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Zhu X, Tian T, Jiesisibieke D, Fang S, Zhang N, Ma J, Xia Y, Liu P, Li R, Qiao J, Yang R. Clinical outcome of different embryo transfer strategies after late rescue ICSI procedure: a 10-year total fertilisation failure cohort study. BMC Pregnancy Childbirth 2023; 23:549. [PMID: 37525112 PMCID: PMC10388511 DOI: 10.1186/s12884-023-05859-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 07/19/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Late rescue intracytoplasmic sperm injection (r-ICSI) has not been widely accepted as an alternative solution for unexpected total fertilisation failure (TFF) after in vitro fertilisation (IVF), due to the time-dependent in vitro deterioration of oocyte quality and endometrial growth not being synchronised with embryo development. This study aimed to evaluate the safety profile and effectiveness of freeze-all blastocyst transfer in combination with late r-ICSI. METHODS This was a retrospective cohort study carried out at the Reproductive Centre of Peking University Third Hospital, Beijing, China. All participants received treatment between 2009 and 2019. 2,270 patients in the aggregate encountered unexpected TFF during 149,054 cycles of IVF and adopted a late r-ICSI procedure. Among these patients, 263 women did not have cleavage-stage embryos available for evaluation. The remaining patients were grouped according to different embryo transfer (ET) strategies (926 women in Group 1 underwent fresh ET, 365 women in Group 2 underwent freeze-all ET, 716 women in Group 3 experienced blastulation failure). Patients received different ET strategies after r-ICSI, with the main outcome measures included live birth rate (LBR), cumulative live birth rate (cLBR), and conservative cLBR. RESULTS TFF occurred in 7.4% of all IVF cycles. Group 1 tended to be older at oocyte retrieval, with more infertile years, higher follicle-stimulating hormone (FSH) levels, higher gonadotropin consumption, and fewer oocytes retrieved. Group 2 exhibited considerably better LBRs following the first ET cycle (37.53% vs. 4.64%) and cLBRs (52.60% vs. 8.21%). After adjustment for covariates using binary logistic regression analyses, Group 2 still showed better obstetric performance in LBRs [OR:11.77, 95% CI (8.42-16.45)], cLBRs (OR:11.29, 95% CI (7.84-16.27)], and conservative cLBRs (OR:2.55, 95% CI (1.83-3.55)]. Additionally, the two groups showed similar miscarriage rates, whilst no new-borns with malformations or congenital diseases were reported. CONCLUSIONS Freeze-all blastocyst stage ET serves as an optimal strategy to support late r-ICSI. However, for women with limited oocytes available for r-ICSI use, weighing the benefits against the costs of the procedure might be prudent before implementing in vitro blastulation.
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Affiliation(s)
- Xiaxuan Zhu
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, No. 49 North Huayuan Road, Haidian District, Beijing, 100191, China
| | - Tian Tian
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, No. 49 North Huayuan Road, Haidian District, Beijing, 100191, China
- National Clinical Research Center for Obstetrics and Gynecology, 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, Beijing, 100191, China
| | - Dina Jiesisibieke
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, No. 49 North Huayuan Road, Haidian District, Beijing, 100191, China
| | - Shilin Fang
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, No. 49 North Huayuan Road, Haidian District, Beijing, 100191, China
| | - Nan Zhang
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, No. 49 North Huayuan Road, Haidian District, Beijing, 100191, China
| | - Jinxi Ma
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, No. 49 North Huayuan Road, Haidian District, Beijing, 100191, China
| | - Yuqi Xia
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, No. 49 North Huayuan Road, Haidian District, Beijing, 100191, China
| | - Ping Liu
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, No. 49 North Huayuan Road, Haidian District, Beijing, 100191, China
- National Clinical Research Center for Obstetrics and Gynecology, 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, Beijing, 100191, China
| | - Rong Li
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, No. 49 North Huayuan Road, Haidian District, Beijing, 100191, China
- National Clinical Research Center for Obstetrics and Gynecology, 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, Beijing, 100191, China
| | - Jie Qiao
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, No. 49 North Huayuan Road, Haidian District, Beijing, 100191, China
- National Clinical Research Center for Obstetrics and Gynecology, 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, Beijing, 100191, China
| | - Rui Yang
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, No. 49 North Huayuan Road, Haidian District, Beijing, 100191, China.
- National Clinical Research Center for Obstetrics and Gynecology, 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, Beijing, 100191, China.
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Bostanci MS, Budak Ö, Çakiroğlu H, Köse O, Erdoğan M, Yuvaci HU, Çokluk E. The Effectiveness of Granulocyte Colony-Stimulating Factor (G-CSF) Against Experimental Ischemia–Reperfusion Injury in Rat Ovaries and Its Effect on In Vitro Fertilization Outcomes. Reprod Sci 2022; 30:1660-1667. [PMID: 36414821 DOI: 10.1007/s43032-022-01132-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 11/14/2022] [Indexed: 11/24/2022]
Abstract
Local ischemic damage resulting from ovarian torsion is a common cause of decreased follicular activity and infertility. It was aimed to evaluate the effect of granulocyte colony-stimulating factor (G-CSF) protection on in vitro fertilization (IVF) results against experimental ischemic (I) and ischemic-reperfusion (I/R) injury in rat ovaries. The study consisted of 35 adult female Sprague-Dawley albino rats (sham, ischemia, I/R, I + G-CSF, and I/R + G-CSF) randomly assigned to 5 groups, each containing 7 rats. While bilateral adnexal torsion was applied to the ischemia groups for 3 h, detorsion was applied to the reperfusion groups. Intraperitoneal 100 IU/kg G-CSF was administered 30 min prior to ischemia (I + G-CSF) or reperfusion (I/R + G-CSF). After ovulation induction (intraperitoneal 150-300 IU/kg PMSG), the oocytes were collected and IVF was applied. Statistically significant differences were observed between the collected oocyte numbers in I and I + G-CSF, I/R, and I/R + G-CSF groups (P values were P = 0.001 for the I-I + G-SCF groups and P = 0.003 for I/R-IR + G-CSF, respectively). An increase in the number of MII oocytes obtained was observed in the I + G-CSF and I/R + G-CSF groups compared to the I and I/R groups. Grade 1 and grade 2 embryo numbers were statically different between the I/R and I/R + G-CSF groups (P values were P = 0.023 for grade 1 embryos and P = 0.045 for grade 2 embryos, respectively). G-CSF treatment was found to be effective in reducing I- and I/R-induced ovarian damage.
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Affiliation(s)
- Mehmet Sühha Bostanci
- Department of Obstetrics and Gynecology and Artificial Reproductive Techniques, Faculty of Medicine, Sakarya University, Sakarya, Turkey.
| | - Özcan Budak
- Department of Histology and Embryology and Artificial Reproductive Techniques, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Hüseyin Çakiroğlu
- Medical and Experimental Research Center, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Osman Köse
- Department of Urology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Mehtap Erdoğan
- Department of Anatomy, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Hilal Uslu Yuvaci
- Department of Obstetrics and Gynecology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Erdem Çokluk
- Department of Biochemistry, Faculty of Medicine, Sakarya University, Sakarya, Turkey
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Yang J, Li D, Zha H, Yabin C, Bie J, Song J, Chen J, Liang Y, Jiang F, Meng Y. Should blastocyst transfer be performed in patients with 1-3 embryos available on day 3? Reprod Biomed Online 2022; 45:1118-1123. [DOI: 10.1016/j.rbmo.2022.08.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 07/30/2022] [Accepted: 08/08/2022] [Indexed: 10/15/2022]
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Strategy for embryo transfer to improve pregnancy outcomes in advanced maternal age. ZYGOTE 2022; 30:781-789. [PMID: 35860989 DOI: 10.1017/s0967199422000259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The purpose of this retrospective study was to optimize the transplantation strategy for women of advanced maternal age to achieve live births within the shortest time. Data were collected from patients older than 40 years who underwent assisted reproductive therapy at our centre from 1 January 2009 to 31 December 2019. In total, 1023 cases of fresh cleavage embryo transfer (CET) cycles, 280 cases of frozen-thawed blastocyst transfer (FBT) cycles, and 26 cases of frozen-thawed CET (FCET) cycles were included. The main outcome was the live birth rate (LBR). The secondary outcomes were the clinical pregnancy rate (CPR) and neonatal outcomes. Multivariable logistic regression was performed to adjust for confounding factors. The blastocyst formation rate of patients older than 40 years was 23.5%, the freezing cycle rate was 19.8%, and the fresh-embryo transfer rate was 83.0%. The implantation rate, CPR, and LBR were significantly different among the CET, FCET, and FBT groups. There were no significant differences in multiple pregnancies and abortion rates among the groups, and neonatal outcomes were similar. Multivariate logistic regression analysis showed that, compared with the CET group, LBR did not increase in the FCET group, whereas LBR increased in the FBT group. For patients older than 40 years when having approximately eight embryos after fertilization, blastocyst transfer can be considered after fully discussing the advantages and disadvantages of blastocyst culture. Alternatively, CET can be performed first, followed by FBT if the cleavage embryo transfer is unsuccessful.
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Abstract
The metaphase II (MII) oocyte is the mature female gamete, produced from a complex maturation process called oogenesis that starts in the first weeks of embryogenesis in the female embryo tract, continues during puberty, and is completed at fertilization with the spermatozoon. Oogenesis is closely related to folliculogenesis. In assisted reproduction techniques, oocytes are retrieved in cumulus-oocyte complexes after ovarian stimulation. Before being used for in vitro fertilization or cryopreservation, the metaphase (MII) oocytes can be classified according to different morphological traits and by the presence/absence of the meiotic spindle. Except for a few and rare morphological characteristics that make the oocyte discarded, none of the morphological characteristics is predictive of oocyte competence in giving a viable embryo. On the other side, specific key performance indicators based on MII oocytes test the efficacy of in vitro treatments. Molecular, cellular, or genetic abnormalities in the oocytes have observable consequences on the embryo development dynamics and its genetic content. Besides what can be seen in vitro, several intrinsic and extrinsic factors related to the patient are responsible for the oocyte quality. The clinician and the patient herself must be aware of these factors to preserve the reproductive functions as much as possible. In the present review, we have revised oogenesis and the role of mature oocytes in supporting the fertilization process and early embryo development; we have also listed the oocyte morphological traits and key performance indicators related to the oocyte quality and studied the intrinsic and extrinsic factors that irreversibly impact female fertility.
