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Bakalova DN, Navarro-Sánchez L, Rubio C. Non-Invasive Preimplantation Genetic Testing. Genes (Basel) 2025; 16:552. [PMID: 40428374 PMCID: PMC12111310 DOI: 10.3390/genes16050552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2025] [Revised: 04/16/2025] [Accepted: 04/25/2025] [Indexed: 05/29/2025] Open
Abstract
To minimise the influence of chromosomal abnormalities during IVF treatment, embryos can be screened before transfer using preimplantation genetic testing. This typically involves an invasive trophectoderm biopsy at the blastocyst stage, where 4-8 cells are collected and analysed. However, emerging evidence indicates that, as embryos develop in vitro in culture media, they release cell-free DNA into the media, providing an alternative source of genetic material that can be accessed non-invasively. Spent blastocyst media samples that contain embryo cell-free DNA demonstrate high informativity rates and ploidy concordance when compared with the corresponding trophectoderm, inner cell mass, or whole blastocyst results. However, optimising this non-invasive approach requires several changes to embryo culture protocols, including additional embryo washes to tackle contamination and extending embryo culture time to maximise the amount of cell-free DNA released into the culture media. In this review, we discuss this novel non-invasive approach for aneuploidy detection and embryo prioritisation, as well as the current data and future prospects for utilising cell-free DNA analysis to identify structural rearrangements and single gene disorders.
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Affiliation(s)
| | | | - Carmen Rubio
- Igenomix (Part of Vitrolife Group), R&D Genetic Services, 46980 Paterna, Valencia, Spain; (D.N.B.); (L.N.-S.)
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Sakkas D, Navarro-Sánchez L, Ardestani G, Barroso G, Bisioli C, Boynukalin K, Cimadomo D, Frantz N, Kopcow L, Andrade GM, Ozturk B, Rienzi L, Weiser A, Valbuena D, Simón C, Rubio C. The impact of implementing a non-invasive preimplantation genetic testing for aneuploidies (niPGT-A) embryo culture protocol on embryo viability and clinical outcomes. Hum Reprod 2024; 39:1952-1959. [PMID: 39059790 DOI: 10.1093/humrep/deae156] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 06/10/2024] [Indexed: 07/28/2024] Open
Abstract
STUDY QUESTION Are modifications in the embryo culture protocol needed to perform non-invasive preimplantation genetic testing for aneuploidies (niPGT-A) affecting clinical reproductive outcomes, including blastocyst development and pregnancy outcomes? SUMMARY ANSWER The implementation of an embryo culture protocol to accommodate niPGT-A has no impact on blastocyst viability or pregnancy outcomes. WHAT IS KNOWN ALREADY The recent identification of embryo cell-free (cf) DNA in spent blastocyst media has created the possibility of simplifying PGT-A. Concerns, however, have arisen at two levels. First, the representativeness of that cfDNA to the real ploidy status of the embryo. Second, the logistical changes that need to be implemented by the IVF laboratory when performing niPGT-A and their effect on reproductive outcomes. Concordance rates of niPGT-A to invasive PGT-A have gradually improved; however, the impact of culture protocol changes is not as well understood. STUDY DESIGN, SIZE, DURATION As part of a trial examining concordance rates of niPGT-A versus invasive PGT-A, the IVF clinics implemented a specific niPGT-A embryo culture protocol. Briefly, this involved initial culture of fertilized oocytes following each laboratory standard routine up to Day 4. On Day 4, embryos were washed and cultured individually in 10 μl of fresh media. On Day 6 or 7, blastocysts were then biopsied, vitrified, and media collected for the niPGT-A analysis. Six IVF clinics from the previously mentioned trial were enrolled in this analysis. In the concordance trial, Clinic A cultured all embryos (97 cycles and 355 embryos) up to Day 6 or 7, whereas in the remaining clinics (B-F) (379 cycles), nearly a quarter of all the blastocysts (231/985: 23.5%) were biopsied on Day 5, with the remaining blastocysts following the niPGT-A protocol (754/985: 76.5%). During the same period (April 2018-December 2020), the IVF clinics also performed standard invasive PGT-A, which involved culture of embryos up to Days 5, 6, or 7 when blastocysts were biopsied and vitrified. PARTICIPANTS/MATERIALS, SETTING, METHODS In total, 428 (476 cycles) patients were in the niPGT-A study group. Embryos from 1392 patients underwent the standard PGT-A culture protocol and formed the control group. Clinical information was obtained and analyzed from all the patients. Statistical comparisons were performed between the study and the control groups according to the day of biopsy. MAIN RESULTS AND THE ROLE OF CHANCE The mean age, number of oocytes, fertilization rates, and number of blastocysts biopsied were not significantly different for the study and the control group. Regarding the overall pregnancy outcomes, no significant effect was observed on clinical pregnancy rate, miscarriage rate, or ongoing pregnancy rate (≥12 weeks) in the study group compared to the control group when stratified by day of biopsy. LIMITATIONS, REASONS FOR CAUTION The limitations are intrinsic to the retrospective nature of the study, and to the fact that the study was conducted in invasive PGT-A patients and not specifically using niPGT-A cases. WIDER IMPLICATIONS OF THE FINDINGS This study shows that modifying current IVF laboratory protocols to adopt niPGT-A has no impact on the number of blastocysts available for transfer and overall clinical outcomes of transferred embryos. Whether removal of the invasive biopsy step leads to further improvements in pregnancy rates awaits further studies. STUDY FUNDING/COMPETING INTEREST(S) This study was funded by Igenomix. C.R., L.N.-S., and D.V. are employees of Igenomix. D.S. was on the Scientific Advisory Board of Igenomix during the study. TRIAL REGISTRATION NUMBER ClinicalTrials.gov (NCT03520933).
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Affiliation(s)
- Denny Sakkas
- Boston IVF R&D Department, Boston IVF-IVIRMA Global Research Alliance, Waltham, MA, USA
| | | | - Goli Ardestani
- Boston IVF R&D Department, Boston IVF-IVIRMA Global Research Alliance, Waltham, MA, USA
| | - Gerardo Barroso
- IVF Clinical Department, Escuela Superior de Medicina Instituto Politécnico Nacional y Centro de Reproducción Arcos S.C. NASCERE, CDMX, Mexico
| | - Claudio Bisioli
- Department of Reproductive Genetics, Pregna Medicina Reproductiva, Buenos Aires, Argentina
| | | | - Danilo Cimadomo
- Science & Research, GENERA Center for Reproductive Medicine, Clinica Valle Giulia, Rome, Italy
| | - Nilo Frantz
- Embryology Department, Nilo Frantz Reproductive Medicine, Porto Alegre, Brazil
| | - Laura Kopcow
- Department of Reproductive Genetics, Pregna Medicina Reproductiva, Buenos Aires, Argentina
| | | | - Bilgen Ozturk
- Clinical Department, Bahçeci Fertility, Istanbul, Turkey
| | - Laura Rienzi
- Science & Research, GENERA Center for Reproductive Medicine, Clinica Valle Giulia, Rome, Italy
| | - Ariane Weiser
- IVF Clinical Department, Escuela Superior de Medicina Instituto Politécnico Nacional y Centro de Reproducción Arcos S.C. NASCERE, CDMX, Mexico
| | | | - Carlos Simón
- Department of Pediatrics, Obstetrics and Gynecology, University of Valencia, INCLIVA, Valencia, Spain
- Research & Medical Department, Carlos Simon Foundation, INCLIVA Health Research Institute, Valencia, Spain
- Department of Obstetrics and Gynecology, BIDMC, Harvard University, Boston, MA, USA
| | - Carmen Rubio
- R&D Department, Igenomix, Paterna, Valencia, Spain
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Florensa M, Cladellas A, Ballesteros A, Esbert M. Preimplantation genetic testing for aneuploidy: predictive embryonic factors. J Assist Reprod Genet 2024; 41:1329-1339. [PMID: 38386119 PMCID: PMC11143088 DOI: 10.1007/s10815-024-03061-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 02/09/2024] [Indexed: 02/23/2024] Open
Abstract
PURPOSE In a preimplantation genetic testing for aneuploidy (PGT-A) cycle, does the blastocyst quality before biopsy, or the day of biopsy, or the embryo hatching status have an impact on either euploidy or the rate of embryo survival after freezing? METHODS This was a retrospective study including 6130 biopsied blastocysts coming from 1849 PGT-A cycles performed in our center (2016-2022). Embryos were categorized according to the inner cell mass and trophectoderm quality, using Gardner's scoring (excellent: AA; good: AB, BA, BB; poor: AC, CA, BC, CB, CC); the day of biopsy (5 or 6); and their hatching status (fully hatched blastocysts [FHB] or non-fully hatched blastocysts [nFHB]). The independent relationship between each group and both euploidy and survival rate was assessed. RESULTS Excellent-quality embryos were more euploid than both good- and poor-quality embryos (52.69%, 39.69%, and 26.21%; p < 0.001), and day 5-biopsied embryos were more euploid than day 6-biopsied embryos (39.98% and 34.80%; p < 0.001). Survival rates of excellent-quality (92.26%) and good-quality (92.47%) embryos were higher than survival rates in the poor-quality group (84.61%) (p = 0.011 and p = 0.002). Day 5-biopsied embryos survived better than day 6-biopsied embryos (93.71% vs. 83.69%; p < 0.001) and FHB had poorer survival than nFHB (78.61% vs. 93.52%; p < 0.001). CONCLUSIONS Excellent-quality and day 5-biopsied embryos are more prone to be euploid than good and poor or day 6-biopsied embryos, respectively. Poor-quality, day 6-biopsied embryos, and FHB have significantly lower survival after biopsy and vitrification.
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Affiliation(s)
- Mireia Florensa
- IVIRMA Barcelona, 45, Carrer Mallorca, 08029, Barcelona, Spain.
| | - Anna Cladellas
- IVIRMA Barcelona, 45, Carrer Mallorca, 08029, Barcelona, Spain
| | | | - Marga Esbert
- IVIRMA Barcelona, 45, Carrer Mallorca, 08029, Barcelona, Spain
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Guo Y, Xiang Y, Wang Y, Li T, Fang C. Influence of delayed blastulation and expansion grade on clinical outcomes of high-quality blastocyst transfer: an analysis of 1751 frozen-thawed cycles. HUM FERTIL 2023; 26:1313-1321. [PMID: 36942458 DOI: 10.1080/14647273.2023.2188491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 12/07/2022] [Indexed: 03/23/2023]
Abstract
The aim of the study was to compare retrospectively the extent of blastulation timing (Day 5 or later) and expansion grade to predict the ability of blastocysts to give rise to a pregnancy. Blastocysts frozen on day 5 with a lower expansion grade (group D5) or day 6 with a higher expansion grade (group D6) were included. A single embryo was thawed and transferred on day 5 after ovulation or progesterone supplementation. Differences in patient baseline characteristics, endometrial preparation and pregnancy outcomes between groups were stratified by patient age and anti-Müllerian hormone (AMH) levels. Logistic regression was used to analyse the results. A total of 617 blastocysts in group D5 and 1134 blastocysts in group D6 were assessed. Stratified analyses showed higher biochemical pregnancy, clinical pregnancy and live birth rates for patients aged less than 30 years old, and higher ongoing pregnancy rate for patients with AMH ≥ 1.1 ng/ml. For patients aged less than 30 years old, the biochemical pregnancy, clinical pregnancy and live birth rates in group D5 were higher than those in group D6.
