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Kemper JM, Liu Y, Afnan M, Hammond ER, Morbeck DE, Mol BWJ. Should we look for a low-grade threshold for blastocyst transfer? A scoping review. Reprod Biomed Online 2021; 42:709-716. [PMID: 33632655 DOI: 10.1016/j.rbmo.2021.01.019] [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: 10/27/2020] [Revised: 01/02/2021] [Accepted: 01/28/2021] [Indexed: 11/18/2022]
Abstract
Embryo quality is a key determinant of the success of IVF. Although the focus has been on selecting the best embryo for transfer, the classification of low-grade blastocysts (LGB) in existing scoring systems has received less attention. This is worrisome; embryo freezing allows optimal use of all created embryos, thus maximizing the cumulative live birth rate, which is arguably the most important outcome for infertile couples. A PubMed search was conducted in August 2020, using '((('poor-quality' OR 'poor quality') OR ('low-grade' OR 'low grade')) AND ('embryo' OR 'blastocyst')) AND ('pregnancy' OR 'live birth')'. This scoping review shows that LGB have similar euploidy and pregnancy success rates after implantation and have no adverse effects on pregnancy or perinatal outcomes. Evidence for pregnancy outcomes is lacking for different grades of LGB, with most studies clustering all LQB as one to compare with optimal blastocysts.
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Affiliation(s)
- James M Kemper
- Monash Women's, Monash Health, 246 Clayton Road Clayton 3168, Australia; Department of Obstetrics and Gynaecology, Monash University Clayton, Australia.
| | - Yanhe Liu
- Monash IVF Queensland, Southport, Australia; School of Human Sciences, University of Western Australia, Crawly, Australia; School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
| | | | | | - Dean E Morbeck
- Fertility Associates Auckland, New Zealand; Department of Obstetrics and Gynaecology, University of Auckland, New Zealand
| | - Ben W J Mol
- Monash Women's, Monash Health, 246 Clayton Road Clayton 3168, Australia; Department of Obstetrics and Gynaecology, Monash University Clayton, Australia; Aberdeen Centre for Women's Health Research, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen Aberdeen, UK
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Romanski PA, Thomas AM, Patel J, Zhang D, Racowsky C. Electronic whiteboard implementation as a quality management tool optimizes IVF laboratory standardization and improves clinical outcomes. J Assist Reprod Genet 2020; 38:203-210. [PMID: 33174094 DOI: 10.1007/s10815-020-02007-x] [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: 07/30/2020] [Accepted: 11/08/2020] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To test whether an electronic whiteboard in the IVF laboratory increases the likelihood that critical evaluation procedures are performed within optimum pre-set time ranges. METHODS A retrospective cohort study of oocyte retrievals in our IVF clinic between 06/01/2012 and 05/31/2018 was included. The electronic whiteboard was introduced on 04/06/2014. Prior to implementation, embryologists strived to adhere to the set evaluation times without a formal guide. The primary outcomes were the proportion of embryologist evaluations performed in optimum time ranges and the proportion of usable embryos per patient. RESULTS A total of 4645 retrievals met inclusion criteria. Implementation of the whiteboard was associated with (1) an increase in the proportion of fertilization checks performed within the optimum time range for ICSI cycles (+ 5.1%, RR = 1.06, CI = 1.02-1.10); (2) an increase in the proportion of day 3 evaluations performed within the optimum time range, whether assisted hatching was performed (+ 23.6%, RR = 1.48, CI = 1.36-1.60) or not (+ 13.8%, RR = 1.23, CI = 1.12-1.35); and (3) an increase in the proportion of day 5 evaluations within the optimum time range (+ 15.5%, RR = 1.23, CI = 1.12-1.35). Additionally, the mean number of usable embryos per patient increased from 2.8 to 4.5 after the whiteboard was implemented (RR = 1.25, CI = 1.19-1.31). CONCLUSION The use of an electronic whiteboard that posts optimum times for performing critical procedures significantly increases the proportion of evaluations that occur within these ranges. Such improved standardization led to positive downstream effects on the number of usable embryos per patient. We suggest that electronic whiteboard implementation driven by real-time data collection should be considered in all IVF laboratories.
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Affiliation(s)
- Phillip A Romanski
- Department of Obstetrics, Gynecology and Reproductive Biology, Brigham & Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
| | - Ann M Thomas
- Department of Obstetrics, Gynecology and Reproductive Biology, Brigham & Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Jay Patel
- Department of Obstetrics, Gynecology and Reproductive Biology, Brigham & Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Dan Zhang
- Department of Obstetrics, Gynecology and Reproductive Biology, Brigham & Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Catherine Racowsky
- Department of Obstetrics, Gynecology and Reproductive Biology, Brigham & Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
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Wang W, Cai J, Liu L, Xu Y, Liu Z, Chen J, Jiang X, Sun X, Ren J. Does the transfer of a poor quality embryo with a good quality embryo benefit poor prognosis patients? Reprod Biol Endocrinol 2020; 18:97. [PMID: 32998748 PMCID: PMC7526391 DOI: 10.1186/s12958-020-00656-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 09/24/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND While single embryo transfer (SET) is widely advocated, double embryo transfer (DET) remains preferable in clinical practice to improve IVF success rate, especially in poor prognosis patients with only poor quality embryos (PQEs) available in addition to one or no good quality embryos (GQEs). Furthermore, previous studies suggest PQE might adversely affect the implantation of a GQE when transferred together. This study aims to evaluate the effect of transferring an additional PQE with a GQE on the outcomes in poor prognosis patients. METHODS A total of 5037 frozen-thawed blastocyst transfer (FBT) cycles between January 2012 and May 2019 were included. Propensity score matching was applied to control for potential confounders, and we used generalized estimating equations (GEE) models to identify the association between the effect of an additional PQE and the outcomes. RESULTS Overall, transferring a PQE with GQE (Group GP) achieved significantly higher pregnancy rate (PR), live birth rate (LBR) and multiple pregnancy rate (MPR) than GQE only (group G). The addition of a PQE increased LBR in patients aged 35 and over and in patients who received over 3 cycles of embryo transfer (ET) (48.1% vs 27.2%, OR:2.56, 95% CI: 1.3-5.03 and 46.6% vs 35.4%, OR:1.6, 95% CI: 1.09-2.35), but not in women under 35 and in women who received less than 3 cycles of ET (48.7% vs 43.9%, OR:1.22, 95% CI: 0.93-1.59 and 48.3% vs 41.4%, OR:1.33, 95% CI: 0.96-1.85). Group GP resulted in significantly higher MPR than group G irrespective of age and the number of previous IVF cycles. CONCLUSIONS An additional PQE does not negatively affect the implantation potential of the co-transferred GQE. Nevertheless, the addition of a PQE contributes to both live birth and multiple birth in poor prognosis patients. Physicians should still balance the benefits and risks of DET.
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Affiliation(s)
- Wenjie Wang
- Reproductive Medicine Center, Xiamen University Affiliated Chenggong Hospital, Wenyuan Road No.94, Siming District, Xiamen, Fujian, 361001, People's Republic of China
| | - Jiali Cai
- Reproductive Medicine Center, Xiamen University Affiliated Chenggong Hospital, Wenyuan Road No.94, Siming District, Xiamen, Fujian, 361001, People's Republic of China
| | - Lanlan Liu
- Reproductive Medicine Center, Xiamen University Affiliated Chenggong Hospital, Wenyuan Road No.94, Siming District, Xiamen, Fujian, 361001, People's Republic of China
| | - Yingpei Xu
- Reproductive Medicine Center, Xiamen University Affiliated Chenggong Hospital, Wenyuan Road No.94, Siming District, Xiamen, Fujian, 361001, People's Republic of China
| | - Zhenfang Liu
- Reproductive Medicine Center, Xiamen University Affiliated Chenggong Hospital, Wenyuan Road No.94, Siming District, Xiamen, Fujian, 361001, People's Republic of China
| | - Jinghua Chen
- Reproductive Medicine Center, Xiamen University Affiliated Chenggong Hospital, Wenyuan Road No.94, Siming District, Xiamen, Fujian, 361001, People's Republic of China
| | - Xiaoming Jiang
- Reproductive Medicine Center, Xiamen University Affiliated Chenggong Hospital, Wenyuan Road No.94, Siming District, Xiamen, Fujian, 361001, People's Republic of China
| | - Xiaohua Sun
- Reproductive Medicine Center, Xiamen University Affiliated Chenggong Hospital, Wenyuan Road No.94, Siming District, Xiamen, Fujian, 361001, People's Republic of China
| | - Jianzhi Ren
- Reproductive Medicine Center, Xiamen University Affiliated Chenggong Hospital, Wenyuan Road No.94, Siming District, Xiamen, Fujian, 361001, People's Republic of China.
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Gleicher N, Albertini DF, Barad DH, Homer H, Modi D, Murtinger M, Patrizio P, Orvieto R, Takahashi S, Weghofer A, Ziebe S, Noyes N. The 2019 PGDIS position statement on transfer of mosaic embryos within a context of new information on PGT-A. Reprod Biol Endocrinol 2020; 18:57. [PMID: 32471441 PMCID: PMC7257212 DOI: 10.1186/s12958-020-00616-w] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 05/20/2020] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND A recently published Position Statement (PS) by the Preimplantation Genetics Diagnosis International Society (PGDIS) regarding utilization of preimplantation genetic testing for aneuploidy (PGT-A) in association with in vitro fertilization (IVF) contained inaccuracies and misrepresentations. Because opinions issued by the PGDIS have since 2016 determined worldwide IVF practice, corrections appear of importance. METHODS The International Do No Harm Group in IVF (IDNHG-IVF) is a spontaneously coalesced body of international investigators, concerned with increasing utilization of add-ons to IVF. It is responsible for the presented consensus statement, which as a final document was reached after review of the pertinent literature and again revised after the recent publication of the STAR trial and related commentaries. RESULTS In contrast to the PGDIA-PS, we recommend restrictions to the increasing, and by IVF centers now often even mandated, utilization of PGT-A in IVF cycles. While PGT-A has been proposed as a tool for achieving enhanced singleton livebirth outcomes through embryo selection, continued false-positive rates and increasing evidence for embryonic self-correction downstream from the testing stage, has led IDNHG-IVF to conclude that currently available data are insufficient to impose overreaching recommendations for PGT-A utilization. DISCUSSION Here presented consensus offers an alternative to the 2019 PGDIS position statement regarding utilization of preimplantation genetic testing for aneuploidy (PGT-A) in association with in vitro fertilization (IVF). Mindful of what appears to offer best outcomes for patients, and in full consideration of patient autonomy, here presented opinion is based on best available evidence, with the goal of improving safety and efficacy of IVF and minimizing wastage of embryos with potential for healthy births. CONCLUSIONS As the PGDIS never suggested restrictions on clinical utilization of PGT-A in IVF, here presented rebuttal represents an act of self-regulation by parts of the IVF community in attempts to control increasing utilization of different unproven recent add-ons to IVF.