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Affiliation(s)
- Sandrine Chamayou
- Unit of Reproductive Medicine, HERA Center, Sant'Agata Li Battiati, Catania, Italy -
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Dietrich JE, Strowitzki T. Embryotransfer an Tag 2/3 vs. Tag 5/6 und „time-lapse imaging“. GYNAKOLOGISCHE ENDOKRINOLOGIE 2021. [DOI: 10.1007/s10304-021-00422-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Lebedev IN, Zhigalina DI. From contemplation to classification of chromosomal mosaicism in human preimplantation embryos. J Assist Reprod Genet 2021; 38:2833-2848. [PMID: 34518954 PMCID: PMC8609036 DOI: 10.1007/s10815-021-02304-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 08/17/2021] [Indexed: 10/20/2022] Open
Abstract
Chromosomal mosaicism is a hallmark of early human embryo development. The last decade yielded an enormous amount of information about diversity and prevalence of mosaicism in preimplantation embryos due to progress in preimplantation genetic testing of aneuploidies (PGT-A) based exclusively on molecular karyotyping of trophectoderm biopsy. However, the inner cell mass karyotype is still missing for mosaic embryos affecting the success rate of assisted reproductive medicine. Here, a classification model of chromosomal mosaicism is proposed based on the analysis of the primary zygote karyotype, the timing and types of primary and secondary chromosome segregation errors, and the distribution of mosaic cell clones between different embryonic and extraembryonic compartments of the blastocyst. Five basic principles for mosaicism analysis are introduced, namely, the estimation of the primary zygote karyotype, the investigation of additional sample point, the requirement of the second time point analysis, the delineating of reciprocity of chromosome segregation, and comprehensive chromosome screening at the single-cell level. The suggested model allows the prediction of the inner cell mass karyotype of the blastocyst and its developmental potential based on information from trophectoderm biopsy and non-invasive PGT-A using blastocoele fluid sample or spent culture medium as additional sample and time points for analysis and considering the reciprocity as a basic process in chromosome segregation errors between daughter cells in postzygotic cell divisions.
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Affiliation(s)
- Igor N. Lebedev
- Research Institute of Medical Genetics, Tomsk National Research Medical Center of the Russian Academy of Sciences, Ushaika Street 10, Tomsk, 634050 Russia
| | - Daria I. Zhigalina
- Research Institute of Medical Genetics, Tomsk National Research Medical Center of the Russian Academy of Sciences, Ushaika Street 10, Tomsk, 634050 Russia
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Sadecki E, Rust L, Walker DL, Fredrickson JR, Krenik A, Kim T, Weaver AL, Zhao Y. Comparison of live birth rates after IVF-embryo transfer with and without preimplantation genetic testing for aneuploidies. Reprod Biomed Online 2021; 43:995-1001. [PMID: 34674943 DOI: 10.1016/j.rbmo.2021.09.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 09/07/2021] [Accepted: 09/08/2021] [Indexed: 10/20/2022]
Abstract
RESEARCH QUESTION Does the use of preimplantation genetic testing for aneuploidies (PGT-A) result in higher live birth rates when compared with both fresh and frozen embryo transfers (FET) not utilizing PGT-A? DESIGN Retrospective cohort study at a single tertiary centre using inverse probability of treatment weighting (IPTW) to adjust for differences in baseline characteristics between groups. RESULTS A total of 107 FET using PGT-A from 74 patients, along with 321 fresh and 286 FET not using PGT-A from 381 patients met the inclusion criteria for this study. In the IPTW-adjusted analysis of transfer-level data, PGT-A transfers resulted in a significantly higher live birth rate when compared with both non-PGT-A fresh (49.5% versus 38.6%, P = 0.036) and FET (50.6% versus 35.8%, P = 0.016). When data were analysed per retrieval level, the live birth rate was similar and acceptably high with or without PGT-A (63.7% versus 52.3%, P = 0.09). CONCLUSION When comparing PGT-A to non-PGT-A fresh and FET, PGT-A embryo transfers have a significantly higher live birth rate. However, this difference did not persist at a per-retrieval level. Further investigation is needed to understand in what scenarios PGT-A has clinical significance and whether differences in the number of available embryos for transfer negates the benefit of PGT-A.
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Affiliation(s)
- Emily Sadecki
- Mayo Clinic College of Medicine and Science, Rochester MN, USA.
| | - Laura Rust
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester MN, USA
| | - David L Walker
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester MN, USA; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester MN, USA
| | - Jolene R Fredrickson
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester MN, USA; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester MN, USA
| | - Anthony Krenik
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester MN, USA; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester MN, USA
| | - Tana Kim
- Reproductive Medicine and Infertility Associates, Woodbury MN, USA
| | - Amy L Weaver
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester MN, USA
| | - Yulian Zhao
- Mayo Clinic College of Medicine and Science, Rochester MN, USA; Department of Obstetrics and Gynecology, Mayo Clinic, Rochester MN, USA; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester MN, USA
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Coccia ME, Rizzello F, Wakunga S, Badolato L, Evangelisti P, Bertocci F, Giachini C, Criscuoli L, Micelli E, Picone R. 'Two countries-two labs': the transnational gamete donation (TGD) programme to support egg donation. J Assist Reprod Genet 2020; 37:3039-3049. [PMID: 33047185 PMCID: PMC7714895 DOI: 10.1007/s10815-020-01961-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 09/30/2020] [Indexed: 11/01/2022] Open
Abstract
PURPOSE To evaluate the effectiveness, efficiency, and safety of a transnational gamete donation (TGD) programme based on the shipping of vitrified donor oocytes. METHODS A retro-prospective observational study was conducted in the Assisted Reproductive Technology Center of the University Hospital of Florence, Italy. The study population included 622 consecutive donor oocyte cycles. A mean number of 6 vitrified oocytes per couple were shipped from two Spanish biobanks. In the receiving centre, gametes were warmed and inseminated and the subsequent embryo transfer (ET) was performed. The main outcome measurement was LBR. Secondary outcomes included oocyte survival rate, ICSI damage rate, normal fertilization, cleavage, and implantation rate (IR) in both 'fresh' and cryotransfer cycles. RESULTS A total number of 3536 mature oocytes were warmed with 81.4% surviving oocytes. 2PN oocytes were 1941 with an ICSI normal fertilization rate of 70.4% and a cleavage rate of 93.4%; 857 day-3 embryos were transferred in 498 women, 63 blastocysts in 44. Couples with at least one vitrified embryo were 181 (32.3%). IR was 25.1% and 33.1% for day-3 ET and blastocyst stage respectively. Crude pregnancy rate and LBR after the first ET were 35.5% and 27% correspondingly with a conservative cumulative LBR of 34% and an optimal LBR of 51.4%. CONCLUSION Imported vitrified donor oocytes retain their competence and are capable of resulting in ongoing pregnancies and healthy babies in a proportion comparable to other existing systems as egg donation with vitrification/warming in the same laboratory and transnational fresh oocyte donation.
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Affiliation(s)
- Maria Elisabetta Coccia
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Francesca Rizzello
- Assisted Reproductive Technology Centre, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy.
| | | | - Laura Badolato
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Paolo Evangelisti
- Assisted Reproductive Technology Centre, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy
| | - Francesco Bertocci
- Assisted Reproductive Technology Centre, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy
| | | | - Luciana Criscuoli
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Elisabetta Micelli
- Assisted Reproductive Technology Centre, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy
| | - Rita Picone
- Assisted Reproductive Technology Centre, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy
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Zhu Q, Lin J, Gao H, Wang N, Wang B, Wang Y. The Association Between Embryo Quality, Number of Transferred Embryos and Live Birth Rate After Vitrified Cleavage-Stage Embryos and Blastocyst Transfer. Front Physiol 2020; 11:930. [PMID: 32922305 PMCID: PMC7456822 DOI: 10.3389/fphys.2020.00930] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 07/10/2020] [Indexed: 11/13/2022] Open
Abstract
Objective The single-embryo transfer (SET) is the recommended approach to improve the live birth rate and reduce the complications related with multiple pregnancies. However, the physicians generally chose to transfer two embryos when the embryo quality decreased. The effect on the in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) outcomes following the transfer of a poor-quality embryo (PQE) along with a good-quality embryo (GQE) has been explored. However, previous studies were limited by the fresh embryo transfer cycles or the small sample size. Methods A retrospective cohort study was performed among 26,676 women (the mean age was 31.72 years) undergoing first frozen embryo transfer (FET) from January 2011 to December 2017. Patients were grouped into five subgroups, including SET with one GQE (SET-GQE, 2235 patients for cleavage-stage embryo transfer and 756 patients for blastocyst transfer), SET with one PQE (SET-PQE, 148 patients for cleavage-stage embryo transfer and 362 patients for blastocyst transfer), double-embryo transfer with two GQE (DET-2GQE, 20,461 patients for cleavage-stage embryo transfer and 519 patients for blastocyst transfer), double-embryo transfer (DET) with one GQE plus one PQE (DET-GQE+PQE, 1541 patients for cleavage-stage embryo transfer and 266 patients for blastocyst transfer), and DET with two PQE (DET-2PQE, 228 patients for cleavage-stage embryo transfer and 160 patients for blastocyst transfer). Multivariable logistic regression models were performed after controlling for other potential confounders to estimate the effect of number and quality of transferred embryos on pregnancy outcomes. Result Although the live birth rate was significantly higher after DET-GQE+PQE compared with SET-GQE for cleavage-stage embryo transfer [574 of 1541 (37.25%) vs. 571 of 2235 (25.55%)], no significant difference was found between DET-GQE+PQE and SET-GQE for blastocyst transfer [143 of 266 (53.76%) vs. 325 of 756 (42.99%)]. However, DET-GQE+PQE also had the highest multiple live births in both cleavage-stage embryo transfer [134 of 1541 (8.70%)] and blastocyst transfer [46 of 266 (17.29%)]. The live birth rate after SET-PQE significantly decreased in comparison with SET-GQE [cleavage-stage embryo transfer: 18 of 148 (12.16%) vs. 571 of 2235 (25.55%); blastocyst transfer: 107 of 362 (29.56%) vs. 325 of 756 (42.99%)] and significantly increased after DET-2GQE compared with SET-GQE [cleavage-stage embryo transfer: 9357 of 20,461 (45.73%) vs. 571 of 2235 (25.55%); blastocyst transfer: 313 of 519 (60.31%) vs. 325 of 756 (42.99%)]. The live birth rate was also not different between DET-2PQE and SET-GQE for cleavage-stage embryo transfer and blastocyst transfer [cleavage-stage embryo transfer: 75 of 228 (32.89%) vs. 571 of 2235 (25.55%); blastocyst transfer: 74 of 160 (46.25%) vs. 325 of 756 (42.99)]. Conclusion In order to minimize the risk of multiple births, the data from this study did not support transferring DET with a GQE plus a PQE compared with SET with a GQE, especially for blastocyst transfer. However, the proportion of patients older than 35 years was small (12.07% for patients aged 36-39 years and 7.31% for patients 40 years or older), which limited the generalization of these results to other population.
