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State of the art in assisted reproductive technologies for patients with advanced maternal age. ZYGOTE 2023; 31:149-156. [PMID: 36810125 DOI: 10.1017/s0967199422000624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
According to the World Health Organization, the female reproductive age lasts up to 49 years, but problems with the realization of women's reproductive rights may arise much earlier. Significant numbers of factors affect the state of reproductive health: socioeconomic, ecological, lifestyle features, the level of medical literacy, and the state of the organization and medical care quality. Among the reasons for fertility decline in advanced reproductive age are the loss of cellular receptors for gonadotropins, an increase in the threshold of sensitivity of the hypothalamic-pituitary system to the action of hormones and their metabolites, and many others. Furthermore, negative changes accumulate in the oocyte genome, reducing the possibility of fertilization, normal development and implantation of the embryo and healthy offspring birth. Another theory of ageing causing changes in oocytes is the mitochondrial free radical theory of ageing. Taking into account all these age-related changes in gametogenesis, this review considers modern technologies aimed at the preservation and realization of female fertility. Among the existing approaches, two main ones can be distinguished: methods allowing the preservation of reproductive cells at a younger age using ART intervention and cryobanking, as well as methods aimed at improving the basic functional state of advanced-age women's oocytes and embryos.
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Utsunomiya T, Yao T, Itoh H, Kai Y, Kumasako Y, Setoguchi M, Nakagata N, Abe H, Ishikawa M, Kyono K, Shibahara H, Tsutsumi O, Terada Y, Fujii S, Yanagida K, Yokoyama M, Niimura S, Endo T, Fukuda Y, Inoue M, Kono T, Kuji N, Tawara F, Yoshida H, Yokota Y, Tada Y. Creation, effects on embryo quality, and clinical outcomes of a new embryo culture medium with 31 optimized components derived from human oviduct fluid: A prospective multicenter randomized trial. Reprod Med Biol 2022; 21:e12459. [PMID: 35431648 PMCID: PMC8999156 DOI: 10.1002/rmb2.12459] [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: 12/03/2021] [Revised: 03/23/2022] [Accepted: 03/29/2022] [Indexed: 11/09/2022] Open
Abstract
Purpose Our aim is to make an ideal embryo culture medium close to human oviduct fluid (HOF) components, and to evaluate the quality of this medium with embryo quality and clinical outcomes in assisted reproductive technology (ART) by a prospective randomized controlled trial (RCT). Methods Study I: HOF was collected laparoscopically from patients (n = 28) with normal pelvic findings. According to HOF analysis results, the new medium "HiGROW OVIT®" (OVIT) was designed. Study II: Embryos (2 pronuclei (2PN) = 9633) were assigned from 1435 patients. The blastulation rate (BR), good BR (gBR), utilized (transferred/cryo-preserved) BR (uBR), pregnancy rate (PR), and miscarriage rate (MR) were compared between the OVIT and control groups by RCT. Results The novel medium 'OVIT' was produced according to 31 HOF components. The concentrations of essential amino acids (e-AAs) were lower in OVIT than in current media, yet the opposite was true for ne-AA concentrations. gBR and uBR were higher in the OVIT group than in the control group. In the older female group, gBT and uBR were significantly higher in the OVIT group. Conclusions The novel medium 'OVIT' was produced according to HOF data. The OVIT had significantly better embryo quality and clinical outcomes than the current media.