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Affiliation(s)
- N Gleicher
- Center for Human Reproduction, 21 East 69th Street, New York, N.Y, 10021, USA.
- The Foundation for Reproductive Medicine, New York, N.Y, USA.
- Stem Cell Biology and Molecular Embryology Laboratory, Rockefeller University, New York, N.Y, USA.
- Department of Obstetrics and Gynecology, Medical University of Vienna, 1090, Vienna, Austria.
| | - D F Albertini
- Center for Human Reproduction, 21 East 69th Street, New York, N.Y, 10021, USA
- Stem Cell Biology and Molecular Embryology Laboratory, Rockefeller University, New York, N.Y, USA
| | - D H Barad
- Center for Human Reproduction, 21 East 69th Street, New York, N.Y, 10021, USA
- The Foundation for Reproductive Medicine, New York, N.Y, USA
| | - H Homer
- Queensland Fertility Group, Watkins Medical Center, Springhill, Queensland, Australia
| | - D Modi
- Molecular and Cellular Biology Laboratory, ICMR - National Institute for Research in Reproductive Health, Mumbai, India
| | - M Murtinger
- Nextclinic, IVF Zentren Prof. Zech, 6900, Bregenz, Austria
| | - P Patrizio
- Department of Obstetrics and Gynecology and Reproductive Sciences, Division of Reproductive Endocrinology and Infertility, Yale University, New Haven, CT, USA
| | - R Orvieto
- Department of Obstetrics and Gynecology, Sheba Medical Center, Ramat Gan, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - S Takahashi
- Department of Biomedical Ethics and Department of Obstetrics and Gynecology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - A Weghofer
- Center for Human Reproduction, 21 East 69th Street, New York, N.Y, 10021, USA
- Department of Obstetrics and Gynecology, Medical University of Vienna, 1090, Vienna, Austria
| | - S Ziebe
- Ringhospitalet, University Hospital Copenhagen, Copenhagen, Denmark
| | - N Noyes
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, and Northwell Health's System, New York, N.Y, USA
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Boynukalin FK, Gultomruk M, Turgut E, Demir B, Findikli N, Serdarogullari M, Coban O, Yarkiner Z, Bahceci M. Measuring the serum progesterone level on the day of transfer can be an additional tool to maximize ongoing pregnancies in single euploid frozen blastocyst transfers. Reprod Biol Endocrinol 2019; 17:102. [PMID: 31783865 PMCID: PMC6884867 DOI: 10.1186/s12958-019-0549-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Accepted: 11/25/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Endometrial preparation with hormone replacement therapy (HRT) is the preferred regimen for clinicians due to the opportunity to schedule the day of embryo transfer and for patients due to the requirement of fewer visits for frozen-warmed embryo transfers (FET). The increasing number of FETs raises the question of the serum P levels required to optimize the pregnancy outcome on the embryo transfer day. METHODS This prospective cohort study includes patients who underwent single euploid FET. All patients received HRT with oestradiol valerate (EV) and 100 mg of intramuscular (IM) progesterone (P). FET was scheduled 117-120 h after the first IM administration of 100 mg P. The serum P level was analyzed 1 h before the embryo transfer (ET). In all cycles, only embryos that were biopsied on day 5 were utilized for FET. Next generation sequencing (NGS) was used for comprehensive chromosomal analysis. RESULTS Overall, the ongoing pregnancy rate (OPR) was 58.9% (99/168). Data were then categorized according to the presence (Group I; n = 99) or the absence (Group II; n = 69) of an ongoing pregnancy. No significant differences regarding, female age, body mass index (BMI), number of previous miscarriages, number of previous live birth, sperm concentration, number of oocytes retrieved, number of mature oocytes (MII), rate of fertilized oocytes with two pronuclei (2PN), trophectoderm score, inner cell mass (ICM) score, endometrial thickness (mm), oestrodiol (E2) and P levels prior to IM P administration were found between two groups. The P levels on the day of ET (ng/ml) were significantly higher in Group I (28 (5.6-76.4) vs 16.4 (7.4-60) p = 0.039). The P level on the day of ET was a predictor of a higher OPR (p < 0.001 OR: 1.033 95%CI [1.009-1.056]) after multivariate analysis. The ROC curve showed a significant predictive value of serum P levels on the day of ET for OPR, with an AUC (95%CI) = 0.716 (0.637-0.795). The optimal cut-off value for prediction of the OPR was a P level of 20.6 ng/ml (71.7% sensitivity, 56.5% specificity). CONCLUSIONS The present study suggests a minimum threshold of the serum P value on the day of ET that needs to be reached in HRT cycles to optimize the clinical outcome. Individualization of the P dosage should be evaluated in further studies.
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Affiliation(s)
| | - Meral Gultomruk
- Bahceci Health Group, Hakki Yeten Cad. No: 11 Terrace Fulya, Fulya, Istanbul, Turkey
| | - Emre Turgut
- Bahceci Health Group, Hakki Yeten Cad. No: 11 Terrace Fulya, Fulya, Istanbul, Turkey
| | - Berfu Demir
- Bahceci Health Group, Hakki Yeten Cad. No: 11 Terrace Fulya, Fulya, Istanbul, Turkey
| | - Necati Findikli
- Bahceci Health Group, Hakki Yeten Cad. No: 11 Terrace Fulya, Fulya, Istanbul, Turkey
| | | | - Onder Coban
- Bahceci Health Group, Hakki Yeten Cad. No: 11 Terrace Fulya, Fulya, Istanbul, Turkey
| | - Zalihe Yarkiner
- Department of Statistics, Cyprus Science University, 99320 Dr. Fazil Kucuk Cad. Ozankoy, Kyrenia, Cyprus
| | - Mustafa Bahceci
- Bahceci Health Group, Hakki Yeten Cad. No: 11 Terrace Fulya, Fulya, Istanbul, Turkey
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Abstract
To investigate the clinical efficacy of growth hormone (GH) in normal response patients with poor embryo quality in previous in vitro fertilization cycles. A total of 1562 infertile women were enrolled in this matched case-control study: 781 women were treated with GH (study group), whereas 781 matched patients were treated without GH (control group). GH was administered by a daily subcutaneous injection of 2 or 4 IU started from either D2 of the previous cycle (6 weeks GH pretreatment) or the initial day of controlled ovarian stimulation (2 weeks GH pretreatment) until hCG trigger. The study group was further divided into four subgroups: 2 IU-6 weeks GH pretreatment, 4 IU-6 weeks GH pretreatment, 2 IU-2 weeks GH pretreatment, and 2 IU-4 weeks GH pretreatment. Patients receiving GH showed significantly lower Gn dosage. The total number of oocytes retrieved, embryos formed, endometrial thickness on hCG day were significantly higher with GH. 2PN rate and high-quality embryo rate were lower in the GH group. However, GH increased clinical pregnancy rate with significant difference. 4 IU-6 weeks GH pretreatment showed lowest duration of Gn and highest clinical pregnancy rate compared with other three groups. Number of transferred embryos was confounding factor both in univariate and multivariate analysis. Our study showed that co-treatment with GH in patients with normal ovarian response could increase pregnancy rate.
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Affiliation(s)
- Xitong Liu
- a Northwest Women's and Children's Hospital, The ART Center , Xi'an , China
| | - Haiyan Bai
- a Northwest Women's and Children's Hospital, The ART Center , Xi'an , China
| | - Jinlin Xie
- a Northwest Women's and Children's Hospital, The ART Center , Xi'an , China
| | - Juanzi Shi
- a Northwest Women's and Children's Hospital, The ART Center , Xi'an , China
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Abstract
Today, most IVF programs have moved to blastocyst transfer but there is still uncertainty regarding when to transfer if there are only one or two embryos at the cleavage stage. The aim of this study was to compare the pregnancy rate of day 3 transfers vs. blastocyst stage transfers in patients who had only one or two embryos on day 3. We conducted a retrospective study of 102 patients with one or two cleavage stage embryos that had their embryos transferred on day 3 and 429 patients had their embryos cultured to day 5 for transfer. The number of mature oocytes (4.0 vs 4.6, p = NS) and number of cleavage stage embryos on day 3 was similar in the two groups (1.3 vs. 1.5, p = NS). The clinical pregnancy rate per retrieval (22% vs. 24.6%, p= NS) and the ongoing pregnancy rate per retrieval (20% vs. 20.2%, p = NS) was comparable between the groups. Fifty seven (13.2%) of the patients had cleavage embryo arrest and did not have an embryo to transfer on day 5. We conclude that the cumulative pregnancy rate is the same for patients with 1-2 cleavage stage embryos regardless of whether the embryo is transferred on day 3 or day 5.
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Affiliation(s)
- Jigal Haas
- a TRIO Fertility Partners, Division of Reproductive Sciences , University of Toronto , Toronto , Canada
| | - Jim Meriano
- a TRIO Fertility Partners, Division of Reproductive Sciences , University of Toronto , Toronto , Canada
| | - Rawad Bassil
- a TRIO Fertility Partners, Division of Reproductive Sciences , University of Toronto , Toronto , Canada
| | - Eran Barzilay
- a TRIO Fertility Partners, Division of Reproductive Sciences , University of Toronto , Toronto , Canada
| | - Robert F Casper
- a TRIO Fertility Partners, Division of Reproductive Sciences , University of Toronto , Toronto , Canada
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Ethics Committee of the American Society for Reproductive Medicine. Electronic address: asrm@asrm.org., Ethics Committee of the American Society for Reproductive Medicine. Disclosure of sex when incidentally revealed as part of preimplantation genetic testing (PGT): an Ethics Committee opinion. Fertil Steril 2018; 110:625-7. [PMID: 30196948 DOI: 10.1016/j.fertnstert.2018.06.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 06/12/2018] [Indexed: 01/10/2023]
Abstract
Clinics may develop a policy to disallow selecting which embryos to transfer based on sex and choose to use only embryo quality as selection criteria. Clinics may also develop a policy to use randomization to select those embryos for transfer if more embryos suitable for transfer are available than can be transferred.