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Affiliation(s)
- Qianqian Zhu
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital Affiliated to Jiao Tong University School of Medicine, Shanghai, China
| | - Jiaying Lin
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital Affiliated to Jiao Tong University School of Medicine, Shanghai, China
| | - Haoyuan Gao
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital Affiliated to Jiao Tong University School of Medicine, Shanghai, China
| | - Ningling Wang
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital Affiliated to Jiao Tong University School of Medicine, Shanghai, China
| | - Bian Wang
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital Affiliated to Jiao Tong University School of Medicine, Shanghai, China
| | - Yun Wang
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital Affiliated to Jiao Tong University School of Medicine, Shanghai, China
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Morula transfer achieves better clinical outcomes than post-thawed cleavage embryos after overnight culture in frozen embryo transfer (FET) cycles. J Assist Reprod Genet 2020; 37:945-952. [PMID: 32072380 DOI: 10.1007/s10815-020-01708-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 01/30/2020] [Indexed: 10/25/2022] Open
Abstract
PURPOSE This study aimed to investigate the clinical outcomes of morula stage transfer derived from post-thawed cleavage embryos undergoing overnight culture in frozen embryo transfer (FET) cycles. METHODS We performed a retrospective study that included 392 FET cycles with 784 thawed embryos undergoing overnight culture between January 2014 and December 2018. Embryos were divided into three groups in terms of their status: 8-16 cells without morula (group I), one morula (group II), and two morulae (group III). The clinical outcomes of these cycles were then compared between the three groups. Logistic regression analysis was performed to control for confounders. RESULTS Group III was associated with a significantly higher clinical pregnancy rate (odds ratio [OR] 2.35; 95% confidence interval [CI] 1.29-4.27; P = 0.005), implantation rate (OR 3.00; CI 1.75-5.16; P < 0.001), multiple pregnancy rate (OR 4.91; CI 2.11-11.40; P < 0.001), and live birth rate (OR 1.96; CI 1.10-3.49; P = 0.022) than group I. Group II had a higher live birth rate than group I after adjustment (OR 1.70; CI 1.04-2.79; P = 0.035). There was no difference in the rate of premature delivery when compared across the three groups after adjustment. CONCLUSION The transfer of morula stage embryos following the overnight culture of post-thawed cleavage embryos led to an improvement in the clinical outcomes of FET cycles. It is important to reduce the number of morula embryos transferred in order to achieve a singleton pregnancy.
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Kontopoulos G, Simopoulou M, Zervomanolakis I, Prokopakis T, Dimitropoulos K, Dedoulis E, Grigorakis S, Agapitou K, Nikitos E, Rapani A, Vlahos N. Cleavage Stage versus Blastocyst Stage Embryo Transfer in Oocyte Donation Cycles. ACTA ACUST UNITED AC 2019; 55:medicina55060293. [PMID: 31226849 PMCID: PMC6631639 DOI: 10.3390/medicina55060293] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 06/04/2019] [Accepted: 06/13/2019] [Indexed: 12/26/2022]
Abstract
Background and Objective: During the last few years, a trend has been noted towards embryos being transferred at the blastocyst stage, which has been associated with improved rates regarding implantation and clinical pregnancy in comparison to cleavage stage embryo transfers. There is a limited number of studies investigating this notion in oocyte donation cycles employing cryopreserved embryos. The aim of this study is to evaluate the implantation potential and clinical pregnancy rates between the day 3 cleavage stage and blastocyst stage embryo transfers in oocyte donation cycles employing vitrified embryos. Methods: This is a retrospective evaluation of oocyte donation frozen–thawed transfers completed in our clinic from January 2017 to December 2017. Intracytoplasmic sperm injection was conducted for all oocytes. Following fertilization, all embryos were cryopreserved either at the cleavage or blastocyst stage. Embryo transfer of two embryos was performed under direct sonographic guidance in all cases. Results: Our results confirmed a 55.6% clinical pregnancy (CP) resulting from day 3 embryo transfers, a 68.8% CP from day 5, and 71.4% CP from day 6. Significantly improved pregnancy rates were related to embryo transfers at the blastocyst stage when compared to cleavage stage transfers (68.9% and 55.6% respectively, p = 0.016). The risk with regards to multiple pregnancies was similar. Conclusion: Our findings indicate that in oocyte donation cycles employing vitrified embryos, embryo transfer at the blastocyst stage is accompanied with a significant improvement in pregnancy rates and merits further investigation.
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Affiliation(s)
- George Kontopoulos
- Institute of LIFE Fertility center, IASO Maternity Hospital, 37-39, Kifissias Avenue, 15123 Athens, Attica, Greece.
| | - Mara Simopoulou
- Assisted Conception Unit, 2nd Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, 76, Vasilisis Sofias Avenue, 11528 Athens, Attica, Greece.
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 75, Mikras Asias, 11527 Athens, Attica, Greece.
| | - Ioannis Zervomanolakis
- Institute of LIFE Fertility center, IASO Maternity Hospital, 37-39, Kifissias Avenue, 15123 Athens, Attica, Greece.
| | - Thomas Prokopakis
- Institute of LIFE Fertility center, IASO Maternity Hospital, 37-39, Kifissias Avenue, 15123 Athens, Attica, Greece.
| | - Kostas Dimitropoulos
- Institute of LIFE Fertility center, IASO Maternity Hospital, 37-39, Kifissias Avenue, 15123 Athens, Attica, Greece.
| | - Evaggelos Dedoulis
- Institute of LIFE Fertility center, IASO Maternity Hospital, 37-39, Kifissias Avenue, 15123 Athens, Attica, Greece.
| | - Stylianos Grigorakis
- Institute of LIFE Fertility center, IASO Maternity Hospital, 37-39, Kifissias Avenue, 15123 Athens, Attica, Greece.
| | - Kristi Agapitou
- Institute of LIFE Fertility center, IASO Maternity Hospital, 37-39, Kifissias Avenue, 15123 Athens, Attica, Greece.
| | - Eros Nikitos
- Institute of LIFE Fertility center, IASO Maternity Hospital, 37-39, Kifissias Avenue, 15123 Athens, Attica, Greece.
| | - Anna Rapani
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 75, Mikras Asias, 11527 Athens, Attica, Greece.
| | - Nikos Vlahos
- Assisted Conception Unit, 2nd Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, 76, Vasilisis Sofias Avenue, 11528 Athens, Attica, Greece.
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Wei D, Liu JY, Sun Y, Shi Y, Zhang B, Liu JQ, Tan J, Liang X, Cao Y, Wang Z, Qin Y, Zhao H, Zhou Y, Ren H, Hao G, Ling X, Zhao J, Zhang Y, Qi X, Zhang L, Deng X, Chen X, Zhu Y, Wang X, Tian LF, Lv Q, Ma X, Zhang H, Legro RS, Chen ZJ. Frozen versus fresh single blastocyst transfer in ovulatory women: a multicentre, randomised controlled trial. Lancet 2019; 393:1310-1318. [PMID: 30827784 DOI: 10.1016/s0140-6736(18)32843-5] [Citation(s) in RCA: 284] [Impact Index Per Article: 56.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 10/29/2018] [Accepted: 11/02/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Elective single embryo transfer (eSET) has been increasingly advocated, but concerns about the lower pregnancy rate after reducing the number of embryos transferred have encouraged transfer of multiple embryos. Extended embryo culture combined with electively freezing all embryos and undertaking a deferred frozen embryo transfer might increase pregnancy rate after eSET. We aimed to establish whether elective frozen single blastocyst transfer improved singleton livebirth rate compared with fresh single blastocyst transfer. METHODS This multicentre, non-blinded, randomised controlled trial was undertaken in 21 academic fertility centres in China. 1650 women with regular menstrual cycles undergoing their first cycle of in-vitro fertilisation were enrolled from Aug 1, 2016, to June 3, 2017. Eligible women were randomly assigned to either fresh or frozen single blastocyst transfer. The randomisation sequence was computer generated, with block sizes of two, four, or six, stratified by study site. For those assigned to frozen blastocyst transfer, all blastocysts were cryopreserved and a delayed frozen-thawed single blastocyst transfer was done. The primary outcome was singleton livebirth rate. Analysis was by intention to treat. This trial is registered at the Chinese Clinical Trial Registry, number ChiCTR-IOR-14005405. FINDINGS 825 women were assigned to each group and included in analyses. Frozen single blastocyst transfer resulted in higher rates of singleton livebirth than did fresh single blastocyst transfer (416 [50%] vs 329 [40%]; relative risk [RR] 1·26, 95% CI 1·14-1·41, p<0·0001). The risks of moderate or severe ovarian hyperstimulation syndrome (four of 825 [0·5%] in frozen single blastocyst transfer vs nine of 825 [1·1%] in fresh single blastocyst transfer; p=0·16), pregnancy loss (134 of 583 [23·0%] vs 124 of 481 [25·8%]; p=0·29), other obstetric complications, and neonatal morbidity were similar between the two groups. Frozen single blastocyst transfer was associated with a higher risk of pre-eclampsia (16 of 512 [3·1%] vs four of 401 [1·0%]; RR 3·13, 95% CI 1·06-9·30, p=0·029). INTERPRETATION Frozen single blastocyst transfer resulted in a higher singleton livebirth rate than did fresh single blastocyst transfer in ovulatory women with good prognosis. The increased risk of pre-eclampsia after frozen blastocyst transfer warrants further studies. FUNDING The National Key Research and Development Program of China.