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Affiliation(s)
- Yingchun Guo
- Reproductive Medicine Research Center, The Sixth Affiliated Hospital#Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Yuting Xiang
- Reproductive Medicine Research Center, The Sixth Affiliated Hospital#Sun Yat-sen University, Guangzhou, Guangdong, China
- Department of Obstetrics and Gynecology, Affiliated Dongguan People's Hospital, Southern Medical University, Dongguan, Guangdong, China
| | - Yanfang Wang
- Reproductive Medicine Research Center, The Sixth Affiliated Hospital#Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Tingting Li
- Reproductive Medicine Research Center, The Sixth Affiliated Hospital#Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Cong Fang
- Reproductive Medicine Research Center, The Sixth Affiliated Hospital#Sun Yat-sen University, Guangzhou, Guangdong, China
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Hu J, Zheng J, Li J, Shi H, Wang H, Zheng B, Liang K, Rong C, Zhou L. D6 high-quality expanded blastocysts and D5 expanded blastocysts have similar pregnancy and perinatal outcomes following single frozen blastocyst transfer. Front Endocrinol (Lausanne) 2023; 14:1216910. [PMID: 38027138 PMCID: PMC10666767 DOI: 10.3389/fendo.2023.1216910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 10/10/2023] [Indexed: 12/01/2023] Open
Abstract
Objective We compared the pregnancy and perinatal outcomes between expanded blastocysts vitrified on D5 versus D6 following single frozen blastocyst transfer. Methods Clinical data on 7,606 cycles of frozen-thawed blastocyst implantations were retrospectively analyzed. Depending on whether blastocysts were vitrified on D5 or D6 and the transferred blastocysts, the blastocysts were divided into 6 groups: HQB-D5, HQB-D6, 4XC-D5, 4XC-D6, 4CX-D5, and 4CX-D6 groups. The differences in clinical pregnancy rate, live birth rate, first trimester abortion rate, preterm birth rate, gestational age, birth weight, and sex ratio at birth among the groups were compared. Results Our study showed that there was no difference in pregnancy and perinatal outcomes between the delayed formation of D6 high-quality expanded blastocysts and D5 expanded blastocysts, whether they were high-quality blastocysts or not. For low-quality blastocysts, the clinical pregnancy rate of D5 was higher than that of D6, and D5 was also better than D6 in live birth rate for those with inner cell mass rating B or above, while there was no difference between D5 and D6 for those with inner cell mass rating C. Conclusion Based on our research, we suggest that when we are developing the implantation strategy, we give priority to the selection of high-quality expanded blastocysts, regardless of D5 and D6, whose clinical outcomes are not different. For low-quality blastocysts, D5 expanded blastocysts are preferred for transfer.
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Affiliation(s)
| | - Juan Zheng
- Reproductive Medicine Center, Ningbo Women and Children’s Hospital, Ningbo, Zhejiang, China
| | | | | | | | | | | | | | - Liming Zhou
- Reproductive Medicine Center, Ningbo Women and Children’s Hospital, Ningbo, Zhejiang, China
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Wu TF, Chen MJ, Lee MS, Huang CC, Ho ST, Cheng EH, Lee TH. Comparison of clinical outcome between day 5 and day 6 single blastocyst transfers in cycles undergoing preimplantation genetic testing for aneuploidy. Taiwan J Obstet Gynecol 2023; 62:429-433. [PMID: 37188448 DOI: 10.1016/j.tjog.2023.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2023] [Indexed: 05/17/2023] Open
Abstract
OBJECTIVE In vitro fertilization (IVF) treatment has gradually adopted the practice of culturing embryos until the blastocyst stage on the D5 or D6 as the standard approach. PGT-A is commonly used in vitro fertilization (IVF). This study aimed to evaluate the clinical outcomes of frozen embryo transfers (FETs) using single blastocyst transfers (SBTs) on the fifth (D5) or sixth (D6) day of development in cycles that underwent preimplantation genetic testing for aneuploidy (PGT-A). MATERIALS AND METHODS The patients who had at least one euploid or mosaic blastocyst of good quality determined by PGT-A results and received single embryo transfer (SET) cycles were included in the study. In this study, the live birth rate (LBR) and neonatal outcomes were compared after the transfer of single biopsied D5 and D6 blastocysts in frozen embryo transfer (FET) cycles. RESULTS A total of 527 frozen-thawed blastocyst transfer (FET) cycles (8449 biopsied embryos were analyzed). No significant difference in the implantation rate (IR), clinical pregnancy rate (CPR), and live birth rate (LBR) between the transfers of D5 and D6 blastocysts. Birth weight was the only perinatal outcome that showed a significant difference between the D5 and D6 groups. CONCLUSION The study confirmed that the transfer of a single euploid or mosaic blastocyst, regardless of whether it was on the fifth (D5) or sixth (D6) day of development, can lead to promising clinical results.
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Affiliation(s)
- Ting-Feng Wu
- Division of Infertility, Lee Women's Hospital, Taichung, Taiwan; Department of Obstetrics and Gynecology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Ming-Jer Chen
- Department of Obstetrics and Gynecology, Taichung Veterans General Hospital, Taichung, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| | - Maw-Sheng Lee
- Division of Infertility, Lee Women's Hospital, Taichung, Taiwan; Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Obstetrics and Gynecology, Chung Shan Medical University Hospital, Taichung, Taiwan.
| | - Chun-Chia Huang
- Division of Infertility, Lee Women's Hospital, Taichung, Taiwan
| | - Shu-Ting Ho
- Division of Infertility, Lee Women's Hospital, Taichung, Taiwan
| | - En-Hui Cheng
- Division of Infertility, Lee Women's Hospital, Taichung, Taiwan
| | - Tsung-Hsien Lee
- Division of Infertility, Lee Women's Hospital, Taichung, Taiwan; Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Obstetrics and Gynecology, Chung Shan Medical University Hospital, Taichung, Taiwan
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Awonuga AO, Camp OG, Abu-Soud HM, Rappolee DA, Puscheck EE, Diamond MP. Determinants of Embryo Implantation: Roles of the Endometrium and Embryo in Implantation Success. Reprod Sci 2023:10.1007/s43032-023-01224-w. [PMID: 36988904 DOI: 10.1007/s43032-023-01224-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 03/15/2023] [Indexed: 03/30/2023]
Abstract
Both uterine endometrium and embryo contribute to implantation success. However, their relative role in the implantation success is still a matter for debate, as are the roles of endometrial receptivity analysis (ERA), endometrial scratch (ES), endometrial microbiome, and intrauterine or intravenous measures that are currently advocated to improve the implantation success. There is insufficient evidence to suggest that the endometrium is more important than the embryo in determining the implantation success and the utility of these measures, especially when euploid embryos are transferred is limited. Although embryo implantation on epithelium other than the endometrium is a very rare event, evidence suggests that embryo implantation and growth is not limited to the endometrium alone. Embryos can implant and develop to result in livebirths on epithelium that lacks the typical endometrial development present at implantation. Currently, the role of embryo euploidy in implantation success is underappreciated. At a minimum, it is the author's opinion that until robust, definitive studies are conducted that demonstrate benefit, reproductive endocrinologists and infertility specialist should be prudent in the way they counsel patients about the utility of ERA, ES, and other measures in improving implantation success.
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Affiliation(s)
- Awoniyi O Awonuga
- Department of Ob/Gyn, CS Mott Center for Human Growth and Development, Reproductive Endocrinology and Infertility, Wayne State University School of Medicine, Detroit, MI, USA.
- Kindbody Fertility, 26400 W 12 Mile Road, Ste. 140D, Southfield, MI, 48034, USA.
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Wayne State University School of Medicine, 26400 West 12 Mile Road, Suite 140, Southfield, MI, 48034, USA.
| | - Olivia G Camp
- Department of Ob/Gyn, CS Mott Center for Human Growth and Development, Reproductive Endocrinology and Infertility, Wayne State University School of Medicine, Detroit, MI, USA
| | - Husam M Abu-Soud
- Department of Ob/Gyn, CS Mott Center for Human Growth and Development, Reproductive Endocrinology and Infertility, Wayne State University School of Medicine, Detroit, MI, USA
- Department of Physiology, Wayne State University School of Medicine, 540 E Canfield St, Detroit, MI, 48201, USA
| | - Daniel A Rappolee
- Department of Ob/Gyn, CS Mott Center for Human Growth and Development, Reproductive Endocrinology and Infertility, Wayne State University School of Medicine, Detroit, MI, USA
- Department of Physiology, Wayne State University School of Medicine, 540 E Canfield St, Detroit, MI, 48201, USA
- Reproductive Stress, Inc., 135 Lake Shore Rd, Grosse Pointe Farms, MI, USA
| | - Elizabeth E Puscheck
- Department of Ob/Gyn, CS Mott Center for Human Growth and Development, Reproductive Endocrinology and Infertility, Wayne State University School of Medicine, Detroit, MI, USA
- Reproductive Stress, Inc., 135 Lake Shore Rd, Grosse Pointe Farms, MI, USA
- InVia Fertility, 2718 W Roscoe St Suite 500, Chicago, IL, 60618, USA
- InVia Fertility, 1585 N. Barrington Road, Suite 406, Doctor's Building Two, Hoffman Estates, IL, 60169, USA
| | - Michael P Diamond
- Department of Obstetrics and Gynecology, Augusta University, 1120 15Th Street, CJ‑1036, Augusta, GA, 30912, USA
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Pregnancy Outcomes for Day 5 Versus Day 6 Single Frozen-thawed Blastocyst Transfer with Different Qualities of Embryos: A Large Matched-cohort Study. Curr Med Sci 2023; 43:297-303. [PMID: 36929109 DOI: 10.1007/s11596-023-2699-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 12/01/2022] [Indexed: 03/18/2023]
Abstract
OBJECTIVE This study aimed to determine whether the day of blastocyst expansion affects pregnancy outcomes in frozen-thawed blastocyst transfer (FBT) cycles. METHODS A retrospective match-cohort study was conducted. Patients who underwent blastocyst transfer in frozen-thawed cycles at day 5 or 6 were matched for potential confounding factors. A total of 2207 matched pairs of FBT cycles were included from January 2016 to December 2019 in our Reproductive Medicine Center. RESULTS The clinical pregnancy rate (CPR) and live birth rate (LBR) were significantly increased in day 5 blastocyst transfers when compared to day 6 blastocyst transfers, in terms of the same embryo quality. For FBT cycles with good-quality embryo, the CPR at day 5 and 6 was 61.30% and 57.56%, respectively (P=0.045), and the LBR was 44.79% and 36.16%, respectively (P<0.001). For FBT cycles with poor-quality embryo, the CPR at day 5 and 6 was 48.61% and 40.89%, respectively (P=0.006), and the LBR was 31.71% and 25.74%, respectively (P=0.019). The CPR for FBT cycles with good-quality embryo was statistically higher at day 6 than that at day 5 with poor-quality embryo transferred (57.56% vs. 48.61%, P=0.001). Maternal age, anti-Müllerian hormone (AMH), endometrial thickness, embryo quality, and the day of blastocyst expansion were independently correlated with the CPR and LBR. The FBT cycles at day 5 had significantly higher CPR (adjusted odds ratio [OR]=1.246, 95% confidence intervals [CI]: 1.097-1.415, P=0.001) and LBR (adjusted OR=1.435, 95% CI: 1.258-1.637, P<0.001) than those at day 6. CONCLUSION The embryo quality is the primary indicator for FBT cycles. Day 5 blastocysts should be preferred when the quality of embryo at day 5 is the same as that at day 6.