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Mittal M, Supramaniam PR, Lim LN, Hamoda H, Savvas M, Narvekar N. Is the clinician an independent variable in embryo transfer outcomes under standardized direct and indirect supervision? A 5-year observational cohort study. GMS J Med Educ 2019; 36:Doc7. [PMID: 30828607 PMCID: PMC6390083 DOI: 10.3205/zma001215] [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] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 10/23/2018] [Accepted: 11/28/2018] [Indexed: 06/09/2023]
Abstract
Objective: To compare the cumulative pregnancy rate (CPR) for experienced clinicians and trainees naive to the skill of embryo transfer (ET) during an assisted reproductive treatment (ART) cycle. To establish the minimum number of procedures required to achieve consistent outcomes. Method: A non-interventional retrospective observational cohort study looking at all consecutive ETs undertaken over a 5-year study period. The CPR was determined by a self-reported urinary home pregnancy test undertaken 16 days after oocyte retrieval. Results: The CPR did not differ between an experienced clinician (39%) and trainee (45%) for the first 50 (p=0.41) and last 50 (40.7% versus 42.7%) (p=0.81) ET procedures. The CPR for the individuals remained consistent with their peaks and troughs mirroring the overall success rate of the unit. This pattern continued when the data was further stratified for co-variables (age [≤37 years of age], catheter type [soft] and embryo quality [expanded blastocyst of grade ≥2]): CPRs for experienced clinicians was 65.7% (first 50 transfers) and 40.9% (last 50 transfers); CPR for trainees was 66.7% (first 50 transfers) and 53.6% (last 50 transfers); p=0.95 and p=0.37, respectively. The trainees, however, were more likely to use a stylet catheter with a 2-step transfer technique, with a cost over clinical implication. Furthermore, patients expressed a preference for an experienced clinician to perform their procedure, despite being informed that the grade of the clinician had no impact on the cycle outcome after an analysis of the unit's data. Conclusion: The clinician's grade and duration of service have not been shown to significantly impact the outcome of the ART cycle. The findings, however, should be interpreted with caution, as they reflect the culture of training in the unit, where there is a strong emphasis on adequate direct and indirect supervision. Furthermore, the relationship between the volume of work and outcomes is established in postgraduate medical education, with the exact number required to achieve clinical competence being dependent on the procedure and intensity of the workload.
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Affiliation(s)
- Monica Mittal
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
- King’s College Hospital NHS Foundation Trust, Denmark Hill, Brixton, UK
| | | | - Lee Nai Lim
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
| | - Haitham Hamoda
- King’s College Hospital NHS Foundation Trust, Denmark Hill, Brixton, UK
| | - Mike Savvas
- King’s College Hospital NHS Foundation Trust, Denmark Hill, Brixton, UK
| | - Nitish Narvekar
- King’s College Hospital NHS Foundation Trust, Denmark Hill, Brixton, UK
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Li W, Xue X, Zhao W, Ren A, Zhuo W, Shi J. Blastocyst transfer is not associated with increased unfavorable obstetric and perinatal outcomes compared with cleavage-stage embryo transfer. Gynecol Endocrinol 2017; 33:857-860. [PMID: 28562102 DOI: 10.1080/09513590.2017.1332175] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Recent studies demonstrated controversial results of whether there are risks in fetal outcomes after blastocyst-stage embryos transfer (BT) compared with cleavage-stage embryos transfer (CT). AIMS To compare the implantation rates (IR), clinical pregnancy rates (cPR), birth rates (BR), gestational weeks, preterm birth rates, birth weights and low birth weight rates between CT and BT groups. METHODS A retrospective study of 1627 embryos transfer cycles was performed from May 2014 to April 2015. The cycles were divided into two groups according to transfer stage: CT on Day 3 (n = 798) and BT on Day 5 (n = 829). For the CT group, it must have surplus embryos and only surplus embryos developed to available blastocysts, the cleavage-stage embryos could be included. The clinical outcomes of two groups were analyzed. RESULTS The IR in CT group was lower than BT group (48.98% vs. 60.68%; p < 0.01). There were no significant differences in the clinical pregnancy rate and birth rate between BT and CT groups. For singletons and twin deliveries, there were no significant differences in gestational weeks, preterm birth rates, birth weights and low birth weight rates between two groups. CONCLUSION Blastocysts had higher implantation potential than cleavage-stage embryos. Extended embryo culture was not related to increased adverse obstetric and perinatal outcome.
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Affiliation(s)
- Wei Li
- a The ART Center , Northwest Women's and Children's Hospital , Xi'an , China
| | - Xia Xue
- a The ART Center , Northwest Women's and Children's Hospital , Xi'an , China
| | - Wanqiu Zhao
- a The ART Center , Northwest Women's and Children's Hospital , Xi'an , China
| | - Anqi Ren
- a The ART Center , Northwest Women's and Children's Hospital , Xi'an , China
| | - Weiwei Zhuo
- a The ART Center , Northwest Women's and Children's Hospital , Xi'an , China
| | - Juanzi Shi
- a The ART Center , Northwest Women's and Children's Hospital , Xi'an , China
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Valdes CT, Schutt A, Simon C. Implantation failure of endometrial origin: it is not pathology, but our failure to synchronize the developing embryo with a receptive endometrium. Fertil Steril 2017; 108:15-18. [PMID: 28668151 DOI: 10.1016/j.fertnstert.2017.05.033] [Citation(s) in RCA: 93] [Impact Index Per Article: 13.3] [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: 05/03/2017] [Accepted: 05/24/2017] [Indexed: 11/19/2022]
Abstract
Repeated implantation failure (RIF) is an intriguing, massive failure of reproductive treatment in otherwise healthy women leading to the introduction of empirical adjuvant interventions that are costly, inefficient, and frustrating for our patients. In this article, we will try to convince the readers that RIF is neither a stigma nor a mysterious pathology but rather our failure to diagnose and properly synchronize the euploid blastocyst with the patient's personalized window of implantation.
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Affiliation(s)
- Cecilia T Valdes
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| | - Amy Schutt
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| | - Carlos Simon
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas; Department of Obstetrics and Gynecology, Valencia University and INCLIVA, Valencia, Spain; Igenomix, Parc Cientific Valencia University, Valencia, Spain; Department of Obstetrics and Gynecology, Stanford University, Stanford, California.
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Rienzi L, Gracia C, Maggiulli R, LaBarbera AR, Kaser DJ, Ubaldi FM, Vanderpoel S, Racowsky C. Oocyte, embryo and blastocyst cryopreservation in ART: systematic review and meta-analysis comparing slow-freezing versus vitrification to produce evidence for the development of global guidance. Hum Reprod Update 2017; 23:139-155. [PMID: 27827818 PMCID: PMC5850862 DOI: 10.1093/humupd/dmw038] [Citation(s) in RCA: 200] [Impact Index Per Article: 28.6] [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: 06/02/2016] [Revised: 09/15/2016] [Accepted: 10/14/2016] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Successful cryopreservation of oocytes and embryos is essential not only to maximize the safety and efficacy of ovarian stimulation cycles in an IVF treatment, but also to enable fertility preservation. Two cryopreservation methods are routinely used: slow-freezing or vitrification. Slow-freezing allows for freezing to occur at a sufficiently slow rate to permit adequate cellular dehydration while minimizing intracellular ice formation. Vitrification allows the solidification of the cell(s) and of the extracellular milieu into a glass-like state without the formation of ice. OBJECTIVE AND RATIONALE The objective of our study was to provide a systematic review and meta-analysis of clinical outcomes following slow-freezing/thawing versus vitrification/warming of oocytes and embryos and to inform the development of World Health Organization guidance on the most effective cryopreservation method. SEARCH METHODS A Medline search was performed from 1966 to 1 August 2016 using the following search terms: (Oocyte(s) [tiab] OR (Pronuclear[tiab] OR Embryo[tiab] OR Blastocyst[tiab]) AND (vitrification[tiab] OR freezing[tiab] OR freeze[tiab]) AND (pregnancy[tiab] OR birth[tiab] OR clinical[tiab]). Queries were limited to those involving humans. RCTs and cohort studies that were published in full-length were considered eligible. Each reference was reviewed for relevance and only primary evidence and relevant articles from the bibliographies of included articles were considered. References were included if they reported cryosurvival rate, clinical pregnancy rate (CPR), live-birth rate (LBR) or delivery rate for slow-frozen or vitrified human oocytes or embryos. A meta-analysis was performed using a random effects model to calculate relative risk ratios (RR) and 95% CI. OUTCOMES One RCT study comparing slow-freezing versus vitrification of oocytes was included. Vitrification was associated with increased ongoing CPR per cycle (RR = 2.81, 95% CI: 1.05-7.51; P = 0.039; 48 and 30 cycles, respectively, per transfer (RR = 1.81, 95% CI 0.71-4.67; P = 0.214; 47 and 19 transfers) and per warmed/thawed oocyte (RR = 1.14, 95% CI: 1.02-1.28; P = 0.018; 260 and 238 oocytes). One RCT comparing vitrification versus fresh oocytes was analysed. In vitrification and fresh cycles, respectively, no evidence for a difference in ongoing CPR per randomized woman (RR = 1.03, 95% CI: 0.87-1.21; P = 0.744, 300 women in each group), per cycle (RR = 1.01, 95% CI: 0.86-1.18; P = 0.934; 267 versus 259 cycles) and per oocyte utilized (RR = 1.02, 95% CI: 0.82-1.26; P = 0.873; 3286 versus 3185 oocytes) was reported. Findings were consistent with relevant cohort studies. Of the seven RCTs on embryo cryopreservation identified, three met the inclusion criteria (638 warming/thawing cycles at cleavage and blastocyst stage), none of which involved pronuclear-stage embryos. A higher CPR per cycle was noted with embryo vitrification compared with slow-freezing, though this was of borderline statistical significance (RR = 1.89, 95% CI: 1.00-3.59; P = 0.051; three RCTs; I2 = 71.9%). LBR per cycle was reported by one RCT performed with cleavage-stage embryos and was higher for vitrification (RR = 2.28; 95% CI: 1.17-4.44; P = 0.016; 216 cycles; one RCT). A secondary analysis was performed focusing on embryo cryosurvival rate. Pooled data from seven RCTs (3615 embryos) revealed a significant improvement in embryo cryosurvival following vitrification as compared with slow-freezing (RR = 1.59, 95% CI: 1.30-1.93; P < 0.001; I2 = 93%). WIDER IMPLICATIONS Data from available RCTs suggest that vitrification/warming is superior to slow-freezing/thawing with regard to clinical outcomes (low quality of the evidence) and cryosurvival rates (moderate quality of the evidence) for oocytes, cleavage-stage embryos and blastocysts. The results were confirmed by cohort studies. The improvements obtained with the introduction of vitrification have several important clinical implications in ART. Based on this evidence, in particular regarding cryosurvival rates, laboratories that continue to use slow-freezing should consider transitioning to the use of vitrification for cryopreservation.