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Affiliation(s)
- Daimin Wei
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China; The Key Laboratory of Reproductive Endocrinology of Ministry of Education, Jinan, China; National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Jinan, China
| | - Jia-Yin Liu
- Department of Reproductive Medicine, First Affiliated Hospital of Nanjing Medical University/Jiangsu Province Hospital, Nanjing, China; State Key Laboratory of Reproductive Medicine, Nanjing, China
| | - Yun Sun
- Center for Reproductive Medicine, Ren Ji Hospital, Shanghai, China; School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Shanghai Key Laboratory of Assisted Reproduction and Reproductive Genetics, Shanghai, China
| | - Yuhua Shi
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China; The Key Laboratory of Reproductive Endocrinology of Ministry of Education, Jinan, China; National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Jinan, China
| | - Bo Zhang
- Center for Reproductive Medicine, Maternal and Child Health Hospital in Guangxi, Guangxi, China
| | - Jian-Qiao Liu
- Department of Reproductive Medicine, Key Laboratory for Major Obstetric Diseases of Guangdong Province, and Key Laboratory for Reproduction and Genetics of Guangdong Higher Education Institutes, the Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jichun Tan
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, Shengjing Hospital, China Medical University, Shenyang, China
| | - Xiaoyan Liang
- Reproductive Medicine Research Centre, the 6th Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yunxia Cao
- Department of Obstetrics and Gynecology, Reproductive Medicine Center, The First Affiliated Hospital, Anhui Medical University, Hefei, China
| | - Ze Wang
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China; The Key Laboratory of Reproductive Endocrinology of Ministry of Education, Jinan, China; National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Jinan, China
| | - Yingying Qin
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China; The Key Laboratory of Reproductive Endocrinology of Ministry of Education, Jinan, China; National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Jinan, China
| | - Han Zhao
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China; The Key Laboratory of Reproductive Endocrinology of Ministry of Education, Jinan, China; National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Jinan, China
| | - Yi Zhou
- Center for Reproductive Medicine, Qingdao Women's and Children's Hospital, Qingdao University, Qingdao, China
| | - Haiqin Ren
- Department of Reproductive Medicine, Shenyang Dongfang Jinghua Hospital, Shenyang, China
| | - Guimin Hao
- Department of Reproductive Medicine, the Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xiufeng Ling
- Department of Reproductive Medicine, the affiliated Obstetrics and Gynecology Hospital with Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
| | - Junzhao Zhao
- Reproductive Medical Center, the Second Affiliated Hospital of Wenzhou Medical College and Yuying Children's hospital, Wenzhou, China
| | - Yunshan Zhang
- Center for Reproductive Medicine, Tianjin Central Hospital of Obstetrics and Gynecology, Tianjin, China
| | - Xiujuan Qi
- Center for Reproductive Medicine, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Lin Zhang
- Department of Occupational Hygiene, School of Public Health and Management, Weifang Medical University, Weifang, China
| | - Xiaohui Deng
- Center for Reproductive Medicine, Qilu Hospital of Shandong University, Jinan, China
| | - Xiaoli Chen
- Division of Reproductive Medicine, Department of Obstetrics and Gynecology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yimin Zhu
- Department of Reproductive Endocrinology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xiaohong Wang
- Reproductive Medical Center, Tangdu Hospital, the Fourth Military Medical University, Xi'an, China
| | - Li-Feng Tian
- Reproductive Medical Center, Jiangxi Provincial Maternal and Child Health Hospital, Nanchang, China
| | - Qun Lv
- Center for Reproductive Medicine, Sichuan Provincial People's Hospital, Chengdu, China
| | - Xiang Ma
- Department of Reproductive Medicine, First Affiliated Hospital of Nanjing Medical University/Jiangsu Province Hospital, Nanjing, China; State Key Laboratory of Reproductive Medicine, Nanjing, China
| | - Heping Zhang
- Department of Biostatistics, Yale University School of Public Health, New Haven, CT, USA
| | - Richard S Legro
- Department of Obstetrics and Gynecology, Penn State College of Medicine, Hershey, PA, USA
| | - Zi-Jiang Chen
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China; The Key Laboratory of Reproductive Endocrinology of Ministry of Education, Jinan, China; National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Jinan, China; Center for Reproductive Medicine, Ren Ji Hospital, Shanghai, China; School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Shanghai Key Laboratory of Assisted Reproduction and Reproductive Genetics, Shanghai, China.
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Bunnell M, Wilkins-Haug L, Reiss R. Should embryos with autosomal monosomy by preimplantation genetic testing for aneuploidy be transferred?: Implications for embryo selection from a systematic literature review of autosomal monosomy survivors. Prenat Diagn 2017; 37:1273-1280. [DOI: 10.1002/pd.5185] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 11/05/2017] [Accepted: 11/08/2017] [Indexed: 01/24/2023]
Affiliation(s)
- M.E. Bunnell
- Maternal Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Biology; Brigham and Women's Hospital; Boston MA 02115 USA
- Geisel School of Medicine; Dartmouth College; Hanover NH 03755 USA
| | - L. Wilkins-Haug
- Maternal Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Biology; Brigham and Women's Hospital; Boston MA 02115 USA
| | - R. Reiss
- Maternal Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Biology; Brigham and Women's Hospital; Boston MA 02115 USA
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15
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Weissman A, Shoham G, Shoham Z, Fishel S, Leong M, Yaron Y. Preimplantation genetic screening: results of a worldwide web-based survey. Reprod Biomed Online 2017; 35:693-700. [PMID: 28988928 DOI: 10.1016/j.rbmo.2017.09.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 09/03/2017] [Accepted: 09/06/2017] [Indexed: 12/12/2022]
Abstract
Our objective was to evaluate and characterize the extent and patterns of worldwide usage of preimplantation genetic screening (PGS) among the assisted reproductive technique community. A prospective, web-based questionnaire with questions relating to practices of, and views on, PGS was directed to users and non-users of PGS. A total of 386 IVF units from 70 countries conducting 342,600 IVF cycles annually responded to the survey. A total of 77% of respondents routinely carry out PGS in their clinics for a variety of indications: advanced maternal age (27%), recurrent implantation failure (32%) and recurrent pregnancy loss (31%). Few (6%) offer PGS to all their patients. In most cycles (72%), trophectoderm biopsy is carried out and either array-comparative genomic hybridization (59%) or next-generation sequencing (16%) are used for genetic analysis. Only 30% of respondents regard PGS as clearly evidenced-based, and most (84%) believe that more randomized controlled trials are needed to support the use of PGS. Despite ongoing debate and lack of robust evidence, most respondents support the use of PGS, and believe that it may aid in transferring only euploid embryos, thereby reducing miscarriage rates and multiple pregnancies, increasing live birth rates and reducing the risk of aneuploid pregnancies and births.
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Affiliation(s)
- Ariel Weissman
- IVF Unit, Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, 62 Halochamim Street, Holon, 5822012, Israel; Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, 6997801, Israel.
