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Metwally M, Chatters R, White D, Hall J, Walters S. Endometrial scratch in women undergoing first-time IVF treatment: a systematic review and meta-analysis of randomized controlled trials. Reprod Biomed Online 2022; 44:617-629. [PMID: 35272939 PMCID: PMC9089309 DOI: 10.1016/j.rbmo.2021.11.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 11/26/2021] [Accepted: 11/29/2021] [Indexed: 11/28/2022]
Abstract
The endometrial scratch procedure is an IVF 'add-on' sometimes provided prior to the first IVF cycle. A 2019 systematic review concluded that there was insufficient evidence to show whether endometrial scratch has a significant effect on pregnancy outcomes (including live birth rate, LBR) when undertaken prior to the first IVF cycle. Further evidence was published following this review, including the Endometrial Scratch Trial (ISRCTN23800982). The objective of the current review was to synthesize and critically appraise the evidence for the clinical effectiveness and safety of the endometrial scratch procedure in women undergoing their first IVF cycle. Databases searched include MEDLINE, Embase, CINAHL and ClinicalTrials.gov. Eligible randomized controlled trials included women undergoing IVF for the first time that reported the effectiveness and/or safety of the endometrial scratch procedure; 12 studies were included. Meta-analysis showed no evidence of a significant effect of the endometrial scratch on LBR (10 trials, odds ratio [OR] 1.17, 95% confidence interval [CI] 0.76-1.79) or other pregnancy outcomes. This review confirms that there is a lack of evidence that endometrial scratch improves pregnancy outcomes, including LBR, for women undergoing their first IVF cycle. Clinicians are recommended not to perform this procedure in individuals undergoing their first cycle of IVF.
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Affiliation(s)
- Mostafa Metwally
- Obstetrics, Gynaecology and Neonatology, Sheffield Teaching Hospitals NHS Foundation Trust and The University of Sheffield, Sheffield, UK.
| | - Robin Chatters
- Sheffield Clinical Trials Research Unit, School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - David White
- Sheffield Clinical Trials Research Unit, School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Jamie Hall
- Sheffield Clinical Trials Research Unit, School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Stephen Walters
- Sheffield Clinical Trials Research Unit, School of Health and Related Research, The University of Sheffield, Sheffield, UK
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Metwally M, Chatters R, Pye C, Dimairo M, White D, Walters S, Cohen J, Young T, Cheong Y, Laird S, Mohiyiddeen L, Chater T, Pemberton K, Turtle C, Hall J, Taylor L, Brian K, Sizer A, Hunter H. Endometrial scratch to increase live birth rates in women undergoing first-time in vitro fertilisation: RCT and systematic review. Health Technol Assess 2022; 26:1-212. [PMID: 35129113 PMCID: PMC8859770 DOI: 10.3310/jnzt9406] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND In vitro fertilisation is a widely used reproductive technique that can be undertaken with or without intracytoplasmic sperm injection. The endometrial scratch procedure is an in vitro fertilisation 'add-on' that is sometimes provided prior to the first in vitro fertilisation cycle, but there is a lack of evidence to support its use. OBJECTIVES (1) To assess the clinical effectiveness, safety and cost-effectiveness of endometrial scratch compared with treatment as usual in women undergoing their first in vitro fertilisation cycle (the 'Endometrial Scratch Trial') and (2) to undertake a systematic review to combine the results of the Endometrial Scratch Trial with those of previous trials in which endometrial scratch was provided prior to the first in vitro fertilisation cycle. DESIGN A pragmatic, multicentre, superiority, open-label, parallel-group, individually randomised controlled trial. Participants were randomised (1 : 1) via a web-based system to receive endometrial scratch or treatment as usual using stratified block randomisation. The systematic review involved searching electronic databases (undertaken in January 2020) and clinicaltrials.gov (undertaken in September 2020) for relevant trials. SETTING Sixteen UK fertility units. PARTICIPANTS Women aged 18-37 years, inclusive, undergoing their first in vitro fertilisation cycle. The exclusion criteria included severe endometriosis, body mass index ≥ 35 kg/m2 and previous trauma to the endometrium. INTERVENTIONS Endometrial scratch was undertaken in the mid-luteal phase of the menstrual cycle prior to in vitro fertilisation, and involved inserting a pipelle into the cavity of the uterus and rotating and withdrawing it three or four times. The endometrial scratch group then received usual in vitro fertilisation treatment. The treatment-as-usual group received usual in vitro fertilisation only. MAIN OUTCOME MEASURES The primary outcome was live birth after completion of 24 weeks' gestation within 10.5 months of egg collection. Secondary outcomes included implantation, pregnancy, ectopic pregnancy, miscarriage, pain and tolerability of the procedure, adverse events and treatment costs. RESULTS One thousand and forty-eight (30.3%) women were randomised to treatment as usual (n = 525) or endometrial scratch (n = 523) and were followed up between July 2016 and October 2019 and included in the intention-to-treat analysis. In the endometrial scratch group, 453 (86.6%) women received the endometrial scratch procedure. A total of 494 (94.1%) women in the treatment-as-usual group and 497 (95.0%) women in the endometrial scratch group underwent in vitro fertilisation. The live birth rate was 37.1% (195/525) in the treatment-as-usual group and 38.6% (202/523) in the endometrial scratch group: an unadjusted absolute difference of 1.5% (95% confidence interval -4.4% to 7.4%; p = 0.621). There were no statistically significant differences in secondary outcomes. Safety events were comparable across groups. No neonatal deaths were recorded. The cost per successful live birth was £11.90 per woman (95% confidence interval -£134 to £127). The pooled results of this trial and of eight similar trials found no evidence of a significant effect of endometrial scratch in increasing live birth rate (odds ratio 1.03, 95% confidence interval 0.87 to 1.22). LIMITATIONS A sham endometrial scratch procedure was not undertaken, but it is unlikely that doing so would have influenced the results, as objective fertility outcomes were used. A total of 9.2% of women randomised to receive endometrial scratch did not undergo the procedure, which may have slightly diluted the treatment effect. CONCLUSIONS We found no evidence to support the theory that performing endometrial scratch in the mid-luteal phase in women undergoing their first in vitro fertilisation cycle significantly improves live birth rate, although the procedure was well tolerated and safe. We recommend that endometrial scratch is not undertaken in this population. TRIAL REGISTRATION This trial is registered as ISRCTN23800982. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 10. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Mostafa Metwally
