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Ahlström A, Lundin K, Cimadomo D, Coticchio G, Selleskog U, Westlander G, Winerdal J, Stenfelt C, Callender S, Nyberg C, Åström M, Löfdahl K, Nolte L, Sundler M, Kitlinski M, Liljeqvist Soltic I, Bohlin T, Baumgart J, Lindgren KE, Gülen Yaldir F, Rienzi L, Lind AK, Bergh C. No major differences in perinatal and maternal outcomes between uninterrupted embryo culture in time-lapse system and conventional embryo culture. Hum Reprod 2023; 38:2400-2411. [PMID: 37879843 DOI: 10.1093/humrep/dead219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 10/06/2023] [Indexed: 10/27/2023] Open
Abstract
STUDY QUESTION Is embryo culture in a closed time-lapse system associated with any differences in perinatal and maternal outcomes in comparison to conventional culture and spontaneous conception? SUMMARY ANSWER There were no significant differences between time-lapse and conventional embryo culture in preterm birth (PTB, <37 weeks), low birth weight (LBW, >2500 g) and hypertensive disorders of pregnancy for singleton deliveries, the primary outcomes of this study. WHAT IS KNOWN ALREADY Evidence from prospective trials evaluating the safety of time-lapse incubation for clinical use show similar embryo development rates, implantation rates, and ongoing pregnancy and live birth rates when compared to conventional incubation. Few studies have investigated if uninterrupted culture can alter risks of adverse perinatal outcomes presently associated with IVF when compared to conventional culture and spontaneous conceptions. STUDY DESIGN, SIZE, DURATION This study is a Swedish population-based retrospective registry study, including 7379 singleton deliveries after fresh embryo transfer between 2013 and 2018 from selected IVF clinics. Perinatal outcomes of singletons born from time-lapse-cultured embryos were compared to singletons from embryos cultured in conventional incubators and 71 300 singletons from spontaneous conceptions. Main perinatal outcomes included PTB and LBW. Main maternal outcomes included hypertensive disorders of pregnancy (pregnancy hypertension and preeclampsia). PARTICIPANTS/MATERIALS, SETTING, METHODS From nine IVF clinics, 2683 singletons born after fresh embryo transfer in a time-lapse system were compared to 4696 singletons born after culture in a conventional incubator and 71 300 singletons born after spontaneous conception matched for year of birth, parity, and maternal age. Patient and treatment characteristics from IVF deliveries were cross-linked with the Swedish Medical Birth Register, Register of Birth Defects, National Patient Register and Statistics Sweden. Children born after sperm and oocyte donation cycles and after Preimplantation Genetic testing cycles were excluded. Odds ratio (OR) and adjusted OR were calculated, adjusting for relevant confounders. MAIN RESULTS AND THE ROLE OF CHANCE In the adjusted analyses, no significant differences were found for risk of PTB (adjusted OR 1.11, 95% CI 0.87-1.41) and LBW (adjusted OR 0.86, 95% CI 0.66-1.14) or hypertensive disorders of pregnancy; preeclampsia and hypertension (adjusted OR 0.99, 95% CI 0.67-1.45 and adjusted OR 0.98, 95% CI 0.62-1.53, respectively) between time-lapse and conventional incubation systems. A significantly increased risk of PTB (adjusted OR 1.31, 95% CI 1.08-1.60) and LBW (adjusted OR 1.36, 95% CI 1.08-1.72) was found for singletons born after time-lapse incubation compared to singletons born after spontaneous conceptions. In addition, a lower risk for pregnancy hypertension (adjusted OR 0.72 95% CI 0.53-0.99) but no significant difference for preeclampsia (adjusted OR 0.87, 95% CI 0.68-1.12) was found compared to spontaneous conceptions. Subgroup analyses showed that some risks were related to the day of embryo transfer, with more adverse outcomes after blastocyst transfer in comparison to cleavage stage transfer. LIMITATIONS, REASONS FOR CAUTION This study is retrospective in design and different clinical strategies may have been used to select specific patient groups for time-lapse versus conventional incubation. The number of patients is limited and larger datasets are required to obtain more precise estimates and adjust for possible effect of additional embryo culture variables. WIDER IMPLICATIONS OF THE FINDINGS Embryo culture in time-lapse systems is not associated with major differences in perinatal and maternal outcomes, compared to conventional embryo culture, suggesting that this technology is an acceptable alternative for embryo incubation. STUDY FUNDING/COMPETING INTEREST(S) The study was financed by a research grant from Gedeon Richter. There are no conflicts of interest for all authors to declare. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- A Ahlström
- IVIRMA Global Research Alliance, Livio Gothenburg, Gothenburg, Sweden
| | - K Lundin
- Reproductive Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - D Cimadomo
- IVIRMA Global Research Alliance, GENERA, Clinica Valle Giulia, Rome, Italy
| | - G Coticchio
- IVIRMA Global Research Alliance, 9.baby, Bologna, Italy
| | - U Selleskog
- IVIRMA Global Research Alliance, Livio Gothenburg, Gothenburg, Sweden
| | - G Westlander
- IVIRMA Global Research Alliance, Livio Gothenburg, Gothenburg, Sweden
| | - J Winerdal
- IVIRMA Global Research Alliance, Livio Gärdet, Stockholm, Sweden
| | - C Stenfelt
- IVIRMA Global Research Alliance, Livio Gärdet, Stockholm, Sweden
| | - S Callender
- IVIRMA Global Research Alliance, Livio Kungsholmen, Stockholm, Sweden
| | - C Nyberg
- IVIRMA Global Research Alliance, Livio Kungsholmen, Stockholm, Sweden
| | - M Åström
- IVIRMA Global Research Alliance, Livio Umeå, Umeå, Sweden
| | - K Löfdahl
- IVIRMA Global Research Alliance, Livio Umeå, Umeå, Sweden
| | - L Nolte
- IVIRMA Global Research Alliance, Livio Malmö, Malmö, Sweden
| | - M Sundler
- IVIRMA Global Research Alliance, Livio Malmö, Malmö, Sweden
| | | | | | - T Bohlin
- Örebro University Hospital, Sweden
| | | | | | | | - L Rienzi
- IVIRMA Global Research Alliance, GENERA, Clinica Valle Giulia, Rome, Italy
- Department of Biomolecular Sciences, Carlo Bo University of Urbino, Urbino, Italy
| | - A K Lind
- IVIRMA Global Research Alliance, Livio Gothenburg, Gothenburg, Sweden
| | - C Bergh
- Reproductive Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
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Ahlström A, Berntsen J, Johansen M, Bergh C, Cimadomo D, Hardarson T, Lundin K. Correlations between a deep learning-based algorithm for embryo evaluation with cleavage-stage cell numbers and fragmentation. Reprod Biomed Online 2023; 47:103408. [PMID: 37866216 DOI: 10.1016/j.rbmo.2023.103408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 08/29/2023] [Accepted: 09/04/2023] [Indexed: 10/24/2023]
Abstract
RESEARCH QUESTION Do cell numbers and degree of fragmentation in cleavage-stage embryos, assessed manually, correlate with evaluations made by deep learning algorithm model iDAScore v2.0? DESIGN Retrospective observational study (n = 5040 embryos; 1786 treatments) conducted at two Swedish assisted reproductive technology centres between 2016 and 2021. Fresh single embryo transfer was carried out on days 2 or 3 after fertilization. Embryo evaluation using iDAScore v2.0 was compared with manual assessment of numbers of cells and grade of fragmentation, analysed by video sequences. RESULTS Data from embryos transferred on days 2 and 3 showed that having three or fewer cells compared with four or fewer cells on day 2, and six or fewer cells versus seven to eight cells on day 3, correlated significantly with a difference in iDAScore (medians 2.4 versus 4.0 and 2.6 versus 4.6 respectively; both P < 0.001). The iDAScore for 0-10% fragmentation was significantly higher compared with the groups with higher fragmentation (P < 0.001). When combining cell numbers and fragmentation, iDAScore values decreased as fragmentation increased, regardless of cell number. iDAScore discriminated between embryos that resulted in live birth or no live birth (AUC of 0.627 and 0.607), compared with the morphological model (AUC of 0.618 and 0.585) for day 2 and day 3, respectively. CONCLUSIONS The iDAScore v2.0 values correlated significantly with cell numbers and fragmentation scored manually for cleavage-stage embryos on days 2 and 3. iDAScore had some predictive value for live birth, conditional that embryo selection was based on morphology.
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Affiliation(s)
| | | | | | - Christina Bergh
- Reproductive Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Danilo Cimadomo
- IVIRMA Global Research Alliance, GENERA, Clinica Valle Giulia, Rome, Italy
| | | | - Kersti Lundin
- Reproductive Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
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Lundin K, Bentzen JG, Bozdag G, Ebner T, Harper J, Le Clef N, Moffett A, Norcross S, Polyzos NP, Rautakallio-Hokkanen S, Sfontouris I, Sermon K, Vermeulen N, Pinborg A. Good practice recommendations on add-ons in reproductive medicine†. Hum Reprod 2023; 38:2062-2104. [PMID: 37747409 PMCID: PMC10628516 DOI: 10.1093/humrep/dead184] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Indexed: 09/26/2023] Open
Abstract
STUDY QUESTION Which add-ons are safe and effective to be used in ART treatment? SUMMARY ANSWER Forty-two recommendations were formulated on the use of add-ons in the diagnosis of fertility problems, the IVF laboratory and clinical management of IVF treatment. WHAT IS KNOWN ALREADY The innovative nature of ART combined with the extremely high motivation of the patients has opened the door to the wide application of what has become known as 'add-ons' in reproductive medicine. These supplementary options are available to patients in addition to standard fertility procedures, typically incurring an additional cost. A diverse array of supplementary options is made available, encompassing tests, drugs, equipment, complementary or alternative therapies, laboratory procedures, and surgical interventions. These options share the common aim of stating to enhance pregnancy or live birth rates, mitigate the risk of miscarriage, or expedite the time to achieving pregnancy. STUDY DESIGN, SIZE, DURATION ESHRE aimed to develop clinically relevant and evidence-based recommendations focusing on the safety and efficacy of add-ons currently used in fertility procedures in order to improve the quality of care for patients with infertility. PARTICIPANTS/MATERIALS, SETTING, METHODS ESHRE appointed a European multidisciplinary working group consisting of practising clinicians, embryologists, and researchers who have demonstrated leadership and expertise in the care and research of infertility. Patient representatives were included in the working group. To ensure that the guidelines are evidence-based, the literature identified from a systematic search was reviewed and critically appraised. In the absence of any clear scientific evidence, recommendations were based on the professional experience and consensus of the working group. The guidelines are thus based on the best available evidence and expert agreement. Prior to publication, the guidelines were reviewed by 46 independent international reviewers. A total of 272 comments were received and incorporated where relevant. MAIN RESULTS AND THE ROLE OF CHANCE The multidisciplinary working group formulated 42 recommendations in three sections; diagnosis and diagnostic tests, laboratory tests and interventions, and clinical management. LIMITATIONS, REASONS FOR CAUTION Of the 42 recommendations, none could be based on high-quality evidence and only four could be based on moderate-quality evidence, implicating that 95% of the recommendations are supported only by low-quality randomized controlled trials, observational data, professional experience, or consensus of the development group. WIDER IMPLICATIONS OF THE FINDINGS These guidelines offer valuable direction for healthcare professionals who are responsible for the care of patients undergoing ART treatment for infertility. Their purpose is to promote safe and effective ART treatment, enabling patients to make informed decisions based on realistic expectations. The guidelines aim to ensure that patients are fully informed about the various treatment options available to them and the likelihood of any additional treatment or test to improve the chance of achieving a live birth. STUDY FUNDING/COMPETING INTEREST(S) All costs relating to the development process were covered from ESHRE funds. There was no external funding of the development process or manuscript production. K.L. reports speakers fees from Merck and was part of a research study by Vitrolife (unpaid). T.E. reports consulting fees from Gynemed, speakers fees from Gynemed and is part of the scientific advisory board of Hamilton Thorne. N.P.P. reports grants from Merck Serono, Ferring Pharmaceutical, Theramex, Gedeon Richter, Organon, Roche, IBSA and Besins Healthcare, speakers fees from Merck Serono, Ferring Pharmaceutical, Theramex, Gedeon Richter, Organon, Roche, IBSA and Besins Healthcare. S.R.H. declares being managing director of Fertility Europe, a not-for-profit organization receiving financial support from ESHRE. I.S. is a scientific advisor for and has stock options from Alife Health, is co-founder of IVFvision LTD (unpaid) and received speakers' fee from the 2023 ART Young Leader Prestige workshop in China. A.P. reports grants from Gedeon Richter, Ferring Pharmaceuticals and Merck A/S, consulting fees from Preglem, Novo Nordisk, Ferring Pharmaceuticals, Gedeon Richter, Cryos and Merck A/S, speakers fees from Gedeon Richter, Ferring Pharmaceuticals, Merck A/S, Theramex and Organon, travel fees from Gedeon Richter. The other authors disclosed no conflicts of interest. DISCLAIMER This Good Practice Recommendations (GPRs) document represents the views of ESHRE, which are the result of consensus between the relevant ESHRE stakeholders and are based on the scientific evidence available at the time of preparation.ESHRE GPRs should be used for information and educational purposes. They should not be interpreted as setting a standard of care or bedeemedinclusive of all proper methods of care, or be exclusive of other methods of care reasonably directed to obtaining the same results.Theydo not replace the need for application of clinical judgement to each individual presentation, or variations based on locality and facility type.Furthermore, ESHRE GPRs do not constitute or imply the endorsement, or favouring, of any of the included technologies by ESHRE.