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Affiliation(s)
- Laura Rienzi
- GENERA Centre for Reproductive Medicine, Clinica Valle Giulia, via de Notaris 2b, Rome, Italy
| | - Clarisa Gracia
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA, USA
| | - Roberta Maggiulli
- GENERA Centre for Reproductive Medicine, Clinica Valle Giulia, via de Notaris 2b, Rome, Italy
| | | | - Daniel J. Kaser
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Filippo M. Ubaldi
- GENERA Centre for Reproductive Medicine, Clinica Valle Giulia, via de Notaris 2b, Rome, Italy
| | - Sheryl Vanderpoel
- HRP (the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction), Geneva, Switzerland(at the time of the study)
- Population Council, Reproductive Health Programme, New York, USA
| | - Catherine Racowsky
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
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Aleksandrova N, Shubina E, Ekimov A, Kodyleva T, Mukosey I, Makarova N, Kulakova E, Levkov L, Trofimov D, Sukhikh G. Comparison of the results of preimplantation genetic screening obtained by a-CGH and NGS methods from the same embryos. Gynecol Endocrinol 2016; 32:1-4. [PMID: 27759447 DOI: 10.1080/09513590.2016.1232892] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Chromosomal aneuploidies are known for being the main cause of abnormal development of embryos with normal morphology, their implantation failure and early reproductive losses in IVF treatments. Preimplantation genetic screening (PGS) allows selecting embryos with normal chromosomal content and increases IVF treatment efficiency due to higher implantation rates and less frequent early pregnancy losses. New technologies used for PGS allow making genome-wide analysis of the presence of all chromosomes in embryos. This article presents our study of evaluation of two techniques used for PGS: previously developed and used in our laboratory a-CGH assay based on Agilent technology and newly tested semi-conductive NGS technique (Torrent technology).
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Affiliation(s)
- N Aleksandrova
- a Federal State Budget Institution "Research Center for Obstetrics, Gynecology and Perinatology" Ministry of Healthcare of the Russian Federation , Russia
| | - E Shubina
- a Federal State Budget Institution "Research Center for Obstetrics, Gynecology and Perinatology" Ministry of Healthcare of the Russian Federation , Russia
| | - A Ekimov
- a Federal State Budget Institution "Research Center for Obstetrics, Gynecology and Perinatology" Ministry of Healthcare of the Russian Federation , Russia
| | - T Kodyleva
- a Federal State Budget Institution "Research Center for Obstetrics, Gynecology and Perinatology" Ministry of Healthcare of the Russian Federation , Russia
| | - I Mukosey
- a Federal State Budget Institution "Research Center for Obstetrics, Gynecology and Perinatology" Ministry of Healthcare of the Russian Federation , Russia
| | - N Makarova
- a Federal State Budget Institution "Research Center for Obstetrics, Gynecology and Perinatology" Ministry of Healthcare of the Russian Federation , Russia
| | - E Kulakova
- a Federal State Budget Institution "Research Center for Obstetrics, Gynecology and Perinatology" Ministry of Healthcare of the Russian Federation , Russia
| | - L Levkov
- a Federal State Budget Institution "Research Center for Obstetrics, Gynecology and Perinatology" Ministry of Healthcare of the Russian Federation , Russia
| | - D Trofimov
- a Federal State Budget Institution "Research Center for Obstetrics, Gynecology and Perinatology" Ministry of Healthcare of the Russian Federation , Russia
| | - G Sukhikh
- a Federal State Budget Institution "Research Center for Obstetrics, Gynecology and Perinatology" Ministry of Healthcare of the Russian Federation , Russia
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Gleicher N, Vidali A, Braverman J, Kushnir VA, Barad DH, Hudson C, Wu YG, Wang Q, Zhang L, Albertini DF. Accuracy of preimplantation genetic screening (PGS) is compromised by degree of mosaicism of human embryos. Reprod Biol Endocrinol 2016; 14:54. [PMID: 27595768 PMCID: PMC5011996 DOI: 10.1186/s12958-016-0193-6] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 08/30/2016] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND To preclude transfer of aneuploid embryos, current preimplantation genetic screening (PGS) usually involves one trophectoderm biopsy at blastocyst stage, assumed to represent embryo ploidy. Whether one such biopsy can correctly assess embryo ploidy has recently, however, been questioned. METHODS This descriptive study investigated accuracy of PGS in two ways. Part I: Two infertile couples donated 11 embryos, previously diagnosed as aneuploid and, therefore, destined to be discarded. They were dissected into 37 anonymized specimens, and sent to another national laboratory for repeat analyses to assess (i) inter-laboratory congruity and (ii) intra-embryo congruity of multiple embryo biopsies in a single laboratory. Part II: Reports on human IVF cycle outcomes after transfer of allegedly aneuploid embryos into 8 infertile patients. RESULTS Only 2/11 (18.2 %) embryos were identically assessed at two PGS laboratories; 4/11 (36.4 %), on repeat analysis were chromosomally normal, 2 mosaic normal/abnormal, and 5/11 (45.5 %) completely differed in reported aneuploidies. In intra-embryo analyses, 5/10 (50 %) differed between biopsy sites. Eight transfers of previously reported aneuploid embryos resulted in 5 chromosomally normal pregnancies, 4 delivered and 1 ongoing. Three patients did not conceive, though 1 among them experienced a chemical pregnancy. CONCLUSIONS Though populations of both study parts are too small to draw statistically adequately powered conclusions on specific degrees of inaccuracy of PGS, here presented results do raise concerns especially about false-positive diagnoses. While inter-laboratory variations may at least partially be explained by different diagnostic platforms utilized, they cannot explain observed intra-embryo variations, suggesting more frequent trophectoderm mosiaicsm than previously reported. Together with recentl published mouse studies of lineages-specific degrees of survival of aneuploid cells in early stage embryos, these results call into question the biological basis of PGS, based on the assumption that a single trophectoderm biopsy can reliably determine embryo ploidy.
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Affiliation(s)
- Norbert Gleicher
- The Center for Human Reproduction, 21 East 69th Street, New York, NY 10021 USA
- The Foundation for Reproductive Medicine, New York, NY USA
- The Brivanlou Laboratory for Stem Cell Biology and Molecular Embryology, Rockefeller University, New York, NY USA
| | - Andrea Vidali
- The Center for Human Reproduction, 21 East 69th Street, New York, NY 10021 USA
- Fertility Specialist in New York, New York, NY USA
| | | | - Vitaly A. Kushnir
- The Center for Human Reproduction, 21 East 69th Street, New York, NY 10021 USA
- Department of Obstetrics and Gynecology, Wake Forest University, Winston Salem, NC USA
| | - David H. Barad
- The Center for Human Reproduction, 21 East 69th Street, New York, NY 10021 USA
- The Foundation for Reproductive Medicine, New York, NY USA
- Department of Obstetrics and Gynecology, Albert Einstein College of Medicine, Bronx, NY USA
| | - Cynthia Hudson
- The Center for Human Reproduction, 21 East 69th Street, New York, NY 10021 USA
| | - Yang-Guan Wu
- The Center for Human Reproduction, 21 East 69th Street, New York, NY 10021 USA
| | - Qi Wang
- The Center for Human Reproduction, 21 East 69th Street, New York, NY 10021 USA
| | - Lin Zhang
- The Center for Human Reproduction, 21 East 69th Street, New York, NY 10021 USA
| | - David F. Albertini
- The Center for Human Reproduction, 21 East 69th Street, New York, NY 10021 USA
- Department of Molecular and Integrative Physiology, University of Kansas School of Medicine, Wichita, KS USA
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Abstract
OBJECTIVE Pre-implantation genetic diagnosis (PGD) is required in order to screen and diagnose embryos of patients at risk of having a genetically affected offspring. A biopsy to diagnose the genetic profile of the embryo may be performed either before or after cryopreservation. The aim of this study was to determine which biopsy timing yields higher embryo survival rates. STUDY DESIGN Retrospective cohort study of all PGD patients in a public IVF unit between 2010 and 2013. Inclusion criteria were patients with good-quality embryos available for cryopreservation by the slow freezing method. Embryos were divided into two groups: biopsy before and biopsy after cryopreservation. The primary outcome was embryo survival rates post thawing. RESULTS Sixty-five patients met inclusion criteria. 145 embryos were biopsied before cryopreservation and 228 embryos were cryopreserved and biopsied after thawing. Embryo survival was significantly greater in the latter group (77% vs. 68%, p < 0.0001). CONCLUSION Cryopreservation preceding biopsy results in better embryo survival compared to biopsy before cryopreservation.