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Zhang GL, Sun TY, Li S, Jiang MX, Guo L. The pregnancy outcomes of day-5 poor-quality and day-6 high-quality blastocysts in single blastocyst transfer cycles. Clin Exp Reprod Med 2023; 50:63-68. [PMID: 36935413 PMCID: PMC10030202 DOI: 10.5653/cerm.2022.05540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 11/24/2022] [Indexed: 02/25/2023] Open
Abstract
OBJECTIVE This study compared the outcomes of single blastocyst transfer cycles, using day- 5 poor-quality blastocysts and day-6 high-quality blastocysts. METHODS We analyzed 462 frozen-thawed embryo transfer (FET) cycles performed at our center from January 2014 to December 2019. The cycles were divided into two groups: a day-5 poor-quality blastocyst transfer group (group A) and a day-6 high-quality blastocyst transfer group (group B). The clinical outcomes were tested. RESULTS In groups A and B, respectively, the clinical pregnancy rate (CPR; 61.65% vs. 67.17%, p=0.258), implantation rate (IR; 61.65% vs. 67.17%, p=0.258), and live birth rate (LBR; 69.51% vs. 77.83%, p=0.134) showed no significant differences. Moreover, when day-3 embryo quality was considered, the CPR, IR, and LBR were also similar in group A and group B (p>0.05). CONCLUSION The clinical outcomes of day-5 poor-quality blastocysts and day-6 high-quality blastocysts were similar, suggesting that the developmental speed of the embryo might be more important than embryo quality for the clinical outcomes of single blastocyst transfer in FET cycles.
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Affiliation(s)
- Guang-Li Zhang
- Center for Reproductive Medicine, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Tian-Yi Sun
- Center for Reproductive Medicine, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Sen Li
- Center for Reproductive Medicine, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Man-Xi Jiang
- Center for Reproductive Medicine, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Lei Guo
- Center for Reproductive Medicine, Guangdong Second Provincial General Hospital, Guangzhou, China
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Jiang Y, Jiang R, He H, Ren X, Yu Q, Jin L. Comparison of clinical outcomes for different morphological scores of D5 and D6 blastocysts in the frozen-thawed cycle. BMC Pregnancy Childbirth 2023; 23:97. [PMID: 36747146 PMCID: PMC9900991 DOI: 10.1186/s12884-023-05415-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 01/30/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Both embryo development speed and embryo morphology score played a significant role in frozen-thawed embryo transfer cycle (FET) outcomes. Most of the literature indicates that D5 embryos performed better than D6 embryos, although a few also indicate that there is no difference in clinical outcomes between D5 and D6 embryos. Clinically, D5 embryos are preferred for equal morphological scores. But how to choose embryos when the morphological score of D6 embryos is better than D5? METHODS A retrospective study including 8199 frozen-thawed embryo transfers (FETs) was conducted to analyze patients who underwent IVF-FET from January 2018 to December 2020. Patients were divided into 8 groups according to the rate of embryonic development and morphological scores to compare pregnancy outcomes. We further compared clinical pregnancy outcomes and neonatal outcomes between BC embryos on day 5 (D5) and BA/BB embryos on day 6 (D6). RESULTS Our study found no difference in clinical pregnancy rate (CPR) and live birth rate (LBR) between AA/AB blastocysts in D5 or D6 frozen blastocysts. However, for BA/BB/BC blastocysts, embryonic pregnancy outcome was significantly better in D5 than in D6. In our further analysis and comparison of BC embryos in D5 and BA/BB embryos in D6, we found no difference in clinical pregnancy outcomes and neonatal outcomes, but D6 BA/BB embryos had a higher rate of miscarriage. After adjusting for confounding factors, none of the indicators differed between groups. CONCLUSION Our study provides suggestions for embryo selection: AA/AB embryos are preferred, regardless of the embryo development day, and the second choice is BA or BB embryos on D5. BA/BB embryos in D6 had a higher miscarriage rate than BC embryos in D5 but were not statistically significant after adjusting for confounding factors.
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Affiliation(s)
- Yaping Jiang
- grid.33199.310000 0004 0368 7223Department of Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei PR China
| | - Rui Jiang
- grid.33199.310000 0004 0368 7223Laboratory of Clinical Immunology, Wuhan No. 1 Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei PR China
| | - Hui He
- grid.33199.310000 0004 0368 7223Department of Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei PR China
| | - Xinling Ren
- grid.33199.310000 0004 0368 7223Department of Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei PR China
| | - Qiong Yu
- Department of Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China.
| | - Lei Jin
- Department of Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China.
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11
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He Y, Tang Y, Liu H, Liu J, Mao Y. No advantage of single day 6 good-quality blastocyst transfer versus single day 5 poor-quality blastocyst transfer in frozen-thawed cycles stratified by age: a retrospective study. BMC Pregnancy Childbirth 2023; 23:79. [PMID: 36717810 PMCID: PMC9885555 DOI: 10.1186/s12884-023-05387-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 01/16/2023] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Blastocyst developmental speed, morphological grading and patient age are associated with pregnancy outcomes of frozen-thawed cycles. This study aimed to compare the clinical and neonatal outcomes between poor-quality D5 blastocysts and good-quality D6 blastocysts stratified by patient age. METHODS A total of 1,623 cycles were divided into two groups: group A (n = 723) received one D5 poor-quality blastocyst; group B (n = 900) received one D6 good-quality blastocyst. Pregnancy and neonatal outcomes were compared among the four groups stratified by 35 years of age. RESULTS When patients were in the same age group, there was no significant difference in terms of age, body mass index, infertility duration, infertility type, fertilization method, proportion of endometrial preparation protocols, and endometrial thickness between D5 poor-quality and D6 high-quality blastocysts groups. Live birth rate of D5 poor-quality blastocysts was higher than that of D6 high-quality blastocysts for patients aged < 35 years (35.48% vs. 31.13%, p > 0.05), but there was no statistical difference. The same trend was showed for patients aged ≥ 35 years (29.09% vs. 21.28%, p > 0.05). Moreover, when patients were in the same age category, there was no significant difference in terms of gestational age, birth weight, birth height, and rates of preterm birth, low birth weight, and very low birth weight between groups A and B. CONCLUSIONS The preferential selection of poor-quality D5 blastocysts for transfer compared to high-quality D6 blastocysts is recommended, especially for advanced age patients. Single good-quality D6 blastocyst transfer can be considered for the acceptable live birth rate.
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Affiliation(s)
- Yuxia He
- grid.417009.b0000 0004 1758 4591Department of Obstetrics and Gynecology, Center of Reproductive Medicine, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, The Third Affiliated Hospital of Guangzhou Medical University, 63 Duobao Road, Guangzhou, Guangdong China ,grid.417009.b0000 0004 1758 4591Key Laboratory for Reproductive Medicine of Guangdong Province, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong China
| | - Yan Tang
- grid.476868.30000 0005 0294 8900Department of Obstetrics and Gynecology, Center of Reproductive Medicine, Zhongshan City People’s Hospital, Zhongshan, China
| | - Haiying Liu
- grid.417009.b0000 0004 1758 4591Department of Obstetrics and Gynecology, Center of Reproductive Medicine, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, The Third Affiliated Hospital of Guangzhou Medical University, 63 Duobao Road, Guangzhou, Guangdong China ,grid.417009.b0000 0004 1758 4591Key Laboratory for Reproductive Medicine of Guangdong Province, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong China
| | - Jianqiao Liu
- grid.417009.b0000 0004 1758 4591Department of Obstetrics and Gynecology, Center of Reproductive Medicine, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, The Third Affiliated Hospital of Guangzhou Medical University, 63 Duobao Road, Guangzhou, Guangdong China ,grid.417009.b0000 0004 1758 4591Key Laboratory for Reproductive Medicine of Guangdong Province, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong China
| | - Yuling Mao
- grid.417009.b0000 0004 1758 4591Department of Obstetrics and Gynecology, Center of Reproductive Medicine, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, The Third Affiliated Hospital of Guangzhou Medical University, 63 Duobao Road, Guangzhou, Guangdong China ,grid.417009.b0000 0004 1758 4591Key Laboratory for Reproductive Medicine of Guangdong Province, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong China
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12
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Shi W, Zhou H, Chen L, Xue X, Shi J. Live birth rate following frozen-thawed blastocyst transfer is higher in high-grade day 6 blastocysts than in low-grade day 5 blastocysts. Front Endocrinol (Lausanne) 2023; 13:1066757. [PMID: 36686429 PMCID: PMC9846233 DOI: 10.3389/fendo.2022.1066757] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 12/08/2022] [Indexed: 01/05/2023] Open
Abstract
Background Day 5 (D5) blastocysts are generally given priority to transfer than day 6 (D6) blastocysts; however, which one should be prioritized to transfer when only low-grade D5 and high-grade D6 blastocysts are available? Methods A large retrospective cohort study was carried out to evaluate the live birth rate (LBR) following D5 and D6 blastocysts in single frozen-thawed blastocyst transfer (FBT) during January 2014 and December 2018. A multivariate logistic regression was conducted to evaluate the combined impact of expansion day (D5 and D6) and blastocyst quality (high grade/low grade) on LBR, accounting for the potential confounding factors. The biopsied blastocysts from a consecutive PGT-A case series during February 2013 to December 2021 were analyzed in a supplementary study. Results The LBR achieved in high-grade D6 blastocyst transfer was significantly higher than that in low-grade D5 blastocyst transfer (50.43% vs. 40.70%, aOR 1.54, 95% CI 1.05-2.26, p = 0.027). There were no significant differences in preterm birth rate, very preterm birth rate, mean live birth weight, and birth weight <1,500 g and >4,000 g between the two cohorts. As for aneuploidy analysis in PGT, there were 54.55% of euploid blastocysts (30/55) among high-grade D6 blastocysts, significantly higher than the 41.39% of euploid blastocysts (565/1,365) among low-grade D5 blastocysts (p < 0.001). Conclusions Our data suggest that D6 blastocysts with high morphology grading are preferred than D5 blastocysts with low morphology grading when selecting blastocyst transfer to shorten the time of conception.