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Affiliation(s)
| | - Tatsuma Yao
- Research and Development CenterFuso Pharmaceutical Industries, Ltd.OsakaJapan
| | | | | | | | | | - Naomi Nakagata
- Centre for Animal Resources and DevelopmentKumamoto UniversityKumamotoJapan
| | - Hiroyuki Abe
- Graduate School of Science and EngineeringYamagata UniversityYamagataJapan
| | | | | | - Hiroaki Shibahara
- Department of Obstetrics and GynaecologyHyogo College of MedicineHyogoJapan
| | | | - Yukihiro Terada
- Graduate School of Medicine and Faculty of MedicineAkita UniversityAkitaJapan
| | | | - Kaoru Yanagida
- Reproduction CentreInternational University of Health and WelfareTochigiJapan
| | | | | | | | | | | | - Tomohiro Kono
- Faculty of Applied BiosciencesTokyo University of AgricultureTokyoJapan
| | - Naoaki Kuji
- Department of Obstetrics and GynaecologyTokyo Medical UniversityTokyoJapan
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Gala A, Ferrières A, Assou S, Monforte M, Bringer-Deutsch S, Vintejoux E, Vincens C, Brunet C, Hamamah S. [Effects of artificial shrinkage prior to vitrification in a closed system: a randomized controlled trial]. ACTA ACUST UNITED AC 2014; 42:772-8. [PMID: 25442824 DOI: 10.1016/j.gyobfe.2014.09.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 09/05/2014] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To evaluate the effect of induced blastocoele shrinkage before vitrification in a closed carrier device. PATIENTS AND METHODS Prior to vitrification, blastocyst cavity was artificially shrinked by laser pulse or not treated according to a 2:1 randomized procedure. A total of 185 warming cycles from April 2011 to March 2013 have been analyzed. Clinical pregnancy rate and survival rate were compared between the two groups. The mean (±SD) women age was 33.5±5.7 years for both groups. RESULTS The pregnancy rate in the group with artificial reduction of the cavity was higher ([32/67] 47.7%) than in the control group but not significantly ([43/113] 38%). The survival rate in the artificial shrinkage group was significantly higher compared with the control group : 99% (102/103) and 91.8% (168/183) respectively (P=0.01). DISCUSSION AND CONCLUSION This study reveals that artificial shrinkage of blastocoelic cavity by laser pulse before vitrification in a closed carrier device improves survival rate after warming.
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Affiliation(s)
- A Gala
- Institut de recherche en biothérapie, hôpital Saint-Éloi, CHU de Montpellier, 34000 Montpellier, France; U1040, Inserm, 34000 Montpellier, France; UFR de médecine, université Montpellier-1, 34000 Montpellier, France; Service de gynécologie-obstétrique, hôpital Arnaud-de-Villeneuve, CHU de Montpellier, 34295 Montpellier cedex 5, France
| | - A Ferrières
- Institut de recherche en biothérapie, hôpital Saint-Éloi, CHU de Montpellier, 34000 Montpellier, France; U1040, Inserm, 34000 Montpellier, France; Service de gynécologie-obstétrique, hôpital Arnaud-de-Villeneuve, CHU de Montpellier, 34295 Montpellier cedex 5, France
| | - S Assou
- Institut de recherche en biothérapie, hôpital Saint-Éloi, CHU de Montpellier, 34000 Montpellier, France; U1040, Inserm, 34000 Montpellier, France; UFR de médecine, université Montpellier-1, 34000 Montpellier, France
| | - M Monforte
- Service de gynécologie-obstétrique, hôpital Arnaud-de-Villeneuve, CHU de Montpellier, 34295 Montpellier cedex 5, France
| | - S Bringer-Deutsch
- Service de gynécologie-obstétrique, hôpital Arnaud-de-Villeneuve, CHU de Montpellier, 34295 Montpellier cedex 5, France
| | - E Vintejoux
- Service de gynécologie-obstétrique, hôpital Arnaud-de-Villeneuve, CHU de Montpellier, 34295 Montpellier cedex 5, France
| | - C Vincens
- Service de gynécologie-obstétrique, hôpital Arnaud-de-Villeneuve, CHU de Montpellier, 34295 Montpellier cedex 5, France
| | - C Brunet
- Service de gynécologie-obstétrique, hôpital Arnaud-de-Villeneuve, CHU de Montpellier, 34295 Montpellier cedex 5, France
| | - S Hamamah
- Institut de recherche en biothérapie, hôpital Saint-Éloi, CHU de Montpellier, 34000 Montpellier, France; U1040, Inserm, 34000 Montpellier, France; UFR de médecine, université Montpellier-1, 34000 Montpellier, France; Service de gynécologie-obstétrique, hôpital Arnaud-de-Villeneuve, CHU de Montpellier, 34295 Montpellier cedex 5, France.
