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Sun L, Li J, Zeng S, Luo Q, Miao H, Liang Y, Cheng L, Sun Z, Tai WH, Han Y, Yin Y, Wu K, Zhang K. Artificial intelligence system for outcome evaluations of human in vitro fertilization-derived embryos. Chin Med J (Engl) 2024; 137:1939-1949. [PMID: 38997251 PMCID: PMC11332789 DOI: 10.1097/cm9.0000000000003162] [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: 01/21/2024] [Indexed: 07/14/2024] Open
Abstract
BACKGROUND In vitro fertilization (IVF) has emerged as a transformative solution for infertility. However, achieving favorable live-birth outcomes remains challenging. Current clinical IVF practices in IVF involve the collection of heterogeneous embryo data through diverse methods, including static images and temporal videos. However, traditional embryo selection methods, primarily reliant on visual inspection of morphology, exhibit variability and are contingent on the experience of practitioners. Therefore, an automated system that can evaluate heterogeneous embryo data to predict the final outcomes of live births is highly desirable. METHODS We employed artificial intelligence (AI) for embryo morphological grading, blastocyst embryo selection, aneuploidy prediction, and final live-birth outcome prediction. We developed and validated the AI models using multitask learning for embryo morphological assessment, including pronucleus type on day 1 and the number of blastomeres, asymmetry, and fragmentation of blastomeres on day 3, using 19,201 embryo photographs from 8271 patients. A neural network was trained on embryo and clinical metadata to identify good-quality embryos for implantation on day 3 or day 5, and predict live-birth outcomes. Additionally, a 3D convolutional neural network was trained on 418 time-lapse videos of preimplantation genetic testing (PGT)-based ploidy outcomes for the prediction of aneuploidy and consequent live-birth outcomes. RESULTS These two approaches enabled us to automatically assess the implantation potential. By combining embryo and maternal metrics in an ensemble AI model, we evaluated live-birth outcomes in a prospective cohort that achieved higher accuracy than experienced embryologists (46.1% vs. 30.7% on day 3, 55.0% vs. 40.7% on day 5). Our results demonstrate the potential for AI-based selection of embryos based on characteristics beyond the observational abilities of human clinicians (area under the curve: 0.769, 95% confidence interval: 0.709-0.820). These findings could potentially provide a noninvasive, high-throughput, and low-cost screening tool to facilitate embryo selection and achieve better outcomes. CONCLUSIONS Our study underscores the AI model's ability to provide interpretable evidence for clinicians in assisted reproduction, highlighting its potential as a noninvasive, efficient, and cost-effective tool for improved embryo selection and enhanced IVF outcomes. The convergence of cutting-edge technology and reproductive medicine has opened new avenues for addressing infertility challenges and optimizing IVF success rates.
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Affiliation(s)
- Ling Sun
- Department of Reproductive Medicine, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, Guangdong 510623, China
| | - Jiahui Li
- Department of Reproductive Medicine, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, Guangdong 510623, China
- Guangzhou National Laboratory, Guangzhou, Guangdong 510000, China
| | - Simiao Zeng
- Department of Reproductive Medicine, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, Guangdong 510623, China
- Guangzhou National Laboratory, Guangzhou, Guangdong 510000, China
| | - Qiangxiang Luo
- Department of Reproductive Medicine, Jiangmen Central Hospital, Jiangmen, Guangdong 529000, China
| | - Hanpei Miao
- Guangzhou National Laboratory, Guangzhou, Guangdong 510000, China
- Department of Ophthalmology, Dongguan People’s Hospital, The First School of Clinical Medicine, Southern Medical University, Dongguan, Guangdong 523000, China
| | - Yunhao Liang
- Department of Reproductive Medicine, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, Guangdong 510623, China
| | - Linling Cheng
- Institute for Artificial Intelligence in Medicine, Faculty of Medicine, Macau University of Science and Technology, Macau Special Administrative Region 999078, China
| | - Zhuo Sun
- Wenzhou Eye Hospital, Institute for Advanced Studies on Eye Health and Diseases, Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
| | - Wa Hou Tai
- Institute for Artificial Intelligence in Medicine, Faculty of Medicine, Macau University of Science and Technology, Macau Special Administrative Region 999078, China
| | - Yibing Han
- Kiang Wu Hospital, Macau Special Administrative Region 999078, China
| | - Yun Yin
- Faculty of Business, City University of Macau, Macau Special Administrative Region 999078, China
| | - Keliang Wu
- State Key Laboratory of Reproductive Medicine and Offspring Health, Center for Reproductive Medicine, Institute of Women, Children and Reproductive Health and Key laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, Shandong 250000,China
| | - Kang Zhang
- Department of Reproductive Medicine, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, Guangdong 510623, China
- Guangzhou National Laboratory, Guangzhou, Guangdong 510000, China
- Institute for Artificial Intelligence in Medicine, Faculty of Medicine, Macau University of Science and Technology, Macau Special Administrative Region 999078, China
- Wenzhou Eye Hospital, Institute for Advanced Studies on Eye Health and Diseases, Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
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Borges E, Braga D, Guilherme P, Iaconelli A, Setti A. The impact of severe oligozoospermia on morphokinetic embryo development in low-prognosis patients according to the Patient-Oriented Strategies Encompassing IndividualizeD Oocyte Number criteria: an analysis of 10,366 injected oocytes. F&S SCIENCE 2024; 5:232-241. [PMID: 38849117 DOI: 10.1016/j.xfss.2024.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 06/01/2024] [Accepted: 06/03/2024] [Indexed: 06/09/2024]
Abstract
OBJECTIVE To study whether severe male factor infertility (SMF), reflected by oligozoospermia, impacts embryo morphokinetic behavior in low-prognosis women as stratified by the Patient-Oriented Strategies Encompassing IndividualizeD Oocyte Number (POSEIDON) criteria. DESIGN Cohort study. SETTING Private university-affiliated in vitro fertilization center. PATIENT(S) A total of 10,366 injected oocytes from 2,272 women who underwent intracytoplasmic sperm injection cycles between March 2019 and April 2022. INTERVENTION(S) Patients were divided into 8 groups according to the POSEIDON criteria (1-4) and the presence or absence of SMF. A control group of normoresponder patients was included. Kinetic markers from the point of insemination were recorded in the EmbryoScope incubator. MAIN OUTCOME MEASURE(S) Morphokinetic milestones and intracytoplasmic sperm injection clinical outcomes. RESULT(S) Embryos from patients in the POSEIDON 1 group showed significantly slower timing to pronuclear appearance, timing to pronuclear fading (tPNf), timing to 2 (t2), 3 (t3), 4 (t4), 6 (t6), and 7 (t7) cells than those from the control group. Known Implantation Diagnosis Score ranking was significantly different between the SMF and non-SMF (nSMF) subgroups in both POSEIDON 1 as well as control groups. Embryos from patients in the POSEIDON 2 group showed significantly slower timing to pronuclear appearance, t4, t6, t7, timing to 8 cells (t8), and timing to morulae than those from the control group. Embryos in the POSEIDON 2 SMF subgroup took longer than those in the POSEIDON 2 nSMF subgroup and those in both control subgroups to achieve tPNf, t2, t3, timing to 5 cells (t5), timing to start blastulation, and timing to blastulation. Known Implantation Diagnosis Score ranking was significantly different between the SMF and nSMF subgroups in both POSEIDON 2 as well as control groups. Embryos from patients in the POSEIDON 3 group showed significantly slower t8 and duration of the second cell cycle (t3-t2) than those from the control group. Known Implantation Diagnosis Score ranking was significantly different across the subgroups. Embryos derived from patients in the POSEIDON 4 group showed significantly slower tPNf, t2, t3, t4, t5, t6, t7, t8, timing to complete t4-t3 synchronous divisions, and timing to complete t8-t5 synchronous divisions than those from the control group. Known Implantation Diagnosis Score ranking was significantly different between the SMF and nSMF subgroups in both POSEIDON 4 as well as control groups. Irrespective of sperm quality, clinical outcomes significantly improved in the control subgroups compared with those in the POSEIDON 2 and 4 subgroups. CONCLUSION(S) Embryos in the SMF groups presented lower Known Implantation Diagnosis Score ranking than those in the nSMF groups in both POSEIDON 1-4 and control groups, suggesting that cumulative differences result in worse morphokinetic development when the algorithm is used.
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Affiliation(s)
- Edson Borges
- Fertility Medical Group/FERTGROUP Medicina Reprodutiva, Clinical Department, São Paulo, Brazil; Sapientiae Institute - Centro de Estudos e Pesquisa em Reprodução Humana Assistida, Scientific Research, São Paulo, Brazil
| | - Daniela Braga
- Sapientiae Institute - Centro de Estudos e Pesquisa em Reprodução Humana Assistida, Scientific Research, São Paulo, Brazil; Fertility Medical Group, Scientific Research, São Paulo, Brazil
| | - Patricia Guilherme
- Fertility Medical Group/FERTGROUP Medicina Reprodutiva, IVF Lab, Sao Paulo, Brazil
| | - Assumpto Iaconelli
- Fertility Medical Group/FERTGROUP Medicina Reprodutiva, Clinical Department, São Paulo, Brazil; Sapientiae Institute - Centro de Estudos e Pesquisa em Reprodução Humana Assistida, Scientific Research, São Paulo, Brazil
| | - Amanda Setti
- Sapientiae Institute - Centro de Estudos e Pesquisa em Reprodução Humana Assistida, Scientific Research, São Paulo, Brazil; Fertility Medical Group, Scientific Research, São Paulo, Brazil.
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Ding K, Li X, Wei Y, Zhang M, Ling X, Zhao C. Pregnancy and perinatal outcomes in pregnancies following frozen embryo transfer (FET) after transcervical resection of adhesions (TCRA): A retrospective cohort study with propensity score matching analysis. Int J Gynaecol Obstet 2024. [PMID: 39072724 DOI: 10.1002/ijgo.15815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 07/06/2024] [Accepted: 07/16/2024] [Indexed: 07/30/2024]
Abstract
OBJECTIVE To compare the pregnancy and perinatal outcomes of frozen-thawed embryo transfer (FET) in patients following transcervical resection of adhesions (TCRA) versus patients with normal uterine morphology, and to investigate the factors influencing pregnancy outcomes in patients undergoing FET after TCRA. METHODS We retrospectively analyzed FET cycles from September 2014 to September 2023, comparing patients with normal uterine morphology to those with intrauterine adhesions (IUAs) treated with TCRA. Propensity score matching (PSM) adjusted for confounding factors. LASSO regression and multivariate logistic regression identified predictors of outcomes, which were visually represented in nomograms. Model performance was assessed using calibration curves, ROC curves, and DCA, with bootstrap method for internal validation. RESULTS Post-PSM analysis showed higher live birth rates in patients with normal uterine morphology after clinical pregnancy (75.1% vs. 61.7%, P < 0.001). No significant differences were noted in clinical pregnancy rates and perinatal outcomes between the groups. Factors influencing clinical pregnancy in FET after TCRA included basal progesterone levels, endometrial thickness, parity, infertility cause, embryo stage at transfer, number and quality of embryos transferred, IUA severity, and TCRA surgical procedures. Body mass index, basal LH levels, and day 14 HCG levels post-embryo transfer were determinants of live birth outcome. CONCLUSION FET cycles following TCRA showed a lower rate of successful live births, but TCRA did not increase adverse perinatal outcome risks. Our study introduces an innovative predictive model for clinical pregnancy and live birth outcomes in patients undergoing FET following TCRA, addressing a significant void in existing research.
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Affiliation(s)
- Kai Ding
- Department of Reproductive Medicine, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, China
| | - Xin Li
- Department of Reproductive Medicine, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, China
| | - Yi Wei
- Department of Reproductive Medicine, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, China
| | - Mianqiu Zhang
- Department of Reproductive Medicine, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, China
| | - Xiufeng Ling
- Department of Reproductive Medicine, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, China
| | - Chun Zhao
- Department of Reproductive Medicine, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, China
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Jiang C, Geng M, Zhang C, She H, Wang D, Wang J, Liu J, Diao F, Cai L, Hu Y. The synergy of morphokinetic parameters and sHLA-G in cleavage embryo enhancing implantation rates. Front Cell Dev Biol 2024; 12:1417375. [PMID: 39081861 PMCID: PMC11286472 DOI: 10.3389/fcell.2024.1417375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Accepted: 05/28/2024] [Indexed: 08/02/2024] Open
Abstract
Objective: This study aimed to assess the relationship between implantation and soluble HLA-G (sHLA-G) expression in cleavage embryo culture medium (ECM) in conjunction with early developmental kinetics determined by time-lapse imaging (TLI). Methods: A retrospective, single-center study was conducted involving 238 embryos from 165 patients who underwent Frozen-thawed embryo transfer (FET) using autologous oocytes, with either single or double embryo transfer. TLI morphokinetic parameters (t2, t3, t4, t5, t6, t7, t8, cc2, s2, cc3, s3) of embryos were analyzed, and sHLA-G levels in D3 ECM were measured using an enzyme-linked immunosorbent assay (ELISA). A hierarchical classification model was developed to categorize embryos into five groups (A, B, C, D, E). The correlation between sHLA-G levels, TLI classification of embryos, and embryo implantation was investigated to establish a non-invasive method for evaluating implantation potential. Multivariate logistic regression analysis was performed to identify potential influencing factors, and receiver operating characteristic (ROC) curves were used to evaluate the predictive value for implantation. Results: Multivariate unconditional logistic regression analysis indicated that TLI parameters t5 and s3 and sHLA-G level in ECM were independent risk factors affecting embryo implantation. The implantation rate decreased from TLI classification A to E. The proposed classification model effectively assessed the implantation potential of embryos. The implantation rate was higher in the sHLA-G positive group compared to the sHLA-G negative group (p < 0.001). The expression of sHLA-G in D3 ECM, combined with the TLI classification model, accurately evaluated the implantation potential of embryos with an AUC of 0.876. Conclusion: The integration of cleavage kinetics and embryonic sHLA-G expression could reliably identify embryos with a high likelihood of successful implantation.
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Affiliation(s)
- Chunyan Jiang
- State Key Laboratory of Reproductive Medicine and Offspring Health, Clinical Center of Reproductive Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Menghui Geng
- Reproductive Medicine Center of Northern Jiangsu People’s Hospital, Yangzhou, China
- Department of Obstetrics and Gynecology, The 2 Affiliated Hospital and Yuying Chidren’s Hospital of Wenzhou Medical University, Wenzhou, China
| | - Can Zhang
- Department of Obstetrics and Gynecology, Tumor Hospital Affiliated to Nantong University, Nantong, China
| | - Hong She
- Reproductive Medicine Center of Northern Jiangsu People’s Hospital, Yangzhou, China
| | - Dalin Wang
- Reproductive Medicine Center of Xu Zhou Maternity and Child Healthcare Hospital Affiliated to Xuzhou Medical University, Xuzhou, China
| | - Jing Wang
- State Key Laboratory of Reproductive Medicine and Offspring Health, Clinical Center of Reproductive Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jiayin Liu
- State Key Laboratory of Reproductive Medicine and Offspring Health, Clinical Center of Reproductive Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Feiyang Diao
- State Key Laboratory of Reproductive Medicine and Offspring Health, Clinical Center of Reproductive Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Lingbo Cai
- State Key Laboratory of Reproductive Medicine and Offspring Health, Clinical Center of Reproductive Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yanqiu Hu
- State Key Laboratory of Reproductive Medicine and Offspring Health, Clinical Center of Reproductive Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Reproductive Medicine Center of Northern Jiangsu People’s Hospital, Yangzhou, China
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Wang G, Wang K, Gao Y, Chen L, Gao T, Ma Y, Jiang Z, Yang G, Feng F, Zhang S, Gu Y, Liu G, Chen L, Ma LS, Sang Y, Xu Y, Lin G, Liu X. A generalized AI system for human embryo selection covering the entire IVF cycle via multi-modal contrastive learning. PATTERNS (NEW YORK, N.Y.) 2024; 5:100985. [PMID: 39081572 PMCID: PMC11284500 DOI: 10.1016/j.patter.2024.100985] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 03/12/2024] [Accepted: 04/10/2024] [Indexed: 08/02/2024]
Abstract
In vitro fertilization (IVF) has revolutionized infertility treatment, benefiting millions of couples worldwide. However, current clinical practices for embryo selection rely heavily on visual inspection of morphology, which is highly variable and experience dependent. Here, we propose a comprehensive artificial intelligence (AI) system that can interpret embryo-developmental knowledge encoded in vast unlabeled multi-modal datasets and provide personalized embryo selection. This AI platform consists of a transformer-based network backbone named IVFormer and a self-supervised learning framework, VTCLR (visual-temporal contrastive learning of representations), for training multi-modal embryo representations pre-trained on large and unlabeled data. When evaluated on clinical scenarios covering the entire IVF cycle, our pre-trained AI model demonstrates accurate and reliable performance on euploidy ranking and live-birth occurrence prediction. For AI vs. physician for euploidy ranking, our model achieved superior performance across all score categories. The results demonstrate the potential of the AI system as a non-invasive, efficient, and cost-effective tool to improve embryo selection and IVF outcomes.
