipids that have been found to be critical for many biological processes. Mouse group X secreted PLA2 (mGX) is abundant in the male reproductive tract and its use during sperm capacitation has been shown to improve in vitro production of viable embryos in a mouse model. Here, we examined its effect in the bovine species, testing the impact of mGX on the three steps involved in vitro production of preimplantation embryos: oocyte maturation, fertilization and preimplantation development. We found that incubating cumulus oocyte complexes (COC) or gametes with mGX resulted in increased blastocyst hatching and blastocyst production, respectively. The increases of embryo production induced by the phospholipase mGX were not observed for the catalytically inactive mutant H48Q-mGX, suggesting that these effects require the enzymatic activity of mGX. We also tested bGIB, a bovine homolog of mGX. bGIB failed to improve blastocyst production, underlining the high specificity of mGX. In conclusion, the results presented show that the effects of mGX are not restricted to the mouse model and that it is potent in the bovine species as well. This result strengthens the potential of mGX as a "pro-fertility drug" for mammalian reproduction.
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Affiliation(s)
- Guillaume Martinez
- Université Grenoble Alpes, Grenoble, F-38000, France; Institute for Advanced Biosciences INSERM U1209, CNRS UMR5309, Grenoble, F-38000, France; IMV Technologies, ZI N 1 Est, F-61300, L'Aigle, France
| | - Jean-Pascal Hograindleur
- Université Grenoble Alpes, Grenoble, F-38000, France; Institute for Advanced Biosciences INSERM U1209, CNRS UMR5309, Grenoble, F-38000, France
| | - Louise Jeammet
- Université Côte d'Azur, CNRS, IPMC, F-06560, Valbonne, Sophia Antipolis, France
| | - Emilie Le Blévec
- Université Grenoble Alpes, Grenoble, F-38000, France; Institute for Advanced Biosciences INSERM U1209, CNRS UMR5309, Grenoble, F-38000, France
| | - Charles Coutton
- Université Grenoble Alpes, Grenoble, F-38000, France; Institute for Advanced Biosciences INSERM U1209, CNRS UMR5309, Grenoble, F-38000, France
| | - Pascal Mermillod
- Laboratoire Physiologie de la Reproduction et des Comportements, INRA UMR 7247, Inra-Cnrs-Université de Tours-Haras Nationaux, F-37380, Nouzilly, France
| | - Gérard Lambeau
- Université Côte d'Azur, CNRS, IPMC, F-06560, Valbonne, Sophia Antipolis, France
| | - Eric Schmitt
- IMV Technologies, ZI N 1 Est, F-61300, L'Aigle, France
| | - Pierre F Ray
- Université Grenoble Alpes, Grenoble, F-38000, France; Institute for Advanced Biosciences INSERM U1209, CNRS UMR5309, Grenoble, F-38000, France; CHU de Grenoble, UM GI-DPI, Grenoble, F-38000, France
| | - Christophe Arnoult
- Université Grenoble Alpes, Grenoble, F-38000, France; Institute for Advanced Biosciences INSERM U1209, CNRS UMR5309, Grenoble, F-38000, France.