- Assisted Conception Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Robin Chatters
- Sheffield Clinical Trials Research Unit (CTRU), School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Clare Pye
- Assisted Conception Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Munya Dimairo
- Sheffield Clinical Trials Research Unit (CTRU), School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - David White
- Sheffield Clinical Trials Research Unit (CTRU), School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Stephen Walters
- Design, Trials and Statistics, School of Health and Related Research (ScHARR), Sheffield, UK
| | - Judith Cohen
- Hull Health Trials Unit, University of Hull, Hull, UK
| | - Tracey Young
- Health Economic and Decision Science, School of Health and Related Research (ScHARR), Sheffield, UK
| | - Ying Cheong
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Susan Laird
- Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK
| | - Lamiya Mohiyiddeen
- Saint Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Tim Chater
- Sheffield Clinical Trials Research Unit (CTRU), School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Kirsty Pemberton
- Sheffield Clinical Trials Research Unit (CTRU), School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Chris Turtle
- Sheffield Clinical Trials Research Unit (CTRU), School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Jamie Hall
- Sheffield Clinical Trials Research Unit (CTRU), School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Liz Taylor
- Assisted Conception Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | | | | | - Helen Hunter
- Department of Reproductive Medicine, Old St Mary's Hospital, Manchester, UK
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Korkidakis A, Au J, Albert A, Havelock J. Higher blastocyst implantation in frozen versus fresh embryo transfers in good prognosis patients. Minerva Obstet Gynecol 2021; 73:776-781. [PMID: 34905881 DOI: 10.23736/s2724-606x.21.04722-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND There is emerging evidence that frozen embryo transfers provide a more favorable environment for implantation as compared to fresh embryo transfers. Our objective was to determine if there is a clinical benefit to frozen versus fresh blastocyst transfers in good prognosis patients. METHODS Subjects undergoing their first or second IVF/ICSI cycle <38 years of age in an OCP pretreated GnRH antagonist stimulation protocol with supernumerary embryos available for blastocyst cryopreservation were eligible for analysis. Primary transfer was exclusively blastocyst transfer. Exclusion criteria consisted of rescue ICSI, preimplantation genetic testing, donor oocytes, and surrogacy. The cohort was divided into two groups based on whether they underwent a fresh vs. frozen primary transfer. The implantation rates were compared using mixed-effects logistic regression. The clinical pregnancy and live birth rates were compared using logistic regression adjusted for number of oocytes retrieved and number of embryos transferred. All models included age, reason for treatment, and number of prior births as covariates. RESULTS A total of 615 subjects were included in the study. There were no differences in the two groups with respect to age, BMI, baseline ovarian reserve testing, total gonadotropin dosage, and duration of stimulation. The implantation rate was higher in the frozen-embryo group as compared to the fresh-embryo group (59% and 48% respectively; OR 1.58; 95% CI 1.02-2.44). There was a trend towards higher clinical pregnancy and live birth rates in the frozen-embryo group. These differences persisted in the adjusted analysis. CONCLUSIONS Among good prognosis patients undergoing IVF, frozen embryo transfer was associated with improved implantation rates. Consideration should be given to primary frozen blastocyst transfer in this population.
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Affiliation(s)
- Ann Korkidakis
- Division of Reproductive Endocrinology and Infertility, University of British Columbia, Vancouver, BC, Canada -
| | - Jason Au
- Pacific Center for Reproductive Medicine, Burnaby, BC, Canada
| | - Arianne Albert
- Women's Health Research Institute, BC Women's Hospital and Health Center, Vancouver, BC, Canada
| | - Jon Havelock
- Division of Reproductive Endocrinology and Infertility, University of British Columbia, Vancouver, BC, Canada.,Women's Health Research Institute, BC Women's Hospital and Health Center, Vancouver, BC, Canada
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Sordia-Hernandez LH, Morales Martinez FA, Orozco EG, Flores-Rodriguez A, Leyva-Camacho PC, Alvarez-Villalobos NA, Zuñiga-Hernandez JA. The Effect of Post warming Culture Period Between Thawing and Transfer of Cryopreserved Embryos on Reproductive Outcomes After In Vitro Fertilization (IVF): A Systematic Review and Meta-analysis. J Reprod Infertil 2021; 22:77-84. [PMID: 34041003 PMCID: PMC8143007 DOI: 10.18502/jri.v22i2.5792] [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] [Indexed: 11/24/2022] Open
Abstract
Background The purpose of this study was to evaluate the effect of post warming culture period between thawing and transfer of cryopreserved embryos on reproductive outcomes after in vitro fertilization (IVF). Methods An extensive literature search was performed using PubMed, EmBase, and the Cochrane library from January 2000 to August 2019. A systematic review and meta-analysis of clinical trials was performed in this manuscript. The trials represented patients with embryo transfers of at least one previously cryopreserved good quality embryo. Main outcome measures of the study included clinical pregnancy rate, live birth rate, miscarriage rate, and ectopic pregnancy rate. Results A total of 5338 trial/abstracts were identified through a literature search. Totally, five studies were included in the systematic review, and three in the final meta-analysis. The studies included 1717 embryo transfers, 605 after short culture, and 1112 after long culture. The clinical pregnancy rate (CPR) was the most consistent outcome reported. The CPR was slightly better after short time culture with a RR of 1.09 (0.95-1.26, 95%CI) but this difference was not statistically significant. The great heterogenicity in the results reported in the included studies made it impossible to compare all planned outcomes. Conclusion There are no differences in reproductive outcomes if cryopreserved embryos are transferred after overnight culture or after two hours of culture following thawing. Due to small number and the poor quality of trials reported on this topic, the results of this review should be treated with caution.