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Affiliation(s)
- Guangyu Wang
- State Key Laboratory of Networking and Switching Technology, Beijing University of Posts and Telecommunications, Beijing, China
| | - Kai Wang
- College of Future Technology, Peking University and Peking-Tsinghua Center for Life Sciences, Beijing 100871, China
| | - Yuanxu Gao
- College of Future Technology, Peking University and Peking-Tsinghua Center for Life Sciences, Beijing 100871, China
| | - Longbin Chen
- Institute of Reproductive and Stem Cells, School of Basic Medicine, Central South University, Changsha, China
| | - Tianrun Gao
- State Key Laboratory of Networking and Switching Technology, Beijing University of Posts and Telecommunications, Beijing, China
| | - Yuanlin Ma
- Reproductive Medicine Center, the First Affiliated Hospital, Sun Yat-sen University, Guangdong, China
| | - Zeyu Jiang
- State Key Laboratory of Networking and Switching Technology, Beijing University of Posts and Telecommunications, Beijing, China
| | - Guoxing Yang
- State Key Laboratory of Networking and Switching Technology, Beijing University of Posts and Telecommunications, Beijing, China
| | - Fajin Feng
- State Key Laboratory of Networking and Switching Technology, Beijing University of Posts and Telecommunications, Beijing, China
| | - Shuoping Zhang
- Research Department, CITIC Xiangya Reproductive and Genetic Hospital, Changsha, China
| | - Yifan Gu
- Research Department, CITIC Xiangya Reproductive and Genetic Hospital, Changsha, China
| | - Guangdong Liu
- Department of Gynaecology and Obstetrics, The Sixth Medical Center of the General Hospital of the People’s Liberation Army, Beijing, China
| | - Lei Chen
- Department of Gynaecology and Obstetrics, The Sixth Medical Center of the General Hospital of the People’s Liberation Army, Beijing, China
| | - Li-Shuang Ma
- Capital Institute of Pediatrics, Affiliated Children’s Hospital, Beijing, China
| | - Ye Sang
- The First College of Clinical Medical Science, China Three Gorges University & Yichang Central People’s Hospital, Yichang 443003, China
| | - Yanwen Xu
- Reproductive Medicine Center, the First Affiliated Hospital, Sun Yat-sen University, Guangdong, China
| | - Ge Lin
- Institute of Reproductive and Stem Cells, School of Basic Medicine, Central South University, Changsha, China
- Research Department, CITIC Xiangya Reproductive and Genetic Hospital, Changsha, China
| | - Xiaohong Liu
- State Key Laboratory of Networking and Switching Technology, Beijing University of Posts and Telecommunications, Beijing, China
- UCL Cancer Institute, University College London, London WC1E 6BT, UK
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Sokol P, Clua E, Pons MC, García S, Racca A, Freour T, Polyzos NP. Developing and validating a prediction model of live birth following single vitrified-warmed blastocyst transfer. Reprod Biomed Online 2024; 49:103890. [PMID: 38744027 DOI: 10.1016/j.rbmo.2024.103890] [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: 09/29/2023] [Revised: 12/28/2023] [Accepted: 02/07/2024] [Indexed: 05/16/2024]
Abstract
RESEARCH QUESTION Can the developed clinical prediction model offer an accurate estimate of the likelihood of live birth, involving blastocyst morphology and vitrification day after single vitrified-warmed blastocyst transfer (SVBT), and therefore assist clinicians and patients? STUDY DESIGN Retrospective cohort study conducted at a Spanish university-based reproductive medicine unit (2017-2021) including consecutive vitrified-warmed blastocysts from IVF cycles. A multivariable logistic regression incorporated key live birth predictors: vitrification day, embryo score, embryo ploidy status and clinically relevant variables, i.e. maternal age. RESULTS The training set involved 1653 SVBT cycles carried out between 2017 and 2020; 592 SVBT cycles from 2021 constituted the external validation dataset. The model revealed that female age and embryo characteristics, including overall quality and blastulation day, is linked to live birth rate in SVBT cycles. Stratification by vitrification day and quality (from day-5A to day-6 C blastocysts) applied to genetically tested and untested embryos. The model's area under the curve was 0.66 (95% CI 0.64 to 0.69) during development and 0.65 (95% CI 0.61 to 0.70) in validation, denoting moderate discrimination. Calibration plots showed strong agreement between predicted and observed probabilities. CONCLUSION By incorporating essential predictors such as vitrification day, embryo morphology grade, age and preimplantation genetic testing for aneuploidy usage, this predictive model offers valuable guidance to clinicians and patients, enabling accurate forecasts of live birth rates for any given vitrified blastocyst within SVBT cycles. Additionally, it serves as a potentially indispensable laboratory tool, aiding in selecting the most promising blastocysts for optimal outcomes.
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Affiliation(s)
- Piotr Sokol
- Department of Obstetrics, Gynecology and Reproductive Medicine, Dexeus University Hospital, Barcelona, Spain.
| | - Elisabet Clua
- Department of Obstetrics, Gynecology and Reproductive Medicine, Dexeus University Hospital, Barcelona, Spain
| | - María Carme Pons
- Department of Obstetrics, Gynecology and Reproductive Medicine, Dexeus University Hospital, Barcelona, Spain
| | - Sandra García
- Department of Obstetrics, Gynecology and Reproductive Medicine, Dexeus University Hospital, Barcelona, Spain
| | - Annalisa Racca
- Department of Obstetrics, Gynecology and Reproductive Medicine, Dexeus University Hospital, Barcelona, Spain
| | - Thomas Freour
- Department of Obstetrics, Gynecology and Reproductive Medicine, Dexeus University Hospital, Barcelona, Spain; Nantes Université, CHU Nantes, Inserm, CR2TI, F-44000 Nantes, France.; CHU Nantes, Service de Medecine et Biologie de la Reproduction, F-44000 Nantes, France
| | - Nikolaos P Polyzos
- Department of Obstetrics, Gynecology and Reproductive Medicine, Dexeus University Hospital, Barcelona, Spain; Faculty of Health, University of Ghent, Ghent, Belgium
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Liperis G, Makieva S, Serdarogullari M, Uraji J, Ali ZE, Pisaturo V, Cuevas-Saiz I, Scarica C, Sharma K, Fraire-Zamora JJ. Agree to disagree: reaching consensus amongst embryologists on the clinical management of low-quality blastocysts. Hum Reprod 2024; 39:1353-1356. [PMID: 38670550 DOI: 10.1093/humrep/deae083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024] Open
Affiliation(s)
- George Liperis
- Westmead Fertility Centre, Institute of Reproductive Medicine, University of Sydney, Westmead, NSW, Australia
- Embryorigin Fertility Centre, Larnaca, Cyprus
| | - Sofia Makieva
- Kinderwunschzentrum, Klinik für Reproduktions-Endokrinologie, Universitätsspital Zürich, Zurich, Switzerland
| | - Munevver Serdarogullari
- Department of Histology and Embryology, Faculty of Medicine, Cyprus International University, Nicosia, Turkey
| | - Julia Uraji
- IVF Laboratory, TFP Düsseldorf GmbH, Düsseldorf, Germany
| | - Zoya Enakshi Ali
- Research & Development Department, Hertility Health Limited, London, UK
| | - Valerio Pisaturo
- Department of Maternal and Child Health and Urology, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | | | - Catello Scarica
- European Hospital, New Fertility Group Centre for Reproductive Medicine, Rome, Italy
| | - Kashish Sharma
- HealthPlus Fertility Center, HealthPlus Network of Specialty Centers, Abu Dhabi, United Arab Emirates
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Borna MR, Sepehri MM, Maleki B. An artificial intelligence algorithm to select most viable embryos considering current process in IVF labs. Front Artif Intell 2024; 7:1375474. [PMID: 38881952 PMCID: PMC11177761 DOI: 10.3389/frai.2024.1375474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 05/16/2024] [Indexed: 06/18/2024] Open
Abstract
Background The most common Assisted Reproductive Technology is In-Vitro Fertilization (IVF). During IVF, embryologists commonly perform a morphological assessment to evaluate embryo quality and choose the best embryo for transferring to the uterus. However, embryo selection through morphological assessment is subjective, so various embryologists obtain different conclusions. Furthermore, humans can consider only a limited number of visual parameters resulting in a poor IVF success rate. Artificial intelligence (AI) for embryo selection is objective and can include many parameters, leading to better IVF outcomes. Objectives This study sought to use AI to (1) predict pregnancy results based on embryo images, (2) assess using more than one image of the embryo in the prediction of pregnancy but based on the current process in IVF labs, and (3) compare results of AI-Based methods and embryologist experts in predicting pregnancy. Methods A data set including 252 Time-lapse Videos of embryos related to IVF performed between 2017 and 2020 was collected. Frames related to 19 ± 1, 43 ± 1, and 67 ± 1 h post-insemination were extracted. Well-Known CNN architectures with transfer learning have been applied to these images. The results have been compared with an algorithm that only uses the final image of embryos. Furthermore, the results have been compared with five experienced embryologists. Results To predict the pregnancy outcome, we applied five well-known CNN architectures (AlexNet, ResNet18, ResNet34, Inception V3, and DenseNet121). DeepEmbryo, using three images, predicts pregnancy better than the algorithm that only uses one final image. It also can predict pregnancy better than all embryologists. Different well-known architectures can successfully predict pregnancy chances with up to 75.0% accuracy using Transfer Learning. Conclusion We have developed DeepEmbryo, an AI-based tool that uses three static images to predict pregnancy. Additionally, DeepEmbryo uses images that can be obtained in the current IVF process in almost all IVF labs. AI-based tools have great potential for predicting pregnancy and can be used as a proper tool in the future.
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Affiliation(s)
- Mahdi-Reza Borna
- Department of IT Engineering, Faculty of Industrial and Systems Engineering, Tarbiat Modares University, Tehran, Iran
| | - Mohammad Mehdi Sepehri
- Department of IT Engineering, Faculty of Industrial and Systems Engineering, Tarbiat Modares University, Tehran, Iran
| | - Behnam Maleki
- Infertility Center, Department of Obstetrics and Gynecology, Mazandaran University of Medical Sciences, Sari, Iran
- Research and Clinical Center for Infertility, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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He H, Wu L, Chen Y, Li T, Ren X, Hu J, Liu J, Chen W, Ma B, Zou Y, Liu Z, Lu S, Huang B, Jin L. A novel non-invasive embryo evaluation method (NICS-Timelapse) with enhanced predictive precision and clinical impact. Heliyon 2024; 10:e30189. [PMID: 38726199 PMCID: PMC11078863 DOI: 10.1016/j.heliyon.2024.e30189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 04/17/2024] [Accepted: 04/22/2024] [Indexed: 05/12/2024] Open
Abstract
The selection of the finest possible embryo in in-vitro fertilization (IVF) was crucial and revolutionary, particularly when just one embryo is transplanted to lessen the possibility of multiple pregnancies. However, practical usefulness of currently used methodologies may be constrained. Here, we established a novel non-invasive embryo evaluation method that combines non-invasive chromosomal screening (NICS) and Timelapse system along with artificial intelligence algorithms. With an area under the curve (AUC) of 0.94 and an accuracy of 0.88, the NICS-Timelapse model was able to predict blastocyst euploidy. The performance of the model was further evaluated using 75 patients in various clinical settings. The clinical pregnancy and live birth rates of embryos predicted by the NICS-Timelapse model, showing that embryos with higher euploid probabilities were associated with higher clinical pregnancy and live birth rates. These results demonstrated the NICS-Timelapse model's significantly wider application in clinical IVF due to its excellent accuracy and noninvasiveness.
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Affiliation(s)
- Hui He
- Reproductive Medicine Center, Tongji Hospital, Tongji Medicine College, Huazhong University of Science and Technology, Wuhan, China
| | - Li Wu
- Reproductive Medicine Center, Tongji Hospital, Tongji Medicine College, Huazhong University of Science and Technology, Wuhan, China
| | - Yulin Chen
- Yikon Genomics Company, Ltd., Shanghai, 201499, China
| | - Tuan Li
- Yikon Genomics Company, Ltd., Shanghai, 201499, China
| | - Xinling Ren
- Reproductive Medicine Center, Tongji Hospital, Tongji Medicine College, Huazhong University of Science and Technology, Wuhan, China
| | - Juan Hu
- Reproductive Medicine Center, Tongji Hospital, Tongji Medicine College, Huazhong University of Science and Technology, Wuhan, China
| | - Jinming Liu
- Reproductive Medicine Center, Tongji Hospital, Tongji Medicine College, Huazhong University of Science and Technology, Wuhan, China
| | - Wen Chen
- Reproductive Medicine Center, Tongji Hospital, Tongji Medicine College, Huazhong University of Science and Technology, Wuhan, China
| | - Bingxin Ma
- Reproductive Medicine Center, Tongji Hospital, Tongji Medicine College, Huazhong University of Science and Technology, Wuhan, China
| | - Yangyun Zou
- Yikon Genomics Company, Ltd., Shanghai, 201499, China
| | - Zhen Liu
- Yikon Genomics Company, Ltd., Shanghai, 201499, China
| | - Sijia Lu
- Yikon Genomics Company, Ltd., Shanghai, 201499, China
| | - Bo Huang
- Reproductive Medicine Center, Tongji Hospital, Tongji Medicine College, Huazhong University of Science and Technology, Wuhan, China
| | - Lei Jin
- Reproductive Medicine Center, Tongji Hospital, Tongji Medicine College, Huazhong University of Science and Technology, Wuhan, China
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10
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Yazdani A, Halvaei I, Boniface C, Esfandiari N. Effect of cytoplasmic fragmentation on embryo development, quality, and pregnancy outcome: a systematic review of the literature. Reprod Biol Endocrinol 2024; 22:55. [PMID: 38745305 PMCID: PMC11092204 DOI: 10.1186/s12958-024-01217-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 04/01/2024] [Indexed: 05/16/2024] Open
Abstract
The role of cytoplasmic fragmentation in human embryo development and reproductive potential is widely recognized, albeit without standard definition nor agreed upon implication. While fragmentation is best understood to be a natural process across species, the origin of fragmentation remains incompletely understood and likely multifactorial. Several factors including embryo culture condition, gamete quality, aneuploidy, and abnormal cytokinesis seem to have important role in the etiology of cytoplasmic fragmentation. Fragmentation reduces the volume of cytoplasm and depletes embryo of essential organelles and regulatory proteins, compromising the developmental potential of the embryo. While it has been shown that degree of fragmentation and embryo implantation potential are inversely proportional, the degree, pattern, and distribution of fragmentation as it relates to pregnancy outcome is debated in the literature. This review highlights some of the challenges in analysis of fragmentation, while revealing trends in our evolving knowledge of how fragmentation may relate to functional development of the human embryos, implantation, and pregnancy outcome.
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Affiliation(s)
- Ariella Yazdani
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Vermont Medical Center, The Robert Larner College of Medicine at the University of Vermont, Burlington, VT, 05405, USA
- Present address: Obstetrics and Gynecology Institute, Cleveland Clinic Foundation, Cleveland, OH, 44195, USA
| | - Iman Halvaei
- Department of Anatomical Sciences, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Catherine Boniface
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Vermont Medical Center, The Robert Larner College of Medicine at the University of Vermont, Burlington, VT, 05405, USA
| | - Navid Esfandiari
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Vermont Medical Center, The Robert Larner College of Medicine at the University of Vermont, Burlington, VT, 05405, USA.
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology and Reproductive Sciences, University of Vermont, 111 Colchester Avenue, Burlington, Vermont, 05401, USA.
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11
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Florensa M, Cladellas A, Ballesteros A, Esbert M. Preimplantation genetic testing for aneuploidy: predictive embryonic factors. J Assist Reprod Genet 2024; 41:1329-1339. [PMID: 38386119 PMCID: PMC11143088 DOI: 10.1007/s10815-024-03061-5] [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: 10/11/2023] [Accepted: 02/09/2024] [Indexed: 02/23/2024] Open
Abstract
PURPOSE In a preimplantation genetic testing for aneuploidy (PGT-A) cycle, does the blastocyst quality before biopsy, or the day of biopsy, or the embryo hatching status have an impact on either euploidy or the rate of embryo survival after freezing? METHODS This was a retrospective study including 6130 biopsied blastocysts coming from 1849 PGT-A cycles performed in our center (2016-2022). Embryos were categorized according to the inner cell mass and trophectoderm quality, using Gardner's scoring (excellent: AA; good: AB, BA, BB; poor: AC, CA, BC, CB, CC); the day of biopsy (5 or 6); and their hatching status (fully hatched blastocysts [FHB] or non-fully hatched blastocysts [nFHB]). The independent relationship between each group and both euploidy and survival rate was assessed. RESULTS Excellent-quality embryos were more euploid than both good- and poor-quality embryos (52.69%, 39.69%, and 26.21%; p < 0.001), and day 5-biopsied embryos were more euploid than day 6-biopsied embryos (39.98% and 34.80%; p < 0.001). Survival rates of excellent-quality (92.26%) and good-quality (92.47%) embryos were higher than survival rates in the poor-quality group (84.61%) (p = 0.011 and p = 0.002). Day 5-biopsied embryos survived better than day 6-biopsied embryos (93.71% vs. 83.69%; p < 0.001) and FHB had poorer survival than nFHB (78.61% vs. 93.52%; p < 0.001). CONCLUSIONS Excellent-quality and day 5-biopsied embryos are more prone to be euploid than good and poor or day 6-biopsied embryos, respectively. Poor-quality, day 6-biopsied embryos, and FHB have significantly lower survival after biopsy and vitrification.
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Affiliation(s)
- Mireia Florensa
- IVIRMA Barcelona, 45, Carrer Mallorca, 08029, Barcelona, Spain.
| | - Anna Cladellas
- IVIRMA Barcelona, 45, Carrer Mallorca, 08029, Barcelona, Spain
| | | | - Marga Esbert
- IVIRMA Barcelona, 45, Carrer Mallorca, 08029, Barcelona, Spain
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12
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Borges E, Braga D, Provenza R, Iaconelli A, Setti A. Association between embryo morphokinetic development and intracytoplasmic sperm injection with epididymal sperm via time-lapse imaging. Mol Reprod Dev 2024; 91:e23747. [PMID: 38785307 DOI: 10.1002/mrd.23747] [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: 05/22/2023] [Revised: 02/14/2024] [Accepted: 05/05/2024] [Indexed: 05/25/2024]
Abstract
The objective of this study was to investigate the impact of sperm source on embryo morphokinetics and the clinical outcomes of intracytoplasmic sperm injection (ICSI) cycles by considering the clustering of data (multiple embryos per patient that share a comparable developmental timing). This matched cohort study was performed at a private university-affiliated in vitro fertilization center. Women who underwent ICSI with epididymal sperm between January 2019 and December 2020 (the percutaneous epididymal sperm aspiration group, n = 32 cycles) were matched with women who underwent ICSI with ejaculated sperm because of idiopathic male factor infertility (the male factor infertility [MFI] group, n = 32 cycles) or female infertility (the control group, n = 32 cycles). Embryos were cultured in a time-lapse imaging incubator, and morphokinetic development was recorded and compared among the groups. Significantly slower divisions were observed in embryos derived from epididymal sperm than in those derived from the MFI and control groups. Embryos derived from epididymal sperm had a significantly lower KIDScore (3.1 ± 0.2) than did those derived from ejaculated spermatozoa from the MFI (5.4 ± 0.1) and control (5.6 ± 0.2, p < 0.001) groups. Epididymal sperm-derived embryos showed a significantly greater occurrence of multinucleation (23.2%) than did those derived from ejaculated sperm from the MFI and control groups (2.8% and 3.7%, p < 0.001, respectively). Epididymal sperm-derived embryos were significantly more likely to undergo direct or reverse cleavage (11.1%) than ejaculated sperm-derived embryos in the control group (4.3%, p = 0.001). In conclusion, delayed cell cleavage and increased incidences of blastomere multinucleation and abnormal cleavage patterns are observed when epididymal-derived sperm are used for ICSI.