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Medrano L, Enciso M, Gomez-Torres MJ, Aizpurua J. First birth of a healthy infant following intra-cytoplasmic sperm injection using a new permeable cryoprotectant-free sperm vitrification protocol. Cryobiology 2019; 87:117-119. [DOI: 10.1016/j.cryobiol.2019.01.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 01/14/2019] [Accepted: 01/29/2019] [Indexed: 10/27/2022]
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Ezoe K, Ohata K, Morita H, Ueno S, Miki T, Okimura T, Uchiyama K, Yabuuchi A, Kobayashi T, Montag M, Kato K. Prolonged blastomere movement induced by the delay of pronuclear fading and first cell division adversely affects pregnancy outcomes after fresh embryo transfer on Day 2: a time-lapse study. Reprod Biomed Online 2018; 38:659-668. [PMID: 30853350 DOI: 10.1016/j.rbmo.2018.12.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 11/09/2018] [Accepted: 12/11/2018] [Indexed: 11/26/2022]
Abstract
RESEARCH QUESTION What is the incidence, origin and clinical significance of blastomere movement after the first cell division in the human embryo? DESIGN A total of 1096 embryos, cultured in the EmbryoScope+ ® time-lapse system and subjected to a single fresh cleaved embryo transfer, were retrospectively analysed. Type and duration of blastomere movement (dBMov) between the first (t2) and second cell division (t3) was monitored, and the ratio of dBMov during the 2-cell stage [dBMov/(t3-t2)] was calculated. Morphological evaluation of embryos was performed by referring to the size of the blastomere and fragmentation after first division in addition to Veeck's criteria on Day 2. The correlation between dBMov and ongoing pregnancy was evaluated and the association of dBMov with patient and embryonic characteristics was determined. RESULTS Both movement type and the value of dBMov/(t3-t2) were significantly associated with asymmetrical first division, fragment formation and morphological grade on Day 2. Multivariate logistic regression analysis revealed that a higher value of dBMov/(t3-t2) significantly correlated with a decreased ongoing pregnancy rate, even after adjustment for co-founders (odds ratio 0.399, P = 0.0419). The time intervals of pronuclear (PN) alignment and PN fading were significantly correlated with the dBMov/(t3-t2) value. CONCLUSIONS Embryos with extended blastomere movement after the first cell division, which is associated with the delay of PN fading and first cell division, have a lower competence to initiate an ongoing pregnancy after fresh embryo transfer on Day 2. Thus, blastomere movement could be a useful predictive parameter for selecting embryos at the early cleavage stage.
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Affiliation(s)
- Kenji Ezoe
- Kato Ladies Clinic, Tokyo 160-0023, Japan.
| | | | | | | | | | | | | | | | | | - Markus Montag
- ilabcomm GmbH, Eisenachstrasse 34, St. Augustin 53757, Germany
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Gouveia Nogueira MF, Bertogna Guilherme V, Pronunciate M, Dos Santos PH, Lima Bezerra da Silva D, Rocha JC. Artificial Intelligence-Based Grading Quality of Bovine Blastocyst Digital Images: Direct Capture with Juxtaposed Lenses of Smartphone Camera and Stereomicroscope Ocular Lens. SENSORS 2018; 18:s18124440. [PMID: 30558278 PMCID: PMC6308431 DOI: 10.3390/s18124440] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 11/21/2018] [Accepted: 11/30/2018] [Indexed: 12/17/2022]
Abstract
In this study, we developed an online graphical and intuitive interface connected to a server aiming to facilitate professional access worldwide to those facing problems with bovine blastocysts classification. The interface Blasto3Q, where 3Q refers to the three qualities of the blastocyst grading, contains a description of 24 variables that were extracted from the image of the blastocyst and analyzed by three Artificial Neural Networks (ANNs) that classify the same loaded image. The same embryo (i.e., the biological specimen) was submitted to digital image capture by the control group (inverted microscope with 40× magnification) and the experimental group (stereomicroscope with maximum of magnification plus 4× zoom from the cell phone camera). The images obtained from the control and experimental groups were uploaded on Blasto3Q. Each image from both sources was evaluated for segmentation and submitted (only if it could be properly or partially segmented) for automatic quality grade classification by the three ANNs of the Blasto3Q program. Adjustments on the software program through the use of scaling algorithm software were performed to ensure the proper search and segmentation of the embryo in the raw images when they were captured by the smartphone, since this source produced small embryo images compared with those from the inverted microscope. With this new program, 77.8% of the images from smartphones were successfully segmented and from those, 85.7% were evaluated by the Blasto3Q in agreement with the control group.
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Affiliation(s)
- Marcelo Fábio Gouveia Nogueira
- Laboratory of Embryonic Micromanipulation, Department of Biological Sciences, School of Sciences and Languages, São Paulo State University (UNESP), Assis, São Paulo 19.806-900, Brazil.