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Affiliation(s)
- Luis H Sordia-Hernandez
- Department of Gynecology and Obstetrics, University Hospital Dr. Jose Eleuterio González Universidad Autónoma de Nuevo León, Monterrey, México
| | - Felipe A Morales Martinez
- Department of Gynecology and Obstetrics, University Hospital Dr. Jose Eleuterio González Universidad Autónoma de Nuevo León, Monterrey, México
| | - Eduardo Gutierrez Orozco
- Department of Gynecology and Obstetrics, University Hospital Dr. Jose Eleuterio González Universidad Autónoma de Nuevo León, Monterrey, México
| | - Andrea Flores-Rodriguez
- Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit México), Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | - Paloma C Leyva-Camacho
- Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit México), Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | | | - Jorge Alberto Zuñiga-Hernandez
- Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit México), Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
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Albertini DF, Crosignani P, Dumoulin J, Evers JLH, Leridon H, Mastenbroek S, Painter R, Pinborg A, Somigliana E, Baird DT, Glasier A, La Vecchia C, Albertini DF, Crosignani P, Dumoulin J, Evers JLH, Leridon H, Mastenbroek S, Painter R, Pinborg A, Somigliana E, Baird DT, Glasier A, La Vecchia C. IVF, from the past to the future: the inheritance of the Capri Workshop Group. Hum Reprod Open 2020; 2020:hoaa040. [PMID: 33005753 PMCID: PMC7508025 DOI: 10.1093/hropen/hoaa040] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 07/07/2020] [Indexed: 12/26/2022] Open
Abstract
Today IVF use is booming all over the world and has even started to play a role in demographic analyses. Prognosis-adjusted estimates suggest that up to two-thirds of couples could achieve a live birth. However, the scenario is less exciting in reality. Discontinuation during the cycles is common, and age and ovarian response continue to be crucial in modulating this rate of success. A growing interest is now given to the risk of abuses and in particular to overtreatment and to prescriptions of useless, if not harmful, expensive additional treatments ('add-ons'). A more rational, evidence-based and wise approach is needed. From a scientific perspective, several obscure aspects remain and warrant future investigations. Of particular interest are the neglected role of sperm selection, the potential adult implications of early embryo life in vitro and the issue of sustainability.
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Cornelisse S, Zagers M, Kostova E, Fleischer K, van Wely M, Mastenbroek S. Preimplantation genetic testing for aneuploidies (abnormal number of chromosomes) in in vitro fertilisation. Cochrane Database Syst Rev 2020; 9:CD005291. [PMID: 32898291 PMCID: PMC8094272 DOI: 10.1002/14651858.cd005291.pub3] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND In in vitro fertilisation (IVF) with or without intracytoplasmic sperm injection (ICSI), selection of the most competent embryo(s) for transfer is based on morphological criteria. However, many women do not achieve a pregnancy even after 'good quality' embryo transfer. One of the presumed causes is that such morphologically normal embryos have an abnormal number of chromosomes (aneuploidies). Preimplantation genetic testing for aneuploidies (PGT-A), formerly known as preimplantation genetic screening (PGS), was therefore developed as an alternative method to select embryos for transfer in IVF. In PGT-A, the polar body or one or a few cells of the embryo are obtained by biopsy and tested. Only polar bodies and embryos that show a normal number of chromosomes are transferred. The first generation of PGT-A, using cleavage-stage biopsy and fluorescence in situ hybridisation (FISH) for the genetic analysis, was demonstrated to be ineffective in improving live birth rates. Since then, new PGT-A methodologies have been developed that perform the biopsy procedure at other stages of development and use different methods for genetic analysis. Whether or not PGT-A improves IVF outcomes and is beneficial to patients has remained controversial. OBJECTIVES To evaluate the effectiveness and safety of PGT-A in women undergoing an IVF treatment. SEARCH METHODS We searched the Cochrane Gynaecology and Fertility (CGF) Group Trials Register, CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, and two trials registers in September 2019 and checked the references of appropriate papers. SELECTION CRITERIA All randomised controlled trials (RCTs) reporting data on clinical outcomes in participants undergoing IVF with PGT-A versus IVF without PGT-A were eligible for inclusion. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies for inclusion, assessed risk of bias, and extracted study data. The primary outcome was the cumulative live birth rate (cLBR). Secondary outcomes were live birth rate (LBR) after the first embryo transfer, miscarriage rate, ongoing pregnancy rate, clinical pregnancy rate, multiple pregnancy rate, proportion of women reaching an embryo transfer, and mean number of embryos per transfer. MAIN RESULTS We included 13 trials involving 2794 women. The quality of the evidence ranged from low to moderate. The main limitations were imprecision, inconsistency, and risk of publication bias. IVF with PGT-A versus IVF without PGT-A with the use of genome-wide analyses Polar body biopsy One trial used polar body biopsy with array comparative genomic hybridisation (aCGH). It is uncertain whether the addition of PGT-A by polar body biopsy increases the cLBR compared to IVF without PGT-A (odds ratio (OR) 1.05, 95% confidence interval (CI) 0.66 to 1.66, 1 RCT, N = 396, low-quality evidence). The evidence suggests that for the observed cLBR of 24% in the control group, the chance of live birth following the results of one IVF cycle with PGT-A is between 17% and 34%. It is uncertain whether the LBR after the first embryo transfer improves with PGT-A by polar body biopsy (OR 1.10, 95% CI 0.68 to 1.79, 1 RCT, N = 396, low-quality evidence). PGT-A with polar body biopsy may reduce miscarriage rate (OR 0.45, 95% CI 0.23 to 0.88, 1 RCT, N = 396, low-quality evidence). No data on ongoing pregnancy rate were available. The effect of PGT-A by polar body biopsy on improving clinical pregnancy rate is uncertain (OR 0.77, 95% CI 0.50 to 1.16, 1 RCT, N = 396, low-quality evidence). Blastocyst stage biopsy One trial used blastocyst stage biopsy with next-generation sequencing. It is uncertain whether IVF with the addition of PGT-A by blastocyst stage biopsy increases cLBR compared