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Affiliation(s)
- Edson Borges
- Fertility Medical Group, São Paulo City, São Paulo, Brazil
- Department of Scientific Research, Instituto Sapientiae, São Paulo City, São Paulo, Brazil
| | - Daniela Braga
- Fertility Medical Group, São Paulo City, São Paulo, Brazil
- Department of Scientific Research, Instituto Sapientiae, São Paulo City, São Paulo, Brazil
| | | | - Assumpto Iaconelli
- Fertility Medical Group, São Paulo City, São Paulo, Brazil
- Department of Scientific Research, Instituto Sapientiae, São Paulo City, São Paulo, Brazil
| | - Amanda Setti
- Fertility Medical Group, São Paulo City, São Paulo, Brazil
- Department of Scientific Research, Instituto Sapientiae, São Paulo City, São Paulo, Brazil
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13
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Zhu Y, Kratka CR, Pea J, Lee HC, Kratka CE, Xu J, Marin D, Treff NR, Duncan FE. The severity of meiotic aneuploidy is associated with altered morphokinetic variables of mouse oocyte maturation. Hum Reprod Open 2024; 2024:hoae023. [PMID: 38764910 PMCID: PMC11099657 DOI: 10.1093/hropen/hoae023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 03/04/2024] [Indexed: 05/21/2024] Open
Abstract
STUDY QUESTION Is there an association between morphokinetic variables of meiotic maturation and the severity of aneuploidy following in vitro maturation (IVM) in the mouse? SUMMARY ANSWER The severity of meiotic aneuploidy correlates with an extended time to first polar body extrusion (tPB1) and duration of meiosis I (dMI). WHAT IS KNOWN ALREADY Morphokinetic variables measured using time-lapse technology allow for the non-invasive evaluation of preimplantation embryo development within clinical assisted reproductive technology (ART). We recently applied this technology to monitor meiotic progression during IVM of mouse gametes. Whether there is a relationship between morphokinetic variables of meiotic progression and aneuploidy in the resulting egg has not been systematically examined at the resolution of specific chromosomes. Next-generation sequencing (NGS) is a robust clinical tool for determining aneuploidy status and has been reverse-translated in mouse blastocysts and oocytes. Therefore, we harnessed the technologies of time-lapse imaging and NGS to determine the relationship between the morphokinetics of meiotic progression and egg aneuploidy. STUDY DESIGN SIZE DURATION Cumulus-oocyte complexes were collected from large antral follicles from hyperstimulated CD-1 mice. Cumulus cells were removed, and spontaneous IVM was performed in the absence or presence of two doses of Nocodazole (25 or 50 nM) to induce a spectrum of spindle abnormalities and chromosome segregation errors during oocyte meiosis. Comprehensive chromosome screening was then performed in the resulting eggs, and morphokinetic variables and ploidy status were compared across experimental groups (control, n = 11; 25 nM Nocodazole, n = 13; 50 nM Nocodazole, n = 23). PARTICIPANTS/MATERIALS SETTING METHODS We monitored IVM in mouse oocytes using time-lapse microscopy for 16 h, and time to germinal vesicle breakdown (tGVBD), tPB1, and dMI were analyzed. Following IVM, comprehensive chromosome screening was performed on the eggs and their matched first polar bodies via adaptation of an NGS-based preimplantation genetic testing for aneuploidy (PGT-A) assay. Bioinformatics analysis was performed to align reads to the mouse genome and determine copy number-based predictions of aneuploidy. The concordance of each polar body-egg pair (reciprocal errors) was used to validate the results. Ploidy status was categorized as euploid, 1-3 chromosomal segregation errors, or ≥4 chromosomal segregation errors. Additionally, aneuploidy due to premature separation of sister chromatids (PSSC) versus non-disjunction (NDJ) was distinguished. MAIN RESULTS AND THE ROLE OF CHANCE We applied and validated state-of-the-art NGS technology to screen aneuploidy in individual mouse eggs and matched polar bodies at the chromosome-specific level. By performing IVM in the presence of different doses of Nocodazole, we induced a range of aneuploidy. No aneuploidy was observed in the absence of Nocodazole (0/11), whereas IVM in the presence of 25 and 50 nM Nocodazole resulted in an aneuploidy incidence of 7.69% (1/13) and 82.61% (19/23), respectively. Of the aneuploid eggs, 5% (1/20) was due to PSSC, 65% (13/20) to NDJ, and the remainder to a combination of both. There was no relationship between ploidy status and tGVBD, but tPB1 and the dMI were both significantly prolonged in eggs with reciprocal aneuploidy events compared to the euploid eggs, and this scaled with the severity of aneuploidy. Eggs with ≥4 aneuploid chromosomes had the longest tPB1 and dMI (P < 0.0001), whereas eggs with one to three aneuploid chromosomes exhibited intermediate lengths of time (P < 0.0001). LARGE SCALE DATA N/A. LIMITATIONS REASONS FOR CAUTION We used Nocodazole in this study to disrupt the meiotic spindle and induce aneuploidy in mouse oocytes. Whether the association between morphokinetic variables of meiotic progression and the severity of aneuploidy occurs with other compounds that induce chromosome segregation errors remain to be investigated. In addition, unlike mouse oocytes, human IVM requires the presence of cumulus cells, which precludes visualization of morphokinetic variables of meiotic progression. Thus, our study may have limited direct clinical translatability. WIDER IMPLICATIONS OF THE FINDINGS We validated NGS in mouse eggs to detect aneuploidy at a chromosome-specific resolution which greatly improves the utility of the mouse model. With a tractable and validated model system for characterizing meiotic aneuploidy, investigations into the molecular mechanisms and factors which may influence aneuploidy can be further elaborated. Time-lapse analyses of morphokinetic variables of meiotic progression may be a useful non-invasive predictor of aneuploidy severity. STUDY FUNDING/COMPETING INTERESTS This work was supported by the Bill & Melinda Gates Foundation (INV-003385). Under the grant conditions of the Foundation, a Creative Commons Attribution 4.0 Generic License has already been assigned to the Author Accepted Manuscript version that might arise from this submission. The authors have no conflict of interest to disclose.
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Affiliation(s)
- Yiru Zhu
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | - Jeffrey Pea
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Hoi Chang Lee
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Caroline E Kratka
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jia Xu
- Genomic Prediction Inc., North Brunswick Township, NJ, USA
| | - Diego Marin
- Genomic Prediction Inc., North Brunswick Township, NJ, USA
- Department of Genetics, Rutgers University, New Brunswick, NJ, USA
| | - Nathan R Treff
- Genomic Prediction Inc., North Brunswick Township, NJ, USA
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers University, New Brunswick, NJ, USA
| | - Francesca E Duncan
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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14
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Tvrdonova K, Belaskova S, Rumpikova T, Rumpik D, Myslivcova Fucikova A, Malir F. Prediction of live birth - selection of embryos using morphokinetic parameters. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2024; 168:74-80. [PMID: 36622075 DOI: 10.5507/bp.2022.052] [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: 08/18/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022] Open
Abstract
BACKROUND The goal of assisted reproduction is for a couple treated with IVF techniques to end the treatment by giving birth to a healthy baby. A neccessary presumption for success is the identification of the best embryo with high implantation and developmental potential. One option is to select an euploid embryo by invasive preimplantaion genetic testing for aneuploidy (PGT-A) or it is possible to select the best embryo by non-invasive time-lapse monitoring (TLM), specifically based on morphokinetic parameters and morphological markers that are able to identify an embryo with high developmental potential. MATERIALS AND METHODS The study involved a total of 1060 embryos (585 euploid and 475 aneuploid embryos after PGT-A) with good morphology from 329 patients in the period 01/2016-10/2021. All embryos were cultured in a time-lapse incubator, trophectoderm (TE) cells biopsies for PGT-A examination were performed on day 5 (D5) or day 6 (D6) of culture. During the study period, 225 frozen embryo transfers (FET) of one euploid embryo were performed. Based on the treatment outcome, the embryos were divided into 2 groups - euploid embryos, which led to the birth of a healthy child, and euploid embryos that did not show fetal heartbeat (FHB) after FET. RESULTS Based on the statistical analysis of the embryos without implantation and the embryos with live birth, it is clear that the morphokinetic parameters t5 (time of division into 5 cells) and tSB (time of start of blastulation) are significantly different. CONCLUSION The results suggest that of the morphokinetic parameters tSB and t5 are predictive indicators for selecting an embryo with high developmental potential and with a high probability of achieving the birth of a healthy child.
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Affiliation(s)
- Katerina Tvrdonova
- Department of Biology, Faculty of Sciences, University Hradec Kralove, 500 03 Hradec Kralove, Czech Republic
- Clinic of Reproductive Medicine and Gynecology Zlin, U Lomu 638, 760 01 Zlin, Czech Republic
| | - Silvie Belaskova
- Institute of Mathematics and Statistics, Faculty of Science, Masaryk University, 611 37 Brno, Czech Republic
- International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic
| | - Tatana Rumpikova
- Clinic of Reproductive Medicine and Gynecology Zlin, U Lomu 638, 760 01 Zlin, Czech Republic
| | - David Rumpik
- Clinic of Reproductive Medicine and Gynecology Zlin, U Lomu 638, 760 01 Zlin, Czech Republic
| | - Alena Myslivcova Fucikova
- Department of Biology, Faculty of Sciences, University Hradec Kralove, 500 03 Hradec Kralove, Czech Republic
| | - Frantisek Malir
- Department of Biology, Faculty of Sciences, University Hradec Kralove, 500 03 Hradec Kralove, Czech Republic
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15
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Lacconi V, Massimiani M, Carriero I, Bianco C, Ticconi C, Pavone V, Alteri A, Muzii L, Rago R, Pisaturo V, Campagnolo L. When the Embryo Meets the Endometrium: Identifying the Features Required for Successful Embryo Implantation. Int J Mol Sci 2024; 25:2834. [PMID: 38474081 DOI: 10.3390/ijms25052834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 02/22/2024] [Accepted: 02/27/2024] [Indexed: 03/14/2024] Open
Abstract
Evaluation of the optimal number of embryos, their quality, and the precise timing for transfer are critical determinants in reproductive success, although still remaining one of the main challenges in assisted reproduction technologies (ART). Indeed, the success of in vitro fertilization (IVF) treatments relies on a multitude of events and factors involving both the endometrium and the embryo. Despite concerted efforts on both fronts, the overall success rates of IVF techniques continue to range between 25% and 30%. The role of the endometrium in implantation has been recently recognized, leading to the hypothesis that both the "soil" and the "seed" play a central role in a successful pregnancy. In this respect, identification of the molecular signature of endometrial receptivity together with the selection of the best embryo for transfer become crucial in ART. Currently, efforts have been made to develop accurate, predictive, and personalized tests to identify the window of implantation and the best quality embryo. However, the value of these tests is still debated, as conflicting results are reported in the literature. The purpose of this review is to summarize and critically report the available criteria to optimize the success of embryo transfer and to better understand current limitations and potential areas for improvement.
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Affiliation(s)
- Valentina Lacconi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
- Saint Camillus International University of Health Sciences, Via di Sant'Alessandro 8, 00131 Rome, Italy
| | - Micol Massimiani
- Saint Camillus International University of Health Sciences, Via di Sant'Alessandro 8, 00131 Rome, Italy
| | - Ilenia Carriero
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
| | - Claudia Bianco
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
| | - Carlo Ticconi
- Department of Surgical Sciences, Section of Gynaecology and Obstetrics, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
| | - Valentina Pavone
- Reproductive Sciences Laboratory, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Alessandra Alteri
- Obstetrics and Gynaecology Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Ludovico Muzii
- Department of Maternal and Child Health and Urological Sciences, "Sapienza" University of Rome, Policlinico Umberto I, 00161 Rome, Italy
| | - Rocco Rago
- Physiopathology of Reproduction and Andrology Unit, Sandro Pertini Hospital, Via dei Monti Tiburtini 385/389, 00157 Rome, Italy
| | - Valerio Pisaturo
- Department of Maternal and Child Health and Urological Sciences, "Sapienza" University of Rome, Policlinico Umberto I, 00161 Rome, Italy
| | - Luisa Campagnolo
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
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16
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Scheffer JB, de Carvalho RF, Scheffer BB, Aguiar APDS, Pessoa LP, Lozano DM, Fanchin R. Correlations between clinical parameters, blastocyst morphological classification and embryo euploidy. JBRA Assist Reprod 2024; 28:54-58. [PMID: 37962968 PMCID: PMC10936908 DOI: 10.5935/1518-0557.20230054] [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: 03/05/2023] [Accepted: 09/21/2023] [Indexed: 11/16/2023] Open
Abstract
OBJECTIVE The aim of the present study was to evaluate clinical and embryo parameters to predict embryo ploidy. METHODS In this retrospective analysis, we studied 838 biopsied day-5 blastocysts from 219 patients in the period from May 2021 to July 2022. All embryos were morphologically classified before biopsy and were divided into two groups according to genetic test results. Euploid embryos (299) were compared with aneuploid embryos (539) based on maternal age, anti-Mullerian hormone, antral follicle count, and embryo morphology. RESULTS Maternal age (36.2±3.0) of euploid embryos was lower than maternal age (37.1±2.5) of aneuploid embryos (p<0.0001). AMH levels were higher (3.9±1.2) in the group of euploid embryos than in the group of aneuploid embryos (3.6±1.3, p<0.0001). However, the AFC was not different in the group of euploid embryos (15.3±6.0) compared to the group of aneuploid embryos (14.5±5.9, p=0.07). The presence of aneuploidy was negatively correlated with top embryo quality (embryos 4AA and 4AB). All euploid embryos (299) were top quality versus 331 of 539 (61.49%) aneuploid embryos (p<0.0001). CONCLUSIONS We found that euploid embryos were associated with lower maternal age, higher AMH levels, and higher quality embryos.
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Affiliation(s)
| | | | - Bruno Brum Scheffer
- IBRRA - Brazilian Institute of Assisted Reproduction, Belo
Horizonte, Brazil
| | | | | | - Daniel Mendez Lozano
- School of Medicine, Tecnologico de Monterrey and Center for
Reproductive Medicine CREASIS, San Pedro Monterrey, Mexico
| | - Renato Fanchin
- Professeur des Universites- Praticien Hospitalier en Medecine de la
Reproduction, France, Hopital Foch, France
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17
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Chen NQ, Si CR, Yung SC, Hon SK, Arasoo J, Ng SC. Analysis of a preimplantation genetic test for aneuploidies in 893 screened blastocysts using KaryoLite BoBs: a single-centre experience. Singapore Med J 2024:00077293-990000000-00089. [PMID: 38363646 DOI: 10.4103/singaporemedj.smj-2021-200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 01/22/2023] [Indexed: 02/18/2024]
Abstract
INTRODUCTION Does euploidy of trophectoderm (TE) biopsies correlate with conventional blastocyst morphological, maternal age and implantation potential? METHODS This is a one-centre, retrospective, observational study. RESULTS Eight hundred and ninety-three blastocysts were biopsied; 57.73% were euploid. The euploidy rate was found to be significantly higher for the embryos with good morphology of inner cell mass (ICM) and TE. Between ICM and TE morphology variables, TE was more predictive of the euploidy rate. When broken down into different age groups, the percentage of good morphology embryos remained similar across all age groups, while the percentage of euploid embryos dropped with increasing age. These results suggest that the correlation between blastocyst morphology and ploidy status was present but poor. Faster growing day 5 blastocysts showed a significantly higher euploidy rate than slower growing day 6 or 7 blastocysts. The number of good-quality blastocysts per cycle, euploid blastocysts per cycle and the euploidy rate were strongly associated with maternal age. A trend towards an increased implantation rate was found with euploid embryo transfers compared to the control group without preimplantation genetic test for aneuploidies (PGT-A). CONCLUSIONS Blastocyst morphology, rate of development and maternal age were found to be significantly associated with euploidy rate. There is a trend that suggests PGT-A may help to improve the pregnancy rate, but it is not statistically different, and therefore, PGT-A remains an unproven hypothesis. Due to the limitation of a small size of the control group, further studies with more data are needed.
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Affiliation(s)
- Nai Qing Chen
- Sincere IVF Centre, Gleneagles Medini Hospital, Johor, Malaysia
| | - Cay Reen Si
- Sincere IVF Centre, Gleneagles Medini Hospital, Johor, Malaysia
| | - Shin Chyi Yung
- Sincere IVF Centre, Gleneagles Medini Hospital, Johor, Malaysia
| | - Sook Kit Hon
- Sincere IVF Centre, Gleneagles Medini Hospital, Johor, Malaysia
| | - Jayanthi Arasoo
- Sincere IVF Centre, Gleneagles Medini Hospital, Johor, Malaysia
- Clinical School JB, Monash University, Johor Bahru, Malaysia
| | - Soon-Chye Ng
- Sincere IVF Centre, Gleneagles Medini Hospital, Johor, Malaysia
- Department of Obstetrics and Gynaecology, National University of Singapore, Singapore
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Santamonkunrot P, Samutchinda S, Niransuk P, Satirapod C, Sukprasert M. The Association between Embryo Development and Chromosomal Results from PGT-A in Women of Advanced Age: A Prospective Cohort Study. J Clin Med 2024; 13:626. [PMID: 38276130 PMCID: PMC10816670 DOI: 10.3390/jcm13020626] [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: 12/05/2023] [Revised: 12/19/2023] [Accepted: 01/10/2024] [Indexed: 01/27/2024] Open
Abstract
Embryo morphology and morphokinetics have been studied for their association with euploid embryos. However, the results are controversial, especially in the advanced-aged women group, when the risk of aneuploidy increases significantly. This prospective cohort study evaluated the association between embryo development between day-3 cleavage and day-5 blastocyst stages and euploidy rates, determined using preimplantation genetic testing for aneuploidy (PGT-A). Embryos from women aged 35 years and above who underwent intracytoplasmic sperm injections and PGT-A were studied. Day-3 cleavage-stage embryos were evaluated for their cell number, and day-5 blastocyst-stage embryos were evaluated for their morphological grade. Embryo development from day 3 to day 5 was categorized as either good or poor development and evaluated for its association with the PGT-A results. We evaluated 325 embryos from 101 infertile couples. It was found that 55.17% of blastocysts with good development and 29.83% with poor development were euploid. A significant association was found between embryo development and euploidy rates in advanced-aged women (p < 0.001). Also, there were significantly higher rates of euploid embryos with good blastocyst morphological grades, especially blastocyst expansion grades and trophectoderm grades. In conclusion, embryo morphokinetics shows promising results in predicting euploidy in advanced female age.
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Affiliation(s)
| | | | | | | | - Matchuporn Sukprasert
- Reproductive Endocrinology and Infertility Unit, Department of Obstetrics and Gynecology, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand; (P.S.); (S.S.); (P.N.); (C.S.)