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Affiliation(s)
| | | | | | | | - Juanzi Shi
- The Assisted Reproduction Center, Northwest women’s and Children’s Hospital, Xi’an, China
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13
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Meeting the challenge of unclaimed cryopreserved embryos. Fertil Steril 2023; 119:15-20. [PMID: 36476953 DOI: 10.1016/j.fertnstert.2022.09.323] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 09/23/2022] [Indexed: 12/08/2022]
Abstract
With the rise of efficient and highly effective embryo cryopreservation techniques, the modern in vitro fertilization laboratory has unintentionally become a long-term storage facility for embryos and gametes. One challenge posed by long-term storage is the issue of unclaimed, effectively abandoned, cryopreserved embryos whose owners cannot be identified or are unable to provide a dispositional decision. Given the nuanced nature of dealing with human tissue, no straightforward solutions for managing this novel scenario have prevailed. In this article, we discuss the problem faced by physicians, clinics, and patients alike when faced with unclaimed cryopreserved embryos. We also review strategies for proactive prevention and resolution of conflicts that may arise when making dispositional decisions.
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14
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Xu M, Yan Y, Shen X, Sun H, Yan G, Kong N, Jiang Y. Prolonging the time of progesterone supplementation to improve the pregnancy outcomes of single day 6 blastocyst transfer in frozen-thawed cycles: study protocol for a randomized controlled trial. Trials 2022; 23:1024. [PMID: 36536470 PMCID: PMC9764536 DOI: 10.1186/s13063-022-07013-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Infertility is one of the most important and underappreciated reproductive health problems in developing countries. Currently, in vitro fertilization and embryo transfer is the most effective treatment strategy for infertility. In a frozen-thawed cycle, single-blastocyst transfer can not only ensure relatively higher pregnancy and live birth rates but also effectively reduce the risk of maternal and neonatal complications. In frozen-thawed cycles, progesterone is initiated to promote the final phase of endometrial preparation prior to embryo transfer. However, the optimal duration of exposure to progesterone has remained inconclusive. Therefore, we designed a randomized controlled trial (RCT) to compare the effects of different prolonged progesterone transformation times (P+6 and P+7) on the pregnancy outcomes of D6 single blastocyst transfer in a frozen-thawed cycle. METHODS This is a single-center, prospective, randomized controlled clinical trial involving 900 patients with single blastocyst transfer in the frozen-thawed cycle, aged from 20 to 38 years, with less than three transfers, and with HRT-cycle single D6 blastocyst transfer in the current cycle. Participants will be randomly assigned (1:1) into two parallel groups: the transfer of day 6 blastocysts on the 7th day of progesterone supplementation and the transfer of day 6 blastocysts on the 6th day of progesterone supplementation. The primary outcome measure is the clinical pregnancy rate. Secondary outcome measures include the miscarriage rate and live birth rate. DISCUSSION This is the first randomized controlled trial to compare the transfer of day 6 blastocysts on the 6th and 7th day of progesterone supplementation. The results of this study will provide evidence for whether to prolong the duration of exposure to progesterone prior to embryo transfer. TRIAL REGISTRATION ClinicalTrials.gov, ID: NCT04938011. Registered on 19 June 2021.
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Affiliation(s)
- Manlin Xu
- grid.428392.60000 0004 1800 1685Center for Reproductive Medicine and Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, China ,grid.41156.370000 0001 2314 964XCenter for Molecular Reproductive Medicine, Nanjing University, Nanjing, 210093 China
| | - Yuan Yan
- grid.428392.60000 0004 1800 1685Center for Reproductive Medicine and Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, China ,grid.41156.370000 0001 2314 964XCenter for Molecular Reproductive Medicine, Nanjing University, Nanjing, 210093 China
| | - Xiaoyue Shen
- grid.428392.60000 0004 1800 1685Center for Reproductive Medicine and Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, China ,grid.41156.370000 0001 2314 964XCenter for Molecular Reproductive Medicine, Nanjing University, Nanjing, 210093 China
| | - Haixiang Sun
- grid.428392.60000 0004 1800 1685Center for Reproductive Medicine and Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, China ,grid.41156.370000 0001 2314 964XCenter for Molecular Reproductive Medicine, Nanjing University, Nanjing, 210093 China
| | - Guijun Yan
- grid.428392.60000 0004 1800 1685Center for Reproductive Medicine and Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, China ,grid.41156.370000 0001 2314 964XCenter for Molecular Reproductive Medicine, Nanjing University, Nanjing, 210093 China
| | - Na Kong
- grid.428392.60000 0004 1800 1685Center for Reproductive Medicine and Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, China ,grid.41156.370000 0001 2314 964XCenter for Molecular Reproductive Medicine, Nanjing University, Nanjing, 210093 China
| | - Yue Jiang
- grid.428392.60000 0004 1800 1685Center for Reproductive Medicine and Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, China ,grid.41156.370000 0001 2314 964XCenter for Molecular Reproductive Medicine, Nanjing University, Nanjing, 210093 China
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15
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D’Angelo A, Panayotidis C, Alteri A, Mcheik S, Veleva Z. Evidence and consensus on technical aspects of embryo transfer. Hum Reprod Open 2022; 2022:hoac038. [PMID: 36196080 PMCID: PMC9522404 DOI: 10.1093/hropen/hoac038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 08/18/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Ultrasound-guided embryo transfer (US-GET) is a widely performed procedure, but standards for the best practice are not available.
OBJECTIVE AND RATIONALE
This document aims to provide an overview of technical aspects of US-GET after considering the published data and including the preparation for the embryo transfer (ET) procedure, the actual procedure, the post-procedure care, associated pathologies, complications and risks, quality assurance and practitioners’ performance.
SEARCH METHODS
A literature search for evidence on key aspects of the ET procedure was carried out from database inception to November 2021. Selected papers (n = 359) relevant to the topic were analysed by the authors. The following key points were considered in the papers: whether ultrasound (US) practice standards were explained, to what extent the ET technique was described and whether complications or incidents and how to prevent such events were reported. In the end, 89 papers could be used to support the recommendations in this document, which focused on transabdominal US-GET.
OUTCOMES
The relevant papers found in the literature search were included in the current document and described according to the topic in three main sections: requirements and preparations prior to ET, the ET procedure, and training and competence for ET. Recommendations are provided on preparations prior to ET, equipment and materials, ET technique, possible risks and complications, training and competence. Specific aspects of the laboratory procedures are covered, in particular the different loading techniques and their potential impact on the final outcomes. Potential future developments and research priorities regarding the ET technique are also outlined.
LIMITATIONS, REASONS FOR CAUTION
Many topics were not covered in the literature review and some recommendations were based on expert opinions and are not necessarily evidence based.
WIDER IMPLICATIONS
ET is the last procedural step in an ART treatment and is a crucial step toward achieving a pregnancy and live birth. The current paper set out to bring together the recent developments considering all aspects of ET, especially emphasizing US quality imaging. There are still many questions needing answers, and these can be subject of future research.
STUDY FUNDING/COMPETING INTEREST(S)
No funding. ADA has received royalties from CRC Press and personal honorarium from Cook, Ferring and Cooper Surgical. The other co-authors have no conflicts of interest to declare that are relevant to the content of this article.
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Affiliation(s)
- Arianna D’Angelo
- Wales Fertility Institute, Swansea Bay Health Board, University Hospital of Wales, Cardiff University , Cardiff, UK
| | - Costas Panayotidis
- Attiki Iatriki advanced gynaecological ultrasound and hysteroscopic centre private practice , Pallini, Athens, Greece
| | | | - Saria Mcheik
- European society of human reproduction and embryology (ESHRE) Central Office , Strombeek-Bever, Belgium
| | - Zdravka Veleva
- Helsinki University Central Hospital , Helsinki, Finland
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16
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LOUBERSAC S, INQUEL A, LEFEBVRE T, LAMMERS J, BARRIERE P, FREOUR T, REIGNIER A. What is the best strategy for slowly developing blastocysts? J Gynecol Obstet Hum Reprod 2022; 51:102414. [DOI: 10.1016/j.jogoh.2022.102414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/04/2022] [Accepted: 05/27/2022] [Indexed: 11/27/2022]
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17
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Abdala A, Elkhatib I, Bayram A, Arnanz A, El-Damen A, Melado L, Lawrenz B, Fatemi HM, De Munck N. Day 5 vs day 6 single euploid blastocyst frozen embryo transfers: which variables do have an impact on the clinical pregnancy rates? J Assist Reprod Genet 2022; 39:379-388. [PMID: 35064434 PMCID: PMC8956773 DOI: 10.1007/s10815-021-02380-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 12/13/2021] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE To determine which variables affect most the clinical pregnancy rate with positive fetal heartbeat (CPR FHB+) when frozen embryo transfer (FET) cycles are performed with day 5 (D5) or day 6 (D6) euploid blastocysts. Design and method A single center retrospective study was performed from March 2017 till February 2021 including all single FET cycles with euploid D5 or D6 blastocysts and transferred in natural cycles (NC) or hormone replacement therapy (HRT) cycles. Trophectoderm (TE) and inner cell mass (ICM) qualities were recorded before biopsy. RESULTS A total of 1102 FET cycles were included, 678 with D5 and 424 with D6 blastocysts. Pregnancy rate (PR), clinical PR (CPR), and CPR FHB+ were significantly higher with D5 blastocysts (PR: 70.7% vs 62.0%, OR = 0.68 [0.53-0.89], p = 0.004; CPR: 63.7% vs 54.2%, OR = 0.68 [0.52-0.96], p = 0.002 and CPR FHB+: 57.8% vs 49.8%, OR = 0.72 [0.53-0.96], p = 0.011). However, miscarriage rate (12.5% vs 11.4%, OR = 0.78 [0.48-1.26], p = 0.311) did not differ. From a multivariate logistic regression model, endometrial thickness (OR = 1.11 [1.01-1.22], p = 0.028), patient's age (OR = 1.03 [1.00-1.05], p = 0.021), BMI (OR = 0.97 [0.94-0.99], p = 0.023), and ICM grade C (OR = 0.23 [0.13-0.43], p < 0.001) were significant in predicting CPR FHB+. CONCLUSION Although clinical outcomes are higher with D5 blastocysts, CPR FHB+ is more affected by endometrial thickness, patient age, BMI, and ICM grade C rather than biopsy day or endometrial preparation protocol.