to IVF without PGT-A, since no data were available. It is uncertain if LBR after the first embryo transfer improves with PGT-A with blastocyst stage biopsy (OR 0.93, 95% CI 0.69 to 1.27, 1 RCT, N = 661, low-quality evidence). It is uncertain whether PGT-A with blastocyst stage biopsy reduces miscarriage rate (OR 0.89, 95% CI 0.52 to 1.54, 1 RCT, N = 661, low-quality evidence). No data on ongoing pregnancy rate or clinical pregnancy rate were available. IVF with PGT-A versus IVF without PGT-A with the use of FISH for the genetic analysis Eleven trials were included in this comparison. It is uncertain whether IVF with addition of PGT-A increases cLBR (OR 0.59, 95% CI 0.35 to 1.01, 1 RCT, N = 408, low-quality evidence). The evidence suggests that for the observed average cLBR of 29% in the control group, the chance of live birth following the results of one IVF cycle with PGT-A is between 12% and 29%. PGT-A performed with FISH probably reduces live births after the first transfer compared to the control group (OR 0.62, 95% CI 0.43 to 0.91, 10 RCTs, N = 1680, I² = 54%, moderate-quality evidence). The evidence suggests that for the observed average LBR per first transfer of 31% in the control group, the chance of live birth after the first embryo transfer with PGT-A is between 16% and 29%. There is probably little or no difference in miscarriage rate between PGT-A and the control group (OR 1.03, 95%, CI 0.75 to 1.41; 10 RCTs, N = 1680, I² = 16%; moderate-quality evidence). The addition of PGT-A may reduce ongoing pregnancy rate (OR 0.68, 95% CI 0.51 to 0.90, 5 RCTs, N = 1121, I² = 60%, low-quality evidence) and probably reduces clinical pregnancies (OR 0.60, 95% CI 0.45 to 0.81, 5 RCTs, N = 1131; I² = 0%, moderate-quality evidence). AUTHORS' CONCLUSIONS There is insufficient good-quality evidence of a difference in cumulative live birth rate, live birth rate after the first embryo transfer, or miscarriage rate between IVF with and IVF without PGT-A as currently performed. No data were available on ongoing pregnancy rates. The effect of PGT-A on clinical pregnancy rate is uncertain. Women need to be aware that it is uncertain whether PGT-A with the use of genome-wide analyses is an effective addition to IVF, especially in view of the invasiveness and costs involved in PGT-A. PGT-A using FISH for the genetic analysis is probably harmful. The currently available evidence is insufficient to support PGT-A in routine clinical practice.
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Affiliation(s)
- Simone Cornelisse
- Department of Obstetrics and Gynaecology, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
| | - Miriam Zagers
- Center for Reproductive Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Elena Kostova
- Center for Reproductive Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Kathrin Fleischer
- Department of Obstetrics and Gynaecology, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
- MVZ TFP-VivaNeo Kinderwunschzentrum, Düsseldorf, Germany
| | - Madelon van Wely
- Center for Reproductive Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Sebastiaan Mastenbroek
- Center for Reproductive Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
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Complexities and potential pitfalls of clinical study design and data analysis in assisted reproduction. Curr Opin Obstet Gynecol 2019; 30:139-144. [PMID: 29652724 DOI: 10.1097/gco.0000000000000454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The purpose of the current review is to describe the common pitfalls in design and statistical analysis of reproductive medicine studies. It serves to guide both authors and reviewers toward reducing the incidence of spurious statistical results and erroneous conclusions. RECENT FINDINGS The large amount of data gathered in IVF cycles leads to problems with multiplicity, multicollinearity, and over fitting of regression models. Furthermore, the use of the word 'trend' to describe nonsignificant results has increased in recent years. Finally, methods to accurately account for female age in infertility research models are becoming more common and necessary. SUMMARY The pitfalls of study design and analysis reviewed provide a framework for authors and reviewers to approach clinical research in the field of reproductive medicine. By providing a more rigorous approach to study design and analysis, the literature in reproductive medicine will have more reliable conclusions that can stand the test of time.
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Vloeberghs V, Verheyen G, Santos-Ribeiro S, Staessen C, Verpoest W, Gies I, Tournaye H. Is genetic fatherhood within reach for all azoospermic Klinefelter men? PLoS One 2018; 13:e0200300. [PMID: 30044810 PMCID: PMC6059408 DOI: 10.1371/journal.pone.0200300] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 06/23/2018] [Indexed: 11/19/2022] Open
Abstract
Background Multidisciplinary management of Klinefelter cases is now considered good clinical practice in order to ensure optimal quality of life. Reproductive performance of Klinefelter men is an important issue however literature in this domain is limited and prone to bias. Study design This was a retrospective longitudinal cohort study performed at a tertiary referral University Centre for Reproductive Medicine and Genetics. One hundred thirty-eight non-mosaic azoospermic Klinefelter patients undergoing their first testicular biopsy (TESE) between 1994 and 2013, followed by intracytoplasmic sperm injection (ICSI) with fresh or frozen-thawed testicular sperm in the female partner, were followed-up longitudinally. The main outcome measure was cumulative live birth rate per Klinefelter patient embarking on TESE-ICSI. Findings In forty-eight men (48/138) sperm were successfully retrieved at the first TESE (34.8%). The mean age of the patients was 32.4 years. Younger age at first TESE was associated with a higher sperm retrieval rate (p<0.001). Overall 39 couples underwent 62 ICSI cycles and 13 frozen embryo transfer cycles resulting in in 20 pregnancies and 14 live birth deliveries (16 children). The mean age of the female partner was 28.1 years. The crude cumulative delivery rate after four ICSI cycles was 35.9%. Per intention-to-treat however, only 10.1% (14/138) of the Klinefelter men starting treatment succeeded in having their biologically own child(ren). Conclusion Non-mosaic Klinefelter patients with azoospermia seeking treatment by TESE-ICSI should be counseled that by intention-to-treat the chance of retrieving sperm is fair, however only a minority will eventually father genetically own children.