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19
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Zou Y, Sui Y, Fu J, Ge N, Sun X, Sun Y. The morphokinetic signature of human blastocysts with mosaicism and the clinical outcomes following transfer of embryos with low-level mosaicism. J Ovarian Res 2024; 17:10. [PMID: 38195558 PMCID: PMC10775590 DOI: 10.1186/s13048-023-01324-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: 09/22/2023] [Accepted: 12/12/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND Genetic mosaicism is commonly observed in human blastocysts. Embryos' morphokinetic feature observed from time-lapse monitoring (TLM) is helpful to predict the embryos' ploidy status in a non-invasive way. However, morphokinetic research on mosaic embryos is extremely limited. Moreover, transfer of mosaic embryos is a new attempt in reproductive medicine, while studies regarding the clinical and neonatal outcomes following transfer of embryos with different levels and types of mosaicism are needed. This study aimed to investigate the morphokinetic characteristics of mosaic blastocysts, uncover clinical outcomes of mosaic embryos, and evaluate the effect of level and type of mosaicism on transfer outcomes. RESULTS A total of 923 blastocysts from 229 preimplantation genetic testing cycles were cultured in TLM incubators in a single fertilization center between July 2016 and July 2021. Multivariate logistic regression models showed mosaic embryos had significantly shorter time to reach morula when compared with euploid (P = 0.002), mosaic with aneuploid (P = 0.005), and aneuploid (P = 0.005) embryos after adjusting the potential confounders. KIDScore is an artificial intelligence scoring program from time lapse incubation system to predict embryo implantation potential. Mosaic with aneuploid embryos had significantly lower KIDScore than euploid (P = 6.47e-4), mosaic (P = 0.005), and aneuploid (P = 0.004) embryos after adjustment. Meanwhile, we compared the clinical outcomes following transfer of low-level (< 50%) mosaic embryos (N = 60) with euploid embryos (N = 1301) matched using propensity scoring collected from September 2020 to January 2023. Mosaic embryos had significantly lower clinical pregnancy rate (41.67% vs. 57.65%, P = 0.015) and live birth rate (38.33% vs. 51.35%, P = 0.048) than the euploid embryos. Subgroup analyses showed the whole, segmental, and complex chromosome mosaic embryos had the similar clinical outcomes. CONCLUSIONS The shortened time to reach morula in mosaic embryos and the low KIDScore in mosaic with aneuploid embryos revealed innovative clues to embryo selection with the non-invasive TLM and provided new insights into biological mechanism of chromosomal abnormality. The analyses of overall and subgroups of mosaic embryo transfer outcomes helped to optimize embryo transfer scheme for in-vitro fertilization procedures. Multi-center prospective studies with large sample sizes are warranted to validate our results in the future.
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Affiliation(s)
- Yaoyu Zou
- Shanghai Ji Ai Genetics & IVF Institute, Obstetrics & Gynecology Hospital, Fudan University, Dalin Road, Shanghai, 200011, China
| | - Yilun Sui
- Shanghai Ji Ai Genetics & IVF Institute, Obstetrics & Gynecology Hospital, Fudan University, Dalin Road, Shanghai, 200011, China
| | - Jing Fu
- Shanghai Ji Ai Genetics & IVF Institute, Obstetrics & Gynecology Hospital, Fudan University, Dalin Road, Shanghai, 200011, China
| | - Naidong Ge
- Shanghai Ji Ai Genetics & IVF Institute, Obstetrics & Gynecology Hospital, Fudan University, Dalin Road, Shanghai, 200011, China
| | - Xiaoxi Sun
- Shanghai Ji Ai Genetics & IVF Institute, Obstetrics & Gynecology Hospital, Fudan University, Dalin Road, Shanghai, 200011, China.
| | - Yijuan Sun
- Shanghai Ji Ai Genetics & IVF Institute, Obstetrics & Gynecology Hospital, Fudan University, Dalin Road, Shanghai, 200011, China.
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Zhu J, Wang C, Cao Z, Luan K, Wu Y, Yin H. Developmental competence and neonatal outcomes of nonpronuclear zygotes following single vitrified-warmed blastocyst transfers using propensity score matching analysis. Arch Gynecol Obstet 2024; 309:295-304. [PMID: 37787836 DOI: 10.1007/s00404-023-07235-x] [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: 05/11/2023] [Accepted: 09/12/2023] [Indexed: 10/04/2023]
Abstract
PURPOSE To investigate developmental competence and neonatal outcomes of nonpronuclear (0PN) zygotes following single vitrified-warmed blastocyst transfers (VBT). METHODS The clinical, laboratorial and neonatal data of 996 patients with ≤ 38 years who underwent blastocyst culture and single VBT were retrospectively analyzed. The pregnancy and neonatal outcomes of VBT were compared between 0PN and 2PN blastocysts using propensity score matching (PSM). Moreover, Day 3 (D3) embryo development and blastocyst formation were compared between 0PN and 2PN zygotes. RESULTS There were no significant differences in clinical pregnancy rate (CPR), live birth rate (LBR) and neonatal outcomes of VBT between the 0PN and 2PN blastocysts irrespectively of whether PSM was used. However, early abortion rate (EAR) was higher in blastocysts from 0PN D3 embryos > 10 cells (p < 0.05) before PSM. Moreover, the early developmental competence of 0PN zygotes was different from that of 2PN zygotes presenting higher percentages of D3 embryos ≤ 6 cells (p < 0.01) and > 10 cells (p < 0.01), lower available blastocyst formation rate (ABFR) (p < 0.01) and good-quality blastocyst formation rate (GBFR) (p < 0.01) in D3 embryos with 4-6 cells. ABFR and GBFR increased with cell number when compared among embryos with 4-6 cells, 7-10 cells and > 10 cells, irrespectively of 0PN or 2PN embryos. CONCLUSION The early developmental competence of 0PN zygotes was different from that of 2PN zygotes, but did not influence pregnancy and neonatal outcomes following VBT. ABFR and GBFR increased with cell number, irrespectively of 0PN or 2PN embryos.
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Affiliation(s)
- Jie Zhu
- Reproductive Medicine Center, the 901st Hospital of the Joint Logistics Support Force of PLA, 424 West Changjiang Road, Hefei, 230031, China
| | - Cunli Wang
- Reproductive Medicine Center, the 901st Hospital of the Joint Logistics Support Force of PLA, 424 West Changjiang Road, Hefei, 230031, China
| | - Zhenyi Cao
- Reproductive Medicine Center, the 901st Hospital of the Joint Logistics Support Force of PLA, 424 West Changjiang Road, Hefei, 230031, China
| | - Kang Luan
- Reproductive Medicine Center, the 901st Hospital of the Joint Logistics Support Force of PLA, 424 West Changjiang Road, Hefei, 230031, China
| | - Yan Wu
- Reproductive Medicine Center, the 901st Hospital of the Joint Logistics Support Force of PLA, 424 West Changjiang Road, Hefei, 230031, China
| | - Huiqun Yin
- Reproductive Medicine Center, the 901st Hospital of the Joint Logistics Support Force of PLA, 424 West Changjiang Road, Hefei, 230031, China.
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21
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Morales C. Current Applications and Controversies in Preimplantation Genetic Testing for Aneuploidies (PGT-A) in In Vitro Fertilization. Reprod Sci 2024; 31:66-80. [PMID: 37515717 DOI: 10.1007/s43032-023-01301-0] [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: 04/20/2023] [Accepted: 07/10/2023] [Indexed: 07/31/2023]
Abstract
Preimplantation genetic testing for aneuploidy (PGT-A) has evolved over recent years, including improvements in embryo culture, biopsy, transfer, and genetic testing. The application of new comprehensive chromosome screening analysis has improved the accuracy in determining the chromosomal status of the analyzed sample, but it has brought new challenges such as the management of partial aneuploidies and mosaicisms. For the past two decades, PGT-A has been involved in a controversy regarding its efficiency in improving IVF outcomes, despite its widespread worldwide implementation. Understanding the impact of embryo aneuploidy in IVF (in vitro fertilization) should theoretically allow improving reproductive outcomes. This review of the literature aims to describe the impact of aneuploidy in human reproduction and how PGT-A was introduced to overcome this obstacle in IVF (in vitro fertilization). The article will try to analyze and summarize the evolution of the PGT-A in the recent years, and its current applications and limitations, as well as the controversy it generates. Conflicting published data could indicate the lacking value of a single biopsied sample to determine embryo chromosomal status and/or the lack of standardized methods for embryo culture and management and genetic analysis among other factors. It has to be considered that PGT-A may not be a universal test to improve the reproductive potential in IVF patients, rather each clinic should evaluate the efficacy of PGT-A in their IVF program based on their population, skills, and limitations.
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Huang B, Li H, Xu B, Li N, Wang X, Li Y, Zhao J. Correlation between controlled ovarian stimulation protocols and euploid blastocyst rate in pre-implantation genetic testing for aneuploidy cycles. Reprod Biol Endocrinol 2023; 21:118. [PMID: 38057895 DOI: 10.1186/s12958-023-01166-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 11/28/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Several studies have explored which COS protocol yields a higher blastocyst euploidy rate, but findings have been inconsistent. The present study aimed to explore whether controlled ovarian stimulation (COS) protocols was associated with euploid blastocyst rate in pre-implantation genetic testing for aneuploidy (PGT-A) cycles. METHODS The study was a retrospective study where data were obtained from three reproductive medicine centers. The study included PGT-A cycles with the GnRH-a, GnRH-ant, or PPOS protocols, and the data on patient demographics, protocols, and embryonic outcomes were collected for the PGT-A cycles performed between January 2019 and August 2022. RESULTS This study included 457 PGT-A cycles from three reproductive medicine centers, with 152, 126, and 179 cycles performed using the PPOS, GnRH-a, and GnRH-ant protocols, respectively. The baseline characteristics of the three groups show no significant differences were observed in female BMI, infertility type, and infertility duration among the PPOS, GnRH-a, and GnRH-ant protocol groups. The study found no significant association between Gn dosage, Gn duration, and blastocyst euploidy. The mean number of euploidy blastocysts in PPOS protocol was significantly lower than that of GnRH-a protocol and GnRH-ant protocol (0.75 ± 0.92 vs. 1.79 ± 1.78 vs. 1.80 ± 1.67). The euploidy rate per biopsy blastocyst (48.4% vs. 49.1% vs. 33.1%), per oocyte retrieved (15.0% vs. 14.7% vs. 10.5%), and per MII oocyte (17.7% vs. 16.4% vs. 11.7%) were significantly higher in the cycles using the GnRH-ant and GnRH-a protocols than that of PPOS protocol group. Regression analyses indicated that, compared with the PPOS protocol, the GnRH-ant protocol was positively associated with the euploid blastocyst rate and the mean number of euploid blastocysts, whereas the GnRH-a protocol showed no such relationship. LIMITATIONS AND REASONS FOR CAUTION The main limitation of this study was the retrospective design. Although this study also used other tests to account for confounding factors and reduce potential bias, multiple tests have its own weaknesses. CONCLUSIONS GnRH-ant protocol was the most effective for PGT-A cycles. The findings emphasize the need for personalized treatment strategies, considering patient demographics, and optimizing COS protocols to enhance the chances of successful outcomes in ART procedures.
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Affiliation(s)
- Bixia Huang
- Reproductive Medicine Center, Xiangya Hospital of Central South University, Changsha, China
- Clinical Research Center for Women's Reproductive Health in Hunan Province, Changsha, Hunan, China
| | - Hui Li
- Reproductive Medicine Center, Xiangya Hospital of Central South University, Changsha, China
- Clinical Research Center for Women's Reproductive Health in Hunan Province, Changsha, Hunan, China
| | - Bin Xu
- Reproductive Medicine Center, Xiangya Hospital of Central South University, Changsha, China
- Clinical Research Center for Women's Reproductive Health in Hunan Province, Changsha, Hunan, China
| | - Ning Li
- Reproductive Medicine Center, The Third Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Xiaofei Wang
- Reproductive Medicine Center, Chengdu Xinan Gynecology Hospital, Chengdu, Sichuan, China
| | - Yanping Li
- Reproductive Medicine Center, Xiangya Hospital of Central South University, Changsha, China
- Clinical Research Center for Women's Reproductive Health in Hunan Province, Changsha, Hunan, China
| | - Jing Zhao
- Reproductive Medicine Center, Xiangya Hospital of Central South University, Changsha, China.
- Clinical Research Center for Women's Reproductive Health in Hunan Province, Changsha, Hunan, China.
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23
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Zhang L, Yang Y, Wang W, Luo L, Zhang Z, Wu J, Ou S, Mai J, Guo L, Wan J, Yuan G, Ding C, Xu Y, Zhou C, Gong F, Wang Q. Predicting risk of blastocyst aneuploidy among women with previous aneuploid pregnancy loss: a multicenter-data-based multivariable model. Hum Reprod 2023; 38:2382-2390. [PMID: 37801294 DOI: 10.1093/humrep/dead202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 09/12/2023] [Indexed: 10/07/2023] Open
Abstract
STUDY QUESTION Can blastocyst aneuploidy be predicted for patients with previous aneuploid pregnancy loss (PAPL) and receiving preimplantation genetic testing for aneuploidy (PGT-A)? SUMMARY ANSWER Multivariable logistic regression models were established to predict high risk of blastocyst aneuploidy using four identified factors, presenting good predictive performance. WHAT IS KNOWN ALREADY Aneuploidy is the most common embryonic chromosomal abnormality leading to pregnancy loss. Several studies have demonstrated a higher embryo aneuploidy rate in patients with PAPL, which has suggested that PGT-A should have benefits in PAPL patients intending to improve their pregnancy outcomes. However, recent studies have failed to demonstrate the efficacy of PGT-A for PAPL patients. One possible way to improve the efficacy is to predict the risk of blastocyst aneuploidy risk in order to identify the specific PAPL population who may benefit from PGT-A. STUDY DESIGN, SIZE, DURATION We conducted a multicenter retrospective cohort study based on data analysis of 1119 patients receiving PGT-A in three reproductive medical centers of university affiliated teaching hospitals during January 2014 to June 2020. A cohort of 550 patients who had one to three PAPL(s) were included in the PAPL group. In addition, 569 patients with monogenic diseases without pregnancy loss were taken as the non-PAPL group. PARTICIPANTS/MATERIALS, SETTING, METHODS PGT-A was conducted using single nucleotide polymorphism microarrays and next-generation sequencing. Aneuploidy rates in Day 5 blastocysts of each patient were calculated and high-risk aneuploidy was defined as a rate of ≥50%. Candidate risk factors for high-risk aneuploidy were selected using the Akaike information criterion and were subsequently included in multivariable logistic regression models. Overall predictive accuracy was assessed using the confusion matrix, discrimination by area under the receiver operating characteristic curve (AUC), and calibration by plotting the predicted probabilities versus the observed probabilities. Statistical significance was set at P < 0.05. MAIN RESULTS AND THE ROLE OF CHANCE Blastocyst aneuploidy rates were 30 ± 25% and 21 ± 19% for PAPL and non-PAPL groups, respectively. Maternal age (odds ratio (OR) = 1.31, 95% CI 1.24-1.39, P < 0.001), number of PAPLs (OR = 1.40, 95% CI 1.05-1.86, P = 0.02), estradiol level on the ovulation trigger day (OR = 0.47, 95% CI 0.30-0.73, P < 0.001), and blastocyst formation rate (OR = 0.13, 95% CI 0.03-0.50, P = 0.003) were associated with high-risk of blastocyst aneuploidy. The predictive model based on the above four variables yielded AUCs of 0.80 using the training dataset and 0.83 using the test dataset, with average and maximal discrepancies of 2.89% and 12.76% for the training dataset, and 0.98% and 5.49% for the test dataset, respectively. LIMITATIONS, REASONS FOR CAUTION Our conclusions might not be compatible with those having fewer than four biopsied blastocysts and diminished ovarian reserves, since all of the included patients had four or more biopsied blastocysts and had exhibited good ovarian reserves. WIDER IMPLICATIONS OF THE FINDINGS The developed predictive model is critical for counseling PAPL patients before PGT-A by considering maternal age, number of PAPLs, estradiol levels on the ovulation trigger day, and the blastocyst formation rate. This prediction model achieves good risk stratification and so may be useful for identifying PAPL patients who may have higher risk of blastocyst aneuploidy and can therefore acquire better pregnancy outcomes by PGT-A. STUDY FUNDING/COMPETING INTEREST(S) This work was supported by the National Natural Science Foundation of China under Grant (81871159). No competing interest existed in the study. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Limei Zhang
- Department of Obstetrics and Gynecology, Reproductive Medicine Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Reproductive Medicine, Guangzhou, China
| | - Yuanyuan Yang
- Institute of Reproductive and Stem Cell Engineering, School of Basic Medical Science, Central South University, Changsha, China
- Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, China
| | - Wenjun Wang
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Lu Luo
- Department of Obstetrics and Gynecology, Reproductive Medicine Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Reproductive Medicine, Guangzhou, China
| | - Zhewei Zhang
- Division of Information and Computational Sciences, School of Mathematical Sciences, Fudan University, Shanghai, China
| | - Jingya Wu
- Department of Gynecology, Zhuhai People's Hospital (Zhuhai Hospital Affiliated with Jinan University), Zhuhai, China
| | - Songbang Ou
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jiayi Mai
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Lan Guo
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Jianxin Wan
- Department of Laboratory Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Guangwei Yuan
- College of Professional Studies, Northeastern University, Boston, MA, USA
| | - Chenhui Ding
- Department of Obstetrics and Gynecology, Reproductive Medicine Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Reproductive Medicine, Guangzhou, China
| | - Yan Xu
- Department of Obstetrics and Gynecology, Reproductive Medicine Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Reproductive Medicine, Guangzhou, China
| | - Canquan Zhou
- Department of Obstetrics and Gynecology, Reproductive Medicine Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Reproductive Medicine, Guangzhou, China
| | - Fei Gong
- Institute of Reproductive and Stem Cell Engineering, School of Basic Medical Science, Central South University, Changsha, China
- Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, China
| | - Qiong Wang
- Department of Obstetrics and Gynecology, Reproductive Medicine Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Reproductive Medicine, Guangzhou, China
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24
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Verdyck P, Altarescu G, Santos-Ribeiro S, Vrettou C, Koehler U, Griesinger G, Goossens V, Magli C, Albanese C, Parriego M, Coll L, Ron-El R, Sermon K, Traeger-Synodinos J. Aneuploidy in oocytes from women of advanced maternal age: analysis of the causal meiotic errors and impact on embryo development. Hum Reprod 2023; 38:2526-2535. [PMID: 37814912 DOI: 10.1093/humrep/dead201] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 09/06/2023] [Indexed: 10/11/2023] Open
Abstract
STUDY QUESTION In oocytes of advanced maternal age (AMA) women, what are the mechanisms leading to aneuploidy and what is the association of aneuploidy with embryo development? SUMMARY ANSWER Known chromosome segregation errors such as precocious separation of sister chromatids explained 90.4% of abnormal chromosome copy numbers in polar bodies (PBs), underlying impaired embryo development. WHAT IS KNOWN ALREADY Meiotic chromosomal aneuploidies in oocytes correlate with AMA (>35 years) and can affect over half of oocytes in this age group. This underlies the rationale for PB biopsy as a form of early preimplantation genetic testing for aneuploidy (PGT-A), as performed in the 'ESHRE STudy into the Evaluation of oocyte Euploidy by Microarray analysis' (ESTEEM) randomized controlled trial (RCT). So far, chromosome analysis of oocytes and PBs has shown that precocious separation of sister chromatids (PSSC), Meiosis II (MII) non-disjunction (ND), and reverse segregation (RS) are the main mechanisms leading to aneuploidy in oocytes. STUDY DESIGN, SIZE, DURATION Data were sourced from the ESTEEM study, a multicentre RCT from seven European centres to assess the clinical utility of PGT-A on PBs using array comparative genomic hybridization (aCGH) in patients of AMA (36-40 years). This included data on the chromosome complement in PB pairs (PGT-A group), and on embryo morphology in a subset of embryos, up to Day 6 post-insemination, from both the intervention (PB biopsy and PGT-A) and control groups. PARTICIPANTS/MATERIALS, SETTING, METHODS ESTEEM recruited 396 AMA patients: 205 in the intervention group and 191 in the control group. Complete genetic data from 693 PB pairs were analysed. Additionally, the morphology from 1034 embryos generated from fertilized oocytes (two pronuclei) in the PB biopsy group and 1082 in the control group were used for statistical analysis. MAIN RESULTS AND THE ROLE OF CHANCE Overall, 461/693 PB pairs showed abnormal segregation in 1162/10 810 chromosomes. The main observed abnormal segregations were compatible with PSSC in Meiosis I (MI) (n = 568/1162; 48.9%), ND of chromatids in MII or RS (n = 417/1162; 35.9%), and less frequently ND in MI (n = 65/1162; 5.6%). For 112 chromosomes (112/1162; 9.6%), we observed a chromosome copy number in the first PB (PB1) and second PB (PB2) that is not explained by any of the known mechanisms causing aneuploidy in oocytes. We observed that embryos in the PGT-A arm of the RCT did not have a significantly different morphology between 2 and 6 days post-insemination compared to the control group, indicating that PB biopsy did not affect embryo quality. Following age-adjusted multilevel mixed-effect ordinal logistic regression models performed for each embryo evaluation day, aneuploidy was associated with a decrease in embryo quality on Day 3 (adjusted odds ratio (aOR) 0.62, 95% CI 0.43-0.90), Day 4 (aOR 0.15, 95% CI 0.06-0.39), and Day 5 (aOR 0.28, 95% CI 0.14-0.58). LIMITATIONS, REASON FOR CAUTION RS cannot be distinguished from normal segregation or MII ND using aCGH. The observed segregations were based on the detected copy number of PB1 and PB2 only and were not confirmed by the analysis of embryos. The embryo morphology assessment was static and single observer. WIDER IMPLICATIONS OF THE FINDINGS Our finding of frequent unexplained chromosome copy numbers in PBs indicates that our knowledge of the mechanisms causing aneuploidy in oocytes is incomplete. It challenges the dogma that aneuploidy in oocytes is exclusively caused by mis-segregation of chromosomes during MI and MII. STUDY FUNDING/COMPETING INTEREST(S) Data were mined from a study funded by ESHRE. Illumina provided microarrays and other consumables necessary for aCGH testing of PBs. None of the authors have competing interests. TRIAL REGISTRATION NUMBER Data were mined from the ESTEEM study (ClinicalTrials.gov Identifier NCT01532284).