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Affiliation(s)
- Andrea Abdala
- ART Fertility Clinics, Al Ain, Abu Dhabi, United Arab Emirates
| | | | - Aşina Bayram
- ART Fertility Clinics, Al Ain, Abu Dhabi, United Arab Emirates
| | - Ana Arnanz
- ART Fertility Clinics, Al Ain, Abu Dhabi, United Arab Emirates ,Biomedicine and Biotechnology Department, University of Alcalá, Alcalá de Henares, Madrid, Spain
| | - Ahmed El-Damen
- ART Fertility Clinics, Al Ain, Abu Dhabi, United Arab Emirates
| | - Laura Melado
- ART Fertility Clinics, Al Ain, Abu Dhabi, United Arab Emirates
| | - Barbara Lawrenz
- ART Fertility Clinics, Al Ain, Abu Dhabi, United Arab Emirates ,Obstetrical Department, Women’s University Hospital Tuebingen, Tuebingen, Germany
| | - Human M. Fatemi
- ART Fertility Clinics, Al Ain, Abu Dhabi, United Arab Emirates
| | - Neelke De Munck
- ART Fertility Clinics, Al Ain, Abu Dhabi, United Arab Emirates
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18
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Navarro-Sánchez L, García-Pascual C, Rubio C, Simón C. Non-invasive PGT-A: An update. Reprod Biomed Online 2022; 44:817-828. [DOI: 10.1016/j.rbmo.2022.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 01/19/2022] [Accepted: 01/24/2022] [Indexed: 12/09/2022]
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19
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Keshavarzi S, Eftekhari AD, Vahabzadeh H, Mehrafza M, Taheripanah R, Asgharnia M, Esfandyari S, Ghazifard A, Hosseinirad H, Paktinat S. A comparative study of post-warming survival rates and clinical outcomes of human blastocysts vitrified/warmed by CryoTouch and Cryotop methods. JBRA Assist Reprod 2022; 26:568-573. [PMID: 35322951 PMCID: PMC9635599 DOI: 10.5935/1518-0557.20210116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE Advances in embryo culture conditions and the development of vitrification as a revolutionary cryopreservation method have allowed for routine use of blastocyst transfer in assisted reproduction technology (ART) cycles. Several vitrification/warming media and devices have been introduced for commercial use so far. The aim of this retrospective study was to compare post-warming survival rates and clinical outcomes of human blastocysts vitrified/warmed by two different commercial methods (CryoTouch and Cryotop) during ART cycles. METHODS This retrospective study assessed a total of 50 frozen embryo transfer (FET) cycles conducted on 56 warmed blastocysts between January 2018 and December 2020. Post-warming blastocyst survival rates and clinical outcomes including clinical pregnancy and live birth rates were calculated after single blastocyst transfer cycles. RESULTS The results revealed no significant differences between two groups in post-warming survival rate (p-value=0.8381), clinical pregnancy rate (p-value=0.8157) and live birth rate (p-value=0.7041). CONCLUSIONS Post-warming survival rates and clinical outcomes were comparable with no significant difference in blastocysts vitrified/warmed by CryoTouch and Cryotop commercial methods.
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Affiliation(s)
- Somayeh Keshavarzi
- Infertility Clinic, Erfan Niayesh Hospital, Iran University of
Medical Sciences, Tehran, Iran
| | | | - Hajar Vahabzadeh
- Mehr Fertility Research Center, Guilan University of Medical
Sciences, Rasht, Iran
| | - Marzieh Mehrafza
- Mehr Fertility Research Center, Guilan University of Medical
Sciences, Rasht, Iran
| | - Robabeh Taheripanah
- Infertility Clinic, Erfan Niayesh Hospital, Iran University of
Medical Sciences, Tehran, Iran , Men's Health and Reproductive Health Research Center, Shahid
Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Sahar Esfandyari
- Infertility Clinic, Erfan Niayesh Hospital, Iran University of
Medical Sciences, Tehran, Iran , College of Medicine, University of Illinois at Chicago, Chicago,
IL, USA
| | - Alaleh Ghazifard
- Infertility Clinic, Erfan Niayesh Hospital, Iran University of
Medical Sciences, Tehran, Iran
| | - Hossein Hosseinirad
- Infertility Clinic, Erfan Niayesh Hospital, Iran University of
Medical Sciences, Tehran, Iran ,Corresponding authors: Hossein Hosseinirad Infertility
Clinic Erfan Niayesh Hospital Iran University of Medical Sciences Tehran, Iran,
E-mail:
| | - Shahrokh Paktinat
- Infertility Clinic, Erfan Niayesh Hospital, Iran University of
Medical Sciences, Tehran, Iran ,Shahrokh Paktinat Infertility Clinic Erfan Niayesh Hospital Iran
University of Medical Sciences Tehran, Iran, E-mail:
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20
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Rao J, Qiu F, Tian S, Yu Y, Zhang Y, Gu Z, Cai Y, Jin F, Jin M. Clinical outcomes for Day 3 double cleavage-stage embryo transfers versus Day 5 or 6 single blastocyst transfer in frozen-thawed cycles: a retrospective comparative analysis. J Int Med Res 2021; 49:3000605211062461. [PMID: 34918976 PMCID: PMC8728785 DOI: 10.1177/03000605211062461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective This study aimed to compare the clinical outcomes for transfer of Day 3 (D3)
double cleavage-stage embryos and Day 5/6 (D5/6) single blastocysts in the
frozen embryo transfer (FET) cycle to formulate a more appropriate embryo
transplantation strategy. Methods We retrospectively analyzed 609 FET cycles from 518 women from April 2017 to
March 2021. All FETs were assigned to the D3-DET group (transfer of a Day 3
double cleavage-stage embryo), D5-SBT group (transfer of a Day 5 single
blastocyst), or D6-SBT group (transfer of a Day 6 single blastocyst).
Clinical outcomes were comparatively analyzed. Results There were no significant differences in the biochemical pregnancy rate,
clinical pregnancy rate, or ongoing pregnancy rate between the D3-DET and
D5-SBT groups, but these rates in the two groups were all significantly
higher compared with those in the D6-SBT group. The implantation rate in the
D5-SBT group was significantly higher than that in the D3-DET group. The
twin pregnancy rate in the D5-SBT and D6-SBT groups was significantly lower
than that in the D3-DET group. Conclusion This study suggests that D5-SBT is the preferred option for transplantation.
D6-SBT reduces the pregnancy rate, making it a more cautious choice for
transfer of such embryos.
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Affiliation(s)
- Jinpeng Rao
- Center for Reproductive Medicine, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Feng Qiu
- Center for Reproductive Medicine, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Shen Tian
- Center for Reproductive Medicine, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Ya Yu
- Center for Reproductive Medicine, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Ying Zhang
- Department of Science and Development, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Zheng Gu
- Department of Science and Development, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Yiting Cai
- Center for Reproductive Medicine, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Fan Jin
- Key Laboratory of Reproductive Genetics, Ministry of Education, Women's Hospital, Zhejiang University, School of Medicine, Hangzhou, China
| | - Min Jin
- Center for Reproductive Medicine, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
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21
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The effects of the day of trophectoderm biopsy and blastocyst grade on the clinical and neonatal outcomes of preimplantation genetic testing-frozen embryo transfer cycles. ZYGOTE 2021; 30:132-137. [PMID: 34184632 DOI: 10.1017/s0967199421000435] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This study analyzed the effects of the day of trophectoderm (TE) biopsy and blastocyst grade on clinical and neonatal outcomes. The results showed that the implantation and live birth rates of day 5 (D5) TE biopsy were significantly higher compared with those of D6 TE biopsy. The miscarriage rate of the former was lower than that of the latter, but there was no statistically significant difference. Higher quality blastocysts can achieve better implantation and live birth rates. Among good quality blastocysts, the implantation and live birth rates of D5 and D6 TE biopsy were not significantly different. Among fair quality and poor quality blastocysts, the implantation and live birth rates of D5 TE biopsy were significantly higher compared with those of D6 TE biopsy. Neither blastocyst grade nor the day of TE biopsy significantly affected the miscarriage rate. Neonatal outcomes, including newborn sex, gestational age, preterm birth, birth weight and low birth weight in the D5 and D6 TE biopsies were not significantly different. Both blastocyst grade and the day of TE biopsy must be considered at the same time when performing preimplantation genetic testing-frozen embryo transfer.
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22
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Polumiskova A, Tevkin S, Jussubaliyeva T, Shishimorova M. INFLUENCE ON THE OUTCOME OF ART PROGRAMS OF FROZEN-THAWED BLASTOCYSTS EXPANDED ON FIVE OR SIX DAY. REPRODUCTIVE MEDICINE 2021. [DOI: 10.37800/rm2021-2-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
In order to increase the effectiveness of assisted reproductive technologies (ART) programs, it is essential to improve and develop conditions of embryo culture prior its transfer or cryopreservation of expanded blastocysts on the day 5 or 6.
The aim of the study was to assess the effect of human blastocysts’ expansion timing on clinical pregnancy rate (CPR), miscarriage rate (MR) and take-home baby rate (THBR) in frozen-thawed cycles during ART programs. The study involved 2275 frozen embryo transfers (FET) of blastocysts expanded on the day 5 (group A) and 170 FET of blastocysts expanded on the day 6 (group B). The pregnancy rates in both groups were 50.8% and 46.5% respectively. There were no statistically significant differences in clinical pregnancy rate 37.4% and 37.0%, miscarriage rate 26.0% and 21.5% in both groups, respectively. THBR, as the main indicator of efficiency in the programs with transfer of post thawed expanded blastocysts on the day 5 (group A) or 6 (group B) were 36.5% and 35.2%, respectively (the difference is insignificant).