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Affiliation(s)
- Veerle Vloeberghs
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
- * E-mail:
| | - Greta Verheyen
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Samuel Santos-Ribeiro
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Catherine Staessen
- Centre for Medical Genetics, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Willem Verpoest
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Inge Gies
- Department of Pediatrics, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Herman Tournaye
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
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Benmachiche A, Benbouhedja S, Zoghmar A, Boularak A, Humaidan P. Impact of Mid-Luteal Phase GnRH Agonist Administration on Reproductive Outcomes in GnRH Agonist-Triggered Cycles: A Randomized Controlled Trial. Front Endocrinol (Lausanne) 2017; 8:124. [PMID: 28663739 DOI: 10.3389/fendo.2017.00124/bibtex] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 05/22/2017] [Indexed: 05/28/2023] Open
Abstract
OBJECTIVE To explore whether the addition of a mid-luteal bolus of GnRH agonist (GnRHa) improves the implantation rate (IR) in in vitro fertilization (IVF) cycles. DESIGN A randomized controlled trial. SETTING Private IVF center. PATIENTS 328 IVF/intracytoplasmic sperm injection patients were triggered with GnRHa and received 1,500 IU HCG on the day of oocyte pick-up (OPU) in addition to a standard luteal phase support (LPS). INTERVENTIONS In addition, the study group received a bolus of GnRHa 6 days after OPU, whereas the control group did not. MAIN OUTCOME MEASURE Implantation rate. SECONDARY OUTCOME MEASURES Ongoing pregnancy (OP) and live birth (LB) rates. RESULTS Although serum concentrations of FSH, LH, E2, and P on day OPU + 7 were significantly higher in the study group compared to the control group, the IR was not statistically different between the treatment group (27%) and the control group (23%) [odds ratio (OR) 1.2 (95% CI 0.9-1.7), P < 0.27]. Similarly, the OP rate was 37% in the treatment group and 31% in the control group [OR 1.3 (95% CI 0.8-2.0), P < 0.23]. The LB rate was 36% in the treatment group and 31% in the control group [OR: 1.3 (95% CI 0.8-2.0), P < 0.27]. CONCLUSION Although a trend toward a higher IR and pregnancy rate was observed in the treatment group, this difference was not statistically significant. However, the absolute risk difference of 5% found for LB is clinically relevant, warranting further investigation. NCT 02053779.
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Affiliation(s)
| | - Sebti Benbouhedja
- Center for Reproductive Medicine, Clinique Ibn Rochd, Constantine, Algeria
| | - Abdelali Zoghmar
- Center for Reproductive Medicine, Clinique Ibn Rochd, Constantine, Algeria
| | - Amel Boularak
- Center for Reproductive Medicine, Clinique Ibn Rochd, Constantine, Algeria
| | - Peter Humaidan
- The Fertility Clinic, Skive Regional Hospital, Skive, Denmark
- Faculty of Health Aarhus University, Aarhus, Denmark
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10
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Carvalho BRD, Barbosa MWP, Bonesi H, Gomes DB, Cabral ÍO, Barbosa ACP, Silva AA, Iglesias JR, Nakagawa HM. Embryo stage of development is not decisive for reproductive outcomes in frozen-thawed embryo transfer cycles. JBRA Assist Reprod 2017; 21:23-26. [PMID: 28333028 PMCID: PMC5365196 DOI: 10.5935/1518-0557.20170007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Objective To evaluate if the outcomes of IVF/ICSI in frozen-thawed embryo transfer and
fresh embryo transfer cycles differ in relation to cleavage and blastocyst
stages. Methods Retrospective cohort study to compare IVF/ICSI outcomes between fresh embryo
transfer and frozen-thawed embryo transfer cycles, according to the stage of
embryo development. Analysis was carried out on 443 consecutive embryo
transfer cycles performed between January 1st and December 31st, 2014. Women
aged up to 38 and submitted to embryo transfer cycles with fresh (n = 309)
or frozen-thawed (n = 134) embryos at a private center for assistance in
human reproduction were considered for analysis. Results in each group were
stratified according to the stage of embryo development: cleavage stage and
blastocyst stage. Main outcome measures were implantation rate, clinical
pregnancy rate, ongoing pregnancy rate and live birth rate per cycle. Results In the fresh embryo transfer group, for cleavage stage versus blastocyst
stage, respectively, implantation rates were 22% and 47% (p
= 0.0005); clinical pregnancy rates were 34% and 64% (p =
0.0057); the ongoing pregnancy rates were 30% and 61% (p =
0.0046) and live birth rates were 28% and 55% (p = 0.0148).
There were no significant differences in the rates between cleavage and
blastocyst stages in the frozen-thawed group, neither between fresh and
frozen-thawed cleavage embryo transfers nor between fresh and frozen-thawed
blastocyst transfers. Conclusion Our results confirm that blastocyst transfer is better than cleavage stage in
fresh embryo transfer cycles. In frozen-thawed cycles, cleavage or
blastocyst stages seem to offer similar reproductive outcomes.