| | - Gon Shoham
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, 6997801, Israel
| | - Zeev Shoham
- IVF Unit, Kaplan Hospital, Rehovot, 7661041, Israel; Hadassah Medical School, Affiliated to the Hebrew University, Jerusalem, Israel
| | - Simon Fishel
- CARE Fertility Group, John Webster House, 6 Lawrence Drive, Nottingham Business Park, Nottingham, NG14 5GU, UK
| | - Milton Leong
- The IVF Clinic, 13/F Central Tower, 28 Queens Road Central, Hong Kong, China
| | - Yuval Yaron
- IVF Unit, Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, 62 Halochamim Street, Holon, 5822012, Israel; Prenatal Genetic Diagnosis Unit, Genetic Institute, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv, 6423906, Israel
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16
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Propensity score-matched study and meta-analysis of cumulative outcomes of day 2/3 versus day 5/6 embryo transfers. Front Med 2017; 11:563-569. [DOI: 10.1007/s11684-017-0535-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 03/10/2017] [Indexed: 10/19/2022]
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17
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Chen M, Wei S, Hu J, Yuan J, Liu F. Does time-lapse imaging have favorable results for embryo incubation and selection compared with conventional methods in clinical in vitro fertilization? A meta-analysis and systematic review of randomized controlled trials. PLoS One 2017; 12:e0178720. [PMID: 28570713 PMCID: PMC5453598 DOI: 10.1371/journal.pone.0178720] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Accepted: 05/17/2017] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE The present study aimed to undertake a review of available evidence assessing whether time-lapse imaging (TLI) has favorable outcomes for embryo incubation and selection compared with conventional methods in clinical in vitro fertilization (IVF). METHODS Using PubMed, EMBASE, Cochrane library and ClinicalTrial.gov up to February 2017 to search for randomized controlled trials (RCTs) comparing TLI versus conventional methods. Both studies randomized women and oocytes were included. For studies randomized women, the primary outcomes were live birth and ongoing pregnancy, the secondary outcomes were clinical pregnancy and miscarriage; for studies randomized oocytes, the primary outcome was blastocyst rate, the secondary outcome was good quality embryo on Day 2/3. Subgroup analysis was conducted based on different incubation and embryo selection between groups. RESULTS Ten RCTs were included, four randomized oocytes and six randomized women. For oocyte-based review, the pool-analysis observed no significant difference between TLI group and control group for blastocyst rate [relative risk (RR) 1.08, 95% CI 0.94-1.25, I2 = 0%, two studies, including 1154 embryos]. The quality of evidence was moderate for all outcomes in oocyte-based review. For woman-based review, only one study provided live birth rate (RR 1,23, 95% CI 1.06-1.44,I2 N/A, one study, including 842 women), the pooled result showed no significant difference in ongoing pregnancy rate (RR 1.04, 95% CI 0.80-1.36, I2 = 59%, four studies, including 1403 women) between two groups. The quality of the evidence was low or very low for all outcomes in woman-based review. CONCLUSIONS Currently there is insufficient evidence to support that TLI is superior to conventional methods for human embryo incubation and selection. In consideration of the limitations and flaws of included studies, more well designed RCTs are still in need to comprehensively evaluate the effectiveness of clinical TLI use.
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Affiliation(s)
- Minghao Chen
- Reproductive Center, Guangdong Women and Children Hospital, Guangzhou, China
| | - Shiyou Wei
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Junyan Hu
- Department of Emergency, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jing Yuan
- School of Traditional Chinese Medicine, Jinan University, Guangzhou, China
| | - Fenghua Liu
- Reproductive Center, Guangdong Women and Children Hospital, Guangzhou, China
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Gleicher N, Metzger J, Croft G, Kushnir VA, Albertini DF, Barad DH. A single trophectoderm biopsy at blastocyst stage is mathematically unable to determine embryo ploidy accurately enough for clinical use. Reprod Biol Endocrinol 2017; 15:33. [PMID: 28449669 PMCID: PMC5408377 DOI: 10.1186/s12958-017-0251-8] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 04/20/2017] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND It has become increasingly apparent that the trophectoderm (TE) at blastocyst stage is much more mosaic than has been appreciated. Whether preimplantation genetic screening (PGS), utilizing a single TE biopsy (TEB), can reliably determine embryo ploidy has, therefore, increasingly been questioned in parallel. METHODS We for that reason here established 2 mathematical models to assess probabilities of false-negative and false-positive results of an on average 6-cell biopsy from an approximately 300-cell TE. This study was a collaborative effort between investigators at The Center for Human Reproduction in New York City and the Center for Studies in Physics and Biology and the Brivanlou Laboratory of Stem Cell Biology and Molecular Embryology, the latter two both at Rockefeller University in New York City. RESULTS Both models revealed that even under best case scenario, assuming even distribution of mosaicism in TE (since mosaicism is usually clonal, a highly unlikely scenario), a biopsy of at least 27 TE cells would be required to reach minimal diagnostic predictability from a single TEB. CONCLUSIONS As currently performed, a single TEB is, therefore, mathematically incapable of reliably determining whether an embryo can be transferred or should be discarded. Since a single TEB, as currently performed, apparently is not representative of the complete TE, this study, thus, raises additional concern about the clinical utilization of PGS.
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Affiliation(s)
- Norbert Gleicher
- The Center for Human Reproduction, 21 East 69th Street, New York, NY, 10021, USA.
- Foundation for Reproductive Medicine, New York, NY, 10022, USA.
- Laboratory of Stem Cell Biology and Molecular Embryology, The Rockefeller University, New York, NY, 10065, USA.
- Department of Obstetrics and Gynecology, University of Vienna School of Medicine, 1090, Vienna, Austria.
| | - Jacob Metzger
- Center for Studies in Physics and Biology, The Rockefeller University, New York, NY, 10065, USA
| | - Gist Croft
- Laboratory of Stem Cell Biology and Molecular Embryology, The Rockefeller University, New York, NY, 10065, USA
| | - Vitaly A Kushnir
- The Center for Human Reproduction, 21 East 69th Street, New York, NY, 10021, USA
- Department of Obstetrics and Gynecology, Wake Forest University, Winston Salem, NC, 27109, USA
| | - David F Albertini
- The Center for Human Reproduction, 21 East 69th Street, New York, NY, 10021, USA
- Laboratory of Stem Cell Biology and Molecular Embryology, The Rockefeller University, New York, NY, 10065, USA
| | - David H Barad
- The Center for Human Reproduction, 21 East 69th Street, New York, NY, 10021, USA
- Foundation for Reproductive Medicine, New York, NY, 10022, USA
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19
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Gleicher N, Orvieto R. Is the hypothesis of preimplantation genetic screening (PGS) still supportable? A review. J Ovarian Res 2017; 10:21. [PMID: 28347334 PMCID: PMC5368937 DOI: 10.1186/s13048-017-0318-3] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 03/22/2017] [Indexed: 11/17/2022] Open
Abstract
The hypothesis of preimplantation genetic diagnosis (PGS) was first proposed 20 years ago, suggesting that elimination of aneuploid embryos prior to transfer will improve implantation rates of remaining embryos during in vitro fertilization (IVF), increase pregnancy and live birth rates and reduce miscarriages. The aforementioned improved outcome was based on 5 essential assumptions: (i) Most IVF cycles fail because of aneuploid embryos. (ii) Their elimination prior to embryo transfer will improve IVF outcomes. (iii) A single trophectoderm biopsy (TEB) at blastocyst stage is representative of the whole TE. (iv) TE ploidy reliably represents the inner cell mass (ICM). (v) Ploidy does not change (i.e., self-correct) downstream from blastocyst stage. We aim to offer a review of the aforementioned assumptions and challenge the general hypothesis of PGS. We reviewed 455 publications, which as of January 20, 2017 were listed in PubMed under the search phrase < preimplantation genetic screening (PGS) for aneuploidy>. The literature review was performed by both authors who agreed on the final 55 references. Various reports over the last 18 months have raised significant questions not only about the basic clinical utility of PGS but the biological underpinnings of the hypothesis, the technical ability of a single trophectoderm (TE) biopsy to accurately assess an embryo’s ploidy, and suggested that PGS actually negatively affects IVF outcomes while not affecting miscarriage rates. Moreover, due to high rates of false positive diagnoses as a consequence of high mosaicism rates in TE, PGS leads to the discarding of large numbers of normal embryos with potential for normal euploid pregnancies if transferred rather than disposed of. We found all 5 basic assumptions underlying the hypothesis of PGS to be unsupported: (i) The association of embryo aneuploidy with IVF failure has to be reevaluated in view how much more common TE mosaicism is than has until recently been appreciated. (ii) Reliable elimination of presumed aneuploid embryos prior to embryo transfer appears unrealistic. (iii) Mathematical models demonstrate that a single TEB cannot provide reliable information about the whole TE. (iv) TE does not reliably reflect the ICM. (v) Embryos, likely, still have strong innate ability to self-correct downstream from blastocyst stage, with ICM doing so better than TE. The hypothesis of PGS, therefore, no longer appears supportable. With all 5 basic assumptions underlying the hypothesis of PGS demonstrated to have been mistaken, the hypothesis of PGS, itself, appears to be discredited. Clinical use of PGS for the purpose of IVF outcome improvements should, therefore, going forward be restricted to research studies.
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Affiliation(s)
- Norbert Gleicher
- The Center for Human Reproduction, New York, NY, 10021, USA. .,Foundation for Reproductive Medicine, New York, NY, 10022, USA. .,Laboratory of Stem Cell Biology and Molecular Embryology, The Rockefeller University, New York, NY, 10065, USA. .,Department of Obstetrics and Gynecology, University of Vienna School of Medicine, 1090, Vienna, Austria.
| | - Raoul Orvieto
- Infertility and IVF Unit, Department of Obstetrics and Gynecology, Sheba Medical Center (Tel Hashomer), Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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20
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Kushnir VA, Barad DH, Albertini DF, Darmon SK, Gleicher N. Systematic review of worldwide trends in assisted reproductive technology 2004-2013. Reprod Biol Endocrinol 2017; 15:6. [PMID: 28069012 PMCID: PMC5223447 DOI: 10.1186/s12958-016-0225-2] [Citation(s) in RCA: 199] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Accepted: 12/21/2016] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Assisted Reproductive Technology (ART) has undergone considerable changes over the last decade, with consequences on ART outcomes in different regions of the world being unknown. METHODS We conducted a systematic review of published national and regional ART registry data to assess how changes in clinical practice between 2004 and 2013 have impacted outcomes in Australia and New Zealand, Canada, Continental Europe, the United Kingdom (U.K.), Japan, Latin America, and the United States (U.S.). The data reflect 7,079,145 total ART cycles utilizing both fresh and previously cryopreserved embryos from autologous oocytes that resulted in 1,454,724 live births. This review focused on the following measures: ART cycle volume, use of cryopreserved embryos, single embryo transfer (SET), live birth rates in fresh and frozen-thawed cycles, and perinatal outcomes in recent years. RESULTS SETs and utilization of frozen-thawed embryos increased worldwide over the study period. In 2012 SET utilization in all ART cycles was highest in Japan and Australia/New Zealand (82.6% and 76.3% respectively) and lowest in Latin America (16.0%). While gradual improvements in live birth rates were observed in most regions, some demonstrated declines. By 2012-2013, fresh cycle live birth rates were highest in the U.S. (29%) and lowest in Japan (5%). In Japan, the observed decline in fresh cycle live birth rate coincided with transition to minimal stimulation protocols, transfer of frozen-thawed rather than fresh embryos, and implementation of an SET policy. Similarly, implementation of an SET policy in parts of Canada was followed by a decline in fresh cycle live birth rate. Increasing live birth rates in frozen-thawed embryo cycles, seen all over the world, partially compensated for declines in fresh ART cycles. During 2012-2013 Australia/New Zealand and Japan reported the lowest multiple delivery rates of 5.6 and 4% respectively while the US had the highest of 27%. In recent years, preterm delivery rates in all regions ranged between 9.0 to 16.6% for singletons, 53.9 to 67.3% for twins, and 91.4 to 100% for triplets and higher order multiples. Inconsistencies in the way perinatal outcome data are presented by various registries, made comparison between regions difficult. CONCLUSIONS ART practices are characterized by outcome differences between regions. International consensus on the definition of ART success, which accounts for perinatal outcomes, may help to standardize worldwide ART practice and improve outcomes. TRIAL REGISTRATION PROSPERO ( CRD42016033011 ).