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Affiliation(s)
- S Shinar
- a The Sarah Racine IVF Unit, Department of Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv University , Tel Aviv , Israel
- b Sackler School of Medicine, Tel Aviv University , Tel Aviv , Israel , and
| | - N Kornecki
- a The Sarah Racine IVF Unit, Department of Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv University , Tel Aviv , Israel
- b Sackler School of Medicine, Tel Aviv University , Tel Aviv , Israel , and
| | - T Schwartz
- a The Sarah Racine IVF Unit, Department of Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv University , Tel Aviv , Israel
- b Sackler School of Medicine, Tel Aviv University , Tel Aviv , Israel , and
| | - N Mey-Raz
- a The Sarah Racine IVF Unit, Department of Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv University , Tel Aviv , Israel
- b Sackler School of Medicine, Tel Aviv University , Tel Aviv , Israel , and
| | - H Amir
- a The Sarah Racine IVF Unit, Department of Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv University , Tel Aviv , Israel
- b Sackler School of Medicine, Tel Aviv University , Tel Aviv , Israel , and
| | - B Almog
- a The Sarah Racine IVF Unit, Department of Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv University , Tel Aviv , Israel
- b Sackler School of Medicine, Tel Aviv University , Tel Aviv , Israel , and
| | - T Shavit
- b Sackler School of Medicine, Tel Aviv University , Tel Aviv , Israel , and
- c IVF Unit, Hillel Yaffe Medical Center , Hedera , Israel
| | - J Hasson
- a The Sarah Racine IVF Unit, Department of Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv University , Tel Aviv , Israel
- b Sackler School of Medicine, Tel Aviv University , Tel Aviv , Israel , and
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El-Danasouri I, Sterzik K, Rinaldi L, Pacchiarotti A, DeSanto M, Selman H. Effect of transferring a morphologically impaired embryo with a good quality embryo on the pregnancy and implantation rates. Eur Rev Med Pharmacol Sci 2016; 20:394-398. [PMID: 26914111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE This study aimed to investigate the effect of transferring embryos with different qualities on pregnancy and implantation rates. PATIENTS AND METHODS In a retrospective multi-center study we analyzed 761 patients aged ≤ 35 years who had an elective transfer of one or two embryos. Embryos were scored morphologically by their developmental stage into good "A" and impaired "B" embryos. Pregnancy and implantation rates were compared between patients who had a transfer of: one grade "A" embryo; two grade "A" embryos, two embryos one grade "A" plus one grade "B" embryos; one grade "B" embryo and two grade "B" embryos. RESULTS Higher pregnancy and implantation rates were observed in patients who had received one embryo of grade "A" (34.6%) and two grade "A" embryos (45.2%, 25.85% respectively), compared to patients who received two embryos, one of grade "A" plus one of grade "B" (25%, 13.77% respectively). CONCLUSIONS Transferring a morphologically and developmentally impaired embryo, significantly lower the implantation chance of the good quality embryo.
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Levron J, Zinchenko V, Kol S, Direnfeld M, Bider D. The use of portable CO2 incubator for cross-border shipping of embryos in an international egg donation program. Gynecol Endocrinol 2014; 30:755-7. [PMID: 24948338 DOI: 10.3109/09513590.2014.929652] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Two groups of egg recipients were treated, one in situ (165 patients; 195 cycles) and one after cross-border embryo transportation (340 cycles; 340 cycles) using mobile CO(2) incubator. The positive pregnancy rate per cycle was 199/340 (58.6%) and 99/195 (50.7%) in the transportation and the traveling group, respectively (NS). The clinical pregnancy rate (fetal heart beat) was 48.1 and 43.1% per embryo transfer cycle, respectively (NS) and the delivery rate was 44.1 and 35.9% per embryo transfer cycle, respectively (p = 0.01). Long distance transportation of human pre-implantation embryos using portable CO(2) incubator is safe and do not jeopardize their developmental potential.
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Affiliation(s)
- Jacob Levron
- Department of Obstetrics & Gynecology, IVF Unit, ISIDA Women's Hospital , Kiev , Ukraine
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Conaghan J, Chen AA, Willman SP, Ivani K, Chenette PE, Boostanfar R, Baker VL, Adamson GD, Abusief ME, Gvakharia M, Loewke KE, Shen S. Improving embryo selection using a computer-automated time-lapse image analysis test plus day 3 morphology: results from a prospective multicenter trial. Fertil Steril 2013; 100:412-9.e5. [PMID: 23721712 DOI: 10.1016/j.fertnstert.2013.04.021] [Citation(s) in RCA: 177] [Impact Index Per Article: 16.1] [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: 12/11/2012] [Revised: 04/10/2013] [Accepted: 04/11/2013] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To assess the first computer-automated platform for time-lapse image analysis and blastocyst prediction and to determine how the screening information may assist embryologists in day 3 (D3) embryo selection. DESIGN Prospective, multicenter, cohort study. SETTING Five IVF clinics in the United States. PATIENT(S) One hundred sixty women ≥ 18 years of age undergoing fresh IVF treatment with basal antral follicle count ≥ 8, basal FSH <10 IU/mL, and ≥ 8 normally fertilized oocytes. INTERVENTION(S) A noninvasive test combining time-lapse image analysis with the cell-tracking software, Eeva (Early Embryo Viability Assessment), was used to measure early embryo development and generate usable blastocyst predictions by D3. MAIN OUTCOME MEASURE(S) Improvement in the ability of experienced embryologists to select which embryos are likely to develop to usable blastocysts using D3 morphology alone, compared with morphology plus Eeva. RESULT(S) Experienced embryologists using Eeva in combination with D3 morphology significantly improved their ability to identify embryos that would reach the usable blastocyst stage (specificity for each of three embryologists using morphology vs. morphology plus Eeva: 59.7% vs. 86.3%, 41.9% vs. 84.0%, 79.5% vs. 86.6%). Adjunctive use of morphology plus Eeva improved embryo selection by enabling embryologists to better discriminate which embryos would be unlikely to develop to blastocyst and was particularly beneficial for improving selection among good-morphology embryos. Adjunctive use of morphology plus Eeva also reduced interindividual variability in embryo selection. CONCLUSION(S) Previous studies have shown improved implantation rates for blastocyst transfer compared with cleavage-stage transfer. Addition of Eeva to the current embryo grading process may improve the success rates of cleavage-stage ETs.
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Affiliation(s)
- Joe Conaghan
- Pacific Fertility Center, San Francisco, California, USA
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Figueira RCS, Setti AS, Cortezzi SS, Martinhago CD, Braga DPAF, Iaconelli A, Borges E. Preimplantation diagnosis for β-thalassemia combined with HLA matching: first "savior sibling" is born after embryo selection in Brazil. J Assist Reprod Genet 2012; 29:1305-9. [PMID: 23015159 DOI: 10.1007/s10815-012-9862-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Accepted: 09/10/2012] [Indexed: 11/25/2022] Open
Affiliation(s)
- Rita C S Figueira
- Fertility-Assisted Fertilization Center, Av. Brigadeiro Luis Antônio, 4545, 01401-002, São Paulo, SP, Brazil
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Kably Ambe A, López Ortiz CS, Serviere Zaragoza C, Velázquez Cornejo G, Pérez Peña E, Santos Haliscack R, Luna Rojas M, Valerio E, Santana H, Gaviño Gaviño F. [Mexican National Consensus on Assisted Reproduction Treatment]. Ginecol Obstet Mex 2012; 80:581-624. [PMID: 23243837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND It is estimated that 15% of couples living in industrialized countries are infertile, ie have failed to conceive, reproductive age, after 12 months ormore of regular intercourse without contraception. During the past decade has increased the demand for fertility treatments because they believe are moreeffective now. OBJECTIVE To unify the therapeutic approach and service to patients and set a precedent for a Mexican Official Standard respect and support for the legislation of these procedures. METHOD Consensus by technical experts group panel with the participation of 34 national centers accredited for use in assisted reproduction. He organized seven workshops with the following themes: 1) selection of patients for assisted reproduction treatment, 2) schemes controlled ovarian stimulation for assisted reproduction techniques of high complexity, 3) preparation and egg retrieval technique, 4) transferembryo; 5) luteal phase supplementation; 6) indications and techniques of cryopreservation and 7) informed consent. Each table had a coordinator who wrote and presented the findings to the full, it made a number of observations until they reached unanimity of criteria, which are reflected in this document. RESULTS Patient selection for assisted reproduction techniques is the first step of the process. Proper selection lead to success, in the same way that a bad pick up for failure. In the case of egg donation the most important recommendation is that only one to two embryos transferred in order to reduce multiple pregnancy rates and maintaining high pregnancy rates.
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Siam EM. Office microlaparoscopic intrafallopian transfer of day one zygote versus day three embryo transfer after previous failed ICSI trials. Afr J Reprod Health 2011; 15:153-161. [PMID: 22590901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The objective of the study was to investigate whether transferring zygotes on day 1 would result in similar pregnancy rates compared to transferring cleavage stage embryos on day 3 in a prospective randomized trial, using the office microlaparoscopic procedure. Patients undergoing IVF/ICSI treatments were randomized to either day 1 or day 3 transfers after previous failed ICSI trials due to failed implantation. The primary outcome measure was pregnancy rate. Pregnancy rates were higher in day 3 group (55/131, 42%) when compared to day 1 (34/123, 28%, P = 0.024). Similarly, implantation rates were higher in day 3 group (P = 0.03). There were more cycles with cryopreservation in the day 1 group (P < 0.001). Embryo quality on day 3 was similar between pattern 0 and non-pattern 0 zygotes. Day 3 embryo transfers result in better pregnancy and implantation rates compared to day 1 zygote transfers.
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Affiliation(s)
- Emad M Siam
- Department of Obstetrics and Gynecology, College of Medicine, El-Minya University, El-Minya University Hospital, Egypt.
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Garrido N, Bellver J, Remohí J, Simón C, Pellicer A. Cumulative live-birth rates per total number of embryos needed to reach newborn in consecutive in vitro fertilization (IVF) cycles: a new approach to measuring the likelihood of IVF success. Fertil Steril 2011; 96:40-6. [PMID: 21621770 DOI: 10.1016/j.fertnstert.2011.05.008] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Revised: 04/15/2011] [Accepted: 05/02/2011] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To report the use of cumulative live-birth rates (CLBRs) per ovarian stimulation cycle to measure the success of IVF is proving to be the most accurate method for advising couples who failed to conceive, although the accuracy yielded is relatively low, and cycle outcome is highly dependent on the number of embryos replaced. Our aim with this work is to report the CLBRs of IVF as a function of the number of embryos required to reach a live birth (EmbR), considering age, day of ET, and infertility etiology. DESIGN Survival curves and Kaplan-Meier methods to analyze CLBR in a retrospective cohort with respect to the number of EmbR. SETTING University-affiliated infertility center. PATIENT(S) Infertile couples undergoing IVF using own oocytes. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) CLBR per embryo transferred. RESULT(S) CLBRs increase rapidly between 1 and 5 EmbR, moderately between 5 and 15, and slowly thereafter. Live-birth rates rise more slowly when embryos are transferred on days 2-3 rather than on days 5-6, with comparable long-term results. Women's age is a negative factor from 35 to 37 years old, with a dramatic decrease in live-birth rates beyond age 40 years. In addition, there are significant worse results in endometriosis patients. CONCLUSION(S) The relationship between CLBR and number of EmbR provides realistic and precise information regarding IVF success and can be used to guide couples and practitioners.