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Affiliation(s)
- P Verdyck
- Centre for Medical Genetics, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
- Research Group Reproduction and Genetics, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - G Altarescu
- Shaare-Zedek Medical Center, The Hebrew University School of Medicine, Jerusalem, Israël
| | - S Santos-Ribeiro
- IVI-RMA Lisboa, Lisbon, Portugal
- Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - C Vrettou
- Laboratory of Medical Genetics, National and Kapodistrian University of Athens, 'Aghia Sophia' Children's Hospital, Athens, Greece
| | - U Koehler
- MGZ-Medizinisch Genetisches Zentrum, Munich, Germany
| | - G Griesinger
- Department of Gynecological Endocrinology and Reproductive Medicine, University Hospital of Schleswig-Holstein, Campus Luebeck, Lübeck, Germany
| | - V Goossens
- The European Society of Human Reproduction and Embryology, Strombeek-Bever, Belgium
| | - C Magli
- SISMER, Reproductive Medicine Unit, Bologna, Italy
| | - C Albanese
- SISMER, Reproductive Medicine Unit, Bologna, Italy
| | - M Parriego
- Department of Obstetrics, Gynecology and Reproductive Medicine, Dexeus University Hospital, Barcelona, Spain
| | - L Coll
- Department of Obstetrics, Gynecology and Reproductive Medicine, Dexeus University Hospital, Barcelona, Spain
| | - R Ron-El
- Shaare-Zedek Medical Center, The Hebrew University School of Medicine, Jerusalem, Israël
| | - K Sermon
- Research Group Reproduction and Genetics, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - J Traeger-Synodinos
- Laboratory of Medical Genetics, National and Kapodistrian University of Athens, 'Aghia Sophia' Children's Hospital, Athens, Greece
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25
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Cimadomo D, Forman EJ, Morbeck DE, Liperis G, Miller K, Zaninovic N, Sturmey R, Rienzi L. Day7 and low-quality blastocysts: opt in or opt out? A dilemma with important clinical implications. Fertil Steril 2023; 120:1151-1159. [PMID: 38008467 DOI: 10.1016/j.fertnstert.2023.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 10/10/2023] [Indexed: 11/28/2023]
Affiliation(s)
| | - Eric J Forman
- Columbia University Fertility Center, New York, New York
| | - Dean E Morbeck
- Morbeck Consulting Ltd., Auckland, New Zealand; Department of Obstetrics and Gynecology, Monash University, Melbourne, Australia
| | - Georgios Liperis
- Westmead Fertility Centre, Institute of Reproductive Medicine, University of Sydney, Westmead, New South Wales, Australia
| | | | - Nikica Zaninovic
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, New York
| | - Roger Sturmey
- Biomedical Institute for Multimorbidity, Hull York Medical School, University of Hull, Hull, United Kingdom
| | - Laura Rienzi
- IVIRMA Global Research Alliance, GENERA, Rome, Italy; Department of Biomolecular Sciences, University of Urbino "Carlo Bo", Urbino, Italy.
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Setti AS, Braga DPDAF, Guilherme P, Iaconelli A, Borges E. Serum anti-Müllerian hormone concentrations are related to embryo development: lessons from time-lapse imaging. ZYGOTE 2023; 31:570-576. [PMID: 37743564 DOI: 10.1017/s0967199423000370] [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] [Indexed: 09/26/2023]
Abstract
Our objective was to study whether serum anti-Müllerian hormone (AMH) concentrations were associated with embryo morphokinetic events. This retrospective cohort study was performed in a private university-affiliated in vitro fertilization centre between March 2019 and December 2020 and included 902 oocytes cultured in a time-lapse imaging incubator, obtained from 114 intracytoplasmic sperm injection cycles performed. The relationship between AMH concentrations and morphokinetic events was investigated by considering the clustering of data (multiple embryos/patient). Evaluated kinetic markers were time to pronuclei appearance (tPNa) and fading (tPNf), time to two (t2), three (t3), four (t4), five (t5), six (t6), seven (t7), and eight cells (t8), (tSB) and time to the start of blastulation (tSB) and to blastulation (tB). Significant inverse relationships were observed between serum AMH concentrations and tPNf, t3, t4, t5, t6, t7, t8, and tB. The AMH was positively correlated with the KIDScore and implantation rate. Increased serum AMH concentrations correlated with faster embryo development. The clinical implications of this effect on embryo development warrant further investigation.
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Affiliation(s)
- Amanda Souza Setti
- Fertility Medical Group, Av. Brigadeiro Luis Antonio, 4545, São Paulo - SP, Brazil01401-002
- Sapientiae Institute, Centro de Estudos e Pesquisa em Reprodução Humana Assistida, Rua Vieira Maciel, 62, São Paulo - SP, Brazil04503-040
| | - Daniela Paes de Almeida Ferreira Braga
- Fertility Medical Group, Av. Brigadeiro Luis Antonio, 4545, São Paulo - SP, Brazil01401-002
- Sapientiae Institute, Centro de Estudos e Pesquisa em Reprodução Humana Assistida, Rua Vieira Maciel, 62, São Paulo - SP, Brazil04503-040
| | - Patricia Guilherme
- Fertility Medical Group, Av. Brigadeiro Luis Antonio, 4545, São Paulo - SP, Brazil01401-002
| | - Assumpto Iaconelli
- Fertility Medical Group, Av. Brigadeiro Luis Antonio, 4545, São Paulo - SP, Brazil01401-002
- Sapientiae Institute, Centro de Estudos e Pesquisa em Reprodução Humana Assistida, Rua Vieira Maciel, 62, São Paulo - SP, Brazil04503-040
| | - Edson Borges
- Fertility Medical Group, Av. Brigadeiro Luis Antonio, 4545, São Paulo - SP, Brazil01401-002
- Sapientiae Institute, Centro de Estudos e Pesquisa em Reprodução Humana Assistida, Rua Vieira Maciel, 62, São Paulo - SP, Brazil04503-040
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Abdala A, Elkhatib I, Bayram A, El-Damen A, Melado L, Nogueira D, Lawrenz B, Fatemi HM. Reproductive outcomes with delayed blastocyst development: the clinical value of day 7 euploid blastocysts in frozen embryo transfer cycles. ZYGOTE 2023; 31:588-595. [PMID: 37955175 DOI: 10.1017/s0967199423000485] [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] [Indexed: 11/14/2023]
Abstract
Embryos of optimal development reach blastocyst stage 116 ± 2 h after insemination. Usable D7 blastocysts represent nearly 5% of embryos in IVF with acceptable pregnancy and live birth rates, however data are still limited. Therefore, this study aimed to analyze the ongoing pregnancy rate (OPR) of D7 blastocysts in single euploid frozen embryo transfer (FET) cycles. An observational study was performed including 1527 FET cycles with blastocysts biopsied on D5 (N = 855), D6 (N = 636) and D7 (N = 36). Blastocysts were classified as good (AA/AB/BA), fair (BB) or poor (AC/BC/CC/CA/CB) (Gardner scoring). FETs were performed in natural cycles (NC) or hormone replacement therapy (HRT) cycles. Patient's age differed significantly between D5, D6 and D7 blastocysts FET cycles (33.2 ± 5.6, 34.4 ± 5.3 and 35.9 ± 5.2, P < 0.001). OPRs were higher when D5 euploid blastocysts were transferred compared with D6 and D7 (56.0% vs. 45.3% and 11.1%, P < 0.001). Poor quality blastocysts were predominant in D7 blastocyst FET cycles (good quality: 35.4%, 27.2%, 5.6%; fair quality: 52.1%, 38.5%, 11.1%; poor quality: 12.5%, 34.3%, 83.3%, P < 0.001 for D5, D6 and D7 blastocysts; respectively). OPR was significantly reduced by D7 blastocyst FETs (OR = 0.23 [0.08;0.62], P = 0.004), patient's BMI (OR = 0.96 [0.94;0.98], P < 0.001), HRT cycles (OR = 0.70 [0.56;0.88], P = 0.002) and poor quality blastocysts (OR = 0.33 [0.24;0.45], P < 0.001). OPR is significantly reduced with D7 compared with D5/D6 euploid blastocysts in FET cycles. The older the patient, the more likely they are to have an FET cycle with blastocysts biopsied on D7, therefore culturing embryos until D7 can be a strategy to increase OPR outcomes in patients ≥38 years.
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Affiliation(s)
- Andrea Abdala
- ART Fertility Clinics, Abu Dhabi, United Arab Emirates
| | | | - Aşina Bayram
- ART Fertility Clinics, Abu Dhabi, United Arab Emirates
| | | | - Laura Melado
- ART Fertility Clinics, Abu Dhabi, United Arab Emirates
| | | | - Barbara Lawrenz
- ART Fertility Clinics, Abu Dhabi, United Arab Emirates
- Department of Reproductive Medicine, UZ Ghent, Ghent, Belgium
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Liu Y, Zhang X, Xu Y, Li R, Cai B, Ding C, Zhou C, Xu Y. Similar implantation competence in euploid blastocysts developed on day 5 or day 6 in young women: a retrospective cohort study. HUM FERTIL 2023; 26:918-926. [PMID: 34983269 DOI: 10.1080/14647273.2021.2021454] [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: 04/25/2021] [Accepted: 10/12/2021] [Indexed: 11/04/2022]
Abstract
The results from different studies are inconsistent regarding whether development potential correlated with embryo development speed after single euploid blastocyst transfer. The age-associated reproductive decline is not only because of the difference in aneuploidy rates but also because of metabolic and epigenetic changes of the embryos. Therefore, we aimed to assess the independent effect of embryo development speed on implantation potential in young women. A total of 326 young women who underwent preimplantation genetic testing for monogenic diseases with aneuploidy screening were analyzed. Day-5 and day-6 euploid blastocysts yielded similar implantation rates (65.20 vs. 61.22%). The odds ratio (OR) remained non-significant after adjusting for confounders (adjusted OR = 0.84, 95% confidence interval 0.52-1.36). There was a trend that day-6 euploid blastocysts had a higher miscarriage rate (13.33 vs. 9.20%). However, the live birth delivery rate of day-5 blastocysts was similar to that of day-6 blastocysts (59.20 vs. 53.06%). In the stratified analysis, live birth delivery rates were similar between day-5 and day-6 similarly graded euploid blastocysts (excellent and good, 62.04 vs. 64.71%; average, 58.73 vs. 53.70%; poor, 43.75 vs. 44.44%). Embryo development speed has no obvious impact on implantation competence in young women's vitrified/warmed euploid embryo transfer cycles.
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Affiliation(s)
- Yi Liu
- Reproductive Medical Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Reproductive Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Xiubing Zhang
- Reproductive Medical Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Reproductive Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Yan Xu
- Reproductive Medical Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Reproductive Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Rong Li
- Reproductive Medical Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Reproductive Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Bing Cai
- Reproductive Medical Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Reproductive Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Chenhui Ding
- Reproductive Medical Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Reproductive Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Canquan Zhou
- Reproductive Medical Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Reproductive Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Yanwen Xu
- Reproductive Medical Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Reproductive Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
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Park JK, Park JE, Bang S, Jeon HJ, Kim JW, Lee WS. Development and validation of a nomogram for predicting ongoing pregnancy in single vitrified-warmed blastocyst embryo transfer cycles. Front Endocrinol (Lausanne) 2023; 14:1257764. [PMID: 38075065 PMCID: PMC10702135 DOI: 10.3389/fendo.2023.1257764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 10/10/2023] [Indexed: 12/18/2023] Open
Abstract
Introduction The global adoption of the "freeze-all strategy" has led to a continuous increase in utilization of single vitrified-warmed blastocyst embryo transfer (SVBT) owing to its clinical effectiveness. Accurate prediction of clinical pregnancy is crucial from a patient-centered perspective. However, this remains challenging, with inherent limitations due to the absence of precise and user-friendly prediction tools. Thus, this study primarily aimed to develop and assess a nomogram based on quantitative clinical data to optimize the efficacy of personalized prognosis assessment. Materials and methods We conducted a retrospective cohort analysis of ongoing pregnancy data from 658 patients with infertility who underwent SVBT at our center between October 17, 2017, and December 18, 2021. Patients were randomly assigned to the training (n=461) or validation (n=197) cohort for nomogram development and testing, respectively. A nomogram was constructed using the results of the multivariable logistic regression (MLR), which included clinical covariates that were assessed for their association with ongoing pregnancy. Results The MLR identified eight significant variables that independently predicted ongoing pregnancy outcomes in the study population. These predictors encompassed maternal physiology, including maternal age at oocyte retrieval and serum anti-Müllerian hormone levels; uterine factors, such as adenomyosis; and various embryo assessment parameters, including the number of fertilized embryos, blastocyst morphology, blastulation day, blastocyst re-expansion speed, and presence of embryo string. The area under the receiver operating characteristic curve in our prediction model was 0.675 (95% confidence interval [CI], 0.622-0.729) and 0.656 (95% CI, 0.573-0.739) in the training and validation cohorts, respectively, indicating good discrimination performance in both cohorts. Conclusions Our individualized nomogram is a practical and user-friendly tool that can provide accurate and useful SVBT information for patients and clinicians. By offering this model to patients, clinical stakeholders can alleviate uncertainty and confusion about fertility treatment options and enhance patients' confidence in making informed decisions.
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Affiliation(s)
| | | | | | | | - Ji Won Kim
- *Correspondence: Ji Won Kim, ; Woo Sik Lee,
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Listorti I, Manzo R, Arrivi C, Mencacci C, Biricik A, Greco E, Greco P. PGT-M, a Useful Tool to Manage the Lynch Syndrome Transmission. Int J Mol Sci 2023; 24:16114. [PMID: 38003305 PMCID: PMC10671219 DOI: 10.3390/ijms242216114] [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: 09/20/2023] [Revised: 10/31/2023] [Accepted: 11/07/2023] [Indexed: 11/26/2023] Open
Abstract
Lynch syndrome is one of the most common hereditary cancer sensitivity syndromes and is caused by autosomal-dominant germline mutations in DNA mismatch repair genes. In patients affected by this syndrome, pre-implantation genetic testing for monogenic disorders (PGT-M) could be the elective technique used to prevent the transmission of this hereditary syndrome to offspring. Notably, despite the severity of the condition, some authors have observed a markedly lower demand for PGT-M in these patients compared to those with other hereditary conditions. A 34-year-old woman with a medical history of Lynch syndrome associated with endometrial cancer came to the Villa Mafalda fertility center in Rome in order to conceive a healthy baby. In a pre-implantation genetic testing for aneuploidy (PGT-A) + PGT-M cycle, eight blastocysts were formed. Six out of eight blastocysts were affected by the same mother syndrome. One of the other two was aneuploid and the other one was a mosaic embryo, which resulted in a healthy pregnancy. The aim of this report is to emphasize the importance of a multidisciplinary approach to managing patients with this condition. In vitro fertilization (IVF), specifically PGT-M, is a tool that allow patients to conceive biological children with lower risk of inheriting the disease.
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Affiliation(s)
- Ilaria Listorti
- Center for Reproductive Medicine, Villa Mafalda, 00199 Rome, Italy (C.M.)