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Affiliation(s)
- Vitaly A. Kushnir
- The Center for Human Reproduction, 21 East 69th Street, New York, NY 10021 USA
- Wake Forest School of Medicine, Winston-Salem, NC USA
| | - David H. Barad
- The Center for Human Reproduction, 21 East 69th Street, New York, NY 10021 USA
- Foundation for Reproductive Medicine, New York, NY USA
| | - David F. Albertini
- The Center for Human Reproduction, 21 East 69th Street, New York, NY 10021 USA
- University of Kansas Medical Center, Kansas City, KS USA
- The Rockefeller University, New York, NY USA
| | - Sarah K. Darmon
- The Center for Human Reproduction, 21 East 69th Street, New York, NY 10021 USA
| | - Norbert Gleicher
- The Center for Human Reproduction, 21 East 69th Street, New York, NY 10021 USA
- Foundation for Reproductive Medicine, New York, NY USA
- University of Vienna School of Medicine, Vienna, Austria
- The Rockefeller University, New York, NY USA
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Humaidan P, Alviggi C, Fischer R, Esteves SC. The novel POSEIDON stratification of 'Low prognosis patients in Assisted Reproductive Technology' and its proposed marker of successful outcome. F1000Res 2016; 5:2911. [PMID: 28232864 PMCID: PMC5302217 DOI: 10.12688/f1000research.10382.1] [Citation(s) in RCA: 158] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/19/2016] [Indexed: 11/20/2022] Open
Abstract
In reproductive medicine little progress has been achieved regarding the clinical management of patients with a reduced ovarian reserve or poor ovarian response (POR) to stimulation with exogenous gonadotropins -a frustrating experience for clinicians as well as patients. Despite the efforts to optimize the definition of this subgroup of patients, the existing POR criteria unfortunately comprise a heterogeneous population and, importantly, do not offer any recommendations for clinical handling. Recently, the POSEIDON group ( Patient- Oriented Strategies Encompassing Individualize D Oocyte Number) proposed a new stratification of assisted reproductive technology (ART) in patients with a reduced ovarian reserve or unexpected inappropriate ovarian response to exogenous gonadotropins. In brief, four subgroups have been suggested based on quantitative and qualitative parameters, namely, i. Age and the expected aneuploidy rate; ii. Ovarian biomarkers (i.e. antral follicle count [AFC] and anti-Müllerian hormone [AMH]), and iii. Ovarian response - provided a previous stimulation cycle was performed. The new classification introduces a more nuanced picture of the "low prognosis patient" in ART, using clinically relevant criteria to guide the physician to most optimally manage this group of patients. The POSEIDON group also introduced a new measure for successful ART treatment, namely, the ability to retrieve the number of oocytes needed for the specific patient to obtain at least one euploid embryo for transfer. This feature represents a pragmatic endpoint to clinicians and enables the development of prediction models aiming to reduce the time-to-pregnancy (TTP). Consequently, the POSEIDON stratification should not be applied for retrospective analyses having live birth rate (LBR) as endpoint. Such an approach would fail as the attribution of patients to each Poseidon group is related to specific requirements and could only be made prospectively. On the other hand, any prospective approach (i.e. RCT) should be performed separately in each specific group.
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Affiliation(s)
- Peter Humaidan
- Fertility Clinic, Skive Regional Hospital, Skive, Denmark; Faculty of Health, Aarhus University, Skive, Denmark
| | - Carlo Alviggi
- Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples Federico II, Naples, Italy
| | | | - Sandro C Esteves
- ANDROFERT, Andrology & Human Reproduction Clinic, Campinas, Brazil
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Abstract
PURPOSE OF REVIEW Utilization of cryopreserved instead of fresh donor oocytes has rapidly increased in recent years. Whether treatment outcomes are comparable has, however, remained controversial. RECENT FINDINGS More than 24% of initiated oocyte donation cycles in the USA during 2013-2014 involved previously cryopreserved oocytes. The use of cryopreserved-donated oocytes may simplify logistics and lower costs per treatment cycle. Whether cryopreserved donor oocytes also lower costs per live birth is still undetermined as they result in lower live birth rates in comparison to fresh donor oocyte cycles. National data regarding the safety of donated oocytes, including miscarriage rates and neonatal health outcomes, are lacking. SUMMARY Currently available data on cryopreserved-donated oocytes are incomplete and, therefore, still insufficient to claim equivalency between fresh and cryopreserved donor oocytes. Until sufficient data are available, patients should be advised about advantages and disadvantages of both methods of oocyte donation, and the use of cryopreserved oocytes should be considered only with caution and appropriate informed consent. Because banking of donated human oocytes facilities their commercial trade, it challenges basic ethical considerations, which have been the basis of oocyte donation since its inception.
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Affiliation(s)
- Vitaly A Kushnir
- aThe Center for Human Reproduction, New York, New York bWake Forest School of Medicine, Winston-Salem, North Carolina cFoundation for Reproductive Medicine dThe Rockefeller University, New York, New York, USA
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Wu YG, Lazzaroni-Tealdi E, Wang Q, Zhang L, Barad DH, Kushnir VA, Darmon SK, Albertini DF, Gleicher N. Different effectiveness of closed embryo culture system with time-lapse imaging (EmbryoScope(TM)) in comparison to standard manual embryology in good and poor prognosis patients: a prospectively randomized pilot study. Reprod Biol Endocrinol 2016; 14:49. [PMID: 27553622 PMCID: PMC4995783 DOI: 10.1186/s12958-016-0181-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 08/04/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Previously manual human embryology in many in vitro fertilization (IVF) centers is rapidly being replaced by closed embryo incubation systems with time-lapse imaging. Whether such systems perform comparably to manual embryology in different IVF patient populations has, however, never before been investigated. We, therefore, prospectively compared embryo quality following closed system culture with time-lapse photography (EmbryoScope™) and standard embryology. We performed a two-part prospectively randomized study in IVF (clinical trial # NCT92256309). Part A involved 31 infertile poor prognosis patients prospectively randomized to EmbryoScope™ and standard embryology. Part B involved embryos from 17 egg donor-recipient cycles resulting in large egg/embryo numbers, thus permitting prospectively alternative embryo assignments to EmbryoScope™ and standard embryology. We then compared pregnancy rates and embryo quality on day-3 after fertilization and embryologist time utilized per processed embryo. RESULTS Part A revealed in poor prognosis patients no differences in day-3 embryo scores, implantation and clinical pregnancy rates between EmbryoScope™ and standard embryology. The EmbryoScope™, however, more than doubled embryology staff time (P < 0.0001). In Part B, embryos grown in the EmbyoScope™ demonstrated significantly poorer day-3 quality (depending on embryo parameter between P = 0.005 and P = 0.01). Suspicion that conical culture dishes of the EmbryoScope™ (EmbryoSlide™) may be the cause was disproven when standard culture dishes demonstrated no outcome difference in standard incubation. CONCLUSIONS Though due to small patient numbers preliminary, this study raises concerns about the mostly uncontrolled introduction of closed incubation systems with time lapse imaging into routine clinical embryology. Appropriately designed and powered prospectively randomized studies appear urgently needed in well-defined patient populations before the uncontrolled utilization of these instruments further expands. TRIAL REGISTRATION NCT02246309 Registered September 18, 2014.