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Kim JW, Kim SD, Yang SH, Yoon SH, Jung JH, Lim JH. Successful pregnancy after SrCl2oocyte activation in couples with repeated low fertilization rates following calcium ionophore treatment. Syst Biol Reprod Med 2014; 60:177-82. [DOI: 10.3109/19396368.2014.900832] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Son WY, Tan SL. Comparison between slow freezing and vitrification for human embryos. Expert Rev Med Devices 2014; 6:1-7. [DOI: 10.1586/17434440.6.1.1] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Yoon HJ, Bae IH, Kim HJ, Jang JM, Hur YS, Kim HK, Yoon SH, Lee WD, Lim JH. Analysis of clinical outcomes with respect to spermatozoan origin after artificial oocyte activation with a calcium ionophore. J Assist Reprod Genet 2013; 30:1569-75. [PMID: 24114629 DOI: 10.1007/s10815-013-0110-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Accepted: 09/29/2013] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Fertilization failures have occurred repeatedly in reproductive centers after intracytoplasmic sperm injection (ICSI) and artificial oocyte activation (AOA) has been used to prevent it. This study was performed to investigate whether spermatozoan origin influences clinical outcomes of AOA with a calcium ionophore. METHODS A total of 185 ICSI cycles with a history of no or low fertilization was included in this retrospective study. The outcomes of AOA after ICSI were compared with ejaculated-normal, ejaculated-oligo-astheno-terato or extracted-testicular spermatozoa. RESULTS There were significant differences between the previous standard ICSI cycles and AOA cycles in the rate of fertilization and clinical outcomes among cases with different sperm origins. Thirty-eight healthy babies (20 singles and 18 twins, 29 cycles) were successfully delivered, and no congenital birth defects were observed. CONCLUSIONS Most patients with a no or low fertilization history obtained an increased fertilization rate and a positive clinical outcome with AOA regardless of the origin of spermatozoa.
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Affiliation(s)
- Hye Jin Yoon
- Maria Fertility Hospital, 103-11, Sinseol-Dong, Dongdaemun-Gu, Seoul, 130-812, Republic of Korea,
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Kang SM, Lee SW, Yoon SH, Kim JC, Lim JH, Lee SG. Comparison of clinical outcomes between single and double vitrified-warmed blastocyst embryo transfer according to the day of vitrification. J Assist Reprod Genet 2013; 30:779-85. [PMID: 23715875 PMCID: PMC3696441 DOI: 10.1007/s10815-013-0017-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Accepted: 05/17/2013] [Indexed: 10/26/2022] Open
Abstract
PURPOSE To compare the efficacy of single vitrified-warmed blastocyst embryo transfer (SVBT) versus double vitrified-warmed blastocyst embryo transfer (DVBT) according to the day of vitrification. METHODS This retrospective study included a total of 1,051 cycles in women less than 37 years of age with their autologous SVBT cryopreserved on day 5 (5d-SVBT, n = 737) or day 6 (6d-SVBT, n = 154) and DVBT on day 5 (5d-DVBT, n = 129) or day 6 (6d-DVBT, n = 31) from January 2009 to December 2011. RESULTS The clinical pregnancy rate (41.8 % vs. 48.1 %, p = 0.184) and ongoing pregnancy rate (36.6 % vs. 45.0 %, p = 0.072) were not significantly different between the 5d-SVBT group and the 5d-DVBT group. However, the clinical pregnancy (29.9 % vs. 58.1 %, p = 0.003) and ongoing pregnancy rates (23.4 % vs. 51.6 %, p = 0.001) were significantly lower in the 6d-SVBT group compared with those in the 6d-DVBT group. The implantation rate (42.2 % vs. 34.5 %, p = 0.03) of the 5d-SVBT group was significantly higher than that of the 5d-DVBT group, while the implantation rate (29.9 % vs. 37.1 %, p = 0.303) of the 6d-SVBT group was not statistically different compared with that in the 6d-DVBT group. The multiple pregnancy rates (1.0 % in the 5d-SVBT group vs. 38.7 % in the 5d-DVBT group, p < 0.001 and 0 % in the 6d-SVBT group vs. 22.2 % in the 6d-DVBT group, p = 0.001) were statistically significantly lower in the SVBT group compared with those in the DVBT group regardless of the day of vitrification. CONCLUSIONS This study showed that the 5d-SVBT resulted in comparable clinical outcomes compared to the 5d-DVBT while the 6d-SVBT yielded significantly lower clinical outcomes compared to the 6d-DVBT.