- Faculty of Biosciences and Agro-Food and Environmental Technologies, University of Teramo, 64100 Teramo, Italy
| | - Roberta Manzo
- Center for Reproductive Medicine, Villa Mafalda, 00199 Rome, Italy (C.M.)
| | - Cristiana Arrivi
- Center for Reproductive Medicine, Villa Mafalda, 00199 Rome, Italy (C.M.)
| | - Cecilia Mencacci
- Center for Reproductive Medicine, Villa Mafalda, 00199 Rome, Italy (C.M.)
| | - Anil Biricik
- Eurofins GENOMA Group, Molecular Genetics Laboratories, 00138 Rome, Italy;
| | - Ermanno Greco
- Center for Reproductive Medicine, Villa Mafalda, 00199 Rome, Italy (C.M.)
- Faculty of Biosciences and Agro-Food and Environmental Technologies, University of Teramo, 64100 Teramo, Italy
- Eurofins GENOMA Group, Molecular Genetics Laboratories, 00138 Rome, Italy;
- Department of Obstetrician and Genecology, Saint Camillus International University of Health and Medical Sciences (Unicamillus), 00131 Rome, Italy
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Tan Z, Gong X, Wang CC, Zhang T, Huang J. Diminished Ovarian Reserve in Endometriosis: Insights from In Vitro, In Vivo, and Human Studies-A Systematic Review. Int J Mol Sci 2023; 24:15967. [PMID: 37958954 PMCID: PMC10647261 DOI: 10.3390/ijms242115967] [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: 08/31/2023] [Revised: 10/18/2023] [Accepted: 10/24/2023] [Indexed: 11/15/2023] Open
Abstract
Endometriosis, a prevalent disorder in women of reproductive age, is often associated with undesired infertility. Ovarian reserve, an essential measure of ovarian function that is crucial for maintaining fecundity, is frequently diminished in women with endometriosis. Though the causative relationship between endometriosis and reduced ovarian reserve is not fully understood due to the lack of standardized and precise measurements of ovarian reserve, there is ongoing discussion regarding the impact of interventions for endometriosis on ovarian reserve. Therefore, in this review, we investigate articles that have related keywords and which were also published in recent years. Thereafter, we provide a comprehensive summary of evidence from in vitro, in vivo, and human studies, thereby shedding light on the decreased ovarian reserve in endometriosis. This research consolidates evidence from in vitro, in vivo, and human studies on the diminished ovarian reserve associated with endometriosis, as well as enhances our understanding of whether and how endometriosis, as well as its interventions, contribute to reductions in ovarian reserve. Furthermore, we explore potential strategies to modify existing therapy options that could help prevent diminished ovarian reserve in patients with endometriosis.
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Affiliation(s)
- Zhouyurong Tan
- Department of Obstetrics and Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; (Z.T.); (X.G.); (C.C.W.)
| | - Xue Gong
- Department of Obstetrics and Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; (Z.T.); (X.G.); (C.C.W.)
- Department of Obstetrics and Gynaecology, The Second Affiliated Hospital, The Chinese University of Hong Kong, Shenzhen 518172, China
| | - Chi Chiu Wang
- Department of Obstetrics and Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; (Z.T.); (X.G.); (C.C.W.)
- School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Chinese University of Hong Kong-Sichuan University Joint Laboratory in Reproductive Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Reproduction and Development, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Tao Zhang
- Department of Obstetrics and Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; (Z.T.); (X.G.); (C.C.W.)
| | - Jin Huang
- Department of Obstetrics and Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; (Z.T.); (X.G.); (C.C.W.)
- Department of Obstetrics and Gynaecology, The Second Affiliated Hospital, The Chinese University of Hong Kong, Shenzhen 518172, China
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Turgut NE, Boynukalin FK, Gultomruk M, Yarkiner Z, Abali R, Bahceci M. The number of prior pregnancy losses does not impact euploidy rates in young patients with idiopathic recurrent pregnancy loss. Arch Gynecol Obstet 2023; 308:1567-1575. [PMID: 37466688 DOI: 10.1007/s00404-023-07155-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: 05/06/2023] [Accepted: 07/10/2023] [Indexed: 07/20/2023]
Abstract
PURPOSE Our study aimed to determine the possible factors that might impact the probability of obtaining a euploid blastocyst following intracytoplasmic sperm injection (ICSI) and preimplantation genetic testing for aneuploidy (PGT-A) procedures in idiopathic recurrent pregnancy loss (RPL) patients. METHODS This single-center retrospective cohort analysis included 180 oocyte retrieval cycles of 166 women under 35 years old and those diagnosed with idiopathic RPL according to American Society of Reproductive Medicine (ASRM) guidelines. Trophectoderm biopsy and next-generation sequencing (NGS) were the techniques used. Patients were stratified by the number of previous losses (Group A: 2, Group B: 3, and Group C: > 3). RESULTS Baseline and embryological characteristics showed no statistically significant differences. The euploidy rate per analyzed blastocyst was comparable within the groups (63.3%, 58.2%, and 58.5%; p = 0.477). Logistic regression analyses confirmed that only the trophectoderm scores of A and B increased the probability of obtaining a euploid embryo [OR: 1.82, 95% CI (1.120-2.956), p: 0.016]. CONCLUSION It is concluded that there was no correlation between the number of previous losses and the chance of finding at least one euploid embryo in ICSI cycles of women younger than 35 years.
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Affiliation(s)
- Niyazi Emre Turgut
- Infertility Department, Bahceci Fulya IVF Center, Teşvikiye Mahallesi, Hakki Yeten Caddesi, Terrace Plaza, M3/11, Şişli, 34394, Istanbul, Turkey.
- Faculty of Health Sciences, Istanbul Gelisim University, Istanbul, Turkey.
| | - Fazilet Kubra Boynukalin
- Infertility Department, Bahceci Fulya IVF Center, Teşvikiye Mahallesi, Hakki Yeten Caddesi, Terrace Plaza, M3/11, Şişli, 34394, Istanbul, Turkey
- Department of Obstetrics and Gynecology, Uskudar University, Istanbul, Turkey
| | - Meral Gultomruk
- Infertility Department, Bahceci Fulya IVF Center, Teşvikiye Mahallesi, Hakki Yeten Caddesi, Terrace Plaza, M3/11, Şişli, 34394, Istanbul, Turkey
| | - Zalihe Yarkiner
- Faculty of Arts and Sciences, Department of Basic Sciences, Cyprus International, Kyrenia, Cyprus
| | - Remzi Abali
- Infertility Department, Bahceci Fulya IVF Center, Teşvikiye Mahallesi, Hakki Yeten Caddesi, Terrace Plaza, M3/11, Şişli, 34394, Istanbul, Turkey
| | - Mustafa Bahceci
- Infertility Department, Bahceci Fulya IVF Center, Teşvikiye Mahallesi, Hakki Yeten Caddesi, Terrace Plaza, M3/11, Şişli, 34394, Istanbul, Turkey
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Havrljenko J, Kopitovic V, Pjevic AT, Milatovic S, Pavlica T, Andric N, Pogrmic-Majkic K. The Prediction of IVF Outcomes with Autologous Oocytes and the Optimal MII Oocyte/Embryo Number for Live Birth at Advanced Maternal Age. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1799. [PMID: 37893517 PMCID: PMC10608663 DOI: 10.3390/medicina59101799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/11/2023] [Accepted: 09/26/2023] [Indexed: 10/29/2023]
Abstract
Background and Objectives: Delayed childbearing in advanced age might be associated with a low prognosis for achieving pregnancy. Therefore, it is important to establish a predictive tool that will optimize the likelihood of a live birth at advanced age. Material and Methods: The retrospective study was conducted at the Ferona Fertility Clinic in Novi Sad (Republic of Serbia), between January 2020 and May 2021. The survey included 491 women aged ≥35 who met the inclusion criteria and who were subjected to an IVF (in vitro fertilization) treatment cycle. Results: The average number of retrieved oocytes, MII (metaphase II) oocytes, and developed embryos significantly decreased in advanced age. Age was also found to have a significant adverse effect on pregnancy and live birth rates. In women aged ≥35, 10/12 MII oocytes or 10/11 embryos are required for reaching an optimal live birth rate/cumulative live birth rate. Optimal CLBR (cumulative live birth rate) per one oocyte was achieved when 9 MII oocyte were retrieved. Conclusions: The study indicates that the cut-off for increased risk is ≥42 year. However, despite low live birth rates, autologous IVF for these women is not futile. An increase in the number of retrieved mature oocytes and a generation of surplus cryopreserved embryos could reinforce LBR (live birth rate) and CLBR. Clinicians should be very cautious in counseling, as autologous IVF may only be applicable to women with good ovarian reserve.
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Affiliation(s)
- Jelena Havrljenko
- Ferona Fertility Clinic, Sarplaninska 19, 21000 Novi Sad, Serbia or (J.H.); (V.K.); (A.T.P.)
- Faculty of Sciences, Department of Biology and Ecology, University of Novi Sad, Trg Dositeja Obradovica 2, 21000 Novi Sad, Serbia; (N.A.); (K.P.-M.)
| | - Vesna Kopitovic
- Ferona Fertility Clinic, Sarplaninska 19, 21000 Novi Sad, Serbia or (J.H.); (V.K.); (A.T.P.)
| | | | - Stevan Milatovic
- Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia;
| | - Tatjana Pavlica
- Faculty of Sciences, Department of Biology and Ecology, University of Novi Sad, Trg Dositeja Obradovica 2, 21000 Novi Sad, Serbia; (N.A.); (K.P.-M.)
| | - Nebojsa Andric
- Faculty of Sciences, Department of Biology and Ecology, University of Novi Sad, Trg Dositeja Obradovica 2, 21000 Novi Sad, Serbia; (N.A.); (K.P.-M.)
| | - Kristina Pogrmic-Majkic
- Faculty of Sciences, Department of Biology and Ecology, University of Novi Sad, Trg Dositeja Obradovica 2, 21000 Novi Sad, Serbia; (N.A.); (K.P.-M.)
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Cascales A, Morales R, Castro A, Ortiz JA, Lledo B, Ten J, Bernabeu A, Bernabeu R. Factors associated with embryo mosaicism: a systematic review and meta-analysis. J Assist Reprod Genet 2023; 40:2317-2324. [PMID: 37592098 PMCID: PMC10504166 DOI: 10.1007/s10815-023-02914-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 08/10/2023] [Indexed: 08/19/2023] Open
Abstract
PURPOSE Evaluate which factors are involved in the increased rate of mosaicism in embryos. METHODS A systematic review and meta-analysis was performed. After an exhaustive search of the literature, a total of seven papers were included in the analysis. In addition, data collected from IVF cycles performed in our fertility clinic were also analysed. Day of biopsy, embryo quality, maternal and paternal age and seminal quality were the chosen factors to be studied. RESULTS The results of the meta-analysis show that neither embryo quality nor seminal quality were related to mosaic embryo rate (OR: 1.09; 95% CI: 0.94-1.28 and OR: 1.10; 95% CI: 0.87-1.37, respectively). A positive association was observed for the variable "biopsy day" with embryos biopsied at day 6 or 7 having the highest rate of mosaicism (OR: 1.06; 95% CI: 1.01-1.11). In opposite to what happens with aneuploidy rate, which increases with maternal age, embryo mosaicism is higher in younger women (<34 years) rather than in older ones (≥34 years) (OR: 0.95; 95% CI: 0.92-0.98). However, for the "paternal age" factor, no association with mosaicism was found (OR: 1.04; 95% CI: 0.90-1.21). CONCLUSIONS With the present study, we can conclude that the factors related to the presence of mosaicism in embryos are the embryo biopsy day and maternal age. The rest of the studied factors showed no significant relationship with mosaicism. These results are of great importance as knowing the possible causes leading to mosaicism helps to improve the clinical results of reproductive treatments.
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Affiliation(s)
- A Cascales
- Molecular Biology Department, Instituto Bernabeu, Avda. Albufereta 31, 03016, Alicante, Spain
| | - R Morales
- Molecular Biology Department, Instituto Bernabeu, Avda. Albufereta 31, 03016, Alicante, Spain.
| | - A Castro
- Molecular Biology Department, Instituto Bernabeu, Avda. Albufereta 31, 03016, Alicante, Spain
| | - J A Ortiz
- Molecular Biology Department, Instituto Bernabeu, Avda. Albufereta 31, 03016, Alicante, Spain
| | - B Lledo
- Molecular Biology Department, Instituto Bernabeu, Avda. Albufereta 31, 03016, Alicante, Spain
| | - J Ten
- Reproductive Biology, Instituto Bernabeu, Alicante, Spain
| | - A Bernabeu
- Reproductive Medicine, Instituto Bernabeu, Alicante, Spain
| | - R Bernabeu
- Reproductive Medicine, Instituto Bernabeu, Alicante, Spain
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Wang J, Guo Y, Zhang N, Li T. Research progress of time-lapse imaging technology and embryonic development potential: A review. Medicine (Baltimore) 2023; 102:e35203. [PMID: 37746957 PMCID: PMC10519478 DOI: 10.1097/md.0000000000035203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/22/2023] [Accepted: 08/23/2023] [Indexed: 09/26/2023] Open
Abstract
Cultivation and selection of high-quality human embryos are critical for the success of in vitro fertilization-embryo transfer. Time-lapse imaging technology (TLI) provides a stable culture environment for embryos, which can continuously observe and record the development process of early embryos, so that doctors can record embryo development time parameters more accurately. In this study, we review the current observation and research on the main embryo dynamics parameters in TLI and discusses their significance and development for embryo development potential. To analysis and summary, the application and research situation of TLI, we searched PubMed, Web of Science, and China National Knowledge Infrastructure, using TLI, embryo dynamics parameters, embryo development potential as Keywords, cited 50 out of the initial 89 selected literatures and summarized. With comparative analysis and research, we found that the embryo dynamic parameters provided by TLI has been intensively studied in clinical empirical and observational research, extensive experimental data verified its effectiveness and advantages in embryo development potential assessment. TLI provides technical support of embryo dynamic parameters, which may become the quantitative indicators for superior embryos and pregnancy prediction as well. Existing studies have shown that certain kinetic parameters provided by TLI culture can predict embryo implantation, but no parameter has been confirmed as the absolute correlation biological indicators yet. In this review we believe that further research is needed to verify these preliminary and sometimes contradictory results, and explore the predictive significance of various embryo kinetic parameters relying on TLI technology for embryo development potential.
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Affiliation(s)
- JinLuan Wang
- School of Basic Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ying Guo
- Reproductive and Genetic Center, Shandong University of Traditional Chinese Medicine Affiliated Hospital, Jinan, China
| | - Ning Zhang
- Reproductive and Genetic Center, Shandong University of Traditional Chinese Medicine Affiliated Hospital, Jinan, China
| | - TingTing Li
- Shandong University of Traditional Chinese Medicine, Jinan, China
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Cimadomo D, Rienzi L, Conforti A, Forman E, Canosa S, Innocenti F, Poli M, Hynes J, Gemmell L, Vaiarelli A, Alviggi C, Ubaldi FM, Capalbo A. Opening the black box: why do euploid blastocysts fail to implant? A systematic review and meta-analysis. Hum Reprod Update 2023; 29:570-633. [PMID: 37192834 DOI: 10.1093/humupd/dmad010] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 03/22/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND A normal chromosomal constitution defined through PGT-A assessing all chromosomes on trophectoderm (TE) biopsies represents the strongest predictor of embryo implantation. Yet, its positive predictive value is not higher than 50-60%. This gap of knowledge on the causes of euploid blastocysts' reproductive failure is known as 'the black box of implantation'. OBJECTIVE AND RATIONALE Several embryonic, maternal, paternal, clinical, and IVF laboratory features were scrutinized for their putative association with reproductive success or implantation failure of euploid blastocysts. SEARCH METHODS A systematic bibliographical search was conducted without temporal limits up to August 2021. The keywords were '(blastocyst OR day5 embryo OR day6 embryo OR day7 embryo) AND (euploid OR chromosomally normal OR preimplantation genetic testing) AND (implantation OR implantation failure OR miscarriage OR abortion OR live birth OR biochemical pregnancy OR recurrent implantation failure)'. Overall, 1608 items were identified and screened. We included all prospective or retrospective clinical studies and randomized-controlled-trials (RCTs) that assessed any feature associated with live-birth rates (LBR) and/or miscarriage rates (MR) among non-mosaic euploid blastocyst transfer after TE biopsy and PGT-A. In total, 41 reviews and 372 papers were selected, clustered according to a common focus, and thoroughly reviewed. The PRISMA guideline was followed, the PICO model was adopted, and ROBINS-I and ROB 2.0 scoring were used to assess putative bias. Bias across studies regarding the LBR was also assessed using visual inspection of funnel plots and the trim and fill method. Categorical data were combined with a pooled-OR. The random-effect model was used to conduct the meta-analysis. Between-study heterogeneity was addressed using I2. Whenever not suitable for the meta-analysis, the included studies were simply described for their results. The study protocol was registered at http://www.crd.york.ac.uk/PROSPERO/ (registration number CRD42021275329). OUTCOMES We included 372 original papers (335 retrospective studies, 30 prospective studies and 7 RCTs) and 41 reviews. However, most of the studies were retrospective, or characterized by small sample sizes, thus prone to bias, which reduces the quality of the evidence to low or very low. Reduced inner cell mass (7 studies, OR: 0.37, 95% CI: 0.27-0.52, I2 = 53%), or TE quality (9 studies, OR: 0.53, 95% CI: 0.43-0.67, I2 = 70%), overall blastocyst quality worse than Gardner's BB-grade (8 studies, OR: 0.40, 95% CI: 0.24-0.67, I2 = 83%), developmental delay (18 studies, OR: 0.56, 95% CI: 0.49-0.63, I2 = 47%), and (by qualitative analysis) some morphodynamic abnormalities pinpointed through time-lapse microscopy (abnormal cleavage patterns, spontaneous blastocyst collapse, longer time of morula formation I, time of blastulation (tB), and duration of blastulation) were all associated with poorer reproductive outcomes. Slightly lower LBR, even in the context of PGT-A, was reported among women ≥38 years (7 studies, OR: 0.87, 95% CI: 0.75-1.00, I2 = 31%), while obesity was associated with both lower LBR (2 studies, OR: 0.66, 95% CI: 0.55-0.79, I2 = 0%) and higher MR (2 studies, OR: 1.8, 95% CI: 1.08-2.99, I2 = 52%). The experience of previous repeated implantation failures (RIF) was also associated with lower LBR (3 studies, OR: 0.72, 95% CI: 0.55-0.93, I2 = 0%). By qualitative analysis, among hormonal assessments, only abnormal progesterone levels prior to transfer were associated with LBR and MR after PGT-A. Among the clinical protocols used, vitrified-warmed embryo transfer was more effective than fresh transfer (2 studies, OR: 1.56, 95% CI: 1.05-2.33, I2 = 23%) after PGT-A. Lastly, multiple vitrification-warming cycles (2 studies, OR: 0.41, 95% CI: 0.22-0.77, I2 = 50%) or (by qualitative analysis) a high number of cells biopsied may slightly reduce the LBR, while simultaneous zona-pellucida opening and TE biopsy allowed better results than the Day 3 hatching-based protocol (3 studies, OR: 1.41, 95% CI: 1.18-1.69, I2 = 0%). WIDER IMPLICATIONS Embryo selection aims at shortening the time-to-pregnancy, while minimizing the reproductive risks. Knowing which features are associated with the reproductive competence of euploid blastocysts is therefore critical to define, implement, and validate safer and more efficient clinical workflows. Future research should be directed towards: (i) systematic investigations of the mechanisms involved in reproductive aging beyond de novo chromosomal abnormalities, and how lifestyle and nutrition may accelerate or exacerbate their consequences; (ii) improved evaluation of the uterine and blastocyst-endometrial dialogue, both of which represent black boxes themselves; (iii) standardization/automation of embryo assessment and IVF protocols; (iv) additional invasive or preferably non-invasive tools for embryo selection. Only by filling these gaps we may finally crack the riddle behind 'the black box of implantation'.