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Affiliation(s)
| | - K Lundin
- Department Reproductive Medicine, Sahlgrenska University Hospital, Göteborg, Sweden
| | - J G Bentzen
- The Fertility Department, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - G Bozdag
- Department Obstetrics and Gynecology, Koc University School of Medicine, Istanbul, Turkey
| | - T Ebner
- Department of Gynecology, Obstetrics, and Gynecological Endocrinology, Kepler University, MedCampus IV, Linz, Austria
| | - J Harper
- Institute for Women’s Health, London, UK
| | - N Le Clef
- European Society of Human Reproduction and Embryology, Brussels, Belgium
| | - A Moffett
- Department of Pathology, University of Cambridge, Cambridge, UK
| | | | - N P Polyzos
- Department Reproductive Medicine, Dexeus University Hospital, Barcelona, Spain
| | | | | | - K Sermon
- Research Group Reproduction and Genetics, Vrije Universiteit Brussel, Brussels, Belgium
| | - N Vermeulen
- European Society of Human Reproduction and Embryology, Brussels, Belgium
| | - A Pinborg
- The Fertility Department, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
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Bergh C, Lundin K. No benefit to pregnancy or livebirth by time-lapse-based embryo selection in IVF. Lancet 2023; 401:1401-1403. [PMID: 37004672 DOI: 10.1016/s0140-6736(23)00219-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 01/27/2023] [Indexed: 04/04/2023]
Affiliation(s)
- Christina Bergh
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Göteborg University and Sahlgrenska University Hospital, Gothenburg SE-413 45, Sweden.
| | - Kersti Lundin
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Göteborg University and Sahlgrenska University Hospital, Gothenburg SE-413 45, Sweden
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Ata B, Vermeulen N, Mocanu E, Gianaroli L, Lundin K, Rautakallio-Hokkanen S, Tapanainen JS, Veiga A. SARS-CoV-2, fertility and assisted reproduction. Hum Reprod Update 2023; 29:177-196. [PMID: 36374645 PMCID: PMC9976972 DOI: 10.1093/humupd/dmac037] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 09/15/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND In 2020, SARS-CoV-2 and the COVID-19 pandemic had a huge impact on the access to and provision of ART treatments. Gradually, knowledge of the virus and its transmission has become available, allowing ART activities to resume. Still, questions on the impact of the virus on human gametes and fertility remain. OBJECTIVE AND RATIONALE This article summarizes published data, aiming to clarify the impact of SARS-CoV-2 and the COVID-19 disease on human fertility and assisted reproduction, as well as the impact of vaccination, and from this, provide answers to questions that are relevant for people contemplating pregnancy and for health care professionals. SEARCH METHODS PUBMED/MEDLINE and the WHO COVID-19 database were searched from inception to 5 October 2022 with search terms focusing on 'SARS-CoV-2' and gametes, embryos, reproductive function, fertility and ART. Non-English studies and papers published prior to 2020 were excluded, as well as reviews and non-peer reviewed publications. Full papers were assessed for relevance and quality, where feasible. OUTCOMES From the 148 papers included, the following observations were made. The SARS-CoV-2-binding proteins, angiotensin-converting enzyme 2 (ACE2) and type II transmembrane serine protease (TMPRSS2), are expressed in the testis, but co-expression remains to be proven. There is some evidence of SARS-CoV-2 RNA in the ejaculate of COVID-19 patients with severe disease, but not in those with mild/moderate disease. SARS-CoV-2 infection can impair spermatogenesis, but this seems to resolve after one spermatogenic cycle. Testosterone levels seem to be lower during and after COVID-19, but long-term data are lacking; disease severity may be associated with testosterone levels. COVID-19 cannot be considered a sexually transmitted disease. There is no co-expression of ACE2 and TMPRSS2 in the myometrium, uterus, ovaries or fallopian tubes. Oocytes seem to have the receptors and protease machinery to be susceptible to SARS-CoV-2 infection; however, viral RNA in oocytes has not been detected so far. Women contemplating pregnancy following COVID-19 may benefit from screening for thyroid dysfunction. There is a possible (transient) impact of COVID-19 on menstrual patterns. Embryos, and particularly late blastocysts, seem to have the machinery to be susceptible to SARS-CoV-2 infection. Most studies have not reported a significant impact of COVID-19 on ovarian reserve, ovarian function or follicular fluid parameters. Previous asymptomatic or mild SARS-CoV-2 infection in females does not seem to negatively affect laboratory and clinical outcomes of ART. There are no data on the minimum required interval, if any, between COVID-19 recovery and ART. There is no evidence of a negative effect of SARS-CoV-2 vaccination on semen parameters or spermatogenesis, ovarian function, ovarian reserve or folliculogenesis. A transient effect on the menstrual cycle has been documented. Despite concerns, cross reactivity between anti-SARS-CoV-2 spike protein antibodies and Syncytin-1, an essential protein in human implantation, is absent. There is no influence of mRNA SARS-CoV-2 vaccine on patients' performance during their immediate subsequent ART cycle. Pregnancy rates post-vaccination are similar to those in unvaccinated patients. WIDER IMPLICATIONS This review highlights existing knowledge on the impact of SARS-CoV-2 infection or COVID-19 on fertility and assisted reproduction, but also identifies gaps and offers suggestions for future research. The knowledge presented should help to provide evidence-based advice for practitioners and couples contemplating pregnancy alike, facilitating informed decision-making in an environment of significant emotional turmoil.
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Affiliation(s)
- Baris Ata
- Obstetrics and Gynecology Department, Koc University, Istanbul, Turkey.,ART Fertility Clinics, Dubai, United Arab Emirates
| | | | - Edgar Mocanu
- Department of Reproductive Medicine, Rotunda Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Luca Gianaroli
- Società Italiana Studi di Medicina della Riproduzione, S.I.S.Me.R. Reproductive Medicine Institute, Bologna, Emilia-Romagna, Italy
| | - Kersti Lundin
- Reproductive Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Juha S Tapanainen
- Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Department of Obstetrics and Gynaecology, Oulu University Hospital and Medical Research Centre PEDEGO Research Unit, Oulu, Finland
| | - Anna Veiga
- Barcelona Stem Cell Bank, IDIBELL Programme for Regenerative Medicine, Barcelona, Spain
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Lundin K. [Developments within the IVF laboratory]. Lakartidningen 2022; 119:22055. [PMID: 36504107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The area of assisted reproduction is continuing to develop at a rapid pace, especially within the laboratory. So called »time-lapse« photography, where embryos can be kept and assessed in a closed environment, has simplified the crucial handling of gametes and embryos as well as the logistics in the laboratory. Pregnancy and live birth rates have increased considerably since the start of IVF. This is to a large extent due to the implementation of prolonged embryo culture to the blastocyst stage, and to the introduction of vitrification, a cryopreservation technique which has greatly improved the survival rates of oocytes and blastocysts. The concept of single embryo transfer (SET) is being increasingly implemented around the world and has been shown to effectively decrease multiple birth rates, without compromising live birth rates.
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Affiliation(s)
- Kersti Lundin
- docent, överbiolog, reproduktionsmedicin, Sahlgrenska universitetssjukhuset, Göteborg
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Kirkman-Brown J, Calhaz-Jorge C, Dancet E, Lundin K, Martins M, Tilleman K, Thorn P, Vermeulen N, Frith L. O-104 Providing accurate information – impact of ancestry testing. Hum Reprod 2022. [DOI: 10.1093/humrep/deac104.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Providing information to patients and, or donors at the ART clinic is essential but challenging, especially in the case of reproductive donation.
Recent developments in direct-to-consumer genetic testing combined with social media have increased the degree of difficulty. Concepts such as donor anonymity, secrecy and disclosure have to be revisited and totally re-thought as the anonymity of donors, their relatives and also of the children born through donation is no longer guaranteed.
This potentially has significant effects on everyone involved: to donors who donated under the assumption that their donation was completely anonymous, to recipients who were under the impression that they could keep donor conception a secret and to donor offspring who were unaware of their donor-assisted conception. It is also effectively retrospective affecting everyone who has, is or might participate.
Providing the correct information to donors, ART couples and donor-conceived offspring is the key, and advise for such information provision will be presented in line with the recently published ESHRE good practice recommendations for information provision for those involved in reproductive donation.
Trial registration number
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Affiliation(s)
- J Kirkman-Brown
- The University of Birmingham , Centre for Human Reproductive Science- IMSR, Birmingham, United Kingdom
| | - C Calhaz-Jorge
- Faculdade de Medicina da Universidade de Lisboa , Lisboa, Portugal
| | - E Dancet
- KU Leuven, Department of Development and Regeneration , Leuven, Belgium
| | - K Lundin
- Department of Reproductive Medicine, Sahlgrenska University Hospital , Gothenburg, Sweden
| | - M Martins
- University of Porto, Faculty of Psychology and Education Sciences , Porto, Portugal
| | - K Tilleman
- Department for Reproductive Medicine, Universitair Ziekenhuis Gent , Ghent, Belgium
| | - P Thorn
- Private Practice, Couple and Family Therapy , Infertility Counseling, Mörfelden, Germany
| | - N Vermeulen
- ESHRE Central Office , Strombeek-Bever, Belgium
| | - L Frith
- Centre for Social Ethics and Policy, University of Manchester , Manchester, United Kingdom
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Danti L, Lundin K, Sepponen K, Yohannes D, Kere J, Tuuri T, Tapanainen J. P-793 The effect of Nuclear Receptor Subfamily 5 Group A Member 1 (NR5A1) in human ovarian somatic cell development. Hum Reprod 2022. [DOI: 10.1093/humrep/deac107.730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Study question
Can an inducible NR5A1 (encoding Steroidogenic Factor 1) cell line be used to study the functional role of NR5A1 in human female gonadal differentiation?
Summary answer
Conditional induction of NR5A1 in a human pluripotent stem cell (hPSC)-based model of gonadal differentiation allows us to study its effect on the differentiating cells.
What is known already
According to animal studies, NR5A1 is a critical factor in gonadal development. Previous research in our lab showed that CRISPR/Cas9 induced upregulation of NR5A1 during gonadal differentiation in male (XY) hPSCs increases expression of early Sertoli cell markers such as Inhibin A and Anti-Müllerian hormone (AMH) and thus pushes the cells into a more mature gonadal cell type. However, the role of NR5A1 in female gonadal differentiation has yet to be determined.
Study design, size, duration
The female (XX) human embryonic stem cell (hESC) line, H9, was edited using CRISPR/Cas9 to conditionally induce NR5A1. These cells were subjected to a 10/20-day gonadal differentiation protocol where NR5A1 was induced through addition of Doxycycline (DOX) and Trimethoprim (TMP) from day 4 until day 10/20. Starting from day 4 technical duplicates/triplicates from every second day were subjected to qRT-PCR. Technical triplicates from day 4, 6, 8 and 10 were subjected to bulk RNA-sequencing.
Participants/materials, setting, methods
The cell line that was used in this project is a female hESC line, H9 (WiCell). A previously established protocol for gonadal differentiation (Sepponen et al., 2017) was followed wherein different cell culture media and matrices were supplemented with small molecules, inhibitors and growth factors. The CRISPR/Cas9 genome-editing system was used to generate the NR5A1 inducible cell line. Cell characterisation was performed using qRT-PCR and bulk RNA sequencing (NovaSeq S4) methods.
Main results and the role of chance
qRT-PCR results showed that without NR5A1 induction there was almost no expression of this gene, but its expression increased drastically upon addition of DOX and TMP to the culture media. NR5A1 induction seemed to upregulate FOXL2 and WNT4, which are crucial genes for female gonadal differentiation, although the increase was not statistically significant. AMH showed a significant increase on day 8 of differentiation after NR5A1 induction. We also saw an increase in the expression of steroidogenic genes such as STAR, CYP11A1, CYP17A1 and CYP19A1 after NR5A1 induction. Subjecting the cells to NR5A1 induction for an additional 10 days resulted in the upregulation of bipotential gonadal markers GATA4, WT1 and EMX2 after NR5A1 induction. Similarly, the female gonadal markers RSPO1 and WNT4 were upregulated over time and WNT4 expression further increased upon NR5A1 induction.
NovaSeq S4 data showed that on day 8, after induction of NR5A1, genes related to reproductive system development and female pregnancy were upregulated. These included DHH, NR5A1, CYP19A1, AR, INHA and NR0B1. On day 10 genes related to reproductive system development such as FOXL2, NR5A1, INHA, LHCGR, and NR0B1 were also upregulated after NR5A1 induction.
Limitations, reasons for caution
The effect of NR5A1 induction on expression levels of bipotential gonadal markers GATA4, LHX9, WT1, EMX2 and female gonadal markers FOXL2, RSPO1, WNT4 was small in comparison to differentiation without additional NR5A1 induction. Moreover, we lack a protocol to generate bipotential gonadal cells expressing NR5A1 without inducing NR5A1 through CRISPR/Cas9.
Wider implications of the findings
Taken together the results will provide valuable insight and novel information on the function of NR5A1 in early female gonadal development and more in general on human ovarian development and sex determination. This knowledge will increase our understanding of pathological gonadal development, which often underlies disorders of sex development.
Trial registration number
Not applicable
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Affiliation(s)
- L Danti
- University of Helsinki, Obstetrics and Gynaecology , Helsinki, Finland
| | - K Lundin
- University of Helsinki, Obstetrics and Gynaecology , Helsinki, Finland
| | - K Sepponen
- University of Helsinki, Obstetrics and Gynaecology , Helsinki, Finland
| | - D.A Yohannes
- University of Helsinki, Research Programs Unit- Translational Immunology Research Program , Helsinki, Finland
| | - J Kere
- Karolinska Institute, Biosciences and Nutrition , Stockholm, Sweden
| | - T Tuuri
- University of Helsinki, Obstetrics and Gynaecology , Helsinki, Finland
| | - J Tapanainen
- University of Helsinki, Obstetrics and Gynaecology , Helsinki, Finland
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Francis J, Kärrberg C, Hermansson J, Lindh M, Ganidou S, Thurin-Kjellberg A, Lundin K, Akouri R, Tsiartas P. Seminal HPV detection: a pilot study comparing the preservation effectiveness and cost between a methanol-based solution and cryopreservation with liquid nitrogen. Asian J Androl 2022; 24:560-561. [PMID: 35488669 PMCID: PMC9491042 DOI: 10.4103/aja202213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Jynfiaf Francis
- Department of Reproductive Medicine, Sahlgrenska University Hospital, Gothenburg 413 45, Sweden
| | - Cecilia Kärrberg
- Department of Reproductive Medicine, Sahlgrenska University Hospital, Gothenburg 413 45, Sweden.,Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg 405 30, Sweden
| | - Jonas Hermansson
- Department of Research and Development, Angered Hospital, Angered 424 65, Sweden
| | - Magnus Lindh
- Department of Clinical Microbiology, Sahlgrenska University Hospital, Gothenburg 413 46, Sweden
| | - Sofia Ganidou
- Department of Reproductive Medicine, Sahlgrenska University Hospital, Gothenburg 413 45, Sweden
| | - Ann Thurin-Kjellberg
- Department of Reproductive Medicine, Sahlgrenska University Hospital, Gothenburg 413 45, Sweden.,Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg 405 30, Sweden
| | - Kersti Lundin
- Department of Reproductive Medicine, Sahlgrenska University Hospital, Gothenburg 413 45, Sweden.,Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg 405 30, Sweden
| | - Randa Akouri
- Department of Reproductive Medicine, Sahlgrenska University Hospital, Gothenburg 413 45, Sweden.,Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg 405 30, Sweden
| | - Panagiotis Tsiartas
- Department of Reproductive Medicine, Sahlgrenska University Hospital, Gothenburg 413 45, Sweden.,Department of Oncology- Pathology, Karolinska Institute, Stockholm 171 77, Sweden
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10
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Kirkman-Brown J, Calhaz-Jorge C, Dancet EAF, Lundin K, Martins M, Tilleman K, Thorn P, Vermeulen N, Frith L. OUP accepted manuscript. Hum Reprod Open 2022; 2022:hoac001. [PMID: 35178481 PMCID: PMC8847071 DOI: 10.1093/hropen/hoac001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 12/14/2021] [Indexed: 11/26/2022] Open
Abstract
STUDY QUESTION What information and support should be offered to donors, intended parents and donor-conceived people, in general and in consideration of the availability of direct-to-consumer genetic testing and matching services? SUMMARY ANSWER For donors, intended parents and donor-conceived offspring, recommendations are made that cover information needs and informed consent, psychosocial implications and disclosure. WHAT IS KNOWN ALREADY Trends indicate that the use of donor-assisted conception is growing and guidance is needed to help these recipients/intended parents, the donors and offspring, navigate the rapidly changing environment in which donor-assisted conception takes place. STUDY DESIGN, SIZE, DURATION A working group (WG) collaborated on writing recommendations based, where available, on evidence collected from a literature search and expert opinion. Draft recommendations were published for stakeholder review and adapted where relevant based on the comments received. PARTICIPANTS/MATERIALS, SETTING, METHODS Papers retrieved from PUBMED were included from 1 January 2014 up to 31 August 2020, focusing on studies published since direct-to-consumer genetic testing has become more widespread and accessible. The current paper is limited to reproductive donation performed in medically assisted reproduction (MAR) centres (and gamete banks): donation outside the medical context was not considered. MAIN RESULTS AND THE ROLE OF CHANCE In total, 32 recommendations were made for information provision and support to donors, 32 for intended parents and 27 for donor-conceived offspring requesting information/support. LIMITATIONS, REASONS FOR CAUTION The available evidence in the area of reproductive donation is limited and diverse with regards to the context and types of donation. General conclusions and recommendations are largely based on expert opinion and may need to be adapted in light of future research. WIDER IMPLICATIONS OF THE FINDINGS These recommendations provide guidance to MAR centres and gamete banks on good practice in information provision and support but should also be considered by regulatory bodies and policymakers at a national and international level to guide regulatory and legislative efforts towards the protection of donors and donor-conceived offspring. STUDY FUNDING/COMPETING INTEREST(S) The development of this good practice paper was funded by European Society of Human Reproduction and Embryology (ESHRE), covering expenses associated with the WG meetings, the literature searches and dissemination. The WG members did not receive any payment. The authors have no conflicts of interest to declare. DISCLAIMER This document represents the views of ESHRE, which are the result of consensus between the relevant ESHRE stakeholders and where relevant based on the scientific evidence available at the time of preparation. The recommendations should be used for informational and educational purposes. They should not be interpreted as setting a standard of care, or be deemed inclusive of all proper methods of care nor exclusive of other methods of care reasonably directed to obtaining the same results. They do not replace the need for application of clinical judgement to each individual presentation, nor variations based on locality and facility type. †ESHRE pages content is not externally peer reviewed. The manuscript has been approved by the Executive Committee of ESHRE.