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Affiliation(s)
| | | | - Helena Bonesi
- GENESIS - Center for Assistance in Human Reproduction, Brasília, DF, Brazil
| | - David B Gomes
- GENESIS - Center for Assistance in Human Reproduction, Brasília, DF, Brazil
| | - Íris O Cabral
- GENESIS - Center for Assistance in Human Reproduction, Brasília, DF, Brazil
| | | | - Adelino A Silva
- GENESIS - Center for Assistance in Human Reproduction, Brasília, DF, Brazil
| | - José R Iglesias
- GENESIS - Center for Assistance in Human Reproduction, Brasília, DF, Brazil
| | - Hitomi M Nakagawa
- GENESIS - Center for Assistance in Human Reproduction, Brasília, DF, Brazil
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11
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Benmachiche A, Benbouhedja S, Zoghmar A, Boularak A, Humaidan P. Impact of Mid-Luteal Phase GnRH Agonist Administration on Reproductive Outcomes in GnRH Agonist-Triggered Cycles: A Randomized Controlled Trial. Front Endocrinol (Lausanne) 2017; 8:124. [PMID: 28663739 PMCID: PMC5471294 DOI: 10.3389/fendo.2017.00124] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 05/22/2017] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To explore whether the addition of a mid-luteal bolus of GnRH agonist (GnRHa) improves the implantation rate (IR) in in vitro fertilization (IVF) cycles. DESIGN A randomized controlled trial. SETTING Private IVF center. PATIENTS 328 IVF/intracytoplasmic sperm injection patients were triggered with GnRHa and received 1,500 IU HCG on the day of oocyte pick-up (OPU) in addition to a standard luteal phase support (LPS). INTERVENTIONS In addition, the study group received a bolus of GnRHa 6 days after OPU, whereas the control group did not. MAIN OUTCOME MEASURE Implantation rate. SECONDARY OUTCOME MEASURES Ongoing pregnancy (OP) and live birth (LB) rates. RESULTS Although serum concentrations of FSH, LH, E2, and P on day OPU + 7 were significantly higher in the study group compared to the control group, the IR was not statistically different between the treatment group (27%) and the control group (23%) [odds ratio (OR) 1.2 (95% CI 0.9-1.7), P < 0.27]. Similarly, the OP rate was 37% in the treatment group and 31% in the control group [OR 1.3 (95% CI 0.8-2.0), P < 0.23]. The LB rate was 36% in the treatment group and 31% in the control group [OR: 1.3 (95% CI 0.8-2.0), P < 0.27]. CONCLUSION Although a trend toward a higher IR and pregnancy rate was observed in the treatment group, this difference was not statistically significant. However, the absolute risk difference of 5% found for LB is clinically relevant, warranting further investigation. NCT 02053779.
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Affiliation(s)
- Abdelhamid Benmachiche
- Center for Reproductive Medicine, Clinique Ibn Rochd, Constantine, Algeria
- *Correspondence: Abdelhamid Benmachiche,
| | - Sebti Benbouhedja
- Center for Reproductive Medicine, Clinique Ibn Rochd, Constantine, Algeria
| | - Abdelali Zoghmar
- Center for Reproductive Medicine, Clinique Ibn Rochd, Constantine, Algeria
| | - Amel Boularak
- Center for Reproductive Medicine, Clinique Ibn Rochd, Constantine, Algeria
| | - Peter Humaidan
- The Fertility Clinic, Skive Regional Hospital, Skive, Denmark
- Faculty of Health Aarhus University, Aarhus, Denmark
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12
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Wilkinson J, Roberts SA, Showell M, Brison DR, Vail A. No common denominator: a review of outcome measures in IVF RCTs. Hum Reprod 2016; 31:2714-2722. [PMID: 27664214 PMCID: PMC5193327 DOI: 10.1093/humrep/dew227] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 08/03/2016] [Accepted: 08/10/2016] [Indexed: 12/20/2022] Open
Abstract
STUDY QUESTION Which outcome measures are reported in RCTs for IVF? SUMMARY ANSWER Many combinations of numerator and denominator are in use, and are often employed in a manner that compromises the validity of the study. WHAT IS KNOWN ALREADY The choice of numerator and denominator governs the meaning, relevance and statistical integrity of a study's results. RCTs only provide reliable evidence when outcomes are assessed in the cohort of randomised participants, rather than in the subgroup of patients who completed treatment. STUDY DESIGN, SIZE, DURATION Review of outcome measures reported in 142 IVF RCTs published in 2013 or 2014. PARTICIPANTS/MATERIALS, SETTING, METHODS Trials were identified by searching the Cochrane Gynaecology and Fertility Specialised Register. English-language publications of RCTs reporting clinical or preclinical outcomes in peer-reviewed journals in the period 1 January 2013 to 31 December 2014 were eligible. Reported numerators and denominators were extracted. Where they were reported, we checked to see if live birth rates were calculated correctly using the entire randomised cohort or a later denominator. MAIN RESULTS AND THE ROLE OF CHANCE Over 800 combinations of numerator and denominator were identified (613 in no more than one study). No single outcome measure appeared in the majority of trials. Only 22 (43%) studies reporting live birth presented a calculation including all randomised participants or only excluding protocol violators. A variety of definitions were used for key clinical numerators: for example, a consensus regarding what should constitute an ongoing pregnancy does not appear to exist at present. LIMITATIONS, REASONS FOR CAUTION Several of the included articles may have been secondary publications. Our categorisation scheme was essentially arbitrary, so the frequencies we present should be interpreted with this in mind. The analysis of live birth denominators was post hoc. WIDER IMPLICATIONS OF THE FINDINGS There is massive diversity in numerator and denominator selection in IVF trials due to its multistage nature, and this causes methodological frailty in the evidence base. The twin spectres of outcome reporting bias and analysis of non-randomised comparisons do not appear to be widely recognised. Initiatives to standardise outcome reporting, such as requiring all effectiveness studies to report live birth or cumulative live birth, are welcome. However, there is a need to recognise that early outcomes of treatment, such as stimulation response or embryo quality, may be appropriate choices of primary outcome for early phase studies. STUDY FUNDING/COMPETING INTERESTS J.W. is funded by a Doctoral Research Fellowship from the National Institute for Health Research. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health. J.W. also declares that publishing research is beneficial to his career. J.W. and A.V. are statistical editors, and M.S. is Information Specialist, for the Cochrane Gynaecology and Fertility Group, although the views expressed here are not necessarily those of the group. D.R.B. is funded by the NHS as Scientific Director of a clinical IVF service. The authors declare no other conflicts of interest.