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Affiliation(s)
- Nicolás Garrido
- Instituto Universitario IVI Valencia, University of Valencia, Valencia, Spain.
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Check JH, Katsoff B, Brasile D, Wilson C, Summers-Chase D. Comparison of pregnancy outcome following frozen embryo transfer (ET) in a gestational carrier program according to source of the oocytes. CLIN EXP OBSTET GYN 2011; 38:26-27. [PMID: 21485720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
PURPOSE To determine any differences in pregnancy rates if frozen-thawed embryos are transferred to a gestational carrier if the source of oocytes came from infertile women trying to conceive vs a paid egg donor. METHODS Gestational carriers were used because of uterine problems or health issues. If there was adequate ovarian egg reserve, controlled ovarian hyperstimulation followed by oocyte retrieval was performed on the infertile woman. Otherwise an egg donor was used. RESULTS No differences in clinical and ongoing delivered pregnancy rates were found but a trend for higher implantation rates in the paid donors was evident. CONCLUSIONS The trend for higher implantation rates when a paid donor was the source of oocytes may be age-related (35.9 for infertile women vs 29.5 for paid donors). The pregnancy results with frozen embryos were sufficient to allow women to proceed with oocyte retrieval if time is of the essence even if a gestational carrier has not as yet been found.
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Affiliation(s)
- J H Check
- The University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School at Camden, NJ, USA.
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Valley JK, Swinton P, Boscardin WJ, Lue TF, Rinaudo PF, Wu MC, Garcia MM. Preimplantation mouse embryo selection guided by light-induced dielectrophoresis. PLoS One 2010; 5:e10160. [PMID: 20405021 PMCID: PMC2854157 DOI: 10.1371/journal.pone.0010160] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [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: 12/03/2009] [Accepted: 03/23/2010] [Indexed: 12/03/2022] Open
Abstract
Selection of optimal quality embryos for in vitro fertilization (IVF) transfer is critical to successful live birth outcomes. Currently, embryos are chosen based on subjective assessment of morphologic developmental maturity. A non-invasive means to quantitatively measure an embryo's developmental maturity would reduce the variability introduced by the current standard. We present a method that exploits the scaling electrical properties of pre-transfer embryos to quantitatively discern embryo developmental maturity using light-induced dielectrophoresis (DEP). We show that an embryo's DEP response is highly correlated with its developmental stage. Uniquely, this technique allows one to select, in sequence and under blinded conditions, the most developmentally mature embryos among a mixed cohort of morphologically indistinguishable embryos cultured in optimized and sub-optimal culture media. Following assay, embryos continue to develop normally in vitro. Light-induced dielectrophoresis provides a non-invasive, quantitative, and reproducible means to select embryos for applications including IVF transfer and embryonic stem cell harvest.
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Affiliation(s)
- Justin K. Valley
- Berkeley Sensor & Actuator Center (BSAC), Electrical Engineering and Computer Sciences, University of California, Berkeley, California, United States of America
| | - Paul Swinton
- Gladstone Transgenic Gene-Targeting Core Laboratory, University of California San Francisco, San Francisco, California, United States of America
| | - W. John Boscardin
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, United States of America
| | - Tom F. Lue
- Department of Urology, University of California San Francisco, San Francisco, California, United States of America
| | - Paolo F. Rinaudo
- Division of Reproductive Endocrinology, Department of Obstetrics and Gynaecology, University of California San Francisco, San Francisco, California, United States of America
| | - Ming C. Wu
- Berkeley Sensor & Actuator Center (BSAC), Electrical Engineering and Computer Sciences, University of California, Berkeley, California, United States of America
| | - Maurice M. Garcia
- Department of Urology, University of California San Francisco, San Francisco, California, United States of America
- * E-mail:
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Affiliation(s)
- T A E Stout
- Department of Equine Sciences, University of Utrecht, The Netherlands
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Kozovski I, Kovachev M, Angelova K, Alexandrov K, Kozovski G, Markova V. [Oocyte and embryo donation and surrogacy. Religious, medico-social, ethical, financial and legal problems]. Akush Ginekol (Sofiia) 2010; 49:43-46. [PMID: 20734677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The authors quote and discuss the postulates of the Orthodox, Jewish, Catholic and Islamic religions towards ART as well as worldwide legislations and standards and the attitude of female students of medicine in Varna. Indications of oocyte and embryo donation and surrogacy are proposed but all kinds or surrogacy should be permitted. The ART legislation and standards in Bulgaria should be thoroughly revised.
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Zhang SJ, Gong F, Lin G, Lu CF, Xiao HM, Lu GX. [Influence of patient age and the number of good-quality-embryos transferred on multiple gestation in in vitro fertilization and embryo transfer]. Zhonghua Fu Chan Ke Za Zhi 2008; 43:567-570. [PMID: 19087488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To observe the influence of patient's age, and the number of transferred-good-quality-embryos on multiple gestation rates in in vitro fertilization and embryo transfer (IVF-ET) cycles. METHODS In this retrospective study, a total of 4,395 patients who transferred fresh embryo between Jan 2004 and Nov 2006 was analyzed. According to the age, the patients were divided into 2 groups: aged < 35 (3,442 cycles) or aged >or= 35 (953 cycles). We regularly transferred 2 - 3 embryos. If the patients had only one embryo, one was transferred. And those patients who had only 2 embryos, even if they were more than 35 years old or it would be the second time for them to transfer, were transferred 2 embryos. The influence of female age and the number of good quality embryos transferred on the multiple gestation rates in IVF-ET cycle was analyzed. RESULTS (1) The multiple gestation rate of the groups of 1 good quality embryo, 2 good quality embryos, or 3 good quality embryos transferred were 21.08% (35/166), 31.41% (413/1315), and 42.37% (75/177), respectively in women aged < 35, with a significant difference between them. The pregnancy rates of these groups were 29.64% (166/560), 51.63% (1,315/2,547), and 52.84% (177/335), respectively; there were no significant differences between 2 good quality embryos transferred group and 3 good quality embryos transferred group. (2) The multiple gestation rates of the groups of 1 good quality embryo, 2 good quality embryos, or 3 good quality embryos transferred were 19.51% (8/41), 20.65% (19/92), and 40.66% (74/182), respectively, in women aged >or= 35; there were no significant differences between 1 good quality embryo transferred group and 2 good quality embryos transferred group. The pregnancy rates of these groups were 19.07% (41/215), 33.70% (92/273), and 39.14% (182/465), respectively; there were no significant differences between 2 good quality embryos transferred group and 3 good quality embryos transferred group. (3) The pregnancy rate of the patients aged < 35 [48.17% (1,658/3,442)] was significantly higher than in women aged >or= 35 [33.05% (315/953)]. CONCLUSION The transfer of 2 good quality embryos results in similar pregnancy rates and significantly reduced multiple gestation rates when compared to the transfer of 3 good quality embryos in women regardless of their ages.
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Affiliation(s)
- Shun-Ji Zhang
- Institute of Reproduction and Stem Cell Engineering Center, Central South University, Changsha 410078, China
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Ata B, Urman B. Ultrasound guided embryo transfer does not offer any benefit in clinical outcome: a randomized controlled study. Hum Reprod 2007; 23:457-8; author reply 458-9. [PMID: 17933752 DOI: 10.1093/humrep/dem320] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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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Abstract
PURPOSE OF REVIEW To give an overview of the current status and future directions of blastocyst transfer and outcome with particular focus on markers of blastocyst quality and their relationship with implantation. RECENT FINDINGS In addition to morphological markers, future embryo grading systems, in general, and blastocyst grading systems, in particular, will be based upon metabolic, genetic and epigenetic markers that will increase their efficiency. Metabolic markers such as soluble human leukocyte antigen-G, analysis of specific gene mutations in the trophectoderm by real-time multiplex polymerase chain reaction and analysis by microarray of differential gene expression will be operational in the near future for accurate blastocyst grading and selection. SUMMARY Gamete and embryo quality as well as culture conditions affect blastocyst formation and quality. Characteristics of the zygote and the cleavage-stage embryo determine the developmental potential of the embryo up to the blastocyst stage. There appears to be a strong relationship between blastocyst quality and implantation. Accurate grading is important for selection of the most implantation-competent blastocyst. Similar to grading systems used in the cleavage-stage embryo, current blastocyst grading systems are mainly based upon morphological characteristics. Incorporation of metabolic, genetic and epigenetic markers will undoubtedly improve the selection process, making it possible to transfer a single blastocyst yielding high pregnancy rates.
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Affiliation(s)
- Bulent Urman
- Assisted Reproduction Unit, American Hospital of Istanbul, Istanbul, Turkey.
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Shibahara H, Hirano Y, Okajima T, Shimada K, Kikuchi K, Suzuki T, Takamizawa S, Suzuki M. Establishment of criteria for elective single embryo transfer at day 2 or day 3 by analyzing cases with successful implantation of all embryos transferred. J Obstet Gynaecol Res 2007; 33:501-5. [PMID: 17688618 DOI: 10.1111/j.1447-0756.2007.00556.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM Elective transfer of two good-quality embryos has been used to avoid triplet or high-order multiple pregnancies. However, the rate of twin pregnancies has remained fairly unchanged. In the present study, criteria for elective single embryo transfer (eSET) at day 2 or day 3 were established by analyzing cases with successful implantation of all embryos transferred. METHODS A total of 685 fresh or frozen-thawed embryo transfers following in vitro fertilization/intracytoplasmic sperm injection between April 2002 and March 2006 were performed. Only embryo transfers at day 2 or day 3, but not at blastocyst stage, were included. Successful implantation of all embryos transferred was obtained in 17 pregnancy cycles. RESULTS Thirty-one gestational sacs with fetal heartbeats were obtained by a total of 31 embryo transfers in 17 infertile women. The average age was 32.6 years (23-38), and 14 (82.3%) of the 17 women were <36 years old. Fifteen (88.2%) of the 17 pregnancies were established at the first attempt of assisted reproductive technology (ART). Of the 17 women, eight (47.1%) women were multigravida and four (23.5%) women were multipara. The indications for ART or insemination methods did not seem to be related to the pregnancy results. Twenty-nine (93.5%) of 31 embryos implanted were considered good-quality embryos. Of the 17 fresh embryos transferred at day 2, 15 were at the 4-cell stage and two were at the 5-cell stage. Of the 11 fresh embryos transferred at day 3, one was at the 6-cell stage, two were at the 7-cell stage and eight were at the 8-cell stage. CONCLUSION The criteria for eSET at day 2 or day 3 were established as follows: <36 years of age, a first treatment cycle and more than two good-quality embryos developed at least to the 4-cell stage at day 2, or 6-cell stage at day 3. Additionally, the past history of pregnancy or delivery should be considered, as patients positive for such history might have better implantation ability. eSET can be highly recommended to avoid twin pregnancies in subjects with the established criteria.