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Affiliation(s)
| | - Jackson Kirkman-Brown
- Centre for Human Reproductive Science, University of Birmingham, IMSR, Birmingham, UK
- Correspondence address. University of Birmingham, IMSR, Birmingham B15 2TT, UK. E-mail: ;
| | | | - Eline A F Dancet
- KU Leuven, Department of Development and Regeneration, Leuven, Belgium
| | - Kersti Lundin
- Department of Reproductive Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Mariana Martins
- University of Porto, Faculty of Psychology and Education Sciences, Porto, Portugal
| | - Kelly Tilleman
- Department for Reproductive Medicine, Universitair Ziekenhuis Gent, Ghent, Belgium
| | - Petra Thorn
- Private Practice, Couple and Family Therapy, Infertility Counseling, Mörfelden, Germany
| | - Nathalie Vermeulen
- European Society of Human Reproduction and Embryology (ESHRE) Central Office, Strombeek-Bever, Belgium
| | - Lucy Frith
- Centre for Social Ethics and Policy, University of Manchester, Manchester, UK
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11
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Lundin K, Sepponen K, Väyrynen P, Liu X, Yohannes DA, Survila M, Ghimire B, Känsäkoski J, Katayama S, Partanen J, Vuoristo S, Paloviita P, Rahman N, Raivio T, Luiro K, Huhtaniemi I, Varjosalo M, Tuuri T, Tapanainen JS. OUP accepted manuscript. Mol Hum Reprod 2022; 28:6574364. [PMID: 35471239 PMCID: PMC9308958 DOI: 10.1093/molehr/gaac012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 03/11/2022] [Indexed: 11/14/2022] Open
Affiliation(s)
- K Lundin
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - K Sepponen
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - P Väyrynen
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - X Liu
- Molecular Systems Biology Research Group, Institute of Biotechnology & HiLIFE, University of Helsinki, Helsinki, Finland
- Proteomics Unit, Institute of Biotechnology & HiLIFE, University of Helsinki, Helsinki, Finland
| | - D A Yohannes
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Research Programs Unit, Translational Immunology & Department of Medical and Clinical Genetics, University of Helsinki, Helsinki, Finland
| | - M Survila
- Molecular and Integrative Biosciences Research Programme, Faculty of Biological and Environmental Sciences, University of Helsinki, Helsinki, Finland
| | - B Ghimire
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland
| | - J Känsäkoski
- Department of Physiology, University of Helsinki, Helsinki, Finland
| | - S Katayama
- Folkhälsan Research Center, Helsinki, Finland
- Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Sweden
- Stem Cells and Metabolism Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - J Partanen
- Molecular and Integrative Biosciences Research Programme, Faculty of Biological and Environmental Sciences, University of Helsinki, Helsinki, Finland
| | - S Vuoristo
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - P Paloviita
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - N Rahman
- Institute of Biomedicine, University of Turku, Turku, Finland
- Department of Reproduction and Gynecological Endocrinology, Medical University of Bialystok, Bialystok, Poland
| | - T Raivio
- Department of Physiology, University of Helsinki, Helsinki, Finland
- Stem Cells and Metabolism Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- New Children's Hospital, Pediatric Research Center, Helsinki University Hospital, HUH, Helsinki, Finland
| | - K Luiro
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - I Huhtaniemi
- Institute of Biomedicine, University of Turku, Turku, Finland
- Department of Metabolism, Endocrinology and Reproduction, Faculty of Medicine, Hammersmith Campus, Imperial College London, London, UK
| | - M Varjosalo
- Molecular Systems Biology Research Group, Institute of Biotechnology & HiLIFE, University of Helsinki, Helsinki, Finland
- Proteomics Unit, Institute of Biotechnology & HiLIFE, University of Helsinki, Helsinki, Finland
| | - T Tuuri
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - J S Tapanainen
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Obstetrics and Gynecology, University Hospital of Oulu, University of Oulu, Medical Research Center Oulu and PEDEGO Research Unit, Oulu, Finland
- Corresponding author. Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, PO Box 140, 00029 Helsinki, Finland. Tel: +358-94711; E-mail:
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Ahlström A, Lundin K, Lind AK, Gunnarsson K, Westlander G, Park H, Thurin-Kjellberg A, Thorsteinsdottir SA, Einarsson S, Åström M, Löfdahl K, Menezes J, Callender S, Nyberg C, Winerdal J, Stenfelt C, Jonassen BR, Oldereid N, Nolte L, Sundler M, Hardarson T. OUP accepted manuscript. Hum Reprod 2022; 37:708-717. [PMID: 35143661 PMCID: PMC9383441 DOI: 10.1093/humrep/deac020] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/12/2021] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION Can use of a commercially available time-lapse algorithm for Day 5 blastocyst selection improve pregnancy rates compared with morphology alone? SUMMARY ANSWER The use of a time-lapse selection model to choose blastocysts for fresh single embryo transfer on Day 5 did not improve ongoing pregnancy rate compared to morphology alone. WHAT IS KNOWN ALREADY Evidence from time-lapse monitoring suggests correlations between timing of key developmental events and embryo viability. No good quality evidence exists to support improved pregnancy rates following time-lapse selection. STUDY DESIGN, SIZE, DURATION A prospective multicenter randomized controlled trial including 776 randomized patients was performed between 2018 and 2021. Patients with at least two good quality blastocysts on Day 5 were allocated by a computer randomization program in a proportion of 1:1 into either the control group, whereby single blastocysts were selected for transfer by morphology alone, or the intervention group whereby final selection was decided by a commercially available time-lapse model. The embryologists at the time of blastocyst morphological scoring were blinded to which study group the patients would be randomized, and the physician and patients were blind to which group they were allocated until after the primary outcome was known. The primary outcome was number of ongoing pregnancies in the two groups. PARTICIPANTS/MATERIALS, SETTING, METHODS From 10 Nordic IVF clinics, 776 patients with a minimum of two good quality blastocysts on Day 5 (D5) were randomized into one of the two study groups. A commercial time-lapse model decided the final selection of blastocysts for 387 patients in the intervention (time-lapse) group, and blastocysts with the highest morphological score were transferred for 389 patients in the control group. Only single embryo transfers in fresh cycles were performed. MAIN RESULTS AND THE ROLE OF CHANCE In the full analysis set, the ongoing pregnancy rate for the time-lapse group was 47.4% (175/369) and 48.1% (181/376) in the control group. No statistically significant difference was found between the two groups: mean difference −0.7% (95% CI −8.2, 6.7, P = 0.90). Pregnancy rate (60.2% versus 59.0%, mean difference 1.1%, 95% CI −6.2, 8.4, P = 0.81) and early pregnancy loss (21.2% versus 18.5%, mean difference 2.7%, 95% CI −5.2, 10.6, P = 0.55) were the same for the time-lapse and the control group. Subgroup analyses showed that patient and treatment characteristics did not significantly affect the commercial time-lapse model D5 performance. In the time-lapse group, the choice of best blastocyst changed on 42% of occasions (154/369, 95% CI 36.9, 47.2) after the algorithm was applied, and this rate was similar for most treatment clinics. LIMITATIONS, REASONS FOR CAUTION During 2020, the patient recruitment rate slowed down at participating clinics owing to coronavirus disease-19 restrictions, so the target sample size was not achieved as planned and it was decided to stop the trial prematurely. The study only investigated embryo selection at the blastocyst stage on D5 in fresh IVF transfer cycles. In addition, only blastocysts of good morphological quality were considered for transfer, limiting the number of embryos for selection in both groups: also, it could be argued that this manual preselection of blastocysts limits the theoretical selection power of time-lapse, as well as restricting the results mainly to a good prognosis patient group. Most patients were aimed for blastocyst stage transfer when a minimum of five zygotes were available for extended culture. Finally, the primary clinical outcome evaluated was pregnancy to only 6–8 weeks. WIDER IMPLICATIONS OF THE FINDINGS The study suggests that time-lapse selection with a commercially available time-lapse model does not increase chance of ongoing pregnancy after single blastocyst transfer on Day 5 compared to morphology alone. STUDY FUNDING/COMPETING INTEREST(S) The study was financed by a grant from the Swedish state under the ALF-agreement between the Swedish government and the county councils (ALFGBG-723141). Vitrolife supported the study with embryo culture dishes and culture media. During the study period, T.H. changed his employment from Livio AB to Vitrolife AB. All other authors have no conflicts of interests to disclose. TRIAL REGISTRATION NUMBER ClinicalTrials.gov registration number NCT03445923. TRIAL REGISTRATION DATE 26 February 2018. DATE OF FIRST PATIENT’S ENROLMENT 11 June 2018.
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Affiliation(s)
- Aisling Ahlström
- Livio Gothenburg, Gothenburg, Sweden
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Correspondence address. Livio Gothenburg, Carlandersparken 24, 402 29 Gothenburg, Sweden. E-mail: https://orcid.org/0000-0002-5074-912X
| | - Kersti Lundin
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Reproductive Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anna-Karin Lind
- Livio Gothenburg, Gothenburg, Sweden
- Livio Falun, Falun, Sweden
| | | | | | - Hannah Park
- Reproductive Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anna Thurin-Kjellberg
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Reproductive Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | | | - Mari Åström
- Livio Umeå, Norrlands Universitetssjukhus, Umeå, Sweden
| | | | - Judith Menezes
- Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
| | | | | | | | | | | | | | | | | | - Thorir Hardarson
- Livio Gothenburg, Gothenburg, Sweden
- Vitrolife Sweden AB, Göteborg, Sweden
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13
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Ata B, Gianaroli L, Lundin K, Mcheik S, Mocanu E, Rautakallio-Hokkanen S, Tapanainen JS, Vermeulen N, Veiga A. Outcomes of SARS-CoV-2 infected pregancies after medically assisted reproduction. Hum Reprod 2021; 36:2883-2890. [PMID: 34515777 PMCID: PMC8523208 DOI: 10.1093/humrep/deab218] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 09/02/2021] [Indexed: 11/30/2022] Open
Abstract
STUDY QUESTION What is the impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection on the outcome of a pregnancy after medically assisted reproduction (MAR)? SUMMARY ANSWER Our results suggest that MAR pregnancies are not differentially affected by SARS-CoV-2 infection compared to spontaneous pregnancies. WHAT IS KNOWN ALREADY Information on the effects of coronavirus disease 2019 (COVID-19) on pregnancy after MAR is scarce when women get infected during MAR or early pregnancy, even though such information is vital for informing women seeking pregnancy. STUDY DESIGN, SIZE, DURATION Data from SARS-CoV-2 affected MAR pregnancies were collected between May 2020 and June 2021 through a voluntary data collection, organised by the European Society of Human Reproduction and Embryology (ESHRE). PARTICIPANTS/MATERIALS, SETTING, METHODS All ESHRE members were invited to participate to an online data collection for SARS-CoV-2-infected MAR pregnancies. MAIN RESULTS AND THE ROLE OF CHANCE The dataset includes 80 cases from 32 countries, including 67 live births, 10 miscarriages, 2 stillbirths and 1 maternal death. An additional 25pregnancies were ongoing at the time of writing. LIMITATIONS, REASONS FOR CAUTION An international data registry based on voluntary contribution can be subject to selective reporting with possible risks of over- or under-estimation. WIDER IMPLICATIONS OF THE FINDINGS The current data can be used to guide clinical decisions in the care of women pregnant after MAR, in the context of the COVID-19 pandemic. STUDY FUNDING/COMPETING INTEREST(S) The authors acknowledge the support of ESHRE for the data registry and meetings. J.S.T. reports grants or contracts from Sigrid Juselius Foundation, EU and Helsinki University Hospital Funds, outside the scope of the current work. The other authors declare that they have no conflict of interest. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
| | - Baris Ata
- Obstetrics and Gynecology Department, Koc University, Istanbul, Turkey
| | - Luca Gianaroli
- Società Italiana Studi di Medicina della Riproduzione, S.I.S.Me.R. Reproductive Medicine Institute, Bologna, Emilia-Romagna, Italy
| | - Kersti Lundin
- Reproductive Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Saria Mcheik
- European Society of Human Reproduction and Embryology (ESHRE) Central Office, Grimbergen, Belgium
| | - Edgar Mocanu
- Department of Reproductive Medicine, Rotunda Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Juha S Tapanainen
- Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Department of Obstetrics and Gynaecology, University of Oulu, Oulu University Hospital and Medical Research Centre, PEDEGO Research Unit, Oulu, Finland
| | - Nathalie Vermeulen
- European Society of Human Reproduction and Embryology (ESHRE) Central Office, Grimbergen, Belgium
| | - Anna Veiga
- Reproductive Medicine Service, Dexeus Mujer, Hospital Universitari Dexeus/Institut d'Investigació Biomedica de Bellvitge, IDIBELL, Barcelona Stem Cell Bank, Regenerative Medicine Programme, Barcelona, Spain
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14
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Saket Z, Kallen K, Lundin K, Magnusson Å, Bergh C. P–767 Cumulative live birth rate after IVF - trend over time and the impact of blastocyst culture and vitrification. Hum Reprod 2021. [DOI: 10.1093/humrep/deab130.766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Study question
Has cumulative live birth rate (CLBR) improved over time and which factors are associated with such an improvement?
