P-144 Amphiregulin - a new indicator for zygote vitrification

Study question

Does the concentration of amphiregulin in follicular fluid affect survival rate and embryo quality after the vitrification process?

Summary answer

The concentration of amphiregulin affects development potential and embryo quality after zygote vitrification and can be used as a predictive biomarker.

What is known already

Epidermal growth factor receptors and its ligands, such as amphiregulin(AR), which are expressed in female reproductive tissues, have been shown to regulate various important reproductive functions. Amphiregulin concentration in follicular fluid is correlated with human oocyte developmental competence and IVF outcomes. Unlike other countries, Germany has a specific Embryo Protection Act (EPA), where the choice of embryos that have the highest potential for successful implantation must be made at the pronuclear stage(PN); in addition, all supernumerary fertilized oocytes are cryopreserved on the zygote stage. Due to EPA, the determination of potential biomarkers is key for successful IVF outcomes in Germany.

Study design, size, duration

This study consisted a total of 43 vitrified 2PN stage zygotes from 19 patients who underwent ICSI at UKS Homburg, (Germany) between April 2020 and November 2020. For the study purpose, follicles were aspirated separately, and the follicular fluid (FF) was centrifuged for 5 min at 1,500×g, after that supernatant was removed and stored at -20. Zygote vitrification was performed according to company guidelines (RapidVit Omni, Vitrolife).

Participants/materials, setting, methods

Concentrations of AR in FF were determined by using a commercially available sandwich ELISA kit (DuoSet Kit; R&D Systems Inc., Minneapolis) in accordance with the manufacturer’s instructions. Good embryo quality on day 3 was defined as a 7-9 cell stage embryo with less than 25% of fragmentation and with equally sized blastomeres. Between-group comparisons were tested using a t-test. Logistic regression analysis was used to determine the influence of amphiregulin on vitrification outcomes.

Main results and the role of chance

The mean age of all patients was 31.6 (±3.5) years. Patients included in the study were stimulated according to a gonadotropin-releasing hormone (GnRH) antagonist protocol. All zygotes were frozen 20h after injection. Out of the 43 frozen zygotes, 38 (88.3%) survived the thawing process and continued development. Obtained results showed that concentrations of amphiregulin were significantly higher in FF where zygote continued the development [(95.88±37.02 ng/mL vs  79.19±9.92 ng/mL) respectively; p < 0.05]. In addition, 26 (68.4%) vitrified zygotes developed into good-quality embryos, while 17 (31.6%) embryos had poor quality. Data comparisons between good and poor-quality embryos indicated that good-quality embryos came from follicles where amphiregulin concentration was significantly higher [(113.52 ±30.36 ng/mL. vs 63.98 ±1.93 ng/mL) respectively; p < 0.0001]. What is more, logistic regression analysis confirmed the positive effect of amphiregulin concentration on embryo quality (p < 0.01).

Limitations, reasons for caution

The limitation of the presented study was a relatively small patient cohort. Although the pregnancy rate in the presented study was 36.8 % single embryo transfer was not performed, therefore further research should link amphiregulin concentrations with blastocyst quality and pregnancy rate as well.

Wider implications of the findings

The literature already confirmed a lower development potential of vitrified zygotes compared to cleaved embryos or blastocyst. Therefore, obtained findings might be helpful for the success of the vitrification process in Germany. Additionally, our findings can be a basis for the future study of amphiregulin as a biomarker.

Trial registration number

not applicable

P–233 The spatial arrangement of blastomeres and time of cavitation forming as predictors of blastocyst quality

Study question

Does the spatial arrangement of blastomeres and the start of blastulation affect blastocyst quality?

Summary answer

Better blastocyst quality is associated with the spatial arrangement of the embryo and the shorter time frame of blastulation (cavitation).