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Affiliation(s)
- Sang Min Kang
- />Maria Fertility Clinic, 9th floor, Samsung Fire Bldg. 2-1 Beomeo 3-Dong, Suseong-Gu, Daegu, 706-743 Republic of Korea
| | - Sang Won Lee
- />Maria Fertility Clinic, 9th floor, Samsung Fire Bldg. 2-1 Beomeo 3-Dong, Suseong-Gu, Daegu, 706-743 Republic of Korea
| | - San Hyun Yoon
- />Seoul Maria Fertility Hospital, 103-11 Shinseol-Dong, Dongdaemun-Gu, Seoul, 130-812 Republic of Korea
| | - Joo Cheol Kim
- />Maria Fertility Clinic, 9th floor, Samsung Fire Bldg. 2-1 Beomeo 3-Dong, Suseong-Gu, Daegu, 706-743 Republic of Korea
| | - Jin Ho Lim
- />Seoul Maria Fertility Hospital, 103-11 Shinseol-Dong, Dongdaemun-Gu, Seoul, 130-812 Republic of Korea
| | - Seong Goo Lee
- />Maria Fertility Clinic, 9th floor, Samsung Fire Bldg. 2-1 Beomeo 3-Dong, Suseong-Gu, Daegu, 706-743 Republic of Korea
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Clinical outcomes of elective single morula embryo transfer versus elective single blastocyst embryo transfer in IVF-ET. J Assist Reprod Genet 2012; 29:423-8. [PMID: 22382643 DOI: 10.1007/s10815-012-9736-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Accepted: 02/21/2012] [Indexed: 10/28/2022] Open
Abstract
PURPOSE To compare the clinical outcomes of elective single morula embryo transfer (eSMET) versus elective single blastocyst embryo transfer (eSBET) in selected patients. METHODS This study was a retrospective study which analyzed for 271 cycles in women under 37 years of age who are undergoing their first or second trial of in vitro fertilization-embryo transfer (IVF-ET) from January 2008 to December 2009. The eSMET was performed on day 4 (n = 130) and the eSBET was conducted on day 5 (n = 141). RESULTS The clinical pregnancy rate (51.5% vs. 51.8%, p = 0.97), implantation rate (52.3% vs. 52.5%, p = 0.98), and live birth rate (39.2% vs. 44.7%, p = 0.36) were similar in the eSMET and eSBET groups, respectively. The miscarriage rate of the eSMET group (23.9%) was slightly higher than that of the eSBET group (13.7%) (p = 0.12), without reaching statistical significance. There was only one case of monozygotic twin pregnancy in each group. CONCLUSIONS The clinical outcomes of day 4 eSMET were comparable to those of day 5 eSBET. Therefore, day 4 eSMET is a viable option or an alternative to day 5 eSBET, with no difference in success rates.