Summary answer
During 2007–2017, CLBR per oocyte aspiration increased significantly (27.0% to 36.3%), in parallel with an increase in blastocyst transfer and cryopreservation by vitrification.
What is known already
While it has been shown that live birth rate (LBR) per embryo transfer (ET) is higher for fresh blastocyst than for fresh cleavage stage embryo transfer, CLBR per oocyte aspiration, including one fresh ET and all subsequent frozen embryo transfers (FET), does not seem to differ between the two culture strategies.
Study design, size, duration
STUDY DESIGN, SIZE, DURATION: National register study including all oocyte aspirations performed in Sweden 2007–2017, n = 124 700. Donation cycles excluded.
Participants/materials, setting, methods
Data were retrieved from the Swedish National Registry of Assisted Reproduction (Q-IVF). CLBR was defined as the number of deliveries with at least one live birth resulting from one oocyte aspiration, including all fresh and/or frozen embryo transfers within one year. The delivery of a singleton, twin, or other multiples was registered as one delivery. Cryopreservation of cleavage stage embryos was performed by slow freezing and of blastocyst by vitrification.
Main results and the role of chance
Overall, the CLBR per oocyte aspiration increased significantly during the study period, from 27.0% to 36.3% (OR 1.039, 95% CI 1.035–1.043) and from 30.0% to 43.3% if at least one ET was performed (AOR 1.055, 95% CI 1.050–1.059). The increase in CLBR was independent of maternal age, number of oocytes retrieved and number of previous IVF live births. The CLBR for women <35 years and ≥ 35 years both increased significantly, following the same pattern. During the study period a substantially increasing number of blastocyst transfers were performed, both in fresh and in FET cycles. An important contributor included in the blastocyst strategy, may be the extended culture of the total cohort of embryos, also embryos earlier discarded at early cleavage stages, in order to reach the blastocyst stage. These embryos may contribute to the total number of available blastocysts and thereby increase the chance of a live birth within that oocyte aspiration cycle. Other important predicting factors for live birth, such as number of embryos transferred, could not explain the improvement, on the contrary the single embryo transfer (SET) rate increased with time.
Limitations, reasons for caution
The retrospective design implicates that other confounders of importance for CLBR can not be ruled out. In addition, some FET cycles might be performed later than one year post oocyte aspiration for the last year (2017) and are thus not included in this study.
Wider implications of the findings: The results suggest that blastocyst transfer, particularly when used in FET cycles and in combination with vitrification, is an important contributor to the improved live birth rates over time. This gives a possibility for fewer oocyte aspirations needed to achieve a live birth and a shortened time to live birth.
Trial registration number
-
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Affiliation(s)
- Z Saket
- Institute of Clinical Sciences- Sahlgrenska Academy, Department of Reproductive Medicine- Sahlgrenska University Hospital- SE–413 45 Göteborg- Sweden, Gothenburg, Sweden
| | - K Kallen
- Intitution of Clinical Sciences- Lund University, Department of Obstetrics and Gynecology- Tornblad Institute, Lund, Sweden
| | - K Lundin
- Institute of Clinical Sciences- Sahlgrenska Academy, Department of Reproductive Medicine- Sahlgrenska University Hospital- SE–413 45 Göteborg- Sweden, Gothenburg, Sweden
| | - Å Magnusson
- Institute of Clinical Sciences- Sahlgrenska Academy, Department of Reproductive Medicine- Sahlgrenska University Hospital- SE–413 45 Göteborg- Sweden, Gothenburg, Sweden
| | - C Bergh
- Institute of Clinical Sciences- Sahlgrenska Academy, Department of Reproductive Medicine- Sahlgrenska University Hospital- SE–413 45 Göteborg- Sweden, Gothenburg, Sweden
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15
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Saket Z, Kallen K, Lundin K, Magnusson Å, Bergh C. P-767 Cumulative live birth rate after IVF - trend over time and the impact of blastocyst culture and vitrification. Hum Reprod 2021. [DOI: 10.1093/humrep/deab125.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Study question
Has cumulative live birth rate (CLBR) improved over time and which factors are associated with such an improvement?
Summary answer
During 2007-2017, CLBR per oocyte aspiration increased significantly (27.0 % to 36.3 %), in parallel with an increase in blastocyst transfer and cryopreservation by vitrification.
What is known already
While it has been shown that live birth rate (LBR) per embryo transfer (ET) is higher for fresh blastocyst than for fresh cleavage stage embryo transfer, CLBR per oocyte aspiration, including one fresh ET and all subsequent frozen embryo transfers (FET), does not seem to differ between the two culture strategies.
Study design, size, duration
STUDY DESIGN, SIZE, DURATION: National register study including all oocyte aspirations performed in Sweden 2007-2017, n = 124 700. Donation cycles excluded.
Participants/materials, setting, methods
Data were retrieved from the Swedish National Registry of Assisted Reproduction (Q-IVF). CLBR was defined as the number of deliveries with at least one live birth resulting from one oocyte aspiration, including all fresh and/or frozen embryo transfers within one year. The delivery of a singleton, twin, or other multiples was registered as one delivery. Cryopreservation of cleavage stage embryos was performed by slow freezing and of blastocyst by vitrification.
Main results and the role of chance
Overall, the CLBR per oocyte aspiration increased significantly during the study period, from 27.0 % to 36.3 % (OR 1.039, 95% CI 1.035-1.043) and from 30.0 % to 43.3 % if at least one ET was performed (AOR 1.055, 95% CI 1.050-1.059). The increase in CLBR was independent of maternal age, number of oocytes retrieved and number of previous IVF live births. The CLBR for women < 35 years and ≥ 35 years both increased significantly, following the same pattern. During the study period a substantially increasing number of blastocyst transfers were performed, both in fresh and in FET cycles. An important contributor included in the blastocyst strategy, may be the extended culture of the total cohort of embryos, also embryos earlier discarded at early cleavage stages, in order to reach the blastocyst stage. These embryos may contribute to the total number of available blastocysts and thereby increase the chance of a live birth within that oocyte aspiration cycle. Other important predicting factors for live birth, such as number of embryos transferred, could not explain the improvement, on the contrary the single embryo transfer (SET) rate increased with time.
Limitations, reasons for caution
The retrospective design implicates that other confounders of importance for CLBR can not be ruled out. In addition, some FET cycles might be performed later than one year post oocyte aspiration for the last year (2017) and are thus not included in this study.
Wider implications of the findings
The results suggest that blastocyst transfer, particularly when used in FET cycles and in combination with vitrification, is an important contributor to the improved live birth rates over time. This gives a possibility for fewer oocyte aspirations needed to achieve a live birth and a shortened time to live birth.
Trial registration number
-
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Affiliation(s)
- Z Saket
- Institute of Clinical Sciences- Sahlgrenska Academy, Department of Reproductive Medicine- Sahlgrenska University Hospital- SE-413 45 Göteborg- Sweden, Gothenburg, Sweden
| | - K Kallen
- Intitution of Clinical Sciences- Lund University, Department of Obstetrics and Gynecology- Tornblad Institute, Lund, Sweden
| | - K Lundin
- Institute of Clinical Sciences- Sahlgrenska Academy, Department of Reproductive Medicine- Sahlgrenska University Hospital- SE-413 45 Göteborg- Sweden, Gothenburg, Sweden
| | - Å Magnusson
- Institute of Clinical Sciences- Sahlgrenska Academy, Department of Reproductive Medicine- Sahlgrenska University Hospital- SE-413 45 Göteborg- Sweden, Gothenburg, Sweden
| | - C Bergh
- Institute of Clinical Sciences- Sahlgrenska Academy, Department of Reproductive Medicine- Sahlgrenska University Hospital- SE-413 45 Göteborg- Sweden, Gothenburg, Sweden
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Saket Z, Källén K, Lundin K, Magnusson Å, Bergh C. Cumulative live birth rate after IVF: trend over time and the impact of blastocyst culture and vitrification. Hum Reprod Open 2021; 2021:hoab021. [PMID: 34195386 PMCID: PMC8240131 DOI: 10.1093/hropen/hoab021] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 04/15/2021] [Indexed: 12/26/2022] Open
Abstract
STUDY QUESTION Has cumulative live birth rate (CLBR) improved over time and which factors are associated with such an improvement? SUMMARY ANSWER During an 11-year period, 2007–2017, CLBR per oocyte aspiration increased significantly, from 27.0% to 36.3%, in parallel with an increase in blastocyst transfer and cryopreservation by vitrification. WHAT IS KNOWN ALREADY While it has been shown that live birth rate (LBR) per embryo transfer (ET) is higher for fresh blastocyst than for fresh cleavage stage embryo transfer, CLBR per oocyte aspiration, including one fresh ET and all subsequent frozen embryo transfers (FET), does not seem to differ between the two culture strategies. STUDY DESIGN, SIZE, DURATION A national register study including all oocyte aspirations performed in Sweden from 2007 to 2017 (n = 124 700 complete IVF treatment cycles) was carried out. Oocyte donation cycles were excluded. PARTICIPANTS/MATERIALS, SETTING, METHODS Data were retrieved from the Swedish National Registry of Assisted Reproduction (Q-IVF) on all oocyte aspirations during the study period where autologous oocytes were used. CLBR was defined as the proportion of deliveries with at least one live birth per oocyte aspiration, including all fresh and/or frozen embryo transfers within 1 year, until one delivery with a live birth or until all embryos were used, whichever occurred first. The delivery of a singleton, twin, or other multiples was registered as one delivery. Cryopreservation of cleavage stage embryos was performed by slow freezing and of blastocyst by vitrification. MAIN RESULTS AND THE ROLE OF CHANCE In total, 124 700 oocyte aspirations were performed (in 61 313 women), with 65 304 aspirations in women <35 years and 59 396 in women ≥ 35 years, resulting in 38 403 deliveries with live born children. Overall, the CLBR per oocyte aspiration increased significantly during the study period, from 27.0% to 36.3% (odds ratio (OR) 1.039, 95% CI 1.035–1.043) and from 30.0% to 43.3% if at least one ET was performed (adjusted OR 1.055, 95% CI 1.050–1.059). The increase in CLBR was independent of maternal age, number of oocytes retrieved and number of previous IVF live births. The CLBR for women <35 and ≥35 years both increased significantly, following the same pattern. During the study period, a substantially increasing number of blastocyst transfers was performed, both in fresh and in FET cycles. Other important predicting factors for live birth, such as number of embryos transferred, could not explain the improvement. An increased single embryo transfer rate was observed with time. LIMITATIONS, REASONS FOR CAUTION The retrospective design implicates that other confounders of importance for CLBR cannot be ruled out. In addition, some FET cycles might be performed later than 1 year post oocyte aspiration for the last year (2017) and are, thus, not included in this study. In addition, no data on ‘dropouts’, i.e. patients that do not continue their treatment despite having cryopreserved embryos, are available, or if this drop-out rate has changed over time. WIDER IMPLICATIONS OF THE FINDINGS The results suggest that blastocyst transfer, particularly when used in FET cycles and in combination with vitrification, is an important contributor to the improved live birth rates over time. This gives a possibility for a lower number of oocyte aspirations needed to achieve a live birth and a shortened time to live birth. STUDY FUNDING/COMPETING INTERESTS The study was financed by grants from the Swedish state under the agreement between the Swedish government and the county councils, the ALF-agreement (ALFGBG-70940) and by Hjalmar Svensson’s research foundation. None of the authors declares any conflict of interest.
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Affiliation(s)
- Zoha Saket
- Department of Reproductive Medicine, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Karin Källén
- Unit of Reproduction Epidemiology, Department of Obstetrics and Gynecology, Tornblad Institute, Institution of Clinical Sciences, Lund University, Lund, Sweden
| | - Kersti Lundin
- Department of Reproductive Medicine, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Åsa Magnusson
- Department of Reproductive Medicine, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Christina Bergh
- Reproductive Medicine, Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital, Göteborg University, Göteborg, Sweden
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Chiware TM, Vermeulen N, Blondeel K, Farquharson R, Kiarie J, Lundin K, Matsaseng TC, Ombelet W, Toskin I. IVF and other ART in low- and middle-income countries: a systematic landscape analysis. Hum Reprod Update 2021; 27:213-228. [PMID: 33238297 PMCID: PMC7903111 DOI: 10.1093/humupd/dmaa047] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 08/06/2020] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Infertility affects 48.5 million couples worldwide with a prevalence estimated at 3.5-16.7% in low- and middle-income countries (LMIC), and as high as 30-40% in Sub-Saharan Africa. ART services are not accessible to the majority of these infertile couples due to the high cost of treatments in addition to cultural, religious and legal barriers. Infertility and childlessness, particularly in LMIC, have devastating consequences, which has resulted in considerable interest in developing affordable IVF procedures. However, there is a paucity of evidence on the safety, efficiency and ability to replicate techniques under different field conditions, and how to integrate more affordable ART options into existing infrastructures. OBJECTIVE AND RATIONALE This review was performed to investigate the current availability of IVF in LMIC and which other ART options are under development. This work will unfold the landscape of available and potential ART services in LMIC and is a key element in positioning infertility more broadly in the Global Public Health Agenda. SEARCH METHODS A systematic literature search was performed of articles and gray literature on IVF and other ART options in LMIC published between January 2010 and January 2020. We selected studies on IVF and other ART treatments for infertile couples of reproductive age (18-44 years) from LMIC. The review was limited to articles published after 2010, based on the recent evolution in the field of ART practices in LMIC over the last decade. Citations from high-income countries, including data prior to 2010 and focusing on specialized ART procedures, were excluded. The literature search included PubMed, Popline, CINHAL, EMBASE and Global Index Medicus. No restrictions were applied with regard to study design or language. Two reviewers independently screened the titles and abstracts, and extracted data. A search for gray literature was performed using the 'Google' search engine and specific databases (worldcat.org, greylit.org). In addition, the reference lists of included studies were assessed. OUTCOMES The search of the electronic databases yielded 3769 citations. After review of the titles and abstracts, 283 studies were included. The full texts were reviewed and a further 199 articles were excluded. The gray literature search yielded 586 citations, most of which were excluded after screening the title, and the remaining documents were excluded after full-text assessment due to duplicate entries, not from LMIC, not relevant or no access to the full document. Eighty-four citations were included as part of the review and separated into regions. The majority of the studies were observational and qualitative studies. In general, ART services are available and described in several LMIC, ranging from advanced techniques in China to basic introduction of IVF in some African countries. Efforts to provide affordable ART treatments are described in feasibility studies and efficacy studies; however, most citations were of low to very low quality. We found no studies from LMIC reporting the implementation of low-cost ART that is effective, accessible and affordable to most of those in need of the services. WIDER IMPLICATIONS The World Health Organization is in a unique position to provide much needed guidance for infertility management in LMIC. This review provides insight into the landscape of ART in LMIC in various regions worldwide, which will guide efforts to improve the availability, quality, accessibility and acceptability of biomedical infertility care, including ART in these countries.