What is known already

The ability to select the human embryo with the highest implantation potential remains one of the greatest challenges in the management of In Vitro Fertilization patients. Several publications have proposed that additional morphological evaluations of blastomere arrangement and the dynamics of late-stage embryonic divisions might be a useful non-invasive way for embryo selection. In the last decade, the introduction of time-lapse technology enables continuous monitoring of embryo development, which leads to better outcomes than a selection based on the traditional morphology assessment.

Study design, size, duration

The spatial arrangement was defined as tetrahedrally if the cleavage planes were perpendicularly orientated, while embryos with rather parallelly orientated cleavage axes were considered as non-tetrahedral embryos. The injection time of ICSI was designated as “time zero” (t0), and EmbryoViewer software was used to calculate the time duration between injection and start of blastulation (cavitation). Obtained results were later correlated with the embryo’s capability to form a blastocyst as well as with blastocyst quality.

Participants/materials, setting, methods

A total of 195 oocytes from 40 patients undergoing the antagonist cycle for ICSI treatment were evaluated. All blastocysts were cultured in Embryoscope™ according to the manufacturer’s specifications (Vitrolife, Sweden). The Gardner and Schoolcraft scoring system was used to describe blastocyst quality. Statistical analyses were performed using IBM SPSS version 24. Data were reported as median and range. Differences between groups were tested using the Mann-Whitney U test. Statistical significance was defined as p < 0.05.

Main results and the role of chance

Obtained data showed that 83.6% (61/73) of embryos with tetrahedral arrangement formed blastocysts compared to 42.4% (50/116) of embryos with the non-tetrahedral arrangement (p < 0,001). Moreover, tetrahedral embryos more frequently formed good quality blastocyst compare to the non-tetrahedral [59% (36/61) vs 18 (9/50)% respectively; p < 0,001]. In addition, we found that good quality blastocyst had a significantly shorter time frame between injection and blastulation start, compared with blastocysts which did not reach good quality [95.00h (84–118) vs 102h (77–121) respectively; p = 0,006].

Limitations, reasons for caution

The limitation of the present study was that due to the double-embryo transfer correlation between those morphokinetic parameters and pregnancy rate can not be calculated. Further research should link these morphokinetic parameters with pregnancy rate and live birth rate as well.

Wider implications of the findings: The potential of our findings is considerable, especially for countries with strict Embryo Law Regulation. Obtained results might be highly useful for selecting embryos with high implantation potential. In addition, the present work illustrates the possibility of additional information that can potentially be incorporated into an embryo classification model.

Trial registration number

Not applicable

P–140 Zygote morphokinetics as a predictor of blastocyst quality

Study question

Does the total cytoplasmic volume (TCV) of the zygote and time of pronuclei disappearance (tPNf) affect blastocyst development potential and blastocyst quality?

Summary answer

The total cytoplasmic volume of zygote and the time of pronuclei disappearance strongly affect blastocyst development as well as blastocyst quality.

What is known already

Extended embryo culture with blastocyst transfer is considered a useful method for selecting embryos with a high implantation potential. One of the main concerns in the German Embryo Protection Act is that the choice of embryos that have a high potential for successful implantation must be made at the pronucleus stage. The introduction of time-lapse technology enabled comprehensive information regarding the morphology and kinetics of the embryo. Although for the past years, strong correlations between embryo morphokinetics and positive outcomes have been demonstrated, some disagreement concerning the wide application of these parameters into an early-stage embryo selection is still present.

Study design, size, duration

The injection time of ICSI was designated as “time zero”, and computer software was used to calculate the time frame between the injection and the moment of pronuclei disappearance (tPNf). The total cytoplasmic volume was calculated 16–18 h after injection based on manually drawn diameters of the zygotes, by the computer. Obtained measurements were later associated with the blastocyst formation potential as well as with blastocyst quality.

Participants/materials, setting, methods

A total of 187 oocytes from 34 patients undergoing the antagonist cycle for ICSI treatment were evaluated. All blastocysts were cultured in Embryoscope™ according to the manufacturer’s specifications (Vitrolife, Sweden). The Gardner and Schoolcraft scoring system was used to describe blastocyst quality. Statistical analyses were performed using IBM SPSS version 24. Data were reported as median and range. Differences between groups were tested using the Mann-Whitney U test. Statistical significance was defined as p < 0.05.