In conclusion, in cryoprotocols the day of blastocyst expansion (day 5 or 6 of development) does not statistically affect PR, MR and THBR. In FET programs the quality of blastocyst (excellent and good) should be prioritized regardless of the day of cryopreservation.
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REPRODUCTIVE OUTCOMES FOLLOWING FROZEN-THAWED EMBRYO TRANSFER IS SUPERIOR WITH THE TRANSFER OF BLASTOCYSTS EXPANDED ON DAY 5 THAN ON DAY 6. INTERNATIONAL JOURNAL OF HEALTH SERVICES RESEARCH AND POLICY 2021. [DOI: 10.33457/ijhsrp.867448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Rubio C, Racowsky C, Barad DH, Scott RT, Simon C. Noninvasive preimplantation genetic testing for aneuploidy in spent culture medium as a substitute for trophectoderm biopsy. Fertil Steril 2021; 115:841-849. [PMID: 33741125 DOI: 10.1016/j.fertnstert.2021.02.045] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 02/24/2021] [Indexed: 12/17/2022]
Affiliation(s)
- Carmen Rubio
- Igenomix, Research and Development, Valencia, Spain; Igenomix Foundation/INCLIVA, Reproductive Genetics, Valencia, Spain
| | - Catherine Racowsky
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hôpital Foch, Suresnes, France
| | - David H Barad
- The Center for Human Reproduction, New York, New York; The Foundation for Reproductive Medicine, New York, New York
| | - Richard T Scott
- IVIRMA New Jersey, Basking Ridge, New Jersey; Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Carlos Simon
- Department of Obstetrics and Gynecology, Valencia University and INCLIVA, Valencia, Spain; Department of Obstetrics and Gynecology, BIDMC Harvard University, Boston, Massachusetts.
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Coello A, Nohales M, Meseguer M, de Los Santos MJ, Remohí J, Cobo A. Prediction of embryo survival and live birth rates after cryotransfers of vitrified blastocysts. Reprod Biomed Online 2021; 42:881-891. [PMID: 33785304 DOI: 10.1016/j.rbmo.2021.02.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 01/17/2021] [Accepted: 02/22/2021] [Indexed: 10/22/2022]
Abstract
RESEARCH QUESTION Which pre-vitrification parameters are the most predictive of survival and live birth in vitrified-warmed blastocyst transfer cycles? DESIGN A retrospective study including 11,936 warmed blastocysts. Pre-vitrification morphological parameters analysed for blastocysts included day of vitrification; blastocyst expansion degree; trophoectoderm grade (A, B and C); and inner cell mass grade (A, B and C). Univariate and multivariate generalized estimating equations models were used to analyse survival, clinical pregnancy and live birth rate. A stepwise regression analysis was conducted to select and classify by order which outcomes were the most predictive. RESULTS The odds of survival increased almost twice for blastocysts with lower expansion degree (OR 1.92; 95% CI 1.37 to 2.69; P < 0.001) and by about 50% for blastocysts vitrified on day 5 (OR 1.56; 95% CI 1.27 to 1.89; P < 0.001). Multivariate generalized estimating equations model showed that trophectoderm grade followed by the day of vitrification were the most significant predictors of live birth. The odds of live birth increased nearly three times for blastocysts with trophectoderm graded as A compared with those with trophectoderm graded as C (OR 2.85; 95% CI 2.48 to 3.27; P < 0.001), and double for blastocysts vitrified on day 5 compared with those vitrified on day 6 (OR 2.22; 95% CI 1.97 to 2.49; P < 0.001). The odds of live birth also increased in higher expansion degree blastocysts. CONCLUSIONS Blastocysts vitrified on day 5 and those with higher trophoectoderm grade should be given priority when warming.
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Affiliation(s)
- Aila Coello
- Instituto Valenciano de Infertilidad (IVI), University of Valencia, Pl. Policía Local 3, Valencia, Spain.
| | - Mar Nohales
- Instituto Valenciano de Infertilidad (IVI), University of Valencia, Pl. Policía Local 3, Valencia, Spain
| | - Marcos Meseguer
- Instituto Valenciano de Infertilidad (IVI), University of Valencia, Pl. Policía Local 3, Valencia, Spain
| | - M José de Los Santos
- Instituto Valenciano de Infertilidad (IVI), University of Valencia, Pl. Policía Local 3, Valencia, Spain
| | - José Remohí
- Instituto Valenciano de Infertilidad (IVI), University of Valencia, Pl. Policía Local 3, Valencia, Spain
| | - Ana Cobo
- Instituto Valenciano de Infertilidad (IVI), University of Valencia, Pl. Policía Local 3, Valencia, Spain
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Transfer of Day 6 Frozen-Thawed Blastocysts on Day 5 Compared with Day 6: Catching Up with the Window of Implantation-a Retrospective Study. Reprod Sci 2021; 28:2208-2215. [PMID: 33428126 DOI: 10.1007/s43032-021-00458-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 01/05/2021] [Indexed: 10/22/2022]
Abstract
To compare clinical pregnancy rate (CPR) and live birth rate (LBR) after frozen-thawed embryo transfer (FET) of day (D-) 6 blastocysts on D-5 versus D-6. A retrospective cohort study. A university-affiliated single-center tertiary hospital. Women undergoing FET of D-6 blastocysts between August 2015 and March 2019 were included in the study. Exclusion criteria were endometriosis and maternal age ≥ 42. Cycles involving embryo transfer (ET) at D-6 were compared to cycles involving ET on D-5. Primary outcomes assessed were CPR and LBR, and the secondary outcomes were spontaneous abortion and chemical pregnancy rates. Forty-two cycles were assessed, 21 in which ET occurred on D-6 and 21 in which ET occurred on D-5. There were no significant differences between groups regarding age, body mass index (BMI), etiology of infertility, number of oocytes aspirated and blastocysts cryopreserved in the fresh cycle, reason for freezing on D-6, endometrial thickness before ET, and blastocyst grade. A comparison of outcomes of ET on D-5 with those involving ET on D-6 revealed that D-5 transfer produced significantly higher CPR (8, 38% vs. 2, 8.5%; P = 0.030) and LBR (6, 28.6% vs. 1, 4.8%; P = 0.038), respectively. FET of D-6 embryos on D-5 compared with D-6 is associated with increased CPR and LBR values. These findings might be related to the limited time window for optimal rates of implantation and indicate that transferring embryos on D-6 of a FET cycle is likely too late.
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Arab S, Badegiesh A, Aldhaheri S, Son WY, Dahan MH. What Are the Live Birth and Multiple Pregnancy Rates When 1 Versus 2 Low-Quality Blastocysts Are Transferred in a Cryopreserved Cycle? a Retrospective Cohort Study, Stratified for Age, Embryo Quality, and Oocyte Donor Cycles. Reprod Sci 2020; 28:1403-1411. [PMID: 33237513 DOI: 10.1007/s43032-020-00404-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 11/16/2020] [Indexed: 11/27/2022]
Abstract
Outcomes among women who transferred only Gardner's grade BB or lower quality frozen embryos transferred (FET) are not well known. Our objective is to study whether transferring 2 versus 1 frozen low-quality blastocysts will increase the live birth rate (LBR) and the multiple pregnancy rate (MPR). This is a retrospective cohort study including 1104 FET cycles. Only day 5-6 blastocysts of grade BB or lower quality were included. Clinical pregnancy rate (CPR), MPR, and LBR per cycle were compared between single embryo transfer (SET) (n = 969) and double embryo transfer (DET) (n = 135). CPR and MPR were compared between SET and DET in grade BB, BC, CB, and CC individually. Among SET, BB blastocysts had higher CPR 34% (P = 0.0001) and a sub-significant increase in LBR 19% (P = 0.059) in comparison to other grade SET. Among all BB, MPR was significantly higher when transferring two versus one (5.9 vs. 1.9, P = 0.009). If age at egg collection ≥ 40 years (n = 97), no difference was found in CPR (11.1 vs. 11.7, P = 0.9), MPR (0 vs. 0), and LBR (6.3 vs. 0,P = 0.13) when SET or DET was performed. If age was < 40 years (n = 818), the MPR was significantly higher in DET than SET (6.7 vs. 1.63, P = 0.004). In egg donor cycles (n = 189), there was no difference in CPR, MPR, and LBR between SET and DET. Single embryo transfer should be offered even in women ≥ 40 years of age or transferring lower quality embryos since transferring more did not increase outcomes in this group, and SET is likely the safest path.
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Affiliation(s)
- Suha Arab
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility Center, McGill University, 888 Boulevard de Maisonneuve East, suit # 200, Montreal, Quebec, H2l 4S8, Canada.
| | - Ahmad Badegiesh
- Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada
| | - Sarah Aldhaheri
- Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada
| | - Weon-Young Son
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility Center, McGill University, 888 Boulevard de Maisonneuve East, suit # 200, Montreal, Quebec, H2l 4S8, Canada
| | - Michael H Dahan
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility Center, McGill University, 888 Boulevard de Maisonneuve East, suit # 200, Montreal, Quebec, H2l 4S8, Canada
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Guo N, Deng T, Jiang H, Gong Y, Yin L, Ren X, Jin L, Li Y. Association between blastocyst morphology and live birth rate following frozen-thawed single blastocyst transfer: Results from a 5-year retrospective analysis of 2593 cryopreserved blastocysts. J Obstet Gynaecol Res 2020; 46:2314-2322. [PMID: 32924248 DOI: 10.1111/jog.14423] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 07/02/2020] [Accepted: 07/26/2020] [Indexed: 11/27/2022]
Abstract
AIM Our aim was to investigate associations between blastocyst morphology parameters and live birth outcome and to make possible additional recommendations for existing embryo selection strategies. METHODS This retrospective cohort study included 2593 frozen-thawed single blastocyst transfers (SBT) cycles from 2012 to 2016. Multivariable logistic regression model was used to analyze the independent predictive effectiveness of blastocyst parameters for live birth rate (LBR). RESULTS The participants enrolled in the present study were 32 (28-35) years old with a median body mass index of 21.20 (19.60-23.40) kg/m2 , among whom 1058 (40.8%) women had live births. Among the three blastocyst morphology parameters, we found only inner cell mass grade and trophectoderm cell grade had significant effects on LBR (P < 0.001). When adjusting for potential confounders in a multivariable logistic regression model, the expansion and hatching (EH) stage of blastocoel also showed obvious correlation with LBR. Blastocysts at EH stage 4-5 had a significantly higher LBR than that at stage 3 (P < 0.05). Additionally, the timing of blastulation was also an important predictor of LBR. Blastocysts vitrified on day 6 and day 7 yielded a lower LBR than that vitrified on day 5 (P < 0.001). CONCLUSION The timing of blastulation and all blastocyst morphology parameters were associated with LBR independently. Although the most important parameter for predicting clinical outcomes remains undetermined, the timing of blastulation was a stable predictor of live birth for frozen-thawed SBT.