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Yoon J, Yoon HJ, Juhn KM, Ko JK, Yoon SH, Ko Y, Lim JH. Application of two different synthetic sequential media for the human IVF-ET program: a prospective, randomized, and comparative study. Clin Exp Reprod Med 2011; 38:186-92. [PMID: 22384441 PMCID: PMC3283082 DOI: 10.5653/cerm.2011.38.4.186] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Revised: 11/18/2011] [Accepted: 11/28/2011] [Indexed: 11/06/2022] Open
Abstract
Objective Since IVF program was first established, various types of media and culture systems have been developed either in-house or commercially. The aim of this study was to compare the efficacy of in-house Maria Research Center (MRC) media to that of commercially available Sydney IVF media in human day 3 embryo transfer cycles. Methods Three hundred sixty nine couples were included in this prospective, randomized, and comparative study. All couples undergoing IVF treatment at the Maria Fertility Hospital were randomly assigned to either Sydney IVF (n=178) or MRC (n=191) media. Results No difference was observed between the MRC media and Sydney IVF media groups with respect to fertilization rate (74.4% vs. 75.5%). The clinical pregnancy and implantation rates of MRC media (47.1% and 20.0%, respectively) were also similar to those of Sydney IVF media (44.4% and 19.4%, respectively). However, the proportion of embryos with good quality on day 3 was significantly higher in the MRC media group than the Sydney IVF media group (50.2% vs. 43.2%) (p<0.05). Conclusion MRC media were as effective as Sydney IVF media for sustaining embryo development and pregnancy rates. The present study implies that MRC media can be a suitable alternative to commercially available media for human IVF-ET program.
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Kang SM, Lee SW, Jeong HJ, Yoon SH, Lim JH, Lee SG. Comparison of elective single cleavage-embryo transfer to elective single blastocyst-embryo transfer in human IVF-ET. Clin Exp Reprod Med 2011; 38:53-60. [PMID: 22384419 PMCID: PMC3283049 DOI: 10.5653/cerm.2011.38.1.53] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Revised: 02/18/2011] [Accepted: 02/25/2011] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE This study was carried out to compare the clinical outcome of elective single cleavage-embryo transfer (eSCET) to that of elective single blastocyst-embryo transfer (eSBET) in human IVF-ET. METHODS This study was a retrospective study which analyzed for 614 women who visited the Daegu Maria Clinic from August 2008 to December 2009. All were under 37 years old and had more than 8 mm of endometrial thickness on the day of hCG administration and at least one good quality embryo on day 3. The eSCETs were performed on day 3 (n=450) and the eSBETs were conducted on day 5 (n=164). RESULTS The numbers of retrieved oocytes, fertilized oocytes, and day 3 good quality embryos were significantly lower in the eSCET group (12.1±6.0, 8.2±4.6, and 4.2±3.1, respectively) compared to the eSBET group (16.7±7.2, 12.1±5.0, and 8.5±4.5, respectively; p<0.001). However, the clinical pregnancy, implantation, on-going pregnancy, and live birth rates of the eSCET group (46.7, 46.9, 40.0, and 36.7%, respectively) were not statistically different from those of the eSBET group (51.2, 51.8, 45.1, and 43.9%, respectively; p=0.318, 0.278, 0.254, and 0.103, respectively). CONCLUSION These results suggested that elective single embryo transfer should be performed regardless of the developmental stage to women less than 37 years old who had more than 8 mm of endometrial thickness on the hCG administration day and at least one good quality embryo on day 3 in order to reduce the twin pregnancy rate without reducing the whole pregnancy rate.
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Affiliation(s)
| | | | | | | | - Jin Ho Lim
- Seoul Maria Fertility Hospital, Seoul, Korea
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Kim YJ, Choi YS, Lee WD, Kim KC, Jee BC, Suh CS, Kim SH, Moon SY. Does a vitrified blastocyst stage embryo transfer program need hormonal priming for endometrial preparation? J Obstet Gynaecol Res 2010; 36:783-8. [PMID: 20666946 DOI: 10.1111/j.1447-0756.2010.01243.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM To compare the clinical outcomes of a vitrified blastocyst stage embryo transfer (ET) program among natural, ovulation induced and artificial cycles. MATERIAL & METHODS The clinical outcomes were retrospectively analyzed in three groups according to endometrial preparation (natural cycle group [n = 34], ovulation induced [n = 21], and artificial cycles [n = 70]) among women that underwent vitrified blastocyst stage ET. RESULTS The overall pregnancy rate was 48.8%. There were no significant differences in the duration of endometrial preparation, endometrial thickness on the day of progesterone or human chorionic gonadotropin administration, implantation and clinical pregnancy rates among the three groups. Triple-line endometrial patterns were more frequently observed in the natural and ovulation induced groups than in the artificial cycle group (85.3% vs 64.3%, P = 0.021; 90.5% vs 64.3%, P = 0.016). CONCLUSION Our findings suggest that the types of endometrial preparation may have no significant effect on the clinical outcomes of vitrified blastocyst ET. Hormonal priming does not appear to be a prerequisite for endometrial preparation for vitrified blastocyst ET.
