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Akino R, Ezoe K, Ohata K, Fukuda J, Kato K. Is the Human Chorionic Gonadotropin Level on Day 10 After Cleaved Embryo Transfer a Predictor of Perinatal Outcome?: A Retrospective Cohort Study. Reprod Sci 2024; 31:2885-2892. [PMID: 38769247 DOI: 10.1007/s43032-024-01593-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 05/09/2024] [Indexed: 05/22/2024]
Abstract
This study aimed to determine whether human chorionic gonadotropin (hCG) levels at day 10 after day 2 cleaved embryo transfer can predict pregnancy and perinatal outcomes. Patients who underwent oocyte retrieval with minimal stimulation or natural cycles and fresh or vitrified-warmed transfer of a single, day 2 cleaved embryo at our clinic between November 2018 and December 2020 were included in this study. Patients were classified into four age groups for oocyte retrieval and into ten groups based on the hCG level on day 10 after embryo transfer; pregnancy complications and delivery and neonatal outcomes were examined. Of the 5,840 cycles, 3,722 (63.7%) and 2,118 (36.3%) were fresh-cleaved and vitrified-warmed embryo transfers, respectively. The mean hCG level was 24.8 mIU/mL and the clinical pregnancy and live birth rates per transfer were 29.6% and 23.4%, respectively. Maternal age at the time of oocyte retrieval, husband's age, treatment cycle, embryo type and grade, cell number, and hCG levels were correlated with pregnancy and delivery outcomes in the univariate analysis. Conversely, only maternal age and hCG levels were correlated with the outcomes in the multivariate analysis. hCG levels on day 10 post-transfer are a useful predictor of pregnancy and delivery outcomes after cleaved embryo transfer. Live birth rates vary with maternal age, even when hCG levels are the same, but they do not vary according to the treatment cycle or type of embryo transferred. Low hCG levels may be associated with vasa previa but did not affect delivery outcomes.
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Affiliation(s)
- Ryosuke Akino
- Kato Ladies Clinic, 7-20-3 Nishi-Shinjuku, Shinjuku, Tokyo, 160-0023, Japan
- Department of Obstetrics and Gynecology, Showa University Koto Toyosu Hospital, 5-1-38 Toyosu, Kotoku, Tokyo, 135-8577, Japan
| | - Kenji Ezoe
- Kato Ladies Clinic, 7-20-3 Nishi-Shinjuku, Shinjuku, Tokyo, 160-0023, Japan
| | - Kazuki Ohata
- Kato Ladies Clinic, 7-20-3 Nishi-Shinjuku, Shinjuku, Tokyo, 160-0023, Japan
| | - Junichiro Fukuda
- Kato Ladies Clinic, 7-20-3 Nishi-Shinjuku, Shinjuku, Tokyo, 160-0023, Japan
| | - Keiichi Kato
- Kato Ladies Clinic, 7-20-3 Nishi-Shinjuku, Shinjuku, Tokyo, 160-0023, Japan.
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Mahmoudinia M, Sovizi B, Ebadi SMR, Zakerinasab F, Sadeghi T, Mahmoudinia M. Live Birth after Cleavage-Stage versus Blastocyst-Stage Embryo Transfer in Assisted Reproductive Technology: A Randomised Controlled Study. INTERNATIONAL JOURNAL OF FERTILITY & STERILITY 2024; 18:10-16. [PMID: 39033365 PMCID: PMC11263845 DOI: 10.22074/ijfs.2023.2000574.1463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 08/20/2023] [Accepted: 11/16/2023] [Indexed: 07/23/2024]
Abstract
BACKGROUND Blastocyst stage transfer appears to improve pregnancy outcomes. The aim of this study is to evaluate the pregnancy results between fresh cycle blastocyst stage embryo transfer and cleavage stage embryo transfer in patients who undergo intracytoplasmic sperm injection (ICSI). MATERIALS AND METHODS This randomised clinical trial study was conducted at the Infertility Research Centre of Milad Hospital in Mashhad, Iran from 2018 to 2020 on 240 infertile women who presented for their first ICSI procedure. These patients were assigned to receive either cleavage embryo transfer (n=112) or blastocyst stage transfer (n=107). Pregnancy outcomes were measured in both groups. RESULTS There were no differences regarding age, body mass index (BMI), serum follicle-stimulating hormone (FSH), duration of infertility, and aetiology of infertility between the groups (P>0.05). There were more follicles, total oocytes, and metaphase II (M2) oocytes in the blastocyst stage group. Considerably more cleavage stage embryos were transferred compared to the number of transferred blastocysts (P=0.001). The blastocyst group had more vitrified embryos than the cleavage group (P=0.000). The rates of implantation (P=0.332), chemical pregnancy (P=0.165), clinical pregnancy (P=0.694), and live births (P=0.727) were higher in the blastocyst group, but they were not significantly different. The rate of abortion was also not significantly higher in the blastocyst group (P=0.296). CONCLUSION Blastocysts transferred in the fresh cycle of an ICSI procedure may be more advantageous compared to cleavage stage embryo transfer (registration number: IRCT20181030041503N1).