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Affiliation(s)
- Danilo Cimadomo
- IVIRMA Global Research Alliance, GENERA, Clinica Valle Giulia, Rome, Italy
| | - Laura Rienzi
- IVIRMA Global Research Alliance, GENERA, Clinica Valle Giulia, Rome, Italy
- Department of Biomolecular Sciences, University of Urbino "Carlo Bo", Urbino, Italy
| | - Alessandro Conforti
- Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University, Naples, Italy
| | - Eric Forman
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Columbia University Irving Medical Centre, New York, NY, USA
| | | | - Federica Innocenti
- IVIRMA Global Research Alliance, GENERA, Clinica Valle Giulia, Rome, Italy
| | - Maurizio Poli
- Centrum voor Kinderwens, Dijklander Hospital, Purmerend, The Netherlands
- Juno Genetics, Rome, Italy
| | - Jenna Hynes
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Columbia University Irving Medical Centre, New York, NY, USA
| | - Laura Gemmell
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Columbia University Irving Medical Centre, New York, NY, USA
| | - Alberto Vaiarelli
- IVIRMA Global Research Alliance, GENERA, Clinica Valle Giulia, Rome, Italy
| | - Carlo Alviggi
- Department of Public Health, Federico II University, Naples, Italy
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La Marca A, Donno V, Longo M, Greco P, Cucinelli F, Varricchio MT, Listorti I, Greco E. Predicting the total number of retrieved oocytes following double ovarian stimulation (DuoStim). Hum Reprod 2023; 38:1784-1788. [PMID: 37470235 DOI: 10.1093/humrep/dead148] [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: 02/22/2023] [Revised: 06/16/2023] [Indexed: 07/21/2023] Open
Abstract
STUDY QUESTION Can anti-Müllerian hormone (AMH) help predict how many oocytes will be retrieved following double stimulation (DuoStim)? SUMMARY ANSWER A simple clinical tool can use serum AMH values to predict ovarian response following DuoStim in IVF cycles. WHAT IS ALREADY KNOWN The knowledge that multiple follicular waves arise during a single ovarian cycle has led to the introduction of unconventional ovarian stimulation protocols. The DuoStim protocol involves two successive ovarian stimulations performed during a single ovarian cycle and has been proposed as an approach for patients with poor ovarian response and for medical fertility preservation. As AMH has been used as a marker of ovarian reserve and stimulation response, the current study aimed to investigate the diagnostic performance of AMH in predicting the number of retrieved oocytes following DuoStim. STUDY DESIGN, SIZE, DURATION This is a retrospective observational study involving 116 patients who received IVF treatment from January 2021 to September 2022. PARTICIPANTS/MATERIALS, SETTING, METHODS The study was conducted at a private IVF centre. Only patients who had their AMH measured prior to treatment and had complete patient records regarding their clinical and IVF/ICSI cycle characteristics were included. The primary outcome was the correlation between AMH values and the number of oocytes retrieved following DuoStim. Parametric and non-parametric tests were used to compare baseline characteristics and outcomes. Spearman's R was used to analyse correlations between variables, while the C statistic was used to calculate the diagnostic performance of AMH. MAIN RESULTS AND THE ROLE OF CHANCE AMH levels were significantly correlated with the total number of oocytes retrieved after the DuoStim (R 0.61; CI 0.44-0.70; P < 0.0001). The difference in the total number of oocytes retrieved between the first (median 4 oocytes, interquartile range (IQR) 2-6) and second (median 6 oocytes, IQR 3.2-8) stimulation was statistically significant (P < 0.0001). However, there was no significant difference in the number of mature oocytes that were retrieved (median of 3 and 4 in the first and second stimulations, respectively). After the first stimulation, 68% of patients had at least one blastocyst available, while after the second stimulation, 74% did (NS). Based on linear regression, each 0.25 ng/ml increase in basal AMH corresponds to one additional oocyte recovered at the end of both stimulations (R2: 0.32, P < 0.0001). LIMITATIONS, REASONS FOR CAUTION The results are limited owing to the observational nature of the study and the number of participants. WIDER IMPLICATIONS OF THE FINDINGS Counselling infertile couples regarding the intermediate outcome of IVF (i.e. number of retrieved oocytes) is one of the most demanding tasks that clinicians face. To our knowledge, this is the first study that provides an easy-to-use clinical tool that enables the quantitative prediction of ovarian response following DuoStim, based on serum AMH values. STUDY FUNDING/COMPETING INTEREST(S) No external funding was obtained for this study. The authors declare no conflicts of interest. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- A La Marca
- Department of Medical and Surgical Sciences of the Mother, Children, and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - V Donno
- Department of Medical and Surgical Sciences of the Mother, Children, and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - M Longo
- Department of Medical and Surgical Sciences of the Mother, Children, and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - P Greco
- Reproductive Medicine, Villa Mafalda, Rome, Italy
| | - F Cucinelli
- Department of Obstetrics and Gynecology, San Camillo Hospital, Rome, Italy
| | | | - I Listorti
- Reproductive Medicine, Villa Mafalda, Rome, Italy
| | - E Greco
- Reproductive Medicine, Villa Mafalda, Rome, Italy
- UniCamillus, International Medical University, Rome, Italy
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Rajendran S, Brendel M, Barnes J, Zhan Q, Malmsten JE, Zisimopoulos P, Sigaras A, Ofori-Atta K, Meseguer M, Miller KA, Hoffman D, Rosenwaks Z, Elemento O, Zaninovic N, Hajirasouliha I. Automatic Ploidy Prediction and Quality Assessment of Human Blastocyst Using Time-Lapse Imaging. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.08.31.555741. [PMID: 37693566 PMCID: PMC10491146 DOI: 10.1101/2023.08.31.555741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
Assessing fertilized human embryos is crucial for in vitro-fertilization (IVF), a task being revolutionized by artificial intelligence and deep learning. Existing models used for embryo quality assessment and chromosomal abnormality (ploidy) detection could be significantly improved by effectively utilizing time-lapse imaging to identify critical developmental time points for maximizing prediction accuracy. Addressing this, we developed and compared various embryo ploidy status prediction models across distinct embryo development stages. We present BELA (Blastocyst Evaluation Learning Algorithm), a state-of-the-art ploidy prediction model surpassing previous image- and video-based models, without necessitating subjective input from embryologists. BELA uses multitask learning to predict quality scores that are used downstream to predict ploidy status. By achieving an AUC of 0.76 for discriminating between euploidy and aneuploidy embryos on the Weill Cornell dataset, BELA matches the performance of models trained on embryologists' manual scores. While not a replacement for preimplantation genetic testing for aneuploidy (PGT-A), BELA exemplifies how such models can streamline the embryo evaluation process, reducing time and effort required by embryologists.
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Paya E, Pulgarín C, Bori L, Colomer A, Naranjo V, Meseguer M. Deep learning system for classification of ploidy status using time-lapse videos. F&S SCIENCE 2023; 4:211-218. [PMID: 37394179 DOI: 10.1016/j.xfss.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 06/27/2023] [Accepted: 06/27/2023] [Indexed: 07/04/2023]
Abstract
OBJECTIVE To develop a spatiotemporal model for de prediction of euploid and aneuploid embryos using time-lapse videos from 10-115 hours after insemination (hpi). DESIGN Retrospective study. MAIN OUTCOME MEASURES The research used an end-to-end approach to develop an automated artificial intelligence system capable of extracting features from images and classifying them, considering spatiotemporal dependencies. A convolutional neural network extracted the most relevant features from each video frame. A bidirectional long short-term memory layer received this information and analyzed the temporal dependencies, obtaining a low-dimensional feature vector that characterized each video. A multilayer perceptron classified them into 2 groups, euploid and noneuploid. RESULTS The model performance in accuracy fell between 0.6170 and 0.7308. A multi-input model with a gate recurrent unit module performed better than others; the precision (or positive predictive value) is 0.8205 for predicting euploidy. Sensitivity, specificity, F1-Score and accuracy are 0.6957, 0.7813, 0.7042, and 0.7308, respectively. CONCLUSIONS This article proposes an artificial intelligence solution for prioritizing euploid embryo transfer. We can highlight the identification of a noninvasive method for chromosomal status diagnosis using a deep learning approach that analyzes raw data provided by time-lapse incubators. This method demonstrated potential automation of the evaluation process, allowing spatial and temporal information to encode.
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Affiliation(s)
- Elena Paya
- Instituto de Investigación e Innovación en Bioingeniería (I3B), Universitat Politècnica de Valencia, Spain; IVIRMA Valencia, Spain.
| | - Cristian Pulgarín
- Instituto de Investigación e Innovación en Bioingeniería (I3B), Universitat Politècnica de Valencia, Spain
| | | | - Adrián Colomer
- Instituto de Investigación e Innovación en Bioingeniería (I3B), Universitat Politècnica de Valencia, Spain
| | - Valery Naranjo
- Instituto de Investigación e Innovación en Bioingeniería (I3B), Universitat Politècnica de Valencia, Spain
| | - Marcos Meseguer
- IVIRMA Valencia, Spain; Health Research Institute la Fe, Valencia, Spain
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Wang X, Xiao Y, Tao T, Xiong W. Influence of maternal age on the birthweight of infants delivered from frozen-thawed blastocyst transfer cycles. Front Endocrinol (Lausanne) 2023; 14:1195256. [PMID: 37497353 PMCID: PMC10368368 DOI: 10.3389/fendo.2023.1195256] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 06/09/2023] [Indexed: 07/28/2023] Open
Abstract
The aim of this study was to investigate whether maternal age had an effect on the birthweight of singletons delivered from frozen-thawed blastocyst transfer (FBT) cycles. A total of 1203 FBT cycles occurring between July 2011 and June 2021 at a single centre were retrospectively analysed. Based on the maternal age at FBT, the patients were divided into four groups: <30, 30-34, 35-37, and ≥38 years of age. Main outcomes measured included singleton birthweights, preterm births, large-for-gestational-age (LGA) and small-for-gestational-age (SGA) live births among the groups. There was no significant difference in birth weight among the four groups, while the highest birth weight was found in the <30 years group. The incidence of very preterm births and very low birth weights demonstrated an increasing trend with age; on the contrary, the incidence of preterm births, low birth weight (LBW), high birth weight and LGA and SGA live births gradually decreased with increasing age, but these differences were not statistically significant among groups (P>0.05, respectively). Although the proportion of females was lower than that of males, the difference was not statistically significant among the groups. After adjusting for possible confounders, maternal age was found to have no effect on adverse neonatal outcomes in the regression analyses (P>0.05). Birthweight in singleton births from FBT was not affected by maternal age.
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Braga DPDAF, Setti AS, Guilherme P, Morishima C, Iaconelli A, Borges E. Time-lapse monitoring: An adjunct tool to select embryos for preimplantation genetic testing. Mol Reprod Dev 2023. [PMID: 37334904 DOI: 10.1002/mrd.23692] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 05/18/2023] [Accepted: 06/06/2023] [Indexed: 06/21/2023]
Abstract
The goal for the present study was to investigate the effect of aneuploidy on embryo morphokinetics events in a time-lapse imaging (TLI) system incubator. This retrospective cohort study was performed in a private university-affiliated in vitro fertilization center, between 2019 March and December 2020. Kinetic data were analyzed in 935 embryos, derived from 316 patients undergoing intracytoplasmic sperm injection cycle with preimplantation genetic testing (PGT) for aneuploidy, individually cultured in a TLI incubator until Day 5 of development. Timing of morphokinetic variables, the incidences of multinucleation, and Known Implantation Data Score (KIDScore)-Day 5 were compared between euploid (n = 352) and aneuploid embryos (n = 583). Aneuploid embryos showed significantly longer timing to complete specific morphokinetic parameters compared to euploidy embryos. Euploidy embryos also showed a significantly higher KIDScore when compared with the aneuploidy ones. Our evidence suggests that TLI monitoring may be an adjunct approach to select embryos for PGT; however, cautious investigation is still needed.
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Affiliation(s)
- Daniela P de Almeida Ferreira Braga
- Fertility Medical Group, São Paulo, Brazil
- Sapientiae Institute - Centro de Estudos e Pesquisa em Reprodução Humana Assistida, São Paulo, Brazil
| | - Amanda S Setti
- Fertility Medical Group, São Paulo, Brazil
- Sapientiae Institute - Centro de Estudos e Pesquisa em Reprodução Humana Assistida, São Paulo, Brazil
| | | | - Christina Morishima
- Sapientiae Institute - Centro de Estudos e Pesquisa em Reprodução Humana Assistida, São Paulo, Brazil
| | - Assumpto Iaconelli
- Fertility Medical Group, São Paulo, Brazil
- Sapientiae Institute - Centro de Estudos e Pesquisa em Reprodução Humana Assistida, São Paulo, Brazil
| | - Edson Borges
- Fertility Medical Group, São Paulo, Brazil
- Sapientiae Institute - Centro de Estudos e Pesquisa em Reprodução Humana Assistida, São Paulo, Brazil
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Zheng Z, Tan J, Chen L, Liu S, Zhou C, Li Y. PGT-A improved singleton live birth rate among all age groups of women who underwent elective single blastocyst transfer: a single-centre retrospective study. J Assist Reprod Genet 2023; 40:1417-1427. [PMID: 37055598 PMCID: PMC10310591 DOI: 10.1007/s10815-023-02775-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 03/14/2023] [Indexed: 04/15/2023] Open
Abstract
PURPOSE This study assessed the difference in singleton live birth rate (SLBR) between preimplantation genetic testing for aneuploidy (PGT-A) and non-PGT in patients undergoing elective single frozen blastocyst transfer (eSFBT). METHODS This retrospective cohort study evaluated 10,701 cycles of eSFBT, including PGT-A (n = 3125) and non-PGT (n = 7576). Cycles were further stratified according to age at retrieval. The main outcome was SLBR; secondary outcomes were clinical pregnancy, conception rates, and multiple live birth rate. Confounders were adjusted using multivariable logistic regression models, and the trend test was performed using the general linear model. RESULTS SLBR was negatively correlated with age in the non-PGT group (p-trend < 0.001) but not in PGT-A group (p-trend = 0.974). Stratified by the age, SLBR were significantly different between two groups except for the 20-24-year-old group: PGT-A vs non-PGT group in 20-24, 25-29, 30-34, 35-39 and ≥ 40-year-old subgroups were, 53.5% vs 53.2%, 53.5% vs 48.0%, 53.5% vs 43.1%, 53.3% vs 32.5%, and 42.9% vs 17.6%, respectively. In addition, after adjusting for potential confounders, SLBR still remained significantly different in all age groups except in the youngest quartile (PGT-A vs non-PGT group, 20-24: adjusted odds ratio (aOR), 1.33, 95% CI, 0.92-1.92, p = 0.129; 25-29: aOR, 1.32, 95% CI, 1.14-1.52, p < 0.001; 30-34: aOR, 1.91, 95% CI, 1.65-2.20, p < 0.001; 35-39: aOR, 2.50, 95% CI, 1.97-3.17, p < 0.001; ≥ 40: aOR, 3.54, 95% CI, 1.66-7.55, p = 0.001). CONCLUSION PGT-A might improve SLBR among all age groups and play an increasingly important role in SLBR in older patients who underwent eSFBT.
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Affiliation(s)
- Zetong Zheng
- Reproductive Medicine Center, The First Affiliated Hospital of Sun Yat-Sen University, Zhoushan 2 Road, Guangzhou, Guangdong, People's Republic of China
- Guangdong Provincial Key Laboratory of Reproductive Medicine, The First Affiliated Hospital of Sun Yat-Sen University, Zhoushan 2 Road, Guangzhou, Guangdong, People's Republic of China
| | - Jifan Tan
- Reproductive Medicine Center, The First Affiliated Hospital of Sun Yat-Sen University, Zhoushan 2 Road, Guangzhou, Guangdong, People's Republic of China
- Guangdong Provincial Key Laboratory of Reproductive Medicine, The First Affiliated Hospital of Sun Yat-Sen University, Zhoushan 2 Road, Guangzhou, Guangdong, People's Republic of China
| | - Lin Chen
- Reproductive Medicine Center, The First Affiliated Hospital of Sun Yat-Sen University, Zhoushan 2 Road, Guangzhou, Guangdong, People's Republic of China
- Guangdong Provincial Key Laboratory of Reproductive Medicine, The First Affiliated Hospital of Sun Yat-Sen University, Zhoushan 2 Road, Guangzhou, Guangdong, People's Republic of China
| | - Simin Liu
- Reproductive Medicine Center, The First Affiliated Hospital of Sun Yat-Sen University, Zhoushan 2 Road, Guangzhou, Guangdong, People's Republic of China
- Guangdong Provincial Key Laboratory of Reproductive Medicine, The First Affiliated Hospital of Sun Yat-Sen University, Zhoushan 2 Road, Guangzhou, Guangdong, People's Republic of China
| | - Canquan Zhou
- Reproductive Medicine Center, The First Affiliated Hospital of Sun Yat-Sen University, Zhoushan 2 Road, Guangzhou, Guangdong, People's Republic of China.
- Guangdong Provincial Key Laboratory of Reproductive Medicine, The First Affiliated Hospital of Sun Yat-Sen University, Zhoushan 2 Road, Guangzhou, Guangdong, People's Republic of China.
| | - Yubin Li
- Reproductive Medicine Center, The First Affiliated Hospital of Sun Yat-Sen University, Zhoushan 2 Road, Guangzhou, Guangdong, People's Republic of China.
- Guangdong Provincial Key Laboratory of Reproductive Medicine, The First Affiliated Hospital of Sun Yat-Sen University, Zhoushan 2 Road, Guangzhou, Guangdong, People's Republic of China.