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Affiliation(s)
- Tendai M Chiware
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of Vermont Medical Center, Burlington, VT, USA
- Department of Reproductive Health and Research, UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Nathalie Vermeulen
- European Society of Human Reproduction and Embryology, Central Office, Grimbergen, Belgium
| | - Karel Blondeel
- Department of Reproductive Health and Research, UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Roy Farquharson
- European Society of Human Reproduction and Embryology, Central Office, Grimbergen, Belgium
| | - James Kiarie
- Department of Reproductive Health and Research, UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Kersti Lundin
- European Society of Human Reproduction and Embryology, Central Office, Grimbergen, Belgium
- Reproductive Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Thabo Christopher Matsaseng
- Department of Reproductive Health and Research, UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
- Reproductive Medicine Unit, Department of Obstetrics & Gynaecology, Stellenbosch University, Cape Town, South Africa
| | - Willem Ombelet
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt 3500, Belgium
- Genk Institute for Fertility Technology, ZOL Hospitals, Genk 3600, Belgium
| | - Igor Toskin
- Department of Reproductive Health and Research, UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
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Coticchio G, Behr B, Campbell A, Meseguer M, Morbeck DE, Pisaturo V, Plancha CE, Sakkas D, Xu Y, D'Hooghe T, Cottell E, Lundin K. Fertility technologies and how to optimize laboratory performance to support the shortening of time to birth of a healthy singleton: a Delphi consensus. J Assist Reprod Genet 2021; 38:1021-1043. [PMID: 33599923 DOI: 10.1007/s10815-021-02077-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 01/18/2021] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To explore how the assisted reproductive technology (ART) laboratories can be optimized and standardized to enhance embryo culture and selection, to bridge the gap between standard practice and the new concept of shortening time to healthy singleton birth. METHODS A Delphi consensus was conducted (January to July 2018) to assess how the ART laboratory could be optimized, in conjunction with existing guidelines, to reduce the time to a healthy singleton birth. Eight experts plus the coordinator discussed and refined statements proposed by the coordinator. The statements were distributed via an online survey to 29 participants (including the eight experts from step 1), who voted on their agreement/disagreement with each statement. Consensus was reached if ≥ 66% of participants agreed/disagreed with a statement. If consensus was not achieved for any statement, that statement was revised and the process repeated until consensus was achieved. Details of statements achieving consensus were communicated to the participants. RESULTS Consensus was achieved for all 13 statements, which underlined the need for professional guidelines and standardization of lab processes to increase laboratory competency and quality. The most important points identified were the improvement of embryo culture and embryo assessment to shorten time to live birth through the availability of more high-quality embryos, priority selection of the most viable embryos and improved cryosurvival. CONCLUSION The efficiency of the ART laboratory can be improved through professional guidelines on standardized practices and optimized embryo culture environment, assessment, selection and cryopreservation methodologies, thereby reducing the time to a healthy singleton delivery.
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Affiliation(s)
- Giovanni Coticchio
- 9.baby Family and Fertility Center, Via Dante, 15, 40125, Bologna, Italy.
| | - Barry Behr
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics & Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| | | | | | - Dean E Morbeck
- Fertility Associates, Auckland, New Zealand
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Valerio Pisaturo
- Reproductive Medicine Department, International Evangelical Hospital, Genoa, Italy
| | - Carlos E Plancha
- Inst. Histologia e Biologia do Desenvolvimento, Faculdade de Medicina, Universidade de Lisboa and CEMEARE, Lisbon, Portugal
| | - Denny Sakkas
- Boston IVF, Waltham, MA, USA
- Department of Obstetrics and Gynecology, Yale University, New Haven, CT, USA
| | - Yanwen Xu
- Reproductive Medicine Center, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Thomas D'Hooghe
- Department of Obstetrics and Gynecology, Yale University, New Haven, CT, USA
- Global Medical Affairs Fertility, R&D Biopharma, Merck KGaA, Darmstadt, Germany
- Department of Development and Regeneration, Biomedical Sciences Group, KU Leuven (University of Leuven), Leuven, Belgium
| | - Evelyn Cottell
- Global Medical Affairs Fertility, R&D Biopharma, Merck KGaA, Darmstadt, Germany
| | - Kersti Lundin
- Reproductive Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
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Gianaroli L, Ata B, Lundin K, Rautakallio-Hokkanen S, Tapanainen JS, Vermeulen N, Veiga A, Mocanu E. The calm after the storm: re-starting ART treatments safely in the wake of the COVID-19 pandemic. Hum Reprod 2021; 36:275-282. [PMID: 33017461 PMCID: PMC7665491 DOI: 10.1093/humrep/deaa285] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 09/03/2020] [Indexed: 12/25/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic created a significant impact on medically assisted reproduction (MAR) services. ESHRE decided to mobilize resources in order to collect, analyse, monitor, prepare and disseminate severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) knowledge specifically related to ART and early pregnancy. This article presents the impact of the SARS-CoV-2 pandemic focusing on reproductive healthcare. It details the rationale behind the guidance prepared to support MAR services in organizing and managing the re-start of treatments or in case of any future wave of COVID-19 disease. The guidance includes information on patient selection and informed consent, staff and patient triage and testing, adaptation of ART services, treatment planning and code of conduct. The initiatives detailed in this article are not necessarily COVID-specific and such action plans could be applied effectively to manage similar emergency situations in different areas of medicine, in the future.
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Affiliation(s)
| | - Luca Gianaroli
- Società Italiana Studi di Medicina della Riproduzione, S.I.S.Me.R. Reproductive Medicine Institute, Bologna, Emilia-Romagna, Italy
| | - Baris Ata
- Obstetrics and Gynecology Department, Koc University, Istanbul, Turkey
| | - Kersti Lundin
- Reproductive Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Juha S Tapanainen
- Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Department of Obstetrics and Gynaecology, University of Oulu, Oulu University Hospital and Medical Research Centre, PEDEGO Research Unit, Oulu, Finland
| | | | - Anna Veiga
- Reproductive Medicine Service, Dexeus Mujer, Hospital Universitari Dexeus/Institut d'Investigació Biomèdica de Bellvitge, IDIBELL, Barcelona Stem Cell Bank, Regenerative Medicine Programme, Barcelona, Spain
| | - Edgar Mocanu
- Rotunda Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland
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20
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Vermeulen N, Ata B, Gianaroli L, Lundin K, Mocanu E, Rautakallio-Hokkanen S, Tapanainen JS, Veiga A. A picture of medically assisted reproduction activities during the COVID-19 pandemic in Europe. Hum Reprod Open 2020; 2020:hoaa035. [PMID: 32821857 PMCID: PMC7430925 DOI: 10.1093/hropen/hoaa035] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 06/23/2020] [Indexed: 11/20/2022] Open
Abstract
STUDY QUESTION How did coronavirus disease 2019 (COVID-19) impact on medically assisted reproduction (MAR) services in Europe during the COVID-19 pandemic (March to May 2020)? SUMMARY ANSWER MAR services, and hence treatments for infertile couples, were stopped in most European countries for a mean of 7 weeks. WHAT IS KNOWN ALREADY With the outbreak of COVID-19 in Europe, non-urgent medical care was reduced by local authorities to preserve health resources and maintain social distancing. Furthermore, ESHRE and other societies recommended to postpone ART pregnancies as of 14 March 2020. STUDY DESIGN, SIZE, DURATION A structured questionnaire was distributed in April among the ESHRE Committee of National Representatives, followed by further information collection through email. PARTICIPANTS/MATERIALS, SETTING, METHODS The information was collected through the questionnaire and afterwards summarised and aligned with data from the European Centre for Disease Control on the number of COVID-19 cases per country. MAIN RESULTS AND THE ROLE OF CHANCE By aligning the data for each country with respective epidemiological data, we show a large variation in the time and the phase in the epidemic in the curve when MAR/ART treatments were suspended and restarted. Similarly, the duration of interruption varied. Fertility preservation treatments and patient supportive care for patients remained available during the pandemic. LARGE SCALE DATA N/A LIMITATIONS, REASONS FOR CAUTION Data collection was prone to misinterpretation of the questions and replies, and required further follow-up to check the accuracy. Some representatives reported that they, themselves, were not always aware of the situation throughout the country or reported difficulties with providing single generalised replies, for instance when there were regional differences within their country. WIDER IMPLICATIONS OF THE FINDINGS The current article provides a basis for further research of the different strategies developed in response to the COVID-19 crisis. Such conclusions will be invaluable for health authorities and healthcare professionals with respect to future similar situations. STUDY FUNDING/COMPETING INTEREST(S) There was no funding for the study, apart from technical support from ESHRE. The authors had no COI to disclose.
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Affiliation(s)
| | | | - Baris Ata
- Obstetrics and Gynecology Department, Koc University, Istanbul 34010, Turkey
| | - Luca Gianaroli
- Società Italiana Studi di Medicina della Riproduzione, S.I.S.Me.R. Reproductive Medicine Institute, Bologna, Emilia-Romagna, Italy
| | - Kersti Lundin
- Reproductive Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Edgar Mocanu
- Department of Reproductive Medicine, Rotunda Hospital and Royal College of Surgeons in Ireland, Parnell Square, Dublin 1, Ireland
| | | | - Juha S Tapanainen
- University of Helsinki and Helsinki University Hospital, Department of Obstetrics and Gynaecology, Helsinki, Finland.,Oulu University Hospital and Medical Research Centre PEDEGO Research Unit, Department of Obstetrics and Gynaecology, Oulu, Finland
| | - Anna Veiga
- Reproductive Medicine Service, Dexeus Mujer, Hospital Universitari Dexeus/Institut d'Investigació Biomèdica de Bellvitge, IDIBELL, Barcelona Stem Cell Bank, Regenerative Medicine Programme, Barcelona, Spain
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21
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Kirkegaard K, Yan Y, Sørensen BS, Hardarson T, Hanson C, Ingerslev HJ, Knudsen UB, Kjems J, Lundin K, Ahlström A. Comprehensive analysis of soluble RNAs in human embryo culture media and blastocoel fluid. J Assist Reprod Genet 2020; 37:2199-2209. [PMID: 32681282 DOI: 10.1007/s10815-020-01891-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 07/13/2020] [Indexed: 01/01/2023] Open
Abstract
PURPOSE miRNAs have been suggested as biomarkers of embryo viability; however, findings from preliminary studies are divergent. Furthermore, the presence of other types of small RNA molecules remains to be investigated. The purpose of this study was to perform a comprehensive analysis of small non-coding RNA levels in spent and unconditioned embryo culture media, along with miRNA levels in blastocoelic fluid samples from human embryos. METHODS miRNAs in unconditioned culture medium from 3 different manufacturers, along with miRNA from day 5 conditioned culture medium, control medium, and corresponding blastocoel fluid from 10 human blastocysts were analyzed with array-based q-PCR analysis. Subsequently, deep sequencing of total and small RNA in day 5 spent culture medium from 5 human blastocysts and corresponding controls was performed. RESULTS In spite of using state-of-the-art sensitive detection methods, no miRNAs were found to be reliably present in the spent culture medium or the blastocoel fluid. Ct values were above the recommended limit for detection in the array-based analysis, a finding that was confirmed by deep sequencing. The majority of miRNAs identified by deep sequencing were expressed in all samples including control media and seem to originate from sources other than conditioned IVF media. CONCLUSIONS Our findings question the use of miRNAs as a reliable biomarker and highlight the need for a critical methodological approach in miRNA studies. Interestingly, tiRNA fragments appear to be overexpressed in conditioned IVF media samples and could potentially be a novel biomarker worthy of investigation.
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Affiliation(s)
- Kirstine Kirkegaard
- Department of Clinical Biochemistry, Aarhus University Hospital, Palle Juul Jensens Boulevard, 8200, Aarhus N, Denmark. .,Department of Gynecology and Obstetrics, Aarhus University Hospital, Palle Juul Jensens Boulevard, 8200, Aarhus N, Denmark.
| | - Yan Yan
- Interdisciplinary Nanoscience Center (iNANO) and Department of Molecular Biology and Genetics, Aarhus University, Aarhus, Denmark
| | - Boe S Sørensen
- Department of Clinical Biochemistry, Aarhus University Hospital, Palle Juul Jensens Boulevard, 8200, Aarhus N, Denmark
| | - Thorir Hardarson
- Livio Fertilitetscentrum Gothenburg, Carlandersparken 24, 402 29, Gothenburg, Sweden
| | - Charles Hanson
- Unit of Reproductive Medicine, Sahlgrenska University Hospital, 41345, Gothenburg, Sweden
| | - Hans J Ingerslev
- Fertility Unit and Centre for Preimplantation diagnosis, Aalborg University Hospital, Søndre Skovvej 3, 9000, Aalborg, Denmark
| | - Ulla Breth Knudsen
- Fertility Clinic, Regional Hospital Horsens, Sundvej 30, 8700, Horsens, Denmark.,Inst. Clin. Medicine, Aarhus University, Palle Juul-Jensens Boulevard 88, 8200, Aarhus N, Denmark
| | - Jørgen Kjems
- Interdisciplinary Nanoscience Center (iNANO) and Department of Molecular Biology and Genetics, Aarhus University, Aarhus, Denmark
| | - Kersti Lundin
- Unit of Reproductive Medicine, Sahlgrenska University Hospital, 41345, Gothenburg, Sweden
| | - Aisling Ahlström
- Unit of Reproductive Medicine, Sahlgrenska University Hospital, 41345, Gothenburg, Sweden
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22
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Kovačič B, Prados FJ, Plas C, Woodward BJ, Verheyen G, Ramos L, Mäkinen S, Apter SJ, Vidal F, Ziebe S, Magli MC, Lundin K, Sunde A, Plancha CE. ESHRE Clinical Embryologist certification: the first 10 years. Hum Reprod Open 2020; 2020:hoaa026. [PMID: 32864474 PMCID: PMC7448581 DOI: 10.1093/hropen/hoaa026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Indexed: 11/15/2022] Open
Abstract
STUDY QUESTION What has the ESHRE programme ‘ESHRE Certification for Clinical Embryologists’ achieved
after 10 years? SUMMARY ANSWER The post-exam analysis showed a pass rate of 60% for Clinical and 50% for Senior
Clinical Embryologists and a high level of internal consistency of all exams, leading to
a total of 773 certified Clinical and 493 Senior Clinical Embryologists over the
decade. WHAT IS KNOWN ALREADY In an ESHRE survey on the educational and professional status of Clinical Embryology in
Europe, it was found that education of laboratory personnel working in the field of
assisted reproduction is highly variable between countries. In 2008, ESHRE introduced a
programme, curriculum and certification in the field of Clinical Embryology. Knowledge
gained by postgraduate study of recommended literature, following a clear curriculum, is
verified by a written two-level exam for obtaining a certificate for Clinical (basic) or
Senior Clinical (advanced) Embryologists. With a total of 1266 certificates awarded over
a period of 10 years and recognition by the Union Européenne des Médecins Spécialistes
and their Council for European Specialists Medical Assessment, the ESHRE Clinical
Embryology exams have become an internationally recognized educational standard in the
field of Clinical Embryology. STUDY DESIGN, SIZE, DURATION A retrospective analysis of all applications for ESHRE Clinical (2009–2018) and Senior
Clinical Embryologist Certification (2008–2018) and exam results of the first decade was
carried out by the Steering Committee for Clinical Embryologist Certification. PARTICIPANTS/MATERIALS, SETTING, METHODS A total of 2894 applications for ESHRE Certification for Clinical Embryologists and the
results of 10 exams for the Clinical (1478 candidates) and 11 exams for Senior Clinical
(987 candidates) levels were analysed. A detailed post-exam retrospective analysis was
performed regarding difficulty, discrimination and reliability levels of 1600
multiple-choice questions (MCQs) with a single best answer among four options, from
eight different curriculum topics (Basic cell biology, Genetics, Developmental biology,
Female reproduction, Male reproduction, IVF laboratory, Cryopreservation and Laboratory
management), representing the core theoretical knowledge of Clinical Embryology.