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Affiliation(s)
- Malihe Mahmoudinia
- Supporting The Family and The Youth of Population Research Core, Department of Obstetrics and Gynaecology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Behnaze Sovizi
- Department of Obstetrics and Gynaecology, School of Medicine, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | | | - Faezeh Zakerinasab
- Department of Obstetrics and Gynaecology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Tahereh Sadeghi
- Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Akbar Hospital, Mashhad University of Medical Sciences, Iran
| | - Mahbbobeh Mahmoudinia
- Department of Obstetrics and Gynaecology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Giladi Yacobi E, Miller N, Gepstein NG, Mashiach J, Herzberger EH, Levi M, Ghetler Y, Wiser A. Does cleavage- versus blastocyst-stage embryo transfer improve fertility rates in women over 38 years of age undergoing assisted reproductive technology? Int J Gynaecol Obstet 2024. [PMID: 38944696 DOI: 10.1002/ijgo.15753] [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: 02/14/2024] [Revised: 06/05/2024] [Accepted: 06/14/2024] [Indexed: 07/01/2024]
Abstract
OBJECTIVE To evaluate whether extending embryo culture to day 5 (D5) affects pregnancy rates in women older than 38 years undergoing in vitro fertilization (IVF). METHODS This retrospective, observational cohort study included data from fresh IVF cycles of women over 38 years, during 2011-2021. The cohort was divided according to day 3 (D3) versus D5 embryo transfer (ET). RESULTS A total of 346 patients (ages 38-45 years) who underwent 496 IVF cycles were included, each yielding one to six embryos. A total of 374 (75%) fresh D3 ETs were compared with 122 (25%) D5 ETs. Demographically, there were more nulliparas in the D3 group (189 [50.9%] vs 47 [38.8%], P = 0.021). Higher gonadotropin dosage was used (3512 ± 1346 vs 3233 ± 1212 IU, P = 0.045) and lower maximum estradiol levels were reached in the D3 group (1129 ± 685 vs 1432 ± 708 pg/mL, P = 0.002). Thirty-three (27%) of the D5 cycles resulted in transfer cancelation due to failure of blastocyst formation (P = 0.001). However, clinical pregnancy rates (P = 0.958), live birth rates (P = 0.988), and miscarriage rates (P = 0.710) did not differ between D3 and D5 ETs. Multivariable logistic regression for clinical pregnancy rate showed that day of transfer did not have a significant effect on the odds (P = 0.376), but maternal age (P = 0.001) and number of retrieved oocytes (P = 0.009) were significant variables. CONCLUSIONS In older women, culturing embryos to blastocyst stage can decrease invalid ETs without reducing pregnancy rates. Cancelation rates are higher but it may avoid interventions and conserve valuable time.
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Affiliation(s)
- Eytan Giladi Yacobi
- IVF and Fertility Institute, Tel-Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel
- Faculty of Medical and Health Sciences, School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Netanella Miller
- Faculty of Medical and Health Sciences, School of Medicine, Tel Aviv University, Tel Aviv, Israel
- IVF Unit, Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel
| | - Nitzan Goren Gepstein
- Faculty of Medical and Health Sciences, School of Medicine, Tel Aviv University, Tel Aviv, Israel
- IVF Unit, Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel
| | - Jordana Mashiach
- Faculty of Medical and Health Sciences, School of Medicine, Tel Aviv University, Tel Aviv, Israel
- IVF Unit, Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel
| | - Einat Haikin Herzberger
- Faculty of Medical and Health Sciences, School of Medicine, Tel Aviv University, Tel Aviv, Israel
- IVF Unit, Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel
| | - Mattan Levi
- Faculty of Medical and Health Sciences, School of Medicine, Tel Aviv University, Tel Aviv, Israel
- IVF Unit, Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel
| | - Yehudith Ghetler
- IVF Unit, Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel
| | - Amir Wiser
- Faculty of Medical and Health Sciences, School of Medicine, Tel Aviv University, Tel Aviv, Israel
- IVF Unit, Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel
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Han Y, Deng X, Cai J, Peng W, Duan C, Huang K. Trade-off between double cleavage-stage embryos transfer and single blastocyst-stage embryo transfer in patients with few good quality embryos in antagonist cycles: a retrospective study using a propensity score matching analysis. BMC Pregnancy Childbirth 2024; 24:339. [PMID: 38702596 PMCID: PMC11067270 DOI: 10.1186/s12884-024-06537-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 04/21/2024] [Indexed: 05/06/2024] Open
Abstract