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Affiliation(s)
- Na Guo
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Taoran Deng
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Huahua Jiang
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yanhong Gong
- Department of Social Medicine, Public Health School, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Li Yin
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xinling Ren
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lei Jin
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yufeng Li
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Xu H, Qiu S, Chen X, Zhu S, Sun Y, Zheng B. D6 blastocyst transfer on day 6 in frozen-thawed cycles should be avoided: a retrospective cohort study. BMC Pregnancy Childbirth 2020; 20:519. [PMID: 32894096 PMCID: PMC7487725 DOI: 10.1186/s12884-020-03224-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Accepted: 08/31/2020] [Indexed: 11/10/2022] Open
Abstract
Background There is no definitive evidence about the suitable timing to transfer blastocysts formed and cryopreserved on day 6 (D6 blastocysts) in frozen-thawed embryo transfer (FET) cycles. This study aimed to investigate the suitable timing to transfer D6 blastocysts in FET cycles and to identify factors affecting clinical pregnancy rate (CPR) and early miscarriage rate (EMR) in FET cycles with blastocysts. Methods This retrospective cohort study included 1788 FET cycles with blastocysts. There were 518 cycles with D6 blastocysts, and 1270 cycles with blastocysts formed and cryopreserved on day 5 (D5 blastocysts) (D5 group). According to the blastocyst transfer timing, the cycles with D6 blastocysts were divided into cycles with D6 blastocysts transferred on day 5 (D6-on-D5 group, 103 cycles) and cycles with D6 blastocysts transferred on day 6 (D6-on-D6 group, 415 cycles). The chi-square test, independent t-test or Mann-Whitney test, and logistic regression analysis were used for data analysis. Results The CPR and implantation rate (IR) were significantly higher in the D6-on-D5 group than in the D6-on-D6 group (55.3% vs. 37.3%, 44.8% vs. 32.6%, P < 0.01). The CPR and IR were significantly higher in the D5 group than in the D6-on-D5 group (66.0% vs. 55.3%, 62.1% vs. 44.8%, P < 0.05), and the EMR was significantly lower in the D5 group than in the D6-on-D5 group (11.2% vs. 21.1%, P < 0.05). Logistic regression analysis demonstrated that transfer D6 blastocysts on day 5, instead of day 6, could significantly increase the CPR (odds ratio[OR]: 2.031, 95% confidence interval (CI): 1.296–3.182, P = 0.002). FET cycles with D6 blastocysts transferred on day 5 had a higher EMR than those with D5 blastocysts (OR: 2.165, 95% CI: 1.040–4.506, P = 0.039). Hormone replacement therapy (HRT) cycles exhibited a higher EMR than natural cycles (OR: 1.953, 95% CI: 1.254–3.043, P = 0.003), while no difference was observed in the CPR (P > 0.05). Conclusions These results indicate that the suitable timing to transfer D6 blastocysts in FET cycles may be day 5, and D6 blastocyst transfer on day 6 in FET cycles should be avoided. D6 blastocysts transfer and HRT cycles may be associated with a higher EMR.
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Affiliation(s)
- Huiling Xu
- Reproductive Medicine Center, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, No.18 Daoshan Road, Fujian Province, 350001, Fuzhou City, China
| | - Shumin Qiu
- Reproductive Medicine Center, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, No.18 Daoshan Road, Fujian Province, 350001, Fuzhou City, China
| | - Xiaojing Chen
- Reproductive Medicine Center, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, No.18 Daoshan Road, Fujian Province, 350001, Fuzhou City, China
| | - Suqin Zhu
- Reproductive Medicine Center, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, No.18 Daoshan Road, Fujian Province, 350001, Fuzhou City, China
| | - Yan Sun
- Reproductive Medicine Center, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, No.18 Daoshan Road, Fujian Province, 350001, Fuzhou City, China
| | - Beihong Zheng
- Reproductive Medicine Center, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, No.18 Daoshan Road, Fujian Province, 350001, Fuzhou City, China.
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Wang C, Shu J, Lin R, Chen H, Gan X, Deng X, Liang G, Wu Z, Wei T, Zhou H. Choosing the optimal blastocyst by morphology score versus developmental rate in frozen-thawed embryo transfer cycles. HUM FERTIL 2020; 25:1-10. [PMID: 32538687 DOI: 10.1080/14647273.2020.1778199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 02/10/2020] [Indexed: 12/13/2022]
Abstract
The aim of this study was to provide guidance for better management in the selection of blastocyst to warm in frozen-thawed embryo transfer (FET) cycles. A retrospective cohort follow-up study was conducted that included single autologous frozen blastocyst transfer cycles performed in our Reproductive Medicine Unit from January 2009 to December 2016. The live birth rate (LBR), clinical pregnancy rate (cPR) were increased as blastocyst morphology scores increased, but the miscarriage rate decreased in all groups. In the high-score groups, there were no differences in LBR between D5 and D6, while in the low-score groups, LBR was significantly higher in D5 compared to the D6. With respect to neonatal outcome, there were no differences in all the groups. After binary logistic regression analysis, it was seen that patients' age, thawed cycles, pre-frozen morphology score and developmental rate were independently associated with LBR. These results suggest that for high-scoring blastocyst, the pre-frozen morphological score should be given priority while for low-scoring blastocysts, the developmental rate should be given priority when thawing in FET cycles.
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Affiliation(s)
- Caizhu Wang
- Reproductive Medicine Center, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Jinhui Shu
- Reproductive Medicine Center, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Rouyun Lin
- Reproductive Medicine Center, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Huanhua Chen
- Reproductive Medicine Center, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Xianyou Gan
- Reproductive Medicine Center, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Xihe Deng
- Reproductive Medicine Center, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Gui Liang
- Reproductive Medicine Center, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Zhulian Wu
- Reproductive Medicine Center, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Tinglv Wei
- Reproductive Medicine Center, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Hong Zhou
- Reproductive Medicine Center, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
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Zeng M, Su Qin S, Wen P, Xu C, Duan J. Perinatal outcomes after vitrified-warmed day 5 blastocyst transfers compared to vitrified-warmed day 6 blastocyst transfers: A meta analysis. Eur J Obstet Gynecol Reprod Biol 2020; 247:219-224. [DOI: 10.1016/j.ejogrb.2020.02.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 02/18/2020] [Accepted: 02/21/2020] [Indexed: 10/24/2022]
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Sardana P, Banker J, Gupta R, Kotdawala A, Lalitkumar PGL, Banker M. The Influence of Delayed Blastocyst Development on the Outcome of Frozen-Thawed Transfer of Euploid and Untested Embryos. J Hum Reprod Sci 2020; 13:155-161. [PMID: 32792766 PMCID: PMC7394094 DOI: 10.4103/jhrs.jhrs_115_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 11/01/2019] [Accepted: 04/03/2020] [Indexed: 11/04/2022] Open
Abstract
Objective The primary objective is to compare live birth rates (LBRs) following frozen embryo transfer (FET) of euploid day 5 with day 6 blastocysts. We also compared LBRs following FET of untested blastocysts vitrified on day 5 and day 6 in self-oocyte and ovum donation (OD) cycles. Design This was a retrospective observational study. Setting Nova IVF Fertility, Ahmedabad. Materials and Methods Ninety-seven FET using self-oocytes following preimplantation genetic testing A (PGT-A), 464 FET following OD, and 907 FET using self-oocytes without PGT-A testing between January 2016 and December 2017 were included in this study. Main Outcome Measures LBR following FET in day 5 versus day 6 blastocysts in euploid embryos using self-oocytes and in untested embryos using both self and donor oocytes. Results In PGT-A cycles, no statistically significant difference was observed in LBRs following transfer of euploid blastocysts developed on day 5 or day 6 (D5: 53%; D6:40%, P = 0.83). However, the LBRs with day 5 blastocysts were higher compared with day 6 group in untested group using both self and donor oocytes (self D5: 52.7%; D6: 38.2%; P = 0.001 and OD D5: 44.7%; D6: 29.8%; P = 0.001). Miscarriage rates were comparable in both the groups. Conclusions The present study demonstrated comparable pregnancy outcomes following FET of euploid embryos vitrified on day 5 and day 6. However, higher LBRs were reported in day 5 group in untested embryos.
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Affiliation(s)
- Parnita Sardana
- Nova IVF Fertility, Swastik Society, Navrangpura, Ahmedabad, Gujarat, India
| | - Jwal Banker
- Nova IVF Fertility, Swastik Society, Navrangpura, Ahmedabad, Gujarat, India
| | | | - Aditi Kotdawala
- Nova IVF Fertility, Swastik Society, Navrangpura, Ahmedabad, Gujarat, India
| | | | - Manish Banker
- Nova IVF Fertility, Swastik Society, Navrangpura, Ahmedabad, Gujarat, India
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Li YX, Wang J, Sun TZ, Lv MQ, Ge P, Li HN, Zhou DX. Pregnancy outcomes after day 5 versus day 6 blastocyst-stage embryo transfer: A systematic review and meta-analysis. J Obstet Gynaecol Res 2020; 46:595-605. [PMID: 32022423 DOI: 10.1111/jog.14188] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 12/13/2019] [Indexed: 01/03/2023]
Abstract
AIM To compare the pregnancy outcomes after day 5 blastocyst-stage embryo transfers (BET) versus day 6 BET following vitrified-warmed cycle and to evaluate whether the number of embryos transferred and the chromosomal status of embryo influence effect estimates. METHODS A literature search (PubMed, Embase and MEDLINE) up to January 2019 was conducted to identify studies where women with day 6 BET were compared to women with day 5 BET. Only studies published in English language, on peer-reviewed journal were considered eligible. The following subgroup analyses were performed: (i) number of embryos transferred and (ii) chromosomal status of embryo. RESULTS From a total of 1956 articles identified, 23 observational studies were included in the meta-analysis. We observed that day 6 BET were associated with lower implantation rate (risk ratio, RR: 1.17, 95% confidence interval, CI: 1.10-1.24), clinical pregnancy rate (RR: 1.17, 95% CI: 1.10-1.24), ongoing pregnancy rate (RR: 1.15, 95% CI: 1.07-1.24) and live birth rate (RR: 1.22, 95% CI: 1.11-1.33) than day 5 BET following vitrified-warmed cycle. The subgroup analysis found that the superiority of day 5 BET compared with day 6 BET is influenced by the number of embryos transferred and chromosomal status of embryos. CONCLUSION Current evidence shows that day 5 BET is superior to day 6 BET following vitrified-warmed cycle in clinical practice. Due to the overall low quality of available evidence, more larger and well-conducted studies are needed to compare the pregnancy outcomes between day 5 and day 6 BET before drawing a clear conclusion.