Difficulty levels of the MCQs were subsequently compared regarding each topic and each
yearly exam. The participation and success rates in the ESHRE Clinical Embryology exams
were also assessed in terms of the educational and geographic backgrounds of
candidates. MAIN RESULTS AND THE ROLE OF CHANCE Over the 10 years studied, the mean pass rate for the Clinical Embryologist exam was
60% (range 41–86%), and for the Senior Clinical Embryologist exam was 50% (range
34–81%). On average, 63% European candidates and 35% non-European candidates passed the
Clinical Embryologist exam, while 52% European candidates and 31% non-European
candidates passed the Senior Clinical Embryologist exam. The candidates’ educational
level impacted on the success of the Clinical Embryologist exam but not of the Senior
Clinical Embryologist exam. The mean difficulty indices by study topic showed that in
the period of 10 years, there were no statistically significant differences between
topics, for either the Clinical or Senior Clinical Embryologist exams. However, the
overall exam difficulty varied between years. Reassuringly, the exam MCQ discrimination
and reliability indices always showed a high level of internal consistency in all
exams. LIMITATIONS, REASONS FOR CAUTION Some data from the initial ESHRE certification programme were not obtained
electronically, in particular data for education, implying tables and figures reflect
the specified valid data periods. Several countries exhibit different study profiles for
those working in ART laboratories, such that laboratory technicians/technologists
predominate in some countries, while in others only biologists and medical doctors are
allowed to work with human embryos. Such differences could consequently affect the exam
performance of candidates from specific countries. WIDER IMPLICATIONS OF THE FINDINGS The ESHRE exams on Clinical Embryology are the most widely, internationally accepted
tests of knowledge in the rapidly growing area of human reproduction. Clinical
Embryology is increasingly recognized as a specific discipline for scientific staff who
are collaborating closely with clinicians in managing human infertility through
medically assisted reproduction. The analysis of the first 10 years of application of a
two-level exam for Clinical Embryology shows a consistent high quality and reliability
of the exam and MCQs used. These results represent an important follow-up of the quality
of the ESHRE Certification programme for Clinical Embryologists, and convincingly
position Clinical Embryology in the wider group of health disciplines that are
harmonized through professional bodies such as ESHRE and European Board & College of
Obstetrics and Gynaecology. The exams provide a clear step towards the increasing
professional recognition and establishment of Clinical Embryology within health systems
at both European and international level. STUDY FUNDING/COMPETING INTEREST(S) No competing interest. All costs of the Steering Committee meetings were covered by
ESHRE.
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Affiliation(s)
- Borut Kovačič
- Department of Reproductive Medicine, University Medical Centre Maribor, Maribor, Slovenia
| | | | | | | | - Greta Verheyen
- University Hospital, Vrije Universiteit Brussel, Centre for Reproductive Medicine, Brussels, Belgium
| | - Liliana Ramos
- Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | | | - Francesca Vidal
- Unitat de Biologia Cellular, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Søren Ziebe
- The Fertility Clinic, Section 4071, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - Kersti Lundin
- Reproductive Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Arne Sunde
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Carlos E Plancha
- Instituto de Histologia e Biologia do Desenvolvimento, Faculdade de Medicina, Universidade de Lisboa, Portugal and CEMEARE, Lisboa, Portugal
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23
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Abstract
Culturing of human embryos in optimal conditions is crucial for a successful in vitro fertilisation (IVF) programme. In addition, the capacity to assess and rank embryos correctly for quality will allow for transfer of the potentially 'best' embryo first, thereby shortening the time to pregnancy, although not improving cumulative pregnancy and live birth rates. It will also encourage and facilitate the implementation of single embryo transfers, thereby increasing safety for mother and offspring. Time-lapse technology introduces the concept of stable culture conditions, in connection with the possibility of continuous viewing and documenting of the embryo throughout development. However, so far, even when embryo quality scoring is based on large datasets, or when using the time-lapse technology, the morphokinetic scores are still mainly based on subjective and intermittent annotations of morphology and timings. Also, the construction of powerful algorithms for widespread use is hampered by large variations in culture conditions between individual IVF laboratories. New methodology, involving machine learning, where every image from the time-lapse documentation is analysed by a computer programme, looking for patterns that link to outcome, may in the future provide a more accurate and non-biased embryo selection.
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Affiliation(s)
- Kersti Lundin
- Reproductive Medicine, Sahlgrenska University Hospital, Göteborg, Sweden
- CONTACT Kersti Lundin Reproductive Medicine, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Hannah Park
- Reproductive Medicine, Sahlgrenska University Hospital, Göteborg, Sweden
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24
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Neufeld J, Hagström A, Van't Westeinde A, Lundin K, Cauvet É, Willfors C, Isaksson J, Lichtenstein P, Bölte S. Global and local visual processing in autism - a co-twin-control study. J Child Psychol Psychiatry 2020; 61:470-479. [PMID: 31452200 PMCID: PMC7155117 DOI: 10.1111/jcpp.13120] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/19/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND Autism Spectrum Disorder (ASD) is associated with altered global and local visual processing. However, the nature of these alterations remains controversial, with contradictory findings and notions ranging from a reduced drive to integrate information into a coherent 'gestalt' ("weak central coherence" = WCC) to an enhanced perceptual functioning (EPF) in local processing. METHODS This study assessed the association between autism and global/local visual processing, using a large sample of monozygotic (MZ) and dizygotic (DZ) twins (N = 290, 48% females, age = 8-31 years). The Fragmented Pictures Test (FPT) assessed global processing, whereas local processing was estimated with the Embedded Figures Test (EFT) and the Block Design Test (BDT). Autism was assessed both categorically (clinical diagnosis), and dimensionally (autistic traits). Associations between visual tasks and autism were estimated both across the cohort and within-twin pairs where all factors shared between twins are implicitly controlled. RESULTS Clinical diagnosis and autistic traits predicted a need for more visual information for gestalt processing in the FPT across the cohort. For clinical diagnosis, this association remained within-pairs and at trend-level even within MZ twin pairs alone. ASD and higher autistic traits predicted lower EFT and BDT performance across the cohort, but these associations were lost within-pairs. CONCLUSIONS In line with the WCC account, our findings indicate an association between autism and reduced global visual processing in children, adolescents and young adults (but no evidence for EPF). Observing a similar association within MZ twins suggests a non-shared environmental contribution.
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Affiliation(s)
- J. Neufeld
- Center of Neurodevelopmental Disorders (KIND)Centre for Psychiatry ResearchDepartment of Women's and Children's HealthKarolinska InstitutetStockholm Health Care Services, Region StockholmStockholmSweden
| | - A. Hagström
- Center of Neurodevelopmental Disorders (KIND)Centre for Psychiatry ResearchDepartment of Women's and Children's HealthKarolinska InstitutetStockholm Health Care Services, Region StockholmStockholmSweden
| | - A. Van't Westeinde
- Center of Neurodevelopmental Disorders (KIND)Centre for Psychiatry ResearchDepartment of Women's and Children's HealthKarolinska InstitutetStockholm Health Care Services, Region StockholmStockholmSweden,Department of Women's and Children's HealthUnit of Pediatric EndocrinologyKarolinska University HospitalKarolinska InstitutetStockholmSweden
| | - K. Lundin
- Center of Neurodevelopmental Disorders (KIND)Centre for Psychiatry ResearchDepartment of Women's and Children's HealthKarolinska InstitutetStockholm Health Care Services, Region StockholmStockholmSweden
| | - É. Cauvet
- Center of Neurodevelopmental Disorders (KIND)Centre for Psychiatry ResearchDepartment of Women's and Children's HealthKarolinska InstitutetStockholm Health Care Services, Region StockholmStockholmSweden
| | - C. Willfors
- Center of Neurodevelopmental Disorders (KIND)Centre for Psychiatry ResearchDepartment of Women's and Children's HealthKarolinska InstitutetStockholm Health Care Services, Region StockholmStockholmSweden,Department of Molecular Medicine and Surgery, Rare DiseasesKarolinska InstitutetStockholmSweden
| | - J. Isaksson
- Center of Neurodevelopmental Disorders (KIND)Centre for Psychiatry ResearchDepartment of Women's and Children's HealthKarolinska InstitutetStockholm Health Care Services, Region StockholmStockholmSweden,Department of Neuroscience, Child and Adolescent Psychiatry UnitUppsala UniversityUppsalaSweden
| | - P. Lichtenstein
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
| | - S. Bölte
- Center of Neurodevelopmental Disorders (KIND)Centre for Psychiatry ResearchDepartment of Women's and Children's HealthKarolinska InstitutetStockholm Health Care Services, Region StockholmStockholmSweden,Curtin Autism Research GroupEssential Partner Autism CRCSchool of Occupational Therapy, Social Work and Speech PathologyCurtin UniversityPerthWAAustralia
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25
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Hreinsson J, Lundin K, Iwarsson E, Hausken J, Einarsson S, Grøndahl ML, Hydén‐Granskog C, Ingerslev HJ. Preimplantation genetic testing legislation and accessibility in the Nordic countries. Acta Obstet Gynecol Scand 2020; 99:716-721. [DOI: 10.1111/aogs.13831] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 02/20/2020] [Accepted: 02/23/2020] [Indexed: 12/30/2022]
Affiliation(s)
| | - Kersti Lundin
- Reproductive Medicine Sahlgrenska University Hospital Gothenburg Sweden
| | - Erik Iwarsson
- Department of Molecular Medicine and Surgery Karolinska Institutet Stockholm Sweden
- Clinical Genetics Karolinska University Laboratory Karolinska University Hospital Stockholm Sweden
| | | | | | - Marie Louise Grøndahl
- Department of Obstetrics and Gynecology Department of Reproductive Medicine Copenhagen University Hospital Herlev Denmark
| | | | - Hans Jakob Ingerslev
- Fertility Unit and Center for Preimplantation Genetic Testing Aalborg University Hospital Aalborg Denmark
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26
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Hreinsson J, Iwarsson E, Hanson C, Grøndahl ML, Løssl K, Hydén‐Granskog C, Ingerslev HJ, Petersen MR, Bredbacka P, Nøhr B, Savolainen L, Hnida C, Toft CLF, Hindkjær J, Aagaard J, Lundin K, Roos LKS. Preimplantation genetic testing practices in the Nordic countries. Acta Obstet Gynecol Scand 2020; 99:707-715. [DOI: 10.1111/aogs.13821] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 01/27/2020] [Accepted: 02/02/2020] [Indexed: 11/29/2022]
Affiliation(s)
| | - Erik Iwarsson
- Department of Molecular Medicine and Surgery Karolinska Institutet and Clinical Genetics Karolinska University Laboratory Karolinska University Hospital Stockholm Sweden
| | - Charles Hanson
- Reproductive Medicine Sahlgrenska University Hospital Gothenburg Sweden
| | - Marie Louise Grøndahl
- Department of Obstetrics and Gynecology Department of Reproductive Medicine Copenhagen University Hospital Herlev Herlev Denmark
| | - Kristine Løssl
- The Fertility Clinic – Section 4071 Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | | | - Hans Jakob Ingerslev
- Fertility Unit and Center for Preimplantation Genetic Testing Aalborg University Hospital Aalborg Denmark
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27
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Isaksson J, Van't Westeinde A, Cauvet É, Kuja-Halkola R, Lundin K, Neufeld J, Willfors C, Bölte S. Social Cognition in Autism and Other Neurodevelopmental Disorders: A Co-twin Control Study. J Autism Dev Disord 2019; 49:2838-2848. [PMID: 30972652 PMCID: PMC6606667 DOI: 10.1007/s10803-019-04001-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Alterations in social cognition (SC) are hypothesized to underlie social communication and interaction challenges in autism spectrum disorder (ASD). The aetiological underpinnings driving this association remain unclear. We examined SC in 196 twins with ASD, other neurodevelopmental disorders or typical development using the naturalistic Movie for the Assessment of Social Cognition. Autism and its severity were assessed with the Autism Diagnostic Observation Schedule-2, and autistic traits with the Social Responsiveness Scale-2. Using within twin-pair regression models, controlling for age, sex, IQ, and unmeasured familial confounders such as genetic background and shared-environment, SC correlated with ASD diagnosis, autism severity, and autistic traits. Our findings highlight the importance of SC alterations in autism and suggest a non-shared environmental impact on the association.
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Affiliation(s)
- J Isaksson
- Center of Neurodevelopmental Disorders (KIND), Division of Neuropsychiatry, Department of Women's and Children's Health, Center for Psychiatry Research, Karolinska Institutet & Region Stockholm, Stockholm, Sweden.,Child and Adolescent Psychiatry, Region Stockholm, Stockholm, Sweden.,Department of Neuroscience, Child and Adolescent Psychiatry Unit, Uppsala University, Uppsala, Sweden
| | - A Van't Westeinde
- Center of Neurodevelopmental Disorders (KIND), Division of Neuropsychiatry, Department of Women's and Children's Health, Center for Psychiatry Research, Karolinska Institutet & Region Stockholm, Stockholm, Sweden.,Child and Adolescent Psychiatry, Region Stockholm, Stockholm, Sweden
| | - É Cauvet
- Center of Neurodevelopmental Disorders (KIND), Division of Neuropsychiatry, Department of Women's and Children's Health, Center for Psychiatry Research, Karolinska Institutet & Region Stockholm, Stockholm, Sweden
| | - R Kuja-Halkola
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - K Lundin
- Center of Neurodevelopmental Disorders (KIND), Division of Neuropsychiatry, Department of Women's and Children's Health, Center for Psychiatry Research, Karolinska Institutet & Region Stockholm, Stockholm, Sweden
| | - J Neufeld
- Center of Neurodevelopmental Disorders (KIND), Division of Neuropsychiatry, Department of Women's and Children's Health, Center for Psychiatry Research, Karolinska Institutet & Region Stockholm, Stockholm, Sweden
| | - C Willfors
- Center of Neurodevelopmental Disorders (KIND), Division of Neuropsychiatry, Department of Women's and Children's Health, Center for Psychiatry Research, Karolinska Institutet & Region Stockholm, Stockholm, Sweden
| | - S Bölte
- Center of Neurodevelopmental Disorders (KIND), Division of Neuropsychiatry, Department of Women's and Children's Health, Center for Psychiatry Research, Karolinska Institutet & Region Stockholm, Stockholm, Sweden. .,Child and Adolescent Psychiatry, Region Stockholm, Stockholm, Sweden.