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Affiliation(s)
- Yong Jin Kim
- Department of Obstetrics and Gynecology, College of Medicine, Medical Research Center, Seoul National University, Seoul, Korea
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Son WY, Tan SL. Laboratory and embryological aspects of hCG-primed in vitro maturation cycles for patients with polycystic ovaries. Hum Reprod Update 2010; 16:675-89. [DOI: 10.1093/humupd/dmq014] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Vitrification of human early cavitating and deflated expanded blastocysts: clinical outcome of 474 cycles. J Assist Reprod Genet 2009; 26:523-9. [PMID: 19876729 DOI: 10.1007/s10815-009-9356-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2009] [Accepted: 10/08/2009] [Indexed: 10/20/2022] Open
Abstract
PURPOSE The present study was undertaken to evaluate and compare the post thaw survival, implantation and pregnancy rates of vitrified human early cavitating blastocysts with deflated expanded blastocysts. MATERIAL AND METHODS Supernumerary blastocysts were vitrified in 30% ethylene glycol-dimethyl sulphoxide based solution using cryoloop. Fully expanded blastocysts were deflated by gentle aspiration of the blastocoelic fluid using a micromanipulator until the cavity collapses prior to vitrification. RESULTS Of the 576 vitrified blastocysts, 545 (94.61%) survived thawing in the early cavitating blastocyst group which was significantly higher than deflated expanded blastocyst group, in which only 370 survived thawing out of 459 (80.62%). However, no significant difference was observed in implantation and pregnancy rates between early cavitating and deflated expanded blastocyst groups. CONCLUSIONS Early cavitating blastocyst would be the ideal stage for cryopreservation of human blastocysts as it has higher survival rate and avoids additional invasive procedures like deflation of the blastocoele.
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Weissman A, Biran G, Nahum H, Glezerman M, Levran D. Blastocyst culture and transfer: lessons from an unselected, difficult IVF population. Reprod Biomed Online 2008; 17:220-8. [PMID: 18681996 DOI: 10.1016/s1472-6483(10)60198-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Blastocyst-stage transfer has yielded excellent results in good prognosis IVF patients, but its efficacy in the general IVF population has not been clearly demonstrated. The objective of this study was to compare cleavage-stage and blastocyst-stage transfer in a mixed, general IVF population. In a prospective, quasi-randomized study, 152 patients underwent 164 treatment cycles. Patients were allocated to cleavage-stage (group 1; n = 94) or blastocyst-stage (group 2; n = 70) transfer. Main outcome measures included implantation, clinical pregnancy and live birth rates. Implantation (11.2% versus 15.5%), clinical pregnancy (34% versus 21%) and live birth rates per transfer (21.3% versus 13.8%) and per started cycle (21.3% versus 11.4%) were all comparable for groups 1 and 2, respectively. Logistic regression analysis revealed that blastocyst culture and transfer reduced the odds for pregnancy in the general IVF population and defined a good prognosis group for blastocyst transfer. Introducing blastocyst culture and transfer to all IVF patients is not advantageous. Blastocyst transfer should be offered primarily to good prognosis patients, and this group should be specifically defined in each clinical set-up.
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Affiliation(s)
- Ariel Weissman
- Department of Obstetrics and Gynecology, IVF Unit, Wolfson Medical Centre, Holon, Israel.