- Multiuser Facility (FitoFarmaTec), Department of Pharmacology, Biosciences Institute, São Paulo State University (UNESP), Botucatu, São Paulo 18.618-689, Brazil.
| | - Vitória Bertogna Guilherme
- Laboratory of Embryonic Micromanipulation, Department of Biological Sciences, School of Sciences and Languages, São Paulo State University (UNESP), Assis, São Paulo 19.806-900, Brazil.
| | - Micheli Pronunciate
- Laboratory of Embryonic Micromanipulation, Department of Biological Sciences, School of Sciences and Languages, São Paulo State University (UNESP), Assis, São Paulo 19.806-900, Brazil.
- Multiuser Facility (FitoFarmaTec), Department of Pharmacology, Biosciences Institute, São Paulo State University (UNESP), Botucatu, São Paulo 18.618-689, Brazil.
| | - Priscila Helena Dos Santos
- Laboratory of Embryonic Micromanipulation, Department of Biological Sciences, School of Sciences and Languages, São Paulo State University (UNESP), Assis, São Paulo 19.806-900, Brazil.
- Multiuser Facility (FitoFarmaTec), Department of Pharmacology, Biosciences Institute, São Paulo State University (UNESP), Botucatu, São Paulo 18.618-689, Brazil.
| | - Diogo Lima Bezerra da Silva
- Laboratory of Applied Mathematics, Department of Biological Sciences, School of Sciences and Languages, São Paulo State University (UNESP), Assis, São Paulo 19.806-900, Brazil.
| | - José Celso Rocha
- Laboratory of Applied Mathematics, Department of Biological Sciences, School of Sciences and Languages, São Paulo State University (UNESP), Assis, São Paulo 19.806-900, Brazil.
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Predicting live birth by combining cleavage and blastocyst-stage time-lapse variables using a hierarchical and a data mining-based statistical model. Reprod Biol 2018; 18:355-360. [DOI: 10.1016/j.repbio.2018.10.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 10/17/2018] [Accepted: 10/19/2018] [Indexed: 10/28/2022]
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Adolfsson E, Porath S, Andershed AN. External validation of a time-lapse model; a retrospective study comparing embryo evaluation using a morphokinetic model to standard morphology with live birth as endpoint. JBRA Assist Reprod 2018; 22:205-214. [PMID: 29932617 PMCID: PMC6106632 DOI: 10.5935/1518-0557.20180041] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objective To validate a morphokinetic implantation model developed for EmbryoScope on
embryos with known outcome, compared to standard morphology in a
retrospective single center study. Methods Morphokinetic annotation of 768 embryos with known outcome between 2013
-2015; corresponding to 116 D3 fresh embryos, 80 D6 frozen blastocysts, and
572 D5 blastocysts, fresh or frozen. The embryos were ranked by the KIDScore
into five classes, KID1-5, and grouped into four classes based on standard
morphology. Pregnancy rates, clinical pregnancy rates and live birth rates
were compared. Combinations of morphology and morphokinetics were evaluated
for implantation rates and live births. Results Live birth rate increased with increasing KIDScore, from 19% for KID1 to 42%
for KID5. Of all live births, KID5 contributed with 71%, KID4 with 20%, KID3
with 4%, KID2 with 4%, and KID1 with 2%. For morphology, the corresponding
figure was 43% for Top Quality, 47% for Good Quality, 4% for Poor Quality,
and 5% for Slow embryos. For day 3 embryos, KID5 embryos had the highest
live birth rates, and contributed to 83% of the live births; whereas the
second best morphological class had the highest live birth rate and
contributed to most of the live births. For blastocysts, the KIDScore and
morphology performed equally well. Combining morphology and morphokinetics
indicated stronger predictive power for morphokinetics. Conclusions Overall, the KIDScore correlates with both implantation and live birth in our
clinical setting. Compared to morphology, the KIDScore was superior for day
3 embryos, and equally good for blastocysts at predicting live births.