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Affiliation(s)
- Jack Wilkinson
- Centre for Biostatistics, Institute of Population Health, Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester M13 9PL, UK .,Research & Development, Salford Royal NHS Foundation Trust , Salford M6 8HD, UK
| | - Stephen A Roberts
- Centre for Biostatistics, Institute of Population Health, Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester M13 9PL, UK
| | - Marian Showell
- Cochrane Gynaecology and Fertility, The University of Auckland, Auckland City Hospital , Auckland 1142, New Zealand
| | - Daniel R Brison
- Department of Reproductive Medicine, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre (MAHSC) , Manchester M13 9WL, UK
| | - Andy Vail
- Centre for Biostatistics, Institute of Population Health, Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester M13 9PL, UK.,Research & Development, Salford Royal NHS Foundation Trust , Salford M6 8HD, UK
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13
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Gameiro S, Boivin J, Dancet E, Emery M, Thorn P, Van den Broeck U, Venetis C, Verhaak CM, Wischmann T, Vermeulen N. Qualitative research in the ESHRE Guideline 'Routine psychosocial care in infertility and medically assisted reproduction - a guide for staff'. Hum Reprod 2016; 31:1928-9. [PMID: 27343273 DOI: 10.1093/humrep/dew155] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- S Gameiro
- Cardiff Fertility Studies Research Group, School of Psychology, Cardiff University, Cardiff CF10 3AT, UK
| | - J Boivin
- Cardiff Fertility Studies Research Group, School of Psychology, Cardiff University, Cardiff CF10 3AT, UK
| | - E Dancet
- Department of Development and Regeneration & Leuven University Fertility Centre, Catholic University Leuven, Leuven 3000, Belgium Center for Reproductive Medicine, Women's and Children's Hospital, Academic Medical Center, University of Amsterdam, Amsterdam 1105 AZ, The Netherlands
| | - M Emery
- Centre for Medically Assisted Procreation-CPMA, Lausanne CH-1003, Switzerland
| | - P Thorn
- Practice for Couple and Family Therapy, Moerfelden 64546, Germany
| | - U Van den Broeck
- Department of Development and Regeneration & Leuven University Fertility Centre, Catholic University Leuven, Leuven 3000, Belgium
| | - C Venetis
- Women's and Children's Health, St George Hospital, University of New South Wales, Sydney, NSW 2217, Australia
| | - C M Verhaak
- Department of Psychology, Radboud University Medical Center, Nijmegen 6500HB, The Netherlands
| | - T Wischmann
- Institute of Medical Psychology, Centre for Psychosocial Medicine, Heidelberg University Hospital, Heidelberg 69115, Germany
| | - N Vermeulen
- European Society for Human Reproduction and Embryology, Grimbergen 1852, Belgium
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14
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Griesinger G. Reply: Skating on thin ice when using the outcome implantation rate for evaluating the utility of embryo selection techniques such as PGS. Hum Reprod 2016; 31:1927-8. [DOI: 10.1093/humrep/dew139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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15
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Forman EJ, Franasiak JM, Patounakis G, Scott RT. Why abandoning sustained implantation rate may be throwing the baby out with the bathwater. Hum Reprod 2016; 31:1926-7. [PMID: 27301363 DOI: 10.1093/humrep/dew138] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Eric J Forman
- Reproductive Medicine Associates of New Jersey, Basking Ridge, NJ, USA
| | - Jason M Franasiak
- Reproductive Medicine Associates of New Jersey, Basking Ridge, NJ, USA
| | | | - Richard T Scott
- Reproductive Medicine Associates of New Jersey, Basking Ridge, NJ, USA
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16
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Sermon K, Capalbo A, Cohen J, Coonen E, De Rycke M, De Vos A, Delhanty J, Fiorentino F, Gleicher N, Griesinger G, Grifo J, Handyside A, Harper J, Kokkali G, Mastenbroek S, Meldrum D, Meseguer M, Montag M, Munné S, Rienzi L, Rubio C, Scott K, Scott R, Simon C, Swain J, Treff N, Ubaldi F, Vassena R, Vermeesch JR, Verpoest W, Wells D, Geraedts J. The why, the how and the when of PGS 2.0: current practices and expert opinions of fertility specialists, molecular biologists, and embryologists. Mol Hum Reprod 2016; 22:845-57. [PMID: 27256483 DOI: 10.1093/molehr/gaw034] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 05/16/2016] [Indexed: 01/11/2023] Open
Abstract
STUDY QUESTION We wanted to probe the opinions and current practices on preimplantation genetic screening (PGS), and more specifically on PGS in its newest form: PGS 2.0? STUDY FINDING Consensus is lacking on which patient groups, if any at all, can benefit from PGS 2.0 and, a fortiori, whether all IVF patients should be offered PGS. WHAT IS KNOWN ALREADY It is clear from all experts that PGS 2.0 can be defined as biopsy at the blastocyst stage followed by comprehensive chromosome screening and possibly combined with vitrification. Most agree that mosaicism is less of an issue at the blastocyst stage than at the cleavage stage but whether mosaicism is no issue at all at the blastocyst stage is currently called into question. STUDY DESIGN, SAMPLES/MATERIALS, METHODS A questionnaire was developed on the three major aspects of PGS 2.0: the Why, with general questions such as PGS 2.0 indications; the How, specifically on genetic analysis methods; the When, on the ideal method and timing of embryo biopsy. Thirty-five colleagues have been selected to address these questions on the basis of their experience with PGS, and demonstrated by peer-reviewed publications, presentations at meetings and participation in the discussion. The first group of experts who were asked about 'The Why' comprised fertility experts, the second