Main results and the role of chance

Obtained data showed that the total cytoplasmic volume values were significantly higher in zygotes that reached the blastocyst stage compared with those that did not [708376,268µm³ (560564,412µm³ - 838602,605µm³) vs 674349,917 (415749,353- 823640,638) respectively; p < 0.0001]. Furthermore, this parameter as well significantly affect blastocyst quality where zygotes which formed better blastocyst quality had smaller cytoplasmic volume [685568,079 µm³ (560564,412- 790112,397µm³) vs 745514,662 µm³ (616581,339- 838602,605) respectively; p < 0.0001]. Time of pronuclei disappearance (tPNf) was significantly different (p < 0.0001) in successfully formed blastocysts [22.00h (17–29 h)] versus arrested or non-blastulating embryos [23.00h (17–56 h)]. Zygotes who had a shorter time frame between injection and pronuclei disappearance showed better blastocyst quality values compared with those who had longer time frame [21.00h (17–28h) vs 23.00h (18–29h) respectively; p < 0.01].

Limitations, reasons for caution

The limitation of the presented study was that due to the double-embryo transfer correlation between morphokinetic parameters and pregnancy rate was not possible to be calculated. Further research should link these morphokinetic parameters with pregnancy rate and live birth rate as well.

Wider implications of the findings: The potential of the present findings is considerable, especially for countries with strict Embryo Law Regulation. Obtained results might be highly useful for selecting embryos with high implantation potential. In addition, the present work illustrates the possibility of additional information that can potentially be incorporated into an embryo classification model.

Trial registration number

Not applicable

WOMEN AND MEN WITH CANCER AND A FUTURE DESIRE FOR CHILDREN - WHAT SHOULD CLINICIANS CONSIDER IN COVID-19 PANDEMIC TIMES?

The topic of fertility preservation has been gaining increasing importance since the beginning of this century. The reasons for this development are the advances in oncological therapy over the past few decades, with cure rates of approximately over 90%, and the fact that starting families is increasingly postponed in later periods of life in industrialized countries. Since March 2020 the whole medical and non-medical world experiences a pandemic due to Covid-19 (coronavirus disease 2019) which has never been seen before. This created a plenty of challenges for both, the patients and healthcare providers. This review article presents the fertility-protective methods currently available for women and men suffering from cancer with their clinical approach, value, advantages and disadvantages. Besides, it focuses on the changes and special considerations which have to be taken into account during pandemic times including preventive measures as well as the patient's access to the fertility preserving options. In conclusion every premenopausal woman and every man with incomplete family planning suffering from cancer should be counselled about the existing fertility preserving techniques before commencing cancer therapy.

Pilot study: placental biomarker predictive capability (sFlt-1, PlGF and their ratio) of postpartum maternal outcome

BACKGROUND

Prenatal measurement of placental biomarkers was able to improve screening and diagnosis of preeclampsia. Little is known about the clinical role of placental biomarkers in the postpartum period.

METHODS

This study is a prospective monocentric trial that included a total of 30 women with preeclamptic pregnancies. Serum placental biomarkers including soluble fms-like tyrosine kinase 1 (sFlt-1) and placental growth factor (PlGF) were measured before and 2 h after delivery by Enzyme-Linked Immunosorbent Assay (ELISA) using commercially available kits according to manufacturer's instructions and correlated with the postpartum outcome.

RESULTS

Postpartum higher serum PlGF level was associated with postpartum elevation of the systolic blood pressure. Yet, the placental biomarkers were not able to predict general worsening of postpartum preeclampsia or other individual clinical or laboratory parameters.

CONCLUSION

Serum concentrations of sFlt-1 and PlGF or their ratio in our study cohort did not completely predict the occurrence of postpartum preeclampsia. Yet, postpartum higher serum PlGF level was associated with postpartum elevation of the systolic blood pressure.