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Affiliation(s)
- Emma Adolfsson
- Örebro University Hospital. Department of Laboratory Medicine. Örebro, Sweden
| | - Sandra Porath
- Örebro University Hospital. Department of Laboratory Medicine. Örebro, Sweden
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Rocafort E, Enciso M, Leza A, Sarasa J, Aizpurua J. Euploid embryos selected by an automated time-lapse system have superior SET outcomes than selected solely by conventional morphology assessment. J Assist Reprod Genet 2018; 35:1573-1583. [PMID: 30030710 PMCID: PMC6133820 DOI: 10.1007/s10815-018-1265-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 07/11/2018] [Indexed: 10/28/2022] Open
Abstract
PURPOSE We investigated if automated TLI selection may be a valuable strategy to identify those euploid embryos with the best chances of success. METHODS This is a unicentric and retrospective study involving 244 patients undergoing preimplantational genetic screening (PGS) cycles with autologous oocytes or oocyte donation (OD) with single euploid embryo transferred. We examined euploid embryos selected for transfer based on morphology evaluation alone (PGS-only; control group) or by assessment using an automated TLI system (Eeva™; PGS-TLI group). RESULTS In both, autologous oocytes and OD patients, significantly better implantation and clinical and ongoing pregnancy rates were obtained in the PGS-TLI group when euploid embryos with high implantation potential as predicted by the automated TLI System (Eeva™) were transferred compared with the PGS-only group. This improvement was also observed when only transfers of good morphological quality embryos were compared. TLI categories showed significant differences on blastocyst formation and euploidy rate. CONCLUSIONS Automated TLI combined with PGS is a useful prognostic tool to identify euploid embryos with the highest potential for implantation and pregnancy. Further, these results provide evidence that a healthy pregnancy does not only depend upon normal chromosomal status.
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Affiliation(s)
- E. Rocafort
- IVF Laboratory, IVF Spain, 13 Ansaldo Avenue, 03540 Alicante, Spain
- Present Address: Barcelona, Spain
| | - M. Enciso
- Genetics Department, iGLS, 7 Britania Street, 03540 Alicante, Spain
| | - A. Leza
- IVF Laboratory, IVF Spain, 13 Ansaldo Avenue, 03540 Alicante, Spain
| | - J. Sarasa
- Genetics Department, iGLS, 7 Britania Street, 03540 Alicante, Spain
| | - J. Aizpurua
- Reproductive Medicine, IVF Spain, 13 Ansaldo Avenue, 03540 Alicante, Spain
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Lindgren KE, Gülen Yaldir F, Hreinsson J, Holte J, Kårehed K, Sundström-Poromaa I, Kaihola H, Åkerud H. Differences in secretome in culture media when comparing blastocysts and arrested embryos using multiplex proximity assay. Ups J Med Sci 2018; 123:143-152. [PMID: 30282508 PMCID: PMC6198226 DOI: 10.1080/03009734.2018.1490830] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES The aim of this study was to assess different patterns of the human embryo secretome analysed as protein levels in culture media. Furthermore, analyses to correlate protein levels with quality and timing to development of human embryos were performed. MATERIAL AND METHODS Human day-2 cryopreserved embryos were cultured for four days in an EmbryoScope® with a time-lapse camera, and embryo quality was evaluated retrospectively. After culture, the media were collected and relative levels of secreted proteins were analysed using Proseek Multiplex Assays. Protein levels were evaluated in relation to timing to development and the ability to form a blastocyst. RESULTS Specific patterns of timing of development of blastocysts were found, where a difference in time to start of cavitation was found between high- and low-quality blastocysts. There appeared to be a correlation between specific protein patterns and successful formation of morulae and blastocysts. Embryos developing into blastocysts had higher levels of EMMPRIN than arrested embryos, and levels of caspase-3 were lower in high- versus low-quality blastocysts. Also, higher levels of VEGF-A, IL-6, and EMMPRIN correlated with shorter times to morula formation. CONCLUSIONS The secretome and timing to development differ in embryos forming blastocysts and those that become arrested, and in high- versus low-quality blastocysts. The levels of certain proteins also correlate to specific times to development.