group of molecular biologists were asked about 'The How' and the third group of embryologists were asked about 'The When'. Furthermore, the geographical distribution of the experts has been taken into account. Thirty have filled in the questionnaire as well as actively participated in the redaction of the current paper. MAIN RESULTS AND THE ROLE OF CHANCE The 30 participants were from Europe (Belgium, Germany, Greece, Italy, Netherlands, Spain, UK) and the USA. Array comparative genome hybridization is the most widely used method amongst the participants, but it is slowly being replaced by massive parallel sequencing. Most participants offering PGS 2.0 to their patients prefer blastocyst biopsy. The high efficiency of vitrification of blastocysts has added a layer of complexity to the discussion, and it is not clear whether PGS in combination with vitrification, PGS alone, or vitrification alone, followed by serial thawing and eSET will be the favoured approach. The opinions range from in favour of the introduction of PGS 2.0 for all IVF patients, over the proposal to use PGS as a tool to rank embryos according to their implantation potential, to scepticism towards PGS pending a positive outcome of robust, reliable and large-scale RCTs in distinct patient groups. LIMITATIONS, REASONS FOR CAUTION Care was taken to obtain a wide spectrum of views from carefully chosen experts. However, not all invited experts agreed to participate, which explains a lack of geographical coverage in some areas, for example China. This paper is a collation of current practices and opinions, and it was outside the scope of this study to bring a scientific, once-and-for-all solution to the ongoing debate. WIDER IMPLICATIONS OF THE FINDINGS This paper is unique in that it brings together opinions on PGS 2.0 from all different perspectives and gives an overview of currently applied technologies as well as potential future developments. It will be a useful reference for fertility specialists with an expertise outside reproductive genetics. LARGE SCALE DATA none. STUDY FUNDING AND COMPETING INTERESTS No specific funding was obtained to conduct this questionnaire.
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Affiliation(s)
- Karen Sermon
- Research Group Reproduction and Genetics, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Antonio Capalbo
- GENETYX, Molecular Genetics Laboratory, Via Fermi 1, 36063 Marostica (VI), Italy
| | - Jacques Cohen
- ART Institute of Washington at Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Edith Coonen
- Department of Reproductive Medicine, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands Department of Clinical Genetics, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | - Martine De Rycke
- Centre for Medical Genetics, UZ Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Anick De Vos
- Centre for Reproductive Medicine, UZ Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Joy Delhanty
- University College London Centre for PGD, UCL, 86-96 Chenies Mews, London WC1E 6HX, UK
| | - Francesco Fiorentino
- GENOMA-Molecular Genetics Laboratories, Via di Castel Giubileo, 11 00138, Rome, Italy
| | - Norbert Gleicher
- The Center for Human Reproduction, New York, NY 10021, USA The Foundation for Reproductive Medicine, New York, NY 1022, USA The Rockefeller University, New York, NY 10065, USA
| | - Georg Griesinger
- Department of Reproductive Medicine and Gynecological Endocrinology, University Hospital of Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538 Luebeck, Germany
| | - Jamie Grifo
- NYU Fertility Center, NYU Langone Medical Center, 660 1st Ave, New York, NY 10016, USA
| | - Alan Handyside
- The Bridge Centre, London SE1 9RY, UK Illumina Cambridge Ltd, Capital Park CPC4, Fulbourn, Cambridge CB21 5XE, UK
| | - Joyce Harper
- University College London Centre for PGD, UCL, 86-96 Chenies Mews, London WC1E 6HX, UK
| | - Georgia Kokkali
- Centre for Human Reproduction, Reproductive Medicine Unit, Genesis Athens Clinic, Papanicoli 14-16, Chalandri, 152-32, Athens, Greece
| | - Sebastiaan Mastenbroek
- Center for Reproductive Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - David Meldrum
- Division of Reproductive Endocrinology and Infertility, University of California San Diego, San Diego, CA, USA
| | - Marcos Meseguer
- Instituto Valenciano de Infertilidad (IVI) Clinic Valencia, Valencia, Spain
| | - Markus Montag
- ilabcomm GmbH, Eisenachstr. 34, 53757 Sankt Augustin, Germany
| | | | - Laura Rienzi
- GENERA, Centres for Reproductive Medicine, Rome, Italy
| | - Carmen Rubio
- Igenomix, and IVI Fundation, Parc Cientific Universitat de Valencia, Catedrático Agustín Escardino 9, 46980 Paterna, Valencia, Spain
| | | | - Richard Scott
- Reproductive Medicine Associates (RMA) of New Jersey, 140 Allen Road, Basking Ridge, NJ 07920, USA
| | - Carlos Simon
- Fundación Instituto Valenciano de Infertilidad, Department of Obstetrics and Gynecology, University of Valencia, Valencia, Spain INCLIVA Health Research Institute, Valencia, Spain IGenomix, Valencia, Spain
| | - Jason Swain
- CCRM IVF Laboratory Network, Englewood, CO 80112 USA
| | - Nathan Treff
- Reproductive Medicine Associates (RMA) of New Jersey, 140 Allen Road, Basking Ridge, NJ 07920, USA
| | | | - Rita Vassena
- Clinica EUGIN, Travessera de Les Corts 322, 08029 Barcelona, Spain
| | | | - Willem Verpoest
- Centre for Reproductive Medicine, UZ Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Dagan Wells
- Nuffield Department of Obstetrics and Gynaecology, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, UK Reprogenetics UK, Institute of Reproductive Sciences, Oxford Business Park, Oxford OX4 2HW, UK
| | - Joep Geraedts
- Department of Reproductive Medicine, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands Department of Clinical Genetics, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
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