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Affiliation(s)
- Hiroaki Shibahara
- Department of Obstetrics and Gynecology, School of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, Japan.
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Abstract
The primary aim of this study was to estimate variance components for traits related to embryo transfer (ET) by applying generalized linear mixed models (GLMM) for different distributions of traits (normal, binomial, and Poisson) in a synergistic context. Synergistic models were originally developed for traits affected by several genotypes, denoted as maternal, paternal, and direct effects. In the case of ET, the number of flushed ova (FO) only depends on a donor's maternal genetic effect, whereas paternal fertility must be considered for other embryo survival traits, such as the number of transferable embryos (TE), the number of degenerated embryos (DE), the number of unfertilized oocytes (UO), and the percentage of transferable embryos (PTE). Data for these traits were obtained from 4,196 flushes of 2,489 Holstein cows within 4 regions of northwest Germany from January 1998 through October 2004. Estimates of maternal heritability were 0.231 for FO, 0.096 for TE, 0.021 for DE, 0.135 for UO, and 0.099 for PTE, whereas the relative genetic impact of the paternal component was near zero. Estimates of the genetic correlations between the maternal and the paternal component were slightly negative, indicating a genetic antagonism. For the analysis of pregnancy after ET, 8,239 transfers to 6,819 different Holstein-Friesian recipients were considered by applying threshold methodology. The direct heritability for pregnancy in the recipient after ET was 0.056. The relative genetic impact of maternal and paternal components on pregnancy of recipients describing a donor's and a sire's ability to produce viable embryos was below 1%. The genetic correlations of the direct effect of the recipient with the sire of embryos (paternal effect) and the donor cow (maternal effect) for pregnancy after ET were -0.32 and -0.14, respectively. With the exception of FO and PTE (-0.17), estimates of genetic correlations among traits for the maternal site were distinctly positive, especially between FO and TE (0.74). Based on this high genetic correlation and due to the higher heritability for FO, indirect selection on FO will increase selection response in TE by about 22% compared with direct selection on TE. The negative genetic correlation of -0.27 between TE and lactation milk yield indicates the need for development of an index for bull dams in multiple ovulation and embryo transfer (MOET) breeding schemes combining production as well as traits related to ET.
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Affiliation(s)
- S König
- Department of Animal and Poultry Science, University of Guelph, N1G 2W1 Guelph, Canada.
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Abstract
The site of embryo replacement has been postulated as being important to the success of IVF/ICSI. In order to determine the best site for embryo deposition during embryo transfer, a meta-analysis of randomized trials comparing different uterine deposition sites was undertaken. Electronic (e.g. PubMed, EMBASE, Cochrane Library, LILACS) and hand searches were performed to locate trials. Outcomes measures were the live-birth (LBR), ongoing pregnancy (OPR), and clinical pregnancy rates (CPR). Assessments of the endometrial cavity length (ECL) and the distance from the fundus to the tip of the catheter (DTC) were utilized. Six studies were identified, of which three were excluded. Meta-analysis was conducted with the Mantel-Haenszel method, utilizing the fixed-effects model. The LBR and OPR showed an increasing trend when transfers were performed to the lower half of the uterine cavity. For the DTC, all rates were significantly higher for the approximately 20 mm versus approximately 10 mm distance from the uterine fundus, supporting the results of the ECL analysis. The results of this systematic review show that there is limited evidence of the superiority of lower cavity transfers (e.g. approximately 20 mm) compared with the traditional high cavity (e.g. approximately 10 mm) transfers. More well-designed and powered randomized trials are needed to confirm this conclusion.
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Abstract
The introduction of intracytoplasmic sperm injection (ICSI) in 1992 has dramatically changed the management of severe male infertility. In severe male infertility, live birth rates with ICSI are superior to those with other non-donor treatments. In non-male infertility, however, pregnancy rates are not better with ICSI than with in vitro fertilization (IVF). With obstructive or non-obstructive azoospermia, reasonable pregnancy rates are now possible with ICSI after recovery of sperm from the testes followed by ICSI. Genetic counselling is indicated for severe male infertility, whether or not ICSI is considered. ICSI is indicated in preimplantation genetic diagnosis (PGD) to avoid contamination by extraneous DNA in the case of PCR-based testing and to increase the number of embryos available for testing. In turn, PGD may be indicated in pregnancies that are at high risk of aneuploidy because of genetic factors associated with azoospermia. As with IVF, not all couples succeed, but 2% of couples with failed ICSI cycles will conceive without treatment. ICSI outcome studies indicate that there is a significant increase in prematurity, low birthweight, and perinatal mortality associated with single and multiple births, similar to the outcomes of conventional IVF. However, as evidenced in long-term follow-up studies, the higher rates of urogenital abnormalities and increased use of healthcare may be associated with paternal characteristics.
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Mahani IM, Davar R. Hyaluronic acid versus albumin in human embryo transfer medium. East Mediterr Health J 2007; 13:876-880. [PMID: 17955771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
We compared the implantation and pregnancy rate through in vitro fertilization (IVF) using hyaluronic acid and albumin as transfer medium in 60 women randomly allocated to 2 groups. In treatment group A (n = 30), embryos were transferred to medium supplemented with hyaluronic acid. In the control group B (n = 30), embryos were transferred to medium containing albumin. There were no significant differences between the groups in terms of mean age of the females, mean duration of infertility and mean number of embryos. The pregnancy rate in groups A and B were 81.8% and 71.4% respectively, a non-statistically significant difference. Hyaluronic acid can successfully replace albumin as transfer medium.
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Affiliation(s)
- I M Mahani
- Department of Obstetrics and Gynaecology, Afzallipour Hospital, Kerman University of Medical Sciences, Kerman, Islamic Republic of Iran.
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Salame Y, Englert Y, Emiliani S, Revelard P, Delbaere A, Devreker F. [Single embryo transfer : impact of new Belgian legislation on the results of the Clinic of Fertility of the Erasme Hospital]. Rev Med Brux 2007; 28:73-81. [PMID: 17561721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
With the progress made in the treatments of assisted reproduction, implantation and pregnancy rates have increased. This evolution has led to increase the rates of multiple pregnancies in the general population. Considering maternal and fetal risks related to multiple pregnancies it was necessary to reduce their incidence. Several efforts have been tried, in particular the limitation of the number of embryos transferred to 2. This reduced the incidence of triplets but that of twin remained unchanged, which convinced the clinicians of the need to reduce further the number of embryo transfer. In Belgium a new policy of transfer was established by a law introduced since the 01/07/2003 aiming to reduce the costs related to the twin pregnancies and to increase the reimbursement of IVF treatments. We have studied the impact of this policy on the results at the clinic of Erasme. Two periods were compared : from 01/01/2001 to 30/06/2003 where the majority of the transfers was transfers of 2 embryos (56.8 %) and from 01/07/2003 to 31/12/2004 where the majority of the transfers was transfers of a single embryo (53.7 %) (p < 0.001). The rates of single embryo transfer were 12.5 % and 53.7 % respectively (p < 0.001). The rates of clinical pregnancies were 33.2 % and 27.3 % respectively (p < 0.001), on the other hand the percentage of twin pregnancies has strongly decreased from 29.9 % to 11.4 % (p < 0.001). The rate of frozen embryos has increased from 22 % policy seems to achieve its goals to the detriment of a reduction of the success rates. Nevertheless, the increase in the number of frozen embryos should allow, after thawing and transfer, to compensate at least partially this reduction of the pregnancy rate.
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Affiliation(s)
- Y Salame
- Clinique de Fertilité, Département d'Obstétrique et de Gynécologie, Hôpital Erasme
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Abstract
The objective of this systematic review was to determine the beneficial or detrimental effect of using air bubbles to bracket the embryo-containing medium during embryo transfer. To test this theory, a meta-analysis of randomized trials comparing air fluid versus fluid-only methods was performed. The primary outcome measures were live birth, ongoing and clinical pregnancy rates. The secondary outcome measures were the rates of implantation, miscarriage, multiple and ectopic pregnancies and retained embryos. Electronic (e.g.PubMed, EMBASE, Cochrane Library) and hand searches of the literature revealed two included studies (298 women). Meta-analysis was conducted using the Mantel-Haenszel method (fixed-effect model). For the primary outcome measures, there were no significant differences between the two methods with regards to live birth (OR = 1.34; 95% CI = 0.59-3.07), ongoing pregnancy (OR = 1.34; 95% CI = 0.59-3.07) and clinical pregnancy (OR = 1.13; 95% CI = 0.70-1.83) rates. For the secondary outcomes, there were no significant differences between the two groups. In conclusion there is insufficient evidence to suggest that the fluid-only method is superior to the use of air brackets during embryo loading. There is a need for well-designed and powered randomized trials to determine any possible benefit to either method.
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Ciray HN, Tosun S, Hacifazlioglu O, Mesut A, Bahceci M. Prolonged duration of transfer does not affect outcome in cycles with good embryo quality. Fertil Steril 2007; 87:1218-21. [PMID: 17241626 DOI: 10.1016/j.fertnstert.2006.08.100] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2006] [Revised: 08/04/2006] [Accepted: 08/04/2006] [Indexed: 11/26/2022]
Abstract
The objective of investigating the impact of the time that embryos remain in the catheter on the outcome of cycles was assessed by measuring the period between loading the catheter and discharging the embryos in 300 transfer cycles. The pregnancy and implantation rates were similar in cycles with good embryo quality regardless of transfer duration.