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Affiliation(s)
- Karin E. Lindgren
- Department of Women’s and Children’s Health, Uppsala University, SE-751 85Uppsala, Sweden
| | - Fatma Gülen Yaldir
- Department of Women’s and Children’s Health, Uppsala University, SE-751 85Uppsala, Sweden
| | - Julius Hreinsson
- Department of Immunology, Genetics and Pathology, Uppsala University, SE-751 85Uppsala, Sweden
- Department of Clinical Sciences, Intervention and Technology, Karolinska Institute and Unit for Reproductive Medicine, Karolinska University Hospital, SE-14186Stockholm, Sweden
| | - Jan Holte
- Department of Women’s and Children’s Health, Uppsala University, SE-751 85Uppsala, Sweden
- Carl von Linné Clinic, SE-751 83Uppsala, Sweden
| | - Karin Kårehed
- Department of Women’s and Children’s Health, Uppsala University, SE-751 85Uppsala, Sweden
| | | | - Helena Kaihola
- Department of Immunology, Genetics and Pathology, Uppsala University, SE-751 85Uppsala, Sweden
| | - Helena Åkerud
- Department of Immunology, Genetics and Pathology, Uppsala University, SE-751 85Uppsala, Sweden
- CONTACT Helena Åkerud Department of Immunology, Genetics and Pathology, Rudbeck Laboratory, Uppsala University, Dag Hammarskjölds väg 20, SE-751 85Uppsala, Sweden
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Time-lapse imaging algorithms rank human preimplantation embryos according to the probability of live birth. Reprod Biomed Online 2018; 37:304-313. [DOI: 10.1016/j.rbmo.2018.05.016] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Revised: 05/15/2018] [Accepted: 05/22/2018] [Indexed: 01/20/2023]
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Are computational applications the "crystal ball" in the IVF laboratory? The evolution from mathematics to artificial intelligence. J Assist Reprod Genet 2018; 35:1545-1557. [PMID: 30054845 DOI: 10.1007/s10815-018-1266-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 07/11/2018] [Indexed: 01/23/2023] Open
Abstract
Mathematics rules the world of science. Innovative technologies based on mathematics have paved the way for implementation of novel strategies in assisted reproduction. Ascertaining efficient embryo selection in order to secure optimal pregnancy rates remains the focus of the in vitro fertilization scientific community and the strongest driver behind innovative approaches. This scoping review aims to describe and analyze complex models based on mathematics for embryo selection, devices, and software most widely employed in the IVF laboratory and algorithms in the service of the cutting-edge technology of artificial intelligence. Despite their promising nature, the practicing embryologist is the one ultimately responsible for the success of the IVF laboratory and thus the one to approve embracing pioneering technologies in routine practice. Applied mathematics and computational biology have already provided significant insight into the selection of the most competent preimplantation embryo. This review describes the leap of evolution from basic mathematics to bioinformatics and investigates the possibility that computational applications may be the means to foretell a promising future for the IVF clinical practice.
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Schenk M, Groselj-Strele A, Eberhard K, Feldmeier E, Kastelic D, Cerk S, Weiss G. Impact of polar body biopsy on embryo morphokinetics-back to the roots in preimplantation genetic testing? J Assist Reprod Genet 2018; 35:1521-1528. [PMID: 29790071 PMCID: PMC6086803 DOI: 10.1007/s10815-018-1207-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 05/09/2018] [Indexed: 11/29/2022] Open
Abstract
Purpose Polar body biopsy (PBB) is a common technique in preimplantation genetic testing (PGT) to assess the chromosomal status of the oocyte. Numerous studies have been implemented to investigate the impact of biopsies on embryo development; however, information on embryo morphokinetics is still lacking. Hence, we investigated the impact of PBB on morphokinetic parameters in early embryo development. Methods Four hundred four embryos (202 PBB, 202 control) were retrospectively analyzed. Patients were stimulated with a gonadotropin-releasing hormone antagonist ovarian hyperstimulation protocol. After fertilization check, embryos were incubated in a time-lapse incubator. The groups were matched for maternal age at time of oocyte retrieval. Results Mean group times for reaching specific developmental time points showed no significant difference comparing embryos with PBB conducted and without. Likewise, further subdivision of the PBB group in euploid and aneuploid embryos revealed no differences in the early embryo morphokinetic development compared to the control group. Aneuploidy testing revealed a high prevalence of chromosomal aberrations for chromosomes 21, 4, 16, and 19. Conclusions In conclusion, PBB does not impact the morphokinetic parameters of the embryo development. PBB can be safely applied without the risk of impairing the reproductive potential of the embryo and can be highly recommended as safe and practicable PGT approach, especially in countries with prevailing restrictions regarding PGT analysis.