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Affiliation(s)
- Yan-Guang Wu
- The Center for Human Reproduction, 21 East 69th Street, New York, NY 10021 USA
| | | | - Qi Wang
- The Center for Human Reproduction, 21 East 69th Street, New York, NY 10021 USA
| | - Lin Zhang
- The Center for Human Reproduction, 21 East 69th Street, New York, NY 10021 USA
| | - David H. Barad
- The Center for Human Reproduction, 21 East 69th Street, New York, NY 10021 USA
- The Foundation for Reproductive Medicine, New York, NY 10021 USA
- Department of Obstetrics and Gynecology, Albert Einstein College of Medicine, Bronx, NY 10461 USA
| | - Vitaly A. Kushnir
- The Center for Human Reproduction, 21 East 69th Street, New York, NY 10021 USA
- Department of Obstetrics and Gynecology, Wake Forest University, Winston Salem, NC 27106 USA
| | - Sarah K. Darmon
- The Center for Human Reproduction, 21 East 69th Street, New York, NY 10021 USA
| | - David F. Albertini
- The Center for Human Reproduction, 21 East 69th Street, New York, NY 10021 USA
- Department of Molecular and Integrative Physiology, The University of Kansas School of Medicine, Wichita, KS 64109 USA
| | - Norbert Gleicher
- The Center for Human Reproduction, 21 East 69th Street, New York, NY 10021 USA
- The Foundation for Reproductive Medicine, New York, NY 10021 USA
- Stem Cell Biology and Molecular Embryology Laboratory, The Rockefeller University, New York, NY 10065 USA
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Gleicher N, Kushnir VA, Albertini DF, Barad DH. Improvements in IVF in women of advanced age. J Endocrinol 2016; 230:F1-6. [PMID: 27154334 DOI: 10.1530/joe-16-0105] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 05/06/2016] [Indexed: 11/08/2022]
Abstract
Women above age 40 years in the US now represent the most rapidly growing age group having children. Patients undergoing in vitro fertilization (IVF) are rapidly aging in parallel. Especially where egg donations are legal, donation cycles, therefore, multiply more rapidly than autologous IVF cycles. The donor oocytes, however, are hardly ever a preferred patient choice. Since with use of own eggs, live birth rates decline with advancing age but remain stable (and higher) with donor eggs, older patients always face the difficult and very personal choice between poorer chances with own and better chances with donor oocytes. Physician contribution to this decision should in our opinion be restricted to accurate outcome information for both options. Achievable pregnancy and live birth rates in older women are, however, frequently underestimated, thereby mistakenly biasing fertility providers, private insurance companies and even regulatory government agencies. Restriction on access to IVF for older women is then often the consequence. In this review, we summarize the limited published data on best treatments of 'older' ovaries, while also addressing treatment approaches that should be avoided in older women. This focused review, therefore, to a degree is subjective. Research addressing aging ovaries in IVF has been disappointingly sparse, and has in our opinion too heavily concentrated on methods of embryo selection (ES), which, especially in older women, not only fail to improve IVF outcomes, but actually, negatively affect live birth chances. We conclude that, aside from breakthroughs in gamete creation, only pharmacological interventions into early (small growing follicle stages) follicle maturation will offer new potential to positively impact oocyte and embryo quality and, therefore, IVF outcomes. Research, therefore, should be accordingly redirected.
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Affiliation(s)
- Norbert Gleicher
- The Center for Human ReproductionNew York, New York, USA The Foundation for Reproductive MedicineNew York, New York, USA The Brivanlou Stem Cell Biology and Molecular Embryology LaboratoryThe Rockefeller University, New York, New York, USA
| | - Vitaly A Kushnir
- The Center for Human ReproductionNew York, New York, USA Department of Obstetrics and GynecologyWake Forest University, Winston Salem, North Carolina, USA
| | - David F Albertini
- The Center for Human ReproductionNew York, New York, USA Department of Molecular and Integrative PhysiologyThe University of Kansas Medical Center, Kansas City, Kansas, USA
| | - David H Barad
- The Center for Human ReproductionNew York, New York, USA The Foundation for Reproductive MedicineNew York, New York, USA
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Vega MG, Gleicher N, Darmon SK, Weghofer A, Wu YG, Wang Q, Zhang L, Albertini DF, Barad DH, Kushnir VA. IVF outcomes in average- and poor-prognosis infertile women according to the number of embryos transferred. Reprod Biomed Online 2016; 33:370-5. [PMID: 27390063 DOI: 10.1016/j.rbmo.2016.06.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 06/16/2016] [Accepted: 06/21/2016] [Indexed: 11/19/2022]
Abstract
Outcome measures of IVF success, which account for effectiveness of IVF and perinatal outcome risks, have recently been described. The association between number of embryos transferred in average and poor-prognosis IVF patients, and the chances of having good or poor IVF and perinatal outcomes, was investigated. Good IVF and perinatal outcome was defined as the birth of a live, term, normal-weight infant (≥2500 g). Poor IVF and perinatal outcome was defined as no live birth or birth of a very low weight neonate (<1500 g) or severe prematurity (birth at <32 weeks gestation). Each neonate was analysed as a separate outcome. A total of 713 IVF cycles in 504 average and poor-prognosis patients from January 2010 to December 2013 were identified. The odds of having good IVF and perinatal outcomes increased by 28% for each additional embryo transferred. The odds of poor IVF and perinatal outcome decreased by 32% with an additional embryo transferred. The likelihood of live birth with good perinatal outcome in average- and poor-prognosis patients after IVF increases with additional embryos being transferred. These data add to recently reported evidence in favour of multiple embryo transfer in older women and those with average or poor IVF prognosis.
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Affiliation(s)
- Mario G Vega
- The Center for Human Reproduction, New York, NY 10021, USA; Department of Obstetrics and Gynecology, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Norbert Gleicher
- The Center for Human Reproduction, New York, NY 10021, USA; The Foundation for Reproductive Medicine, New York, NY 10021, USA; Stem Cell Biology and Molecular Embryology Laboratory, The Rockefeller University, New York, NY 10065-6399, USA
| | - Sarah K Darmon
- The Center for Human Reproduction, New York, NY 10021, USA
| | - Andrea Weghofer
- The Center for Human Reproduction, New York, NY 10021, USA; Vienna University School of Medicine, Vienna 1090, Austria
| | - Yan-Guang Wu
- The Center for Human Reproduction, New York, NY 10021, USA
| | - Qi Wang
- The Center for Human Reproduction, New York, NY 10021, USA
| | - Lin Zhang
- The Center for Human Reproduction, New York, NY 10021, USA
| | - David F Albertini
- The Center for Human Reproduction, New York, NY 10021, USA; Department of Molecular and Integrative Physiology, The University of Kansas School of Medicine, Kansas City, KS 66160, USA
| | - David H Barad
- The Center for Human Reproduction, New York, NY 10021, USA; Department of Obstetrics and Gynecology, Albert Einstein College of Medicine, Bronx, NY 10461, USA; Stem Cell Biology and Molecular Embryology Laboratory, The Rockefeller University, New York, NY 10065-6399, USA
| | - Vitaly A Kushnir
- The Center for Human Reproduction, New York, NY 10021, USA; Department of Obstetrics and Gynecology, Wake Forest University, Winston Salem, NC 27106, USA.
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26
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Kliebisch TK, Bielfeld AP, Krüssel JS, Baston-Büst DM. The German Middleway as Precursor for Single Embryo Transfer. A Retrospective Data-analysis of the Düsseldorf University Hospital's Interdisciplinary Fertility Centre - UniKiD. Geburtshilfe Frauenheilkd 2016; 76:690-698. [PMID: 27365539 DOI: 10.1055/s-0042-105747] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Introduction: Patients receiving fertility treatment in Germany appear to be disadvantaged in comparison to those in other countries due to the restrictive Embryo Protection Act ("Embryonenschutzgesetz, ESchG"), which prohibits the selection of a "top" embryo. The so-called German Middleway ("Deutscher Mittelweg, DMW") now provides for a liberal interpretation of the ESchG by allowing the culture of numerous pronuclear stages (2PN stage). Materials and Methods: Retrospective cohort study of 2 assisted reproduction treatment cycles in n = 400 patients between the ages of 21 and 45 years, either treated 2× conservatively or 1× conservatively and 1× liberally according to DMW. Results: Pregnancy was achieved in 35 % of patients in the DMW group and 31 % of controls. The birth rate among controls was 28.5 % and 30.5 % in the DMW group. Most pregnancies resulted from the culture of 4 × 2PN stages. Conclusion: Patients in the DMW group had significantly higher pregnancy and birth rates compared to their previous cycles despite significantly increased age and significantly fewer transferred embryos. Key factors were the number of 2PNs generated and the quality of embryos transferred. Thus it can be assumed that particularly older patients with adequate ovarian reserves will benefit from DMW, i.e. the transfer of fewer embryos of the best possible quality.
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Affiliation(s)
- T K Kliebisch
- Medical Research School der Medizinischen Fakultät der Heinrich-Heine-Universität, Düsseldorf
| | - A P Bielfeld
- Medical Center University of Düsseldorf, Dept. of OB/GYN/REI, Düsseldorf
| | - J S Krüssel
- Medical Center University of Düsseldorf, Dept. of OB/GYN/REI, Düsseldorf
| | - D M Baston-Büst
- Medical Center University of Düsseldorf, Dept. of OB/GYN/REI, Düsseldorf
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Gleicher N, Kushnir VA, Sen A, Darmon SK, Weghofer A, Wu YG, Wang Q, Zhang L, Albertini DF, Barad DH. Definition by FSH, AMH and embryo numbers of good-, intermediate- and poor-prognosis patients suggests previously unknown IVF outcome-determining factor associated with AMH. J Transl Med 2016; 14:172. [PMID: 27286817 PMCID: PMC4901433 DOI: 10.1186/s12967-016-0924-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 05/30/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Though outcome models have been proposed previously, it is unknown whether cutoffs in clinical pregnancy and live birth rates at all ages are able to classify in vitro fertilization (IVF) patients into good-, intermediate- and poor prognosis. METHODS We here in 3 infertile patient cohorts, involving 1247, 1514 and 632 women, built logistic regression models based on 3 functional ovarian reserve (FOR) parameters, including (1) number of good quality embryos, (2) follicle stimulating hormone (FSH, mIU/mL) and (3) anti-Müllerian hormone (AMH, ng/mL), determining whether clinical pregnancy and live birth rates can discriminate between good, intermediate and poor prognosis patients. RESULTS All models, indeed, allowed at all ages for separation by prognosis, though cut offs changed with age. In the embryo model, increasing embryo production resulted in linear improvement of IVF outcomes despite transfer of similar embryo numbers; in the FSH model outcomes and FSH levels related inversely, while the association of AMH followed a bell-shaped polynomial pattern, demonstrating "best" outcomes at mid-ranges. All 3 models demonstrated increasingly poor outcomes with advancing ages, though "best" AMH even above age 43 was still associated with unexpectedly good pregnancy and delivery outcomes. Excessively high AMH, in contrast, was at all ages associated with spiking miscarriage rates. CONCLUSIONS At varying peripheral serum concentrations, AMH, thus, demonstrates hithero unknown and contradictory effects on IVF outcomes, deserving at different concentrations investigation as a potential therapeutic agent, with pregnancy-supporting and pregnancy-interrupting properties.