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Affiliation(s)
- H Nadir Ciray
- Bahceci Women's Health Care Center and German Hospital IVF Unit, Istanbul, Turkey
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Giorgetti C, Hans E, Terriou P, Salzmann J, Barry B, Chabert-Orsini V, Chinchole JM, Franquebalme JP, Glowaczower E, Sitri MC, Thibault MC, Roulier R. Early cleavage: an additional predictor of high implantation rate following elective single embryo transfer. Reprod Biomed Online 2007; 14:85-91. [PMID: 17207338 DOI: 10.1016/s1472-6483(10)60768-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The value of early cleavage (EC) assessment is still being debated. The aim of this prospective study was to examine the predictive value of EC assessment performed exactly 26 h after insemination by IVF or intracytoplasmic sperm injection (ICSI) in a programme of elective single embryo transfer (SET) performed at day 2. If day 2 scoring demonstrated several embryos with high implantation potential, an EC embryo was transferred preferentially. EC was assessed only during normal laboratory hours so that there were two groups: EC assessed, and EC not assessed, the latter being the control. A total of 277 elective SET were performed in women under 37 years undergoing their first IVF or ICSI cycle (mean age 30.5 years, range 21-37). The overall clinical and ongoing pregnancy rates were 40.1% (111/277) and 32.9% (91/277) respectively. Significantly higher overall clinical and ongoing pregnancy rates were obtained after transfer of an EC embryo than a non-EC embryo: 49.4 versus 33.3% (P < 0.05) and 42.4 versus 25.9% (P < 0.02) respectively. However there was no significant difference between the EC assessed and control groups: 40.4 versus 39.3% and 33.2 versus 32.1 respectively. These findings confirm the value of EC assessment for selection of embryos with high implantation potential.
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Affiliation(s)
- C Giorgetti
- Institut de Médecine de la Reproduction, 6 rue Rocca, 13008 Marseille, France.
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Van Soom A, Imberechts H, Delahaut P, Thiry E, Van Roy V, Walravens K, Roels S, Saegerman C. Sanitary control in bovine embryo transfer How far should we go? A review. Vet Q 2007; 29:2-17. [PMID: 17471787 DOI: 10.1080/01652176.2007.9695223] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
Abstract
Embryo transfer is a globally executed technique which, when properly done, has both economic and sanitary advantages. International guidelines are available to prevent infection of the embryo with pathogens, both originating from the donor animals as from the environment. This manuscript describes the bacteria, viruses, protozoa, fungi and prions that are of major concern in the context of embryo transfer in cattle. In addition, the actual scientific knowledge on these pathogens is evaluated in terms of the current international and national guidelines and legislation.
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Affiliation(s)
- A Van Soom
- Department of Obstetrics, Reproduction and Herd Health, Faculty of Veterinary Medicine, Ghent University, Salisburylaan, Merelbeke, Belgium.
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Abstract
OBJECTIVE To review the effect of the number of embryos transferred on the outcome of in vitro fertilization (IVF), to provide guidelines on the number of embryos to transfer in IVF-embryo transfer (ET) in order to optimize healthy live births and minimize multiple pregnancies. OPTIONS Rates of live birth, clinical pregnancy, and multiple pregnancy or birth by number of embryos transferred are compared. OUTCOMES Clinical pregnancy, multiple pregnancy, and live birth rates. EVIDENCE The Cochrane Library and MEDLINE were searched for English language articles from 1990 to April 2006. Search terms included embryo transfer (ET), assisted reproduction, in vitro fertilization (IVF), ntracytoplasmic sperm injection (ICSI), multiple pregnancy, and multiple gestation. Additional references were identified through hand searches of bibliographies of identified articles. VALUES Available evidence was reviewed by the Reproductive Endocrinology and Infertility Committee and the Maternal-Fetal Medicine Committee of the Society of Obstetricians and Gynaecologists of Canada and the Board of the Canadian Fertility and Andrology Society, and was qualified using the Evaluation of Evidence Guidelines developed by the Canadian Task Force on the Periodic Health Exam. BENEFITS, HARMS, AND COSTS This guideline is intended to minimize the occurrence of multifetal gestation, particularly high-order multiples (HOM), while maintaining acceptable overall pregnancy and live birth rates following IVF-ET.
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Emiliani S, Fasano G, Vandamme B, Vannin AS, Verdoodt M, Biramane J, Delbaere A, Englert Y, Devreker F. Impact of the assessment of early cleavage in a single embryo transfer policy. Reprod Biomed Online 2006; 13:255-60. [PMID: 16895641 DOI: 10.1016/s1472-6483(10)60623-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The policy of single embryo transfer (SET) adopted for women <36 years old since 1 July 2003, strongly calls for improvement of embryo selection. A total of 196 cycles in which SET was performed were randomly allocated to two groups. In the first group, early cleavage was assessed (ECA) 25 h after insemination. The embryo with the best score that cleaved early, if present, was selected for transfer. In the second group, early cleavage was not assessed (ECNA) and embryo selection was based solely on the embryo score. Ninety-eight cycles were allocated in the ECA and ECNA group respectively. Early cleavage occurred in 64% of cycles and 32.2% of embryos. Patient population and embryo morphology were similar between the two groups, and similar delivery rates were observed (27.6 versus 24.5% respectively in the ECA and ECNA groups). The assessment of early cleavage as additional parameter did not improve the delivery rate in the single embryo transfer policy.
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Affiliation(s)
- Serena Emiliani
- Fertility Clinic Erasmus Hospital, Free University of Brussels, French Speaking, Route de Lennik 808, 1070 Brussels Belgium.
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Baxter Bendus AE, Mayer JF, Shipley SK, Catherino WH. Interobserver and intraobserver variation in day 3 embryo grading. Fertil Steril 2006; 86:1608-15. [PMID: 17074349 DOI: 10.1016/j.fertnstert.2006.05.037] [Citation(s) in RCA: 114] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2006] [Revised: 05/03/2006] [Accepted: 05/03/2006] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Variations in pregnancy rates (PR) between IVF programs are due to multiple factors, including embryo quality. Standardized embryo grading systems have been developed to improve communication between embryologists and clinicians. However, these grading systems have not been validated. We sought to quantify both interobserver and intraobserver variability using a standardized day 3 embryo grading system (Veeck scale). DESIGN Prospective, sample-randomized, controlled, blinded study. SETTING University hospital. PATIENT(S) Twenty-six practicing embryologists. INTERVENTION(S) Observation and grading of 35 video clips of day 3 embryos. MAIN OUTCOME MEASURE(S) Interobserver and intraobserver variability. Embryologists were also assessed by education level, years of experience, size of IVF program, and type of grading system used. Kappa scores and intraclass correlation coefficients were calculated. RESULT(S) Practicing embryologists differed from control (Lucinda Veeck) by as much as two grades, despite using the same grading system (Kappa = 0.24, interclass correlation coefficient = 0.98). There was also variability in grading the same embryo (Kappa = 0.69, interclass correlation coefficient = 0.88). Programs with higher cycle numbers per year had lower variability. CONCLUSION(S) There is substantial interobserver variability and moderate intraobserver variability among embryologists. Such variability could alter both the expected quality of embryos transferred, as well as the number transferred, both of which directly impact IVF program success.
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Holte J, Berglund L, Milton K, Garello C, Gennarelli G, Revelli A, Bergh T. Construction of an evidence-based integrated morphology cleavage embryo score for implantation potential of embryos scored and transferred on day 2 after oocyte retrieval. Hum Reprod 2006; 22:548-57. [PMID: 17095516 DOI: 10.1093/humrep/del403] [Citation(s) in RCA: 167] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Evidence-based morphological embryo scoring models for ranking of implantation potential are still scarce, and the need for a precise model increases when aiming for singleton pregnancies. METHODS Prospectively, 2266 IVF/ICSI double-embryo, day 2 transfers were studied. The five variables scored in 3- to 5-step scales for the embryos transferred are blastomere number (BL), fragmentation, blastomere size variation ('equality', EQ), symmetry of the cleavage and mononuclearity in the blastomeres (NU). The scoring results of embryos with an individual traceability from scoring to implantation, i.e. treatments resulting in either no implantation (n=1385) or twin implantation (n=228), were studied for prognostic potential. RESULTS Although all five variables correlated highly with implantation potential, only BL, NU and EQ remained independently significant after regression analysis. The equation thus derived formed the basis for a 10-point integrated morphology cleavage (IMC) embryo score. A table with the scoring point for each possible combination of the embryo variables is presented. The scoring model was statistically validated on the singleton pregnancy group (n=653). CONCLUSIONS We suggest that this IMC embryo scoring, incorporating cleavage stage and information on the variation in blastomere size and the number of mononucleated blastomeres, may optimize embryo ranking and selection for day 2 transfers.
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Affiliation(s)
- J Holte
- Carl von Linné Clinic, Uppsala Science Park, Uppsala, Sweden.
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Abstract
At 12.5%, the preterm birth rate is the highest it has ever been in the US. In tandem with the rise in preterm birth is a dramatic increase in multiple birth rates. The recent trend of delayed maternal age at first birth and the associated use of assisted reproductive technologies (ARTs) have led to the increase in multiple gestation and its attendant increased risk for preterm birth. While ARTs are not responsible for the majority of preterm births, the attributable fraction has increased, is iatrogenic- and preventable. Despite widespread recognition of this problem, the rate of associated twin gestation has not decreased. We offer options for policymakers on several levels--from medical to health systems to societal policy--to decrease ART-related preterm births.
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MESH Headings
- Embryo Transfer/adverse effects
- Embryo Transfer/standards
- Embryo Transfer/statistics & numerical data
- Female
- Fertilization in Vitro/adverse effects
- Fertilization in Vitro/standards
- Fertilization in Vitro/statistics & numerical data
- Humans
- Iatrogenic Disease/epidemiology
- Infant, Newborn
- Infant, Premature, Diseases/epidemiology
- Infant, Premature, Diseases/etiology
- Infant, Premature, Diseases/prevention & control
- Maternal Age
- Multiple Birth Offspring/statistics & numerical data
- Organizational Policy
- Practice Guidelines as Topic
- Pregnancy
- Pregnancy, Multiple/statistics & numerical data
- Premature Birth/epidemiology
- Premature Birth/etiology
- Premature Birth/prevention & control
- Public Policy
- Reproductive Techniques, Assisted/adverse effects
- Reproductive Techniques, Assisted/standards
- Reproductive Techniques, Assisted/statistics & numerical data
- Social Change
- United States/epidemiology
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Affiliation(s)
- Blair Johnson
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Columbia Presbyterian Medical Center, 622 W. 168th Street, PH-16, New York, NY 10032, USA.
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Beyond IVF: should parents be free to decide what is acceptable? New Sci 2006; 192:5. [PMID: 17165217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
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