OBJECTIVE This study aimed to compare the per OPU clinical outcomes for transfer of Day 3 double cleavage-stage embryos (DET) and Day 5 single blastocyst-stage (SBT) in patients with five or fewer good quality embryos on day 3 per occyte pick-up cycle (OPU) in antagonist cycles with consideration of blastocyst formation failure. METHODS This was a retrospective, observational cohort study of 2,116 cases of OPU treated with antagonist protocol in the affiliated Chenggong Hospital of Xiamen University between January 2013 and December 2020. DET was performed in 1,811cycles and SBT was performed in 305 cycles. The DET group was matched to the SBT group by propensity score (PS) matching according to multiple maternal baseline covariates. After PS matching, there were 303 ET cycles in each group. The primary outcomes were the cumulative live birth rate (CLBR), cumulative multiple pregnancy rate(CMPR)per OPU and the number of ET to achieve live birth per OPU. Secondary outcomes were the percentage of clinical pregnancy(CPR), live birth rate(LBR), multiple pregnancy rate(MPR). RESULTS Following PS mating, the CLBR was slightly higher (48.8% versus 40.3% ; P = 0.041) and the CMPR was significantly higher in the DET group compared to SBT group(44.2% versus 7.9%, P < 0.001). The CPR, LBR and MPR per fresh transfer were higher in DET group compared to SBT group(50.2% versus 28.7%; 41.3% versus 21.5%;29.6% versus 0%, P < 0.001). The number of ET to achieve live birth per OPU in SBT group was obiviously more than in DET group(1.48 ± 0.578 versus 1.22 ± 0.557 ,P < 0.001). CONCLUSION With a marginal difference cumulative live birth rate, the lower live birth rate per fresh transfer and higher number of ET per OPU in the SBT group suggested that it might take longer time to achieve a live birth with single blastocyst strategy. A trade-off decision should be made between efficiency and safety.
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Affiliation(s)
- Yan Han
- The Assisted Reproduction Department, Yichun Maternal and Child Health Hospital, Yichun, China
| | - Xing Deng
- The Assisted Reproduction Department, Yichun Maternal and Child Health Hospital, Yichun, China
| | - Jiali Cai
- Reproductive Medicine Centre, Affifiliated Chenggong Hospital of Xiamen University, Xiamen, China
- School of Medicine, Xiamen University, Xiamen, China
| | - Wei Peng
- The Assisted Reproduction Department, Yichun Maternal and Child Health Hospital, Yichun, China
| | - Chaoqun Duan
- The Assisted Reproduction Department, Yichun Maternal and Child Health Hospital, Yichun, China
| | - Kezhen Huang
- Reproductive Medicine Centre, Affifiliated Chenggong Hospital of Xiamen University, Xiamen, China.
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Rauchfuss LK, Zhao Y, Walker D, Galantis T, Fredrickson J, Barud K, Shenoy C. Optimal Embryo Selection: The Irreplaceable Role of the Embryologist in an Age of Advancing Technology. J Hum Reprod Sci 2023; 16:227-232. [PMID: 38045503 PMCID: PMC10688284 DOI: 10.4103/jhrs.jhrs_98_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 08/26/2023] [Accepted: 09/07/2023] [Indexed: 12/05/2023] Open
Abstract
Background Time-lapse incubators allow for ongoing evaluation of embryos without culture condition disruption. The use of time-lapse incubation has been shown to improve outcomes either by improving overall conditions or providing additional information to aid in embryo selection for transfer. Time-lapse incubators can also utilise morphokinetic models to rank embryos based on morphokinetic parameters. We sought to compare a morphokinetic model for embryo comparison to traditional morphologic evaluation. Aims The aim of the study is to compare a morphokinetic model for embryo comparison to traditional morphologic evaluation. Settings and Design This is a retrospective cohort design. Materials and Methods Embryos cultured in a time-lapse culture system that had traditional morphologic evaluation, morphokinetic modelling and known live birth outcomes were included in this study. Embryos with unknown competence were excluded, including when two embryos were transferred with a single live birth resulted. Statistical Analysis Used Receiver operating characteristic (ROC) curves were determined for both the morphologic analysis and the morphokinetic model on culture day 3 and day 5. Using the ROC-determined cutoff that optimised both sensitivity and specificity, a binary outcome for each test was analysed using agreement statistics to determine if one method of embryo evaluation was superior to the other. Results Morphological and morphokinetic grading were both predictive of embryo competence on days 3 and 5. However, on day 3, morphologic grading was superior to morphokinetic grading with area under the curve (AUC) of 0.66 (P < 0.001) and 0.58 (P = 0.009), respectively. Contrarily, on day 5, the morphokinetic model had a higher AUC of 0.65 (P = 0.03) compared to the morphologic grading, AUC 0.56 (P = 0.02). Conclusion Traditional morphology was noted to be a better diagnostic tool (higher AUC) on culture day 3 while a morphokinetic model was superior on day 5.
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