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Affiliation(s)
- Michael Schenk
- Das Kinderwunsch Institut Schenk GmbH, Am Sendergrund 11, 8143, Dobl, Austria.,Institute of Human Genetics, Medical University of Graz, Neue Stiftingtalstrasse 2, 8010, Graz, Austria
| | - Andrea Groselj-Strele
- Core Facility Computational Bioanalytics, Center for Medical Research, Medical University of Graz, Stiftingtalstraße 24, 8010, Graz, Austria
| | - Katharina Eberhard
- Core Facility Computational Bioanalytics, Center for Medical Research, Medical University of Graz, Stiftingtalstraße 24, 8010, Graz, Austria
| | - Elisabeth Feldmeier
- Das Kinderwunsch Institut Schenk GmbH, Am Sendergrund 11, 8143, Dobl, Austria
| | - Darja Kastelic
- Das Kinderwunsch Institut Schenk GmbH, Am Sendergrund 11, 8143, Dobl, Austria
| | - Stefanie Cerk
- Das Kinderwunsch Institut Schenk GmbH, Am Sendergrund 11, 8143, Dobl, Austria
| | - Gregor Weiss
- Das Kinderwunsch Institut Schenk GmbH, Am Sendergrund 11, 8143, Dobl, Austria.
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Storr A, Venetis C, Cooke S, Kilani S, Ledger W. Time-lapse algorithms and morphological selection of day-5 embryos for transfer: a preclinical validation study. Fertil Steril 2018; 109:276-283.e3. [PMID: 29331237 DOI: 10.1016/j.fertnstert.2017.10.036] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 10/01/2017] [Accepted: 10/27/2017] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To determine the agreement between published time-lapse algorithms in selecting the best day-5 embryo for transfer, as well as the agreement between these algorithms and embryologists. DESIGN Prospective study. SETTING Private in vitro fertilization center. PATIENT(S) Four hundred and twenty-eight embryos from 100 cycles cultured in the EmbryoScope. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Interalgorithm agreement as assessed by the Fleiss kappa coefficient. RESULT(S) Of seven published algorithms analyzed in this study, only one of the 18 possible pairs showed very good agreement (κ = 0.867); one pair showed good agreement (κ = 0.725), four pairs showed fair agreement (κ = 0.226-0.334), and the remaining 12 pairs showed poor agreement (κ = 0.008-0.149). Even in the best-case scenario, the majority of algorithms showed poor to moderate kappa scores (κ = 0.337-0.722) for the assessment of agreement between the embryo(s) selected as "best" by the algorithms and the embryo that was chosen by the majority (>5) of embryologists, as well as with the embryo that was actually selected in the laboratory on the day of transfer (κ = 0.315-0.802). CONCLUSION(S) The results of this study raise concerns as to whether the tested algorithms are applicable in different clinical settings, emphasizing the need for proper external validation before clinical use.
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Affiliation(s)
- Ashleigh Storr
- IVF Australia, Sydney; and School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Randwick, New South Wales, Australia.
| | - Christos Venetis
- IVF Australia, Sydney; and School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Randwick, New South Wales, Australia
| | - Simon Cooke
- IVF Australia, Sydney; and School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Randwick, New South Wales, Australia
| | - Suha Kilani
- IVF Australia, Sydney; and School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Randwick, New South Wales, Australia
| | - William Ledger
- IVF Australia, Sydney; and School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Randwick, New South Wales, Australia
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