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Affiliation(s)
- Norbert Gleicher
- The Center for Human Reproduction, 21 East 69th Street, New York, NY, 10021, USA. .,The Foundation for Reproductive Medicine, New York, NY, USA. .,Stem Cell Biology and Molecular Embryology Laboratory, The Rockefeller University, New York, NY, USA.
| | - Vitaly A Kushnir
- The Center for Human Reproduction, 21 East 69th Street, New York, NY, 10021, USA.,Department of Obstetrics and Gynecology, Wake Forest University, Winston Salem, NC, USA
| | - Aritro Sen
- The Center for Human Reproduction, 21 East 69th Street, New York, NY, 10021, USA.,Division of Medical Endocrinology and Metabolism, Department of Medicine, Rochester University School of Medicine and Dentistry, Rochester, NY, USA
| | - Sarah K Darmon
- The Center for Human Reproduction, 21 East 69th Street, New York, NY, 10021, USA
| | - Andrea Weghofer
- The Center for Human Reproduction, 21 East 69th Street, New York, NY, 10021, USA.,Vienna University School of Medicine, Vienna, 1090, Austria
| | - Yan-Guang Wu
- The Center for Human Reproduction, 21 East 69th Street, New York, NY, 10021, USA
| | - Qi Wang
- The Center for Human Reproduction, 21 East 69th Street, New York, NY, 10021, USA
| | - Lin Zhang
- The Center for Human Reproduction, 21 East 69th Street, New York, NY, 10021, USA
| | - David F Albertini
- The Center for Human Reproduction, 21 East 69th Street, New York, NY, 10021, USA.,Department of Molecular and Integrative Physiology, The University of Kansas Medical Center, Kansas City, KS, USA
| | - David H Barad
- The Center for Human Reproduction, 21 East 69th Street, New York, NY, 10021, USA.,The Foundation for Reproductive Medicine, New York, NY, USA.,Department of Obstetrics and Gynecology, Albert Einstein College of Medicine, Bronx, NY, USA
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28
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Gleicher N, Kushnir VA, Barad DH. The impact of patient preselection on reported IVF outcomes. J Assist Reprod Genet 2016; 33:455-9. [PMID: 26861966 DOI: 10.1007/s10815-016-0673-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 01/26/2016] [Indexed: 10/22/2022] Open
Abstract
We, in this manuscript, address the fact that increasing numbers of published studies in reproductive medicine selectively report outcomes for only favorably selected patients; while failing to note that, so reported outcome data,therefore, cannot be applied to unselected patient populations. Almost all favorable patient selection methods, starting with prolonged embryo culture to blastocyst stage, have, thus, been widely misrepresented in the literature since they almost universally report outcomes only in reference to embryo transfer. These outcome reports, however, do not include outcomes for poorer prognosis patients who do not reach embryo transfer. Study outcomes are universally applicable only if performed in unselected patient populations and reported with reference point cycle start (intent to treat). All other studies greatly exaggerate clinical pregnancy and live birth rates if applied to general populations, unless specifically noting that they can be extrapolated only to women who reach embryo transfer.
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Affiliation(s)
- Norbert Gleicher
- The Center for Human Reproduction, 21 East 69th Street, New York, NY, 10021, USA. .,The Foundation for Reproductive Medicine, New York, NY, USA. .,The Rockefeller University, New York, NY, USA.
| | - Vitaly A Kushnir
- The Center for Human Reproduction, 21 East 69th Street, New York, NY, 10021, USA.,Department of Obstetrics and Gynecology, Wake Forest University, Winston Salem, NC, USA
| | - David H Barad
- The Center for Human Reproduction, 21 East 69th Street, New York, NY, 10021, USA.,The Foundation for Reproductive Medicine, New York, NY, USA
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29
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Lazzaroni-Tealdi E, Barad DH, Albertini DF, Yu Y, Kushnir VA, Russell H, Wu YG, Gleicher N. Oocyte Scoring Enhances Embryo-Scoring in Predicting Pregnancy Chances with IVF Where It Counts Most. PLoS One 2015; 10:e0143632. [PMID: 26630267 PMCID: PMC4668065 DOI: 10.1371/journal.pone.0143632] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 11/06/2015] [Indexed: 11/18/2022] Open
Abstract
Context Our center’s quality improvement optimization process on many occasions anecdotally suggested that oocyte assessments might enhance embryo assessment in predicting pregnancy chances with in vitro fertilization (IVF). Objective To prospectively compare a morphologic oocyte grading system to standard day-3 morphologic embryo assessment. Design, Setting, Patients We prospectively investigated in a private academically-affiliated infertility center 94 consecutive IVF cycles based on 6 criteria for oocyte quality: morphology, cytoplasm, perivitelline space (PVS), zona pellucida (ZP), polar body (PB) and oocyte size, each assigned a value of -1 (worst), 0 (average) or +1 (best), so establishing an average total oocyte score (TOS). Embryo assessment utilized grade and cell numbers of each embryo on day-3 after oocyte retrieval. Clinical pregnancy was defined by presence of at least one intrauterine gestational sac. Interventions Standard IVF cycles in infertile women. Main Outcome Measures Predictability of pregnancy based on oocyte and embryo-grading systems. Results Average age for all patients was 36.5 ± 7.3 years; mean oocyte yield was 7.97± 5.76; Patient specific total oocyte score (PTOS) was -1.05 ± 2.24. PTOS, adjusted for patient age, was directly related to odds of increased embryo cell numbers (OR 1.12, P = 0.025), embryo grade (OR 1.19, P < 0.001) and clinical pregnancy [OR 1.58 (95%CI 1.23 to 2.02), P < 0.001]. Restricting the analysis to day three embryos of high quality (8-cell/ good grades), TOS was still predictive of clinical pregnancy (OR 2.08 (95%CI 1.26 to 3.44, P = 0.004). Among the 69 patients with embryos of Grade 4 or better available for transfer 23 achieved Clinical Pregnancy. When the analysis was restricted to the 69 transfers with good quality embryos (≥ Grade 4) the Oocyte Scoring System (TOS) (AUC±SE 0.863±0.044, oocyte score) provided significantly greater predictive value for clinical pregnancy compared to the embryo grade alone (AUC 0.646 ± 0.072, embryo grade) p = 0.015. Conclusions Oocyte-scoring, thus, provides useful clinical information especially in good prognosis patients with large numbers of high quality embryos. This finding appears of particular importance at a time when many IVF centers are committing sizable investments to closed incubation systems with time-lapse photography, which are exclusively meant to define embryo morphology.
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Affiliation(s)
| | - David H. Barad
- The Center for Human Reproduction, New York, New York, United States of America
- The Foundation for Reproductive Medicine, New York, New York, United States of America
- Department of Obstetrics and Gynecology, Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - David F. Albertini
- The Center for Human Reproduction, New York, New York, United States of America
- Department of Molecular and Integrative Physiology, University of Kansas Medical Center, Kansas City, Kansas, United States of America
| | - Yao Yu
- The Center for Human Reproduction, New York, New York, United States of America
| | - Vitaly A. Kushnir
- The Center for Human Reproduction, New York, New York, United States of America
- Department of Obstetrics and Gynecology, Wake Forest University, Winston Salem, North Carolina, United States of America
| | - Helena Russell
- School of Health Professions, Eastern Virginia Medical School, Norfolk, Virginia, United States of America
| | - Yan-Guang Wu
- The Center for Human Reproduction, New York, New York, United States of America
| | - Norbert Gleicher
- The Center for Human Reproduction, New York, New York, United States of America
- The Foundation for Reproductive Medicine, New York, New York, United States of America
- Stem Cell and Molecular Embryology Laboratory, The Rockefeller University, New York, New York, United States of America
- * E-mail:
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30
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Dahdouh EM, Balayla J, García-Velasco JA. Comprehensive chromosome screening improves embryo selection: a meta-analysis. Fertil Steril 2015; 104:1503-12. [DOI: 10.1016/j.fertnstert.2015.08.038] [Citation(s) in RCA: 119] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 08/26/2015] [Accepted: 08/26/2015] [Indexed: 02/03/2023]
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31
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Li M, Zhao W, Li W, Zhao X, Shi J. Prognostic value of three pro-nuclei (3PN) incidence in elective single blastocyst-stage embryo transfer. Int J Clin Exp Med 2015; 8:21699-21702. [PMID: 26885129 PMCID: PMC4723974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 10/29/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES To investigate whether 3PN incidence could lead to a worse pregnancy outcome of elective single blastocyst stage embryo transfer (eSBET). METHODS This study included 706 eSBET cycles from January 2013 to March 2015. The patients were divided into two groups as follows: group 1 included 286 patients with no 3PN zygotes and group 2 included 420 patients with 3PN zygotes. MAIN OUTCOME MEASURE female age, endometrial thickness, infertility duration, type of infertility, main etiology of infertility, clinical pregnancy and abortion rate. RESULTS We observed that there was no significant difference in female age, endometrial thickness, infertility duration and abortion rate between two groups. It's worth noting that the clinical pregnancy rate in 3PN > 0% group was significantly lower than 3PN = 0 group (P = 0.021). CONCLUSIONS 3PN incidence might make anegative effect on pregnancy outcomes in elective single blastocyst stage embryo transfer.
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Affiliation(s)
- Mingzhao Li
- The ART Center, Northwest Women's and Children's Hospital Xi'an 710003, China
| | - Wanqiu Zhao
- The ART Center, Northwest Women's and Children's Hospital Xi'an 710003, China
| | - Wei Li
- The ART Center, Northwest Women's and Children's Hospital Xi'an 710003, China
| | - Xiaoli Zhao
- The ART Center, Northwest Women's and Children's Hospital Xi'an 710003, China
| | - Juanzi Shi
- The ART Center, Northwest Women's and Children's Hospital Xi'an 710003, China
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