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28
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Grønvold B, Ali M, Remberger M, Mattsson J, Egeland T, Lundin K, Myhre A, Abrahamsen I, Heldal D, Dybedal I, Tjønnfjord G, Fløisand Y, Gedde-Dahl T. The Impact of HLA-DPB1 Mismatch in T-Cell Replete Unrelated Donor Allogeneic Stem Cell Transplantation. Biol Blood Marrow Transplant 2019. [DOI: 10.1016/j.bbmt.2018.12.678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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29
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Mol BW, Bossuyt PM, Sunkara SK, Garcia Velasco JA, Venetis C, Sakkas D, Lundin K, Simón C, Taylor HS, Wan R, Longobardi S, Cottell E, D'Hooghe T. Personalized ovarian stimulation for assisted reproductive technology: study design considerations to move from hype to added value for patients. Fertil Steril 2018; 109:968-979. [DOI: 10.1016/j.fertnstert.2018.04.037] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 04/23/2018] [Accepted: 04/25/2018] [Indexed: 12/20/2022]
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30
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Leese HJ, Guerif F, Allgar V, Brison DR, Lundin K, Sturmey RG. Biological optimization, the Goldilocks principle, and how much is lagom in the preimplantation embryo. Mol Reprod Dev 2018; 83:748-754. [PMID: 27465801 DOI: 10.1002/mrd.22684] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 07/18/2016] [Indexed: 11/09/2022]
Abstract
The quiet embryo hypothesis postulates that early embryo viability is associated with a relatively low metabolism (Leese, 2002 BioEssays 24: 845-849). This proposal is re-visited here using retrospective and prospective data on the metabolic activity and kinetics of preimplantation development alongside the concept that an optimal range of such indices and of energetic efficiency influences embryogenesis. It is concluded that these considerations may be rationalized by proposing the existence of a "Goldilocks zone," or as it is known in Sweden, of lagom-meaning "just the right amount"-within which embryos with maximum developmental potential can be categorized. Mol. Reprod. Dev. 83: 748-754, 2016 © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Henry J Leese
- Centre for Cardiovascular Metabolic Research, Hull York Medical School, University of Hull, Hull, United Kingdom.
| | - Fabrice Guerif
- Medecine et Biologie de la Reproduction, Université de Tours, Tours, France
| | - Victoria Allgar
- Centre for Cardiovascular Metabolic Research, Hull York Medical School, University of Hull, Hull, United Kingdom
| | - Daniel R Brison
- Department of Reproductive Medicine, Central Manchester University Hospitals NHS Foundation Trust, St Mary's Hospital, Manchester, United Kingdom
| | - Kersti Lundin
- Reproductive Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Roger G Sturmey
- Centre for Cardiovascular Metabolic Research, Hull York Medical School, University of Hull, Hull, United Kingdom
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31
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Harper JC, Aittomäki K, Borry P, Cornel MC, de Wert G, Dondorp W, Geraedts J, Gianaroli L, Ketterson K, Liebaers I, Lundin K, Mertes H, Morris M, Pennings G, Sermon K, Spits C, Soini S, van Montfoort APA, Veiga A, Vermeesch JR, Viville S, Macek M. Recent developments in genetics and medically assisted reproduction: from research to clinical applications. Eur J Hum Genet 2018; 26:12-33. [PMID: 29199274 PMCID: PMC5839000 DOI: 10.1038/s41431-017-0016-z] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Accepted: 09/14/2017] [Indexed: 12/15/2022] Open
Abstract
Two leading European professional societies, the European Society of Human Genetics and the European Society for Human Reproduction and Embryology, have worked together since 2004 to evaluate the impact of fast research advances at the interface of assisted reproduction and genetics, including their application into clinical practice. In September 2016, the expert panel met for the third time. The topics discussed highlighted important issues covering the impacts of expanded carrier screening, direct-to-consumer genetic testing, voiding of the presumed anonymity of gamete donors by advanced genetic testing, advances in the research of genetic causes underlying male and female infertility, utilisation of massively parallel sequencing in preimplantation genetic testing and non-invasive prenatal screening, mitochondrial replacement in human oocytes, and additionally, issues related to cross-generational epigenetic inheritance following IVF and germline genome editing. The resulting paper represents a consensus of both professional societies involved.
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Affiliation(s)
- J C Harper
- Institute for Women's Health, University College London, London, UK
| | - K Aittomäki
- Laboratory of Genetics, Helsinki University Hospital, Helsinki, Finland
| | - P Borry
- Department of Public Health and Primary Care, Centre for Biomedical Ethics and Law, KU Leuven, Leuven, Belgium
| | - M C Cornel
- Department of Clinical Genetics, Section Community Genetics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - G de Wert
- Department of Health, Ethics and Society, Research Schools CAPHRI and GROW, Maastricht University, Maastricht, The Netherlands
| | - W Dondorp
- Department of Health, Ethics and Society, Research Schools CAPHRI and GROW, Maastricht University, Maastricht, The Netherlands
| | - J Geraedts
- Department Genetics and Cell Biology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - L Gianaroli
- S.I.S.Me.R. Reproductive Medicine Unit, Bologna, Italy
| | | | - I Liebaers
- Center for Medical Genetics, UZ Brussels, Brussels, Belgium
- Research Group Reproduction and Genetics, Vrije Universiteit Brussel, Brussels, Belgium
| | - K Lundin
- Reproductive Medicine, Sahlgrenska University Hospital, Göteborg, Sweden
| | - H Mertes
- Bioethics Institute Ghent, Department of Philosophy and Moral Science, Ghent University, Ghent, Belgium
| | - M Morris
- Synlab Genetics, Lausanne, Switzerland
| | - G Pennings
- Bioethics Institute Ghent, Department of Philosophy and Moral Science, Ghent University, Ghent, Belgium
| | - K Sermon
- Research Group Reproduction and Genetics, Vrije Universiteit Brussel, Brussels, Belgium
| | - C Spits
- Research Group Reproduction and Genetics, Vrije Universiteit Brussel, Brussels, Belgium
| | - S Soini
- Helsinki Biobank, Helsinki University Central Hospital, Helsinki, Finland
| | - A P A van Montfoort
- IVF Laboratory, Department of Obstetrics & Gynaecology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - A Veiga
- Barcelona Stem Cell Bank, Centre of Regenerative Medicine in Barcelona, Hospital Duran i Reynals, Barcelona, Spain
- Reproductive Medicine Service of Dexeus Woman Health, Barcelona, Spain
| | - J R Vermeesch
- Department of Human Genetics, KU Leuven, Leuven, Belgium
| | - S Viville
- Institute of Parasitology and Pathology, University of Strasbourg, Strasbourg, France
- Laboratory of Genetic Diagnostics, UF3472-Genetics of Infertility, Nouvel Hôpital Civil, Strasbourg, France
| | - M Macek
- Department of Biology and Medical Genetics, Charles University-2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic.
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32
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Harper JC, Aittomäki K, Borry P, Cornel MC, de Wert G, Dondorp W, Geraedts J, Gianaroli L, Ketterson K, Liebaers I, Lundin K, Mertes H, Morris M, Pennings G, Sermon K, Spits C, Soini S, van Montfoort APA, Veiga A, Vermeesch JR, Viville S, Macek M. Recent developments in genetics and medically-assisted reproduction: from research to clinical applications †‡. Hum Reprod Open 2017; 2017:hox015. [PMID: 31486804 PMCID: PMC6276693 DOI: 10.1093/hropen/hox015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 11/14/2017] [Indexed: 12/13/2022] Open
Abstract
Two leading European professional societies, the European Society of Human Genetics and the European Society for Human Reproduction and Embryology, have worked together since 2004 to evaluate the impact of fast research advances at the interface of assisted reproduction and genetics, including their application into clinical practice. In September 2016, the expert panel met for the third time. The topics discussed highlighted important issues covering the impacts of expanded carrier screening, direct-to-consumer genetic testing, voiding of the presumed anonymity of gamete donors by advanced genetic testing, advances in the research of genetic causes underlying male and female infertility, utilisation of massively-parallel sequencing in preimplantation genetic testing and non-invasive prenatal screening, mitochondrial replacement in human oocytes, and additionally, issues related to cross-generational epigenetic inheritance following IVF and germline genome editing. The resulting paper represents a consensus of both professional societies involved.
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Affiliation(s)
- J C Harper
- Institute for Women's Health, University College London, 86-96 Chenies Mews, London WC1E 6HX, UK
| | - K Aittomäki
- Laboratory of Genetics, Helsinki University Hospital, PO Box 720, FI-00029, Helsinki, Finland
| | - P Borry
- Department of Public Health and Primary Care, Centre for Biomedical Ethics and Law, KU Leuven, Kapucijnenvoer 35 - Box 7001. B-3000, Leuven Belgium
| | - M C Cornel
- Department of Clinical Genetics, Amsterdam Public Health Research Institute, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - G de Wert
- Department of Health, Ethics and Society, Research Schools CAPHRI and GROW, Maastricht University, De Byeplein 1, 6229 HA Maastricht, The Netherlands
| | - W Dondorp
- Department of Health, Ethics and Society, Research Schools CAPHRI and GROW, Maastricht University, De Byeplein 1, 6229 HA Maastricht, The Netherlands
| | - J Geraedts
- Department Genetics and Cell Biology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - L Gianaroli
- S.I.S.Me.R. Reproductive Medicine Unit, Via Mazzini 12, 40138 Bologna, Italy
| | - K Ketterson
- Althea Science, Inc., 3 Regent St #301, Livingston, NJ 07039, USA
| | - I Liebaers
- Centre for Medical Genetics, UZ Brussel, Laarbeeklaan 101, B-1090 Brussels, Belgium
- Research Group Reproduction and Genetics, Vrije Universiteit Brussel, Laarbeeklaan 101, B-1090, Brussels, Belgium
| | - K Lundin
- Reproductive Medicine, Sahlgrenska University Hospital, Blå Stråket 6, 413 45, Göteborg, Sweden
| | - H Mertes
- Bioethics Institute Ghent, Department of Philosophy and Moral Science, Ghent University, Belgium
| | - M Morris
- Synlab Genetics, chemin d'Entre-Bois 21, CH-1018, Lausanne, Switzerland
| | - G Pennings
- Bioethics Institute Ghent, Department of Philosophy and Moral Science, Ghent University, Belgium
| | - K Sermon
- Research Group Reproduction and Genetics, Vrije Universiteit Brussel, Laarbeeklaan 101, B-1090, Brussels, Belgium
| | - C Spits
- Research Group Reproduction and Genetics, Vrije Universiteit Brussel, Laarbeeklaan 101, B-1090, Brussels, Belgium
| | - S Soini
- Helsinki Biobank, Helsinki University Central Hospital, Haartmaninkatu 3, PO Box 400, 00029 HUS, Helsinki, Finland
| | - A P A van Montfoort
- IVF laboratory, Department of Obstetrics and Gynaecology, Maastricht University Medical Center, PO Box 5800, 6202 AZ Maastricht, The Netherlands
| | - A Veiga
- Barcelona Stem Cell Bank, Centre of Regenerative Medicine in Barcelona, Hospital Duran i Reynals, Gran Via de l' Hospitalet 199, 08908, Hospitalet de Llobregat, Barcelona, Spain
- Reproductive Medicine Service of Dexeus Woman Health, Gran Via Carles III, 71-75 - 08028 Barcelona, Spain
| | - J R Vermeesch
- Department of Human Genetics, KU Leuven, O&N I Herestraat 49 - Box 602, B-3000 Leuven, Belgium
| | - S Viville
- Institute of Parasitology and Pathology, University of Strasbourg, 3 rue Koberlé, 67000 Strasbourg, France
- Laboratory of Genetic Diagnostics, UF3472-Genetics of Infertility, Nouvel Hôpital Civil, 1 place de l'Hôpital, 67091 Strasbourg cedex, France
| | - M Macek
- Department of Biology and Medical Genetics, Charles University 2nd Faculty of Medicine and Motol University Hospital, V Úvalu 84, Prague CZ-15006, Czech Republic
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33
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Harper J, Jackson E, Sermon K, Aitken RJ, Harbottle S, Mocanu E, Hardarson T, Mathur R, Viville S, Vail A, Lundin K. Adjuncts in the IVF laboratory: where is the evidence for 'add-on' interventions? Hum Reprod 2017; 32:485-491. [PMID: 28158511 DOI: 10.1093/humrep/dex004] [Citation(s) in RCA: 102] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Accepted: 01/05/2017] [Indexed: 01/20/2023] Open
Abstract
Globally, IVF patients are routinely offered and charged for a selection of adjunct treatments and tests or 'add-ons' that they are told may improve their chance of a live birth, despite there being no clinical evidence supporting the efficacy of the add-on. Any new IVF technology claiming to improve live birth rates (LBR) should, in most cases, first be tested in an appropriate animal model, then in clinical trials, to ensure safety, and finally in a randomized controlled trial (RCT) to provide high-quality evidence that the procedure is safe and effective. Only then should the technique be considered as 'routine' and only when applied to the similar patient population as those studied in the RCT. Even then, further pediatric and long-term follow-up studies will need to be undertaken to examine the long-term safety of the procedure. Alarmingly, there are currently numerous examples where adjunct treatments are used in the absence of evidence-based medicine and often at an additional fee. In some cases, when RCTs have shown the technique to be ineffective, it is eventually withdrawn from the clinic. In this paper, we discuss some of the adjunct treatments currently being offered globally in IVF laboratories, including embryo glue and adherence compounds, sperm DNA fragmentation, time-lapse imaging, preimplantation genetic screening, mitochondria DNA load measurement and assisted hatching. We examine the evidence for their safety and efficacy in increasing LBRs. We conclude that robust studies are needed to confirm the safety and efficacy of any adjunct treatment or test before they are offered routinely to IVF patients.