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Abstract
Cryopreservation of human gametes and embryos has become an essential part of assisted reproduction. Successful cryopreservation of human blastocysts is increasingly relevant as extended in-vitro culture of human embryos becomes more common, permitting routine use of blastocyst transfer in IVF programmes. This reduces the number of embryos transferred, thereby reducing multiple pregnancies and maximizing cumulative pregnancy rates per oocyte retrieval. The superiority of blastocyst freezing over earlier stage freezing in terms of implantation per thawed embryo transferred improves overall expectations for the cryopreservation programme. Therefore, a reliable procedure for the cryopreservation of blastocysts is needed because, after transfer, only a small number of supernumerary blastocysts are likely to be available for cryopreservation. Since the early 1980s, two common techniques have been used in cryopreservation: the conventional slow cooling method and the more recent rapid procedure known as vitrification. Vitrification has become an attractive alternative to slow freezing, since it appears to result in significantly higher survival and pregnancy rates. The aim of this review is to focus on the cryopreservation of human blastocysts using slow and rapid protocols and to assess the impact of the crypreservation protocol used on the survival, implantation and pregnancy rates.
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Lee SY, Son WY, Yoon SH, Lim JH. Clinical-pregnancy outcome after vitrification of blastocysts produced from in vitro maturation cycles. Fertil Steril 2007; 88:1449-51. [PMID: 17418831 DOI: 10.1016/j.fertnstert.2007.01.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2006] [Revised: 01/03/2007] [Accepted: 01/03/2007] [Indexed: 11/12/2022]
Abstract
This study was conducted to report the clinical-pregnancy outcome after vitrification of the blastocysts produced from in vitro maturation cycles. The survival rate after thawing was 92.0% (92/100). The clinical-pregnancy and implantation rates were 43.8% and 23.6%, respectively. These results suggest that the blastocyst-stage embryos produced from in vitro maturation cycles can be safely cryopreserved through vitrification.
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Lee SY, Kim HJ, Park SJ, Yoon HJ, Yoon SH, Lee KH, Lee WD, Lim JH. Optimization of a dilution method for human expanded blastocysts vitrified using EM grids after artificial shrinkage. J Assist Reprod Genet 2006; 23:87-91. [PMID: 16468090 PMCID: PMC3454907 DOI: 10.1007/s10815-005-9006-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2005] [Accepted: 10/28/2005] [Indexed: 10/25/2022] Open
Abstract
PURPOSE To verify a more effective dilution method that can be applied to human expanded blastocysts that are vitrified after artificial shrinkage. METHODS Surplus expanded blastocysts that remained after embryo transfer (ET) in in vitro fertilization (IVF) cycles, were cryopreserved. The blastocysts were vitrified on EM grids following artificial shrinkage. After thawing the blastocysts, cryoprotectants were diluted using either a 6- or 2-step method. We examined the survival rate and clinical outcome of blastocysts of 151 patients in our ET program after thawing. RESULTS The survival rate of blastocysts that were thawed using a 2-step method (91.6%, 239/261) was comparable with that of the 6-step method (89%, 186/209). The clinical pregnancy rate (45.9%, 39/85) and implantation rate (24.1%, 53/220) were slightly higher in the 2-step method than in the 6-step method (40.9%, 27/66; 19.4%, 33/170). CONCLUSIONS Our data indicate that the 2-step dilution method could be a simpler and more effective protocol for human expanded blastocysts that are vitrified using EM-grid following artificial shrinkage.
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Affiliation(s)
- So-Young Lee
- In Vitro Fertilization Laboratory, Maria Infertility Hospital, Dongdaemun-gu, Seoul, South Korea.