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Gao J, Wei N, Zhu X, Li R, Yan L, Qiao J. The correlation between morphological parameters and the incidence of de novo chromosomal abnormalities in 3238 biopsied blastocysts. J Assist Reprod Genet 2023; 40:1089-1098. [PMID: 37058258 PMCID: PMC10239399 DOI: 10.1007/s10815-023-02780-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 03/17/2023] [Indexed: 04/15/2023] Open
Abstract
PURPOSE The aim of this study was to determine the relationship between morphological parameters and the incidence of de novo chromosomal abnormalities. METHODS This was a retrospective cohort study of 652 patients who underwent 921 cycles with 3238 blastocysts biopsied. The embryo grades were evaluated according to Gardner and Schoolcraft's system. The incidence of euploidy, whole chromosomal aneuploidy (W-aneuploidy), segmental chromosomal aneuploidy (S-aneuploidy), and mosaicism in trophectoderm (TE) cell biopsies was analyzed. RESULTS The euploidy decreased significantly with maternal age and was positively correlated biopsy day and morphological parameters. The W-aneuploidy increased significantly with maternal age and was negatively correlated biopsy day and morphological parameters. Parental age, TE biopsy day, and morphological parameters were not associated with S-aneuploidy and mosaicism, except that TE grade C blastocysts had significantly higher mosaicism than TE grade A blastocysts. Subanalysis in different female age groups showed that euploidy and W-aneuploidy had a significant correlation with TE biopsy day among women aged ≤ 30 y and 31-35 y, with expansion degree among women aged ≥ 36 y, with ICM grade among women aged ≥ 31 y, and with TE grade among all female age ranges. CONCLUSION Female age, embryo developmental speed and blastocyst morphological parameters are associated with euploidy and whole chromosomal aneuploidy. The predictive value of these factors varies across female age groups. Parental age, embryo developmental speed, expansion degree, and ICM grade are not associated with the incidence of segmental aneuploidy or mosaicism, but TE grade seemingly has a weak correlation with segmental aneuploidy and mosaicism in embryos.
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Affiliation(s)
- Jiangman Gao
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, 100191, China
- National Clinical Research Center for Obstetrics and Gynecology, (Peking University Third Hospital), Beijing, 100191, China
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, 100191, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology (Peking University Third Hospital), Beijing, 100191, China
| | - Nan Wei
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, 100191, China
| | - Xiaohui Zhu
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, 100191, China
- National Clinical Research Center for Obstetrics and Gynecology, (Peking University Third Hospital), Beijing, 100191, China
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, 100191, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology (Peking University Third Hospital), Beijing, 100191, China
| | - Rong Li
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, 100191, China
- National Clinical Research Center for Obstetrics and Gynecology, (Peking University Third Hospital), Beijing, 100191, China
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, 100191, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology (Peking University Third Hospital), Beijing, 100191, China
| | - Liying Yan
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, 100191, China.
- National Clinical Research Center for Obstetrics and Gynecology, (Peking University Third Hospital), Beijing, 100191, China.
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, 100191, China.
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology (Peking University Third Hospital), Beijing, 100191, China.
| | - Jie Qiao
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, 100191, China.
- National Clinical Research Center for Obstetrics and Gynecology, (Peking University Third Hospital), Beijing, 100191, China.
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, 100191, China.
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology (Peking University Third Hospital), Beijing, 100191, China.
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44
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Suebthawinkul C, Babayev E, Lee HC, Duncan FE. Morphokinetic parameters of mouse oocyte meiotic maturation and cumulus expansion are not affected by reproductive age or ploidy status. J Assist Reprod Genet 2023; 40:1197-1213. [PMID: 37012451 PMCID: PMC10239409 DOI: 10.1007/s10815-023-02779-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 03/17/2023] [Indexed: 04/05/2023] Open
Abstract
INTRODUCTION Morphokinetic analysis using a closed time-lapse monitoring system (EmbryoScope + ™) provides quantitative metrics of meiotic progression and cumulus expansion. The goal of this study was to use a physiologic aging mouse model, in which egg aneuploidy levels increase, to determine whether there are age-dependent differences in morphokinetic parameters of oocyte maturation. METHODS Denuded oocytes and intact cumulus-oocyte complexes (COCs) were isolated from reproductively young and old mice and in vitro matured in the EmbryoScope + ™. Morphokinetic parameters of meiotic progression and cumulus expansion were evaluated, compared between reproductively young and old mice, and correlated with egg ploidy status. RESULTS Oocytes from reproductively old mice were smaller than young counterparts in terms of GV area (446.42 ± 4.15 vs. 416.79 ± 5.24 µm2, p < 0.0001) and oocyte area (4195.71 ± 33.10 vs. 4081.62 ± 41.04 µm2, p < 0.05). In addition, the aneuploidy incidence was higher in eggs with advanced reproductive age (24-27% vs. 8-9%, p < 0.05). There were no differences in the morphokinetic parameters of oocyte maturation between oocytes from reproductively young and old mice with respect to time to germinal vesicle breakdown (GVBD) (1.03 ± 0.03 vs. 1.01 ± 0.04 h), polar body extrusion (PBE) (8.56 ± 0.11 vs. 8.52 ± 0.15 h), duration of meiosis I (7.58 ± 0.10 vs. 7.48 ± 0.11 h), and kinetics of cumulus expansion (0.093 ± 0.002 vs. 0.089 ± 0.003 µm/min). All morphokinetic parameters of oocyte maturation were similar between euploid and aneuploid eggs irrespective of age. CONCLUSION There is no association between age or ploidy and the morphokinetics of mouse oocyte in vitro maturation (IVM). Future studies are needed to evaluate whether there is an association between morphokinetic dynamics of mouse IVM and embryo developmental competence.
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Affiliation(s)
- Chanakarn Suebthawinkul
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Elnur Babayev
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Hoi Chang Lee
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Francesca E Duncan
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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45
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Serrano-Novillo C, Uroz L, Márquez C. Novel Time-Lapse Parameters Correlate with Embryo Ploidy and Suggest an Improvement in Non-Invasive Embryo Selection. J Clin Med 2023; 12:jcm12082983. [PMID: 37109319 PMCID: PMC10146271 DOI: 10.3390/jcm12082983] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/12/2023] [Accepted: 04/19/2023] [Indexed: 04/29/2023] Open
Abstract
Selecting the best embryo for transfer is key to success in assisted reproduction. The use of algorithms or artificial intelligence can already predict blastulation or implantation with good results. However, ploidy predictions still rely on invasive techniques. Embryologists are still essential, and improving their evaluation tools can enhance clinical outcomes. This study analyzed 374 blastocysts from preimplantation genetic testing cycles. Embryos were cultured in time-lapse incubators and tested for aneuploidies; images were then studied for morphokinetic parameters. We present a new parameter, "st2, start of t2", detected at the beginning of the first cell cleavage, as strongly implicated in ploidy status. We describe specific cytoplasmic movement patterns associated with ploidy status. Aneuploid embryos also present slower developmental rates (t3, t5, tSB, tB, cc3, and t5-t2). Our analysis demonstrates a positive correlation among them for euploid embryos, while aneuploids present non-sequential behaviors. A logistic regression study confirmed the implications of the described parameters, showing a ROC value of 0.69 for ploidy prediction (95% confidence interval (CI), 0.62 to 0.76). Our results show that optimizing the relevant indicators to select the most suitable blastocyst, such as by including st2, could reduce the time until the pregnancy of a euploid baby while avoiding invasive and expensive methods.
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Affiliation(s)
| | - Laia Uroz
- Gravida, Hospital de Barcelona, 08034 Barcelona, Spain
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46
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Wang X, Xiao Y, Zhou Y, Wang H. Development speed of sibling embryo positively reflects live birth rate after fresh day 3 embryo transfer. Sci Rep 2023; 13:6402. [PMID: 37076577 PMCID: PMC10115796 DOI: 10.1038/s41598-023-33573-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 04/14/2023] [Indexed: 04/21/2023] Open
Abstract
The ability of sibling embryos to form blastocysts may reflect the developmental potential of the embryos that were transferred into the uterus. The purpose of the study was to investigate whether the development speed of sibling embryos positively reflects the live birth rate following fresh embryo transfer. We examined 1262 cycles of women who underwent day 3 (D3) cleavage embryo transfer in the Peking Union Medical College Hospital in 2015-2020, who were divided into three groups (D5, D5 + D6, and D6) according to blastocyst formation. The live birth rate in patients with blastocysts that formed on D6 was significantly lower than the other two groups (36.1%, 45.6% and 44.7%, P < 0.05). For women with blastocysts that formed on D6, the live birth rate was higher in those with more good quality blastocysts than poor-quality blastocysts (42.4 vs 32.3%, P < 0.05). Multiple regression analysis showed that the blastocyst development speed of sibling embryos was an independent factor affecting live birth after fresh embryo transfer (P < 0.05). We concluded that the blastocyst development speed of sibling embryos may reflect live birth rate following the transfer of D3 cleavage embryos.
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Affiliation(s)
- Xue Wang
- Department of Gynaecology Endocrine and Reproductive Centre, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
| | - Yaling Xiao
- Department of Gynaecology Endocrine and Reproductive Centre, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Yuanzheng Zhou
- Department of Gynaecology Endocrine and Reproductive Centre, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Hanbi Wang
- Department of Gynaecology Endocrine and Reproductive Centre, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
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47
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Poh QH, Rai A, Salamonsen LA, Greening DW. Omics insights into extracellular vesicles in embryo implantation and their therapeutic utility. Proteomics 2023; 23:e2200107. [PMID: 36591946 DOI: 10.1002/pmic.202200107] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/14/2022] [Accepted: 12/15/2022] [Indexed: 01/03/2023]
Abstract
Implantation success relies on intricate interplay between the developing embryo and the maternal endometrium. Extracellular vesicles (EVs) represent an important player of this intercellular signalling through delivery of functional cargo (proteins and RNAs) that reprogram the target cells protein and RNA landscape. Functionally, the signalling reciprocity of endometrial and embryo EVs regulates the site of implantation, preimplantation embryo development and hatching, antioxidative activity, embryo attachment, trophoblast invasion, arterial remodelling, and immune tolerance. Omics technologies including mass spectrometry have been instrumental in dissecting EV cargo that regulate these processes as well as molecular changes in embryo and endometrium to facilitate implantation. This has also led to discovery of potential cargo in EVs in human uterine fluid (UF) and embryo spent media (ESM) of diagnostic and therapeutic value in implantation success, fertility, and pregnancy outcome. This review discusses the contribution of EVs in functional hallmarks of embryo implantation, and how the integration of various omics technologies is enabling design of EV-based diagnostic and therapeutic platforms in reproductive medicine.
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Affiliation(s)
- Qi Hui Poh
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.,Department of Biochemistry and Chemistry, School of Agriculture, Biomedicine and Environment, La Trobe University, Melbourne, Victoria, Australia
| | - Alin Rai
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.,Baker Department of Cardiovascular Research, Translation and Implementation, La Trobe University, Melbourne, Victoria, Australia.,Baker Department of Cardiometabolic Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Lois A Salamonsen
- Centre for Reproductive Health, Hudson Institute of Medical Research, Clayton, Victoria, Australia.,Department of Molecular and Translational Medicine, Monash University, Clayton, Victoria, Australia
| | - David W Greening
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.,Department of Biochemistry and Chemistry, School of Agriculture, Biomedicine and Environment, La Trobe University, Melbourne, Victoria, Australia.,Baker Department of Cardiovascular Research, Translation and Implementation, La Trobe University, Melbourne, Victoria, Australia.,Baker Department of Cardiometabolic Health, University of Melbourne, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
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48
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Jiang Y, Jiang R, He H, Ren X, Yu Q, Jin L. Comparison of clinical outcomes for different morphological scores of D5 and D6 blastocysts in the frozen-thawed cycle. BMC Pregnancy Childbirth 2023; 23:97. [PMID: 36747146 PMCID: PMC9900991 DOI: 10.1186/s12884-023-05415-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 01/30/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Both embryo development speed and embryo morphology score played a significant role in frozen-thawed embryo transfer cycle (FET) outcomes. Most of the literature indicates that D5 embryos performed better than D6 embryos, although a few also indicate that there is no difference in clinical outcomes between D5 and D6 embryos. Clinically, D5 embryos are preferred for equal morphological scores. But how to choose embryos when the morphological score of D6 embryos is better than D5? METHODS A retrospective study including 8199 frozen-thawed embryo transfers (FETs) was conducted to analyze patients who underwent IVF-FET from January 2018 to December 2020. Patients were divided into 8 groups according to the rate of embryonic development and morphological scores to compare pregnancy outcomes. We further compared clinical pregnancy outcomes and neonatal outcomes between BC embryos on day 5 (D5) and BA/BB embryos on day 6 (D6). RESULTS Our study found no difference in clinical pregnancy rate (CPR) and live birth rate (LBR) between AA/AB blastocysts in D5 or D6 frozen blastocysts. However, for BA/BB/BC blastocysts, embryonic pregnancy outcome was significantly better in D5 than in D6. In our further analysis and comparison of BC embryos in D5 and BA/BB embryos in D6, we found no difference in clinical pregnancy outcomes and neonatal outcomes, but D6 BA/BB embryos had a higher rate of miscarriage. After adjusting for confounding factors, none of the indicators differed between groups. CONCLUSION Our study provides suggestions for embryo selection: AA/AB embryos are preferred, regardless of the embryo development day, and the second choice is BA or BB embryos on D5. BA/BB embryos in D6 had a higher miscarriage rate than BC embryos in D5 but were not statistically significant after adjusting for confounding factors.
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Affiliation(s)
- Yaping Jiang
- grid.33199.310000 0004 0368 7223Department of Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei PR China
| | - Rui Jiang
- grid.33199.310000 0004 0368 7223Laboratory of Clinical Immunology, Wuhan No. 1 Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei PR China
| | - Hui He
- grid.33199.310000 0004 0368 7223Department of Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei PR China
| | - Xinling Ren
- grid.33199.310000 0004 0368 7223Department of Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei PR China
| | - Qiong Yu
- Department of Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China.
| | - Lei Jin
- Department of Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China.
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Mariya T, Sugimoto T, Kato T, Endo T, Kurahashi H. The age-related required number of zygotes estimated from prior clinical studies of preimplantation genetic testing for aneuploidy (PGT-A). Syst Biol Reprod Med 2023; 69:50-56. [PMID: 36624976 DOI: 10.1080/19396368.2022.2151387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Women who are undergoing preimplantation genetic testing for aneuploidy (PGT-A) often wish to know how many eggs will be required to optimize the chances of a live birth. However, no precise data on this can yet be provided during genetic counseling for this procedure. On the basis of PGT-A data from related studies and current databases, we have estimated that the number of zygotes required for a 50% chance of a live birth is 8 at age 40 but increases markedly to 21 at age 43. PGT-A markedly reduces the miscarriage rate per embryo transfer but does not alleviate the extremely high number of zygotes required for a live birth in women of an advanced maternal age. Detailed genetic counseling will therefore be desirable prior to undergoing this procedure.
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Affiliation(s)
- Tasuku Mariya
- Division of Molecular Genetics, Institute for Comprehensive Medical Science, Fujita Health University, Aichi, Japan.,Department of Obstetrics and Gynecology, School of Medicine, Sapporo Medical University, Sapporo, Japan
| | - Takeshi Sugimoto
- Division of Molecular Genetics, Institute for Comprehensive Medical Science, Fujita Health University, Aichi, Japan.,Kobe Motomachi Yume Clinic, Kobe, Japan
| | - Takema Kato
- Division of Molecular Genetics, Institute for Comprehensive Medical Science, Fujita Health University, Aichi, Japan
| | - Toshiaki Endo
- Department of Obstetrics and Gynecology, School of Medicine, Sapporo Medical University, Sapporo, Japan
| | - Hiroki Kurahashi
- Department of Obstetrics and Gynecology, School of Medicine, Sapporo Medical University, Sapporo, Japan
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50
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Villanacci R, Buzzaccarini G, Marzanati D, Vanni VS, De Santis L, Alteri A, Candiani M, Pagliardini L, Papaleo E. Delayed blastocyst development is influenced by the level of progesterone on the day of trigger. J Assist Reprod Genet 2023; 40:361-370. [PMID: 36542311 PMCID: PMC9935760 DOI: 10.1007/s10815-022-02682-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2022] Open
Abstract
PURPOSE To evaluate the association between progesterone (P) level on the day of trigger and time to blastulation in IVF cycles. METHODS This was a retrospective cohort study with autologous IVF cycles performed at our Institution from January 2019 to December 2021. A total of 1109 IVF cycles were included. The primary outcome was to compare time to blastulation in terms of percentage of expanded (grade 3) blastocysts on day 5 according to progesterone level at trigger. RESULTS A total of 3517 blastocysts were analyzed. After dividing progesterone level in quartiles (Q1, P < 0.50 ng/ml; Q2 0.50 ng/ml ≤ P ≤ 0.78 ng/ml; Q3, 0.79 ng/ml ≤ P ≤ 1.15 ng/ml; Q4, P > 1.15 ng/ml), we observed a delay in blastocyst development according to the increasing level of progesterone at trigger (analysis by rank, P-value = 0.01). After adjusting for confounding factors at the multivariate analysis, the percentage of day 5 blastocysts was reduced for Q3 (- 13.8%, 95% CI from - 20.5 to - 7.0%, p < 0.001) and Q4 (- 7.7%, 95% CI from - 15.5 to 0.0%, p = 0.05) compared to Q1 (reference). CONCLUSIONS Progesterone levels on day of trigger correlate to the percentage of expanded (grade 3) blastocysts on day 5 and a delayed blastocyst development day 5 is expected for high progesterone levels.
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Affiliation(s)
- Roberta Villanacci
- Gynecology/Obstetrics Unit, IRCCS San Raffaele Scientific Institute, 20132, Milan, Italy
| | - Giovanni Buzzaccarini
- Gynecology/Obstetrics Unit, IRCCS San Raffaele Scientific Institute, 20132, Milan, Italy
| | - Daria Marzanati
- Reproductive Sciences Lab, Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Valeria Stella Vanni
- Gynecology/Obstetrics Unit, IRCCS San Raffaele Scientific Institute, 20132, Milan, Italy
| | - Lucia De Santis
- Gynecology/Obstetrics Unit, IRCCS San Raffaele Scientific Institute, 20132, Milan, Italy
| | - Alessandra Alteri
- Gynecology/Obstetrics Unit, IRCCS San Raffaele Scientific Institute, 20132, Milan, Italy
| | - Massimo Candiani
- Gynecology/Obstetrics Unit, IRCCS San Raffaele Scientific Institute, 20132, Milan, Italy
| | - Luca Pagliardini
- Reproductive Sciences Lab, Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.
- Department of Brain and Behavioral Sciences, University of Pavia, 27100, Pavia, Italy.
| | - Enrico Papaleo
- Gynecology/Obstetrics Unit, IRCCS San Raffaele Scientific Institute, 20132, Milan, Italy
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