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Affiliation(s)
- Joyce Harper
- Embryology, IVF and Reproductive Genetics, Institute for Women's Health, University College London, London, UK
| | - Emily Jackson
- Law Department, London School of Economics and Political Science, London, UK
| | - Karen Sermon
- Research Group Reproduction and Genetics, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Robert John Aitken
- Priority Research Centre for Reproductive Science, University of Newcastle, NSW, Australia
| | - Stephen Harbottle
- Cambridge IVF, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - Edgar Mocanu
- Rotunda Hospital and RCSI, Parnell Square, Dublin 1, Ireland
| | - Thorir Hardarson
- Fertilitetscentrum, Carlanders Hospital, 402 29Gothenburg, Sweden
| | - Raj Mathur
- Department of Reproductive Medicine, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester M13 9WL, UK
| | - Stephane Viville
- Institut de Parasitologie et Pathologie Tropicale, EA 7292, three rue Koeberlé, 67000 Strasbourg, France and Laboratoire de diagnostic génétique, UF3472-génétique de l'infertilité, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France
| | - Andy Vail
- Centre for Biostatistics, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK
| | - Kersti Lundin
- Reproductive Medicine, Sahlgrenska University Hospital, Goteborg, Sweden
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Milenkovic M, Brännström M, Diaz-Garcia C, Lundin K, Selleskog U, Söderlund B, Khatibi A, Gull B, Bokström H, Mateoiu C, Akyürek LM, Thurin-Kjellberg A. Spontaneous twin pregnancy with live births after cryopreservation and re-implantation of ovarian tissue. ACTA ACUST UNITED AC 2017; 14:9. [PMID: 28725171 PMCID: PMC5486449 DOI: 10.1186/s10397-017-1012-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 06/02/2017] [Indexed: 11/10/2022]
Affiliation(s)
- Milan Milenkovic
- Department of Obstetrics and Gynecology, Sahlgrenska Academy Hospital, University of Gothenburg, Gothenburg, Sweden.,Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden
| | - Mats Brännström
- Department of Obstetrics and Gynecology, Sahlgrenska Academy Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Cesar Diaz-Garcia
- Department of Obstetrics and Gynecology, La Fe University Hospital, University of Valencia, Valencia, Spain.,Human Reproduction Research Group, IIS La Fe, Valencia, Spain
| | - Kersti Lundin
- Department of Obstetrics and Gynecology, Sahlgrenska Academy Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Ulrika Selleskog
- Department of Obstetrics and Gynecology, Sahlgrenska Academy Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Brita Söderlund
- Department of Obstetrics and Gynecology, Sahlgrenska Academy Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Ali Khatibi
- Department of Obstetrics and Gynecology, Sahlgrenska Academy Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Berit Gull
- Department of Obstetrics and Gynecology, Sahlgrenska Academy Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Hans Bokström
- Department of Obstetrics and Gynecology, Sahlgrenska Academy Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Claudia Mateoiu
- Department of Clinical Pathology and Genetics, Sahlgrenska Academy Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Levent M Akyürek
- Department of Clinical Pathology and Genetics, Sahlgrenska Academy Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Ann Thurin-Kjellberg
- Department of Obstetrics and Gynecology, Sahlgrenska Academy Hospital, University of Gothenburg, Gothenburg, Sweden
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Sunde A, Brison D, Dumoulin J, Harper J, Lundin K, Magli MC, Van den Abbeel E, Veiga A. Reply I: Embryo culture media effects. Hum Reprod 2017; 32:719. [PMID: 28039225 DOI: 10.1093/humrep/dew339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Arne Sunde
- Deparment of Obstetrics and Gynecology, St. Olav's University Hospital, Trondheim, Norway
| | - Daniel Brison
- Department of Reproductive Medicine, St Mary's Hospital, Central Manchester NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, UK
| | - John Dumoulin
- Department of Obstetrics and Gynaecology, IVF Laboratory, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Joyce Harper
- Embryology, IVF and Reproductive Genetics Group, Institute for Women's Health, University College London, London, UK
| | - Kersti Lundin
- Reproductive Medicine, Sahlgrenska University Hospital, Göteborg, Sweden
| | | | | | - Anna Veiga
- Reproductive Medicine Service, Hospital Universitari Dexeus, Barcelona, Spain
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Abstract
STUDY QUESTION Is it important that end-users know the composition of human embryo culture media? SUMMARY ANSWER We argue that there is as strong case for full transparency concerning the composition of embryo culture media intended for human use. WHAT IS KNOWN ALREADY Published data suggest that the composition of embryo culture media may influence the phenotype of the offspring. STUDY DESIGN, SIZE, DURATION A review of the literature was carried out. PARTICIPANTS/MATERIALS, SETTING, METHODS Data concerning the potential effects on embryo development of culture media were assessed and recommendations for users made. MAIN RESULTS AND THE ROLE OF CHANCE The safety of ART procedures, especially with respect to the health of the offspring, is of major importance. There are reports from the literature indicating a possible effect of culture conditions, including culture media, on embryo and fetal development. Since the introduction of commercially available culture media, there has been a rapid development of different formulations, often not fully documented, disclosed or justified. There is now evidence that the environment the early embryo is exposed to can cause reprogramming of embryonic growth leading to alterations in fetal growth trajectory, birthweight, childhood growth and long-term disease including Type II diabetes and cardiovascular problems. The mechanism for this is likely to be epigenetic changes during the preimplantation period of development. In the present paper the ESHRE working group on culture media summarizes the present knowledge of potential effects on embryo development related to culture media, and makes recommendations. LIMITATIONS, REASONS FOR CAUTION There is still a need for large prospective randomized trials to further elucidate the link between the composition of embryo culture media used and the phenotype of the offspring. We do not presently know if the phenotypic changes induced by in vitro embryo culture represent a problem for long-term health of the offspring. WIDER IMPLICATIONS OF THE FINDINGS Published data indicate that there is a strong case for demanding full transparency concerning the compositions of and the scientific rationale behind the composition of embryo culture media. STUDY FUNDING/COMPETING INTERESTS This work was funded by The European Society for Human Reproduction and Embryology. No competing interests to declare.
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Affiliation(s)
- Arne Sunde
- Department of Obstetrics and Gynaecology, St. Olav's University Hospital in Trondheim, Trondheim, Norway
| | - Daniel Brison
- Department of Reproductive Medicine, St Mary's Hospital, Central Manchester NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, UK
| | - John Dumoulin
- Department of Obstetrics and Gynaecology, IVF Laboratory, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Joyce Harper
- Embryology, IVF and reproductive genetics group, Institute for Women's Health, University College London, London, UK
| | - Kersti Lundin
- Reproductive Medicine, Sahlgrenska University Hospital, Göteborg, Sweden
| | | | | | - Anna Veiga
- Reproductive Medicine Service, Hospital Universitari Dexeus, Barcelona, Spain
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Ahlstrom A, Park H, Bergh C, Selleskog U, Lundin K. Conventional morphology performs better than morphokinetics for prediction of live birth after day 2 transfer. Reprod Biomed Online 2016; 33:61-70. [PMID: 27090968 DOI: 10.1016/j.rbmo.2016.03.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 03/24/2016] [Accepted: 03/24/2016] [Indexed: 11/29/2022]
Abstract
Numerous studies have reported on the potential value of time-lapse variables for prediction of embryo viability. However, these variables have not been evaluated in combination with conventional morphological grading and patient characteristics. The aim of this study was to assess the ability of patient characteristics and embryo morphology together with morphokinetic variables to predict live birth after day 2 transfer. This retrospective analysis included 207 transferred embryos from 199 couples cultured in a time-lapse system up to day 2 of development. Good prediction of live birth or ranking of embryos with respect to live birth potential was achieved with early cleavage combined with fragmentation grade at 43-45 h. These variables were selected as the strongest predictors of live birth, as assessed by stepwise logistic regression, and additional inclusion of morphokinetic variables did not improve the model significantly. Also, neither logistic regression models nor classification tree models with morphokinetic variables were able to achieve equally good prediction of live birth, as measured by AUC on an external data set not used for model development. In conclusion, for fresh day 2 transfers early cleavage in combination with fragmentation grade at 43-45 h should be considered when selecting between good quality embryos.
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Affiliation(s)
- Aisling Ahlstrom
- Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, Reproductive Medicine, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden.
| | - Hannah Park
- Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, Reproductive Medicine, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden
| | - Christina Bergh
- Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, Reproductive Medicine, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden
| | - Ulrika Selleskog
- Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, Reproductive Medicine, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden
| | - Kersti Lundin
- Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, Reproductive Medicine, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden
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Olofsson JI, Friberg B, Lundin K. [Introduce a uniform compensation for egg and sperm donors]. Lakartidningen 2015; 112:DR3A. [PMID: 26661269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Lundin K, Ahlström A. Quality control and standardization of embryo morphology scoring and viability markers. Reprod Biomed Online 2015; 31:459-71. [PMID: 26277586 DOI: 10.1016/j.rbmo.2015.06.026] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 06/16/2015] [Accepted: 06/23/2015] [Indexed: 01/03/2023]
Abstract
A so-called 'good-quality embryo' may be defined as an embryo that has the potential to implant into the uterine endometrium and give rise to the birth of a healthy child. A standardized and objective scoring of embryo 'quality' is therefore crucial in the classification and selection of embryos. However, embryo scoring is still being performed mainly via ocular evaluation, which often results in different interpretations of embryo quality. The addition of viability markers, such as measuring gene expression or the uptake/release of metabolites, proteins or RNA/DNA molecules in the culture media, would increase the possibility of standardized measurements. However, no single biomarker has yet been introduced into standard clinical practice, mainly due to the complexity of the techniques and the influence of biological variations and differences in culture conditions. In this paper different methods for the scoring of embryos and the possibility of standardizing and implementing quality control systems are discussed.
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Affiliation(s)
- Kersti Lundin
- Reproductive Medicine, Sahlgrenska University Hospital, Göteborg 413 45, Sweden.
| | - Aisling Ahlström
- Reproductive Medicine, Sahlgrenska University Hospital, Göteborg 413 45, Sweden
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40
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Kovačič B, Plas C, Woodward B, Verheyen G, Prados F, Hreinsson J, De los Santos M, Magli M, Lundin K, Plancha C. The educational and professional status of clinical embryology and clinical embryologists in Europe. Hum Reprod 2015; 30:1755-62. [DOI: 10.1093/humrep/dev118] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 04/20/2015] [Indexed: 11/13/2022] Open
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41
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Horneland R, Paulsen V, Lindahl JP, Grzyb K, Eide TJ, Lundin K, Aabakken L, Jenssen T, Aandahl EM, Foss A, Øyen O. Pancreas transplantation with enteroanastomosis to native duodenum poses technical challenges--but offers improved endoscopic access for scheduled biopsies and therapeutic interventions. Am J Transplant 2015; 15:242-50. [PMID: 25394773 DOI: 10.1111/ajt.12953] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 07/02/2014] [Accepted: 07/22/2014] [Indexed: 01/25/2023]
Abstract
To facilitate endoscopic access for rejection surveillance and stenting of the pancreas, we have abandoned the duodenojejunostomy (DJ) in favor of duodenoduodenostomy (DD) in pancreas transplantation (PTx). From September 2012 to September 2013 we performed 40 PTx with DD; 20 solitary-PTx (S-PTx) and 20 simultaneous pancreas and kidney transplantation (SPK). We compared the outcomes with results from 40 PTx-DJ (10 S-PTx and 30 SPK) from the preceding era. The DD-enteroanastomoses were performed successfully. Endoscopic pancreas biopsies (endoscopic ultrasound examination [EUS]) yielded representative material in half of the cases. One exocrine fistula was treated by endoscopic stenting. PTxs-DD were associated with a higher rate of thrombosis compared to PTx-DJ (23% vs. 5%) and reoperations (48% vs. 30%), as well as inferior graft survival (80% vs. 88%). Time on waiting list, HLA A + B mismatches and reoperations were associated with graft loss. Only recipient age remained an independent predictor of patient death in multivariate analysis. PTx-DD showed a higher rate of thrombosis and inferior results, but facilitated a protocol biopsy program by EUS that was feasible and safe. Given that technical difficulties can be solved, the improved endoscopic access might confer long-term benefits, yet this remains to be proven.
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Affiliation(s)
- R Horneland
- Clinic for Cancer, Surgery and Transplantation, Department of Transplantation Medicine, Section for Transplant Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway
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Park H, Bergh C, Selleskog U, Thurin-Kjellberg A, Lundin K. No benefit of culturing embryos in a closed system compared with a conventional incubator in terms of number of good quality embryos: results from an RCT. Hum Reprod 2014; 30:268-75. [DOI: 10.1093/humrep/deu316] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
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Van den Abbeel E, Balaban B, Ziebe S, Lundin K, Cuesta MJG, Klein BM, Helmgaard L, Arce JC. Association between blastocyst morphology and outcome of single-blastocyst transfer. Reprod Biomed Online 2013; 27:353-61. [DOI: 10.1016/j.rbmo.2013.07.006] [Citation(s) in RCA: 115] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Revised: 07/05/2013] [Accepted: 07/09/2013] [Indexed: 11/15/2022]
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44
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Allen J, Lundin K, Erentaite D. Cutaneous lymphadenoma with unusual localization. J Plast Reconstr Aesthet Surg 2013; 66:1300-2. [DOI: 10.1016/j.bjps.2013.04.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 03/26/2013] [Accepted: 04/01/2013] [Indexed: 11/26/2022]
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45
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Magli MC, Jones GM, Lundin K, van den Abbeel E. Atlas of human embryology: from oocytes to preimplantation embryos. Preface. Hum Reprod 2012; 27 Suppl 1:i1. [PMID: 22863770 DOI: 10.1093/humrep/des229] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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46
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Davies S, Christopikou D, Tsorva E, Karagianni A, Handyside AH, Mastrominas M, Alfarawati S, Poli M, Wells D, Fragouli E, Fragouli E, Alfarawati S, Konstantinidis M, Jaroudi S, Wells D, Van den Abbeel E, Balaban B, Ziebe S, Lundin K, Klein BM, Helmgaard L, Arce JC, Yokota Y, Yokota M, Yokota H, Sato S, Nakagawa M, Sato M, Anazawa I, Araki Y, Ledee N, Gridelet V, Ravet S, Jouan C, Gaspard O, Wenders F, Thonon F, Hincourt N, Dubois M, Foidart JM, Frankenne F, Munaut C, Perrier d'hauterive S, van Loendersloot LL, Van Wely M, van der Veen F, Bossuyt PMM, Repping S. SESSION 59: EMBRYOLOGY - DEVELOPMENT AND QUALITY. Hum Reprod 2012. [DOI: 10.1093/humrep/27.s2.58] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Harper J, Cristina Magli M, Lundin K, Barratt CLR, Brison D. When and how should new technology be introduced into the IVF laboratory? Hum Reprod 2011; 27:303-13. [DOI: 10.1093/humrep/der414] [Citation(s) in RCA: 127] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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48
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Van den Abbeel E, Balaban B, Lundin K, Ziebe S, Helmgaard L, Arce JC. Blastocyst quality in relation to pregnancy rate and early pregnancy loss. Fertil Steril 2011. [DOI: 10.1016/j.fertnstert.2011.07.394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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49
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Ziebe S, Van den Abbeel E, Balaban B, Lundin K, Helmgaard L, Arce JC. Blastocyst quality according to embryo development on days 3 and 4. Fertil Steril 2011. [DOI: 10.1016/j.fertnstert.2011.07.940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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50
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Harton GL, Magli MC, Lundin K, Montag M, Lemmen J, Harper JC. ESHRE PGD Consortium/Embryology Special Interest Group--best practice guidelines for polar body and embryo biopsy for preimplantation genetic diagnosis/screening (PGD/PGS). Hum Reprod 2010; 26:41-6. [DOI: 10.1093/humrep/deq265] [Citation(s) in RCA: 151] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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