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Suzuki T, Shibahara H, Hirano Y, Ohno A, Takamizawa S, Suzuki M. Randomized study comparing day 2 versus day 3 elective transfer of two good-quality embryos. Reprod Med Biol 2004; 3:99-104. [PMID: 29699188 DOI: 10.1111/j.1447-0578.2004.00056.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective: The number of embryos transferred is very important to avoid multiple pregnancies without compromising pregnancy rates in in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI)-embryo transfer (ET). We established criteria for the elective transfer of two embryos (age <40, first treatment cycle, good-quality embryos ≥3) to avoid high-order multiple pregnancies, and reported their usefulness. In the current study, we compared the clinical outcome of day 2 versus day 3 elective transfer of two good-quality embryos, in order to investigate the day of preferential transfer. Methods: A total of 228 cycles were treated with IVF/ICSI-ET from August 1999 to August 2002. From this total, 114 patients who were less than 40 years old and also had a first treatment cycle were enrolled in the present study (50.0%). The elective transfer of two good-quality embryos was carried out in 36 cycles (31.6%). Patients were randomized for transfer on either day 2 or day 3 after oocyte retrieval. Results: The pregnancy rate of women who received two good-quality embryos was 44.4% (16 out of 36). The multiple pregnancy rate was 12.5% (two out of 16) and all pregnancies outcomes were twins. There were no significant differences between day 2 and day 3 ET for the following criteria: the number of cycles (24, 12); age (32.8 ± 3.4 years, 32.5 ± 2.7 years); number of oocytes retrieved (10.0 ± 3.3, 9.0 ± 6.0); number of embryos developed (7.6 ± 3.5, 6.9 ± 3.7); and number of good-quality embryos cryopreserved (3.5 ± 2.7, 3.6 ± 2.1). Higher pregnancy and implantation rates were obtained in day 3 ET than day 2 ET (37.5 and 20.8% in day 2 ET vs 58.3 and 33.3% in day 3 ET); however, there were no significant differences. Conclusion: Day 3 ET appears to be preferable to achieve more viable embryos than day 2 ET. (Reprod Med Biol 2004; 3: 99-104).
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Affiliation(s)
- Tatsuya Suzuki
- Department of Obstetrics and Gynecology, Jichi Medical School, Tochigi, Japan
| | - Hiroaki Shibahara
- Department of Obstetrics and Gynecology, Jichi Medical School, Tochigi, Japan
| | - Yuki Hirano
- Department of Obstetrics and Gynecology, Jichi Medical School, Tochigi, Japan
| | - Akiko Ohno
- Department of Obstetrics and Gynecology, Jichi Medical School, Tochigi, Japan
| | - Satoru Takamizawa
- Department of Obstetrics and Gynecology, Jichi Medical School, Tochigi, Japan
| | - Mitsuaki Suzuki
- Department of Obstetrics and Gynecology, Jichi Medical School, Tochigi, Japan
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Son WY, Yoon SH, Yoon HJ, Lee SM, Lim JH. Pregnancy outcome following transfer of human blastocysts vitrified on electron microscopy grids after induced collapse of the blastocoele. Hum Reprod 2003; 18:137-9. [PMID: 12525454 DOI: 10.1093/humrep/deg029] [Citation(s) in RCA: 165] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The purpose of this study was to examine the effects on blastocyst survival and subsequent pregnancy rate of 'artificial shrinkage' (i.e. induced collapse of the blastocoele) before vitrification of human blastocysts. METHODS After embryo transfer in IVF cycles, surplus embryos that developed to the expanded blastocyst stage were cryopreserved. Before vitrification on electron microscopy (EM) grids, artificial shrinkage was induced in expanded blastocysts using a 29-gauge needle. After thawing, transfers were performed on 25 couples. Post-thaw survival rates and clinical outcome after the transfer of vitrified blastocysts were examined. RESULTS Of 90 expanded blastocysts vitrified from 25 patients, 81 survived (90.0%) and 40 of them were hatched (49.4%) at the time of transfer. The implantation rate was 29.0% (20/69), and the pregnancy rate was 48.0% (12/25). Nine patients delivered 15 infants, two pregnancies are ongoing and one ended in miscarriage. CONCLUSIONS The results suggest that artificial shrinkage is a useful technique for vitrification of expanded blastocysts on EM grids.
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