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Affiliation(s)
- Yi-Xin Li
- Department of Pathology, Medical School, Xi'an Jiaotong University, Xi'an, China.,Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education, Xi'an, China.,Institute of Genetics and Developmental Biology, Xi'an, China
| | - Jin Wang
- Department of Obstetrics and Gynecology, Xi'an Angel Women's & Children's Hospital, Xi'an, China
| | - Tian-Ze Sun
- Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education, Xi'an, China.,Institute of Genetics and Developmental Biology, Xi'an, China.,Department of Human Anatomy and Histology and Embryology, Medical School, Xi'an Jiaotong University, Xi'an, China
| | - Mo-Qi Lv
- Department of Pathology, Medical School, Xi'an Jiaotong University, Xi'an, China.,Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education, Xi'an, China.,Institute of Genetics and Developmental Biology, Xi'an, China
| | - Pan Ge
- Department of Pathology, Medical School, Xi'an Jiaotong University, Xi'an, China.,Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education, Xi'an, China.,Institute of Genetics and Developmental Biology, Xi'an, China
| | - Hao-Nan Li
- Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education, Xi'an, China.,Institute of Genetics and Developmental Biology, Xi'an, China.,Department of Pathogenic Biology and Immunology, Medical School, Xi'an Jiaotong University, Xi'an, China
| | - Dang-Xia Zhou
- Department of Pathology, Medical School, Xi'an Jiaotong University, Xi'an, China.,Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education, Xi'an, China.,Institute of Genetics and Developmental Biology, Xi'an, China
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Bourdon M, Pocate-Cheriet K, Finet de Bantel A, Grzegorczyk-Martin V, Amar Hoffet A, Arbo E, Poulain M, Santulli P. Day 5 versus Day 6 blastocyst transfers: a systematic review and meta-analysis of clinical outcomes. Hum Reprod 2019; 34:1948-1964. [PMID: 31644803 PMCID: PMC7967799 DOI: 10.1093/humrep/dez163] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 07/08/2019] [Indexed: 01/04/2023] Open
Abstract
STUDY QUESTION Is there a difference in clinical pregnancy and live birth rates (LBRs) between blastocysts developing on Day 5 (D5) and blastocysts developing on Day 6 (D6) following fresh and frozen transfers? SUMMARY ANSWER D5 blastocyst transfers (BTs) present higher clinical pregnancy and LBRs than D6 in both fresh and frozen transfers. WHAT IS KNOWN ALREADY BT is increasingly popular in assisted reproductive technology (ART) centers today. To our knowledge, no meta-analysis has focused on clinical outcomes in both fresh and frozen BT. Concerning frozen blastocysts, one meta-analysis in 2010 found no significant difference in pregnancy outcomes between D5 and D6 BT. Since then, ART practices have evolved particularly with the wide use of vitrification, and more articles comparing D5 and D6 BT cycles have been published and described conflicting results. STUDY DESIGN, SIZE, DURATION Systematic review and meta-analysis of published controlled studies. Searches were conducted from 2005 to February 2018 on MEDLINE and Cochrane Library and from 2005 to May 2017 on EMBASE, Eudract and clinicaltrials.gov, using the following search terms: blastocyst, Day 5, Day 6, pregnancy, implantation, live birth and embryo transfer (ET). PARTICIPANTS/MATERIALS, SETTING, METHODS A total of 47 full-text articles were preselected from 808 references, based on title and abstract and assessed utilizing the Newcastle-Ottowa Quality Assessment Scales. Study selection and data extraction were carried out by two independent reviewers according to Cochrane methods. Random-effect meta-analysis was performed on all data (overall analysis) followed by subgroup analysis (fresh, vitrified/warmed, slow frozen/thawed). MAIN RESULTS AND THE ROLE OF CHANCE Data from 29 relevant articles were extracted and integrated in the meta-analysis. Meta-analysis of the 23 studies that reported clinical pregnancy rate (CPR) as an outcome, including overall fresh and/or frozen ET cycles, showed a significantly higher CPR following D5 ET compared with D6 ET (risk ratio (RR) = 1.27, 95% CI: 1.15-1.39, P < 0.001). For CPR, calculated subgroup RRs were 2.38 (95% CI: 1.74-3.24, P < 0.001) for fresh BT; 1.27 (95% CI: 1.16-1.39, P < 0.001) for vitrified/warmed BT; and 1.15 (95% CI: 0.93-1.41, P = 0.20) for slow frozen/thawed BT. LBR was also significantly higher after D5 BT (overall RR = 1.50 (95% CI: 1.32-1.69), P < 0.001). The LBR calculated RRs for subgroups were 1.74 (95% CI: 1.37-2.20, P < 0.001) for fresh BT; 1.38 (95% CI: 1.23-1.56, P < 0.001) for vitrified/warmed BT; and 1.44 (95% CI: 0.70-2.96, P = 0.32) for slow frozen/thawed BT. Sensitivity analysis led to similar results and conclusions: CPR and LBR were significantly higher following D5 compared to D6 BT. LIMITATIONS, REASONS FOR CAUTION The validity of meta-analysis results depends mainly on the quality and the number of the published studies available. Indeed, this meta-analysis included no randomized controlled trial (RCT). Slow frozen/thawed subgroups showed substantial heterogeneity. WIDER IMPLICATIONS OF THE FINDINGS In regards to the results of this original meta-analysis, ART practitioners should preferably transfer D5 rather than D6 blastocysts in both fresh and frozen cycles. Further RCTs are needed to address the question of whether D6 embryos should be transferred in a fresh or a frozen cycle. STUDY FUNDING/COMPETING INTEREST(S) This work was sponsored by an unrestricted grant from GEDEON RICHTER France. The authors have no competing interests to declare. REGISTRATION NUMBER CRD42018080151.
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Affiliation(s)
- Mathilde Bourdon
- Sorbonne Paris Cité, Faculté de Médecine, Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire Cochin, Service de Gynécologie–Obstétrique II et de Médecine de la Reproduction, Université Paris Descartes, 53 Avenue de l’Observatoire, 75014 Paris, France
- Département Stress Oxydant, Prolifération Cellulaire et Inflammation, Institut Cochin, INSERM (Institut national de la santé et de la recherche médicale) U1016, Université Paris Descartes, Sorbonne Paris Cité, 22 Rue Mechain, 75014 Paris, France
| | - Khaled Pocate-Cheriet
- Sorbonne Paris Cité, Faculté de Médecine, Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire Cochin, Service d’Histologie–Embryologie–Biologie de la Reproduction, Université Paris Descartes, 53 Avenue de l’Observatoire, 75014 Paris, France
- Département Génomique, Epigénétique et Physiopathologie de la Reproduction, Institut Cochin, INSERM (Institut national de la santé et de la recherche médicale) U1016, CNRS UMR8104, Université Paris Descartes, Sorbonne Paris Cité, 22 Rue Mechain, 75014 Paris, France
| | - Astri Finet de Bantel
- Médecine de la Reproduction, Clinique Mathilde, 7 Boulevard de l’Europe, 76100 Rouen, France
| | | | | | - Elisangela Arbo
- Gedeon Richter France, 103 Boulevard Haussmann 75008 Paris, France
| | - Marine Poulain
- Unité de Biologie de la Reproduction, Service de Gynécologie Obstétrique et Médecine de la Reproduction, Hôpital Foch, 40 Rue Worth, 92151 Suresnes, France
- Gametes-Gestation-Implantation (EA 7404), Université Versailles Saint Quentin, 2 Avenue de la Source de la Bièvre 78180 Montigny-le-Bretonneux, France
| | - Pietro Santulli
- Sorbonne Paris Cité, Faculté de Médecine, Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire Cochin, Service de Gynécologie–Obstétrique II et de Médecine de la Reproduction, Université Paris Descartes, 53 Avenue de l’Observatoire, 75014 Paris, France
- Département Stress Oxydant, Prolifération Cellulaire et Inflammation, Institut Cochin, INSERM (Institut national de la santé et de la recherche médicale) U1016, Université Paris Descartes, Sorbonne Paris Cité, 22 Rue Mechain, 75014 Paris, France
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Increased pregnancy outcome after day 5 versus day 6 transfers of human vitrified-warmed blastocysts. ZYGOTE 2019; 27:279-284. [PMID: 31412960 DOI: 10.1017/s0967199419000273] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Vitrification is a highly efficient technique for the cryopreservation of the human embryo. The effect of delayed blastulation may be responsible for implantation failures and negatively affects in vitro fertilization (IVF) outcomes. The current literature displays discordant results; some studies have announced higher pregnancy rates after day 5 (D5) transfer compared with day 6 (D6) transfer, while others have shown equivalent outcomes. In the present study an investigation into the clinical implications of delayed blastulation (D5 versus D6) was carried out. We performed a retrospective study comparing clinical pregnancies and implantation rates following warmed single blastocyst transfer (WSBT). All patients coming for a programmed warmed transfer at Edinburgh Assisted Conception Programme, EFREC, Royal Infirmary of Edinburgh, were included in this study and divided in two groups according to the day of blastocyst vitrification: D5 (n = 1563) and D6 (n = 517). The overall survival rate was 95.0% (1976/2080) with no significant difference between the D5 and D6 groups: 95.3% (1489/1563) and 94.2% (487/517) respectively. WSBT of D6 blastocysts resulted in a lower implantation and clinical pregnancy compared with D5 embryos. The implantation rate (IPR) and clinical pregnancy rate (CPR) were respectively 49.4% and 42.6% for the D5 and 37.4% and 32.2% for the D6 embryos, which was statistically significant. The multiple pregnancy rate was 1.32% (1.14% for D5 vs 1.84% for D6). Although the transfer of D6 vitrified-warmed blastocyst remains a reasonable option, priority to a D5 embryo would reduce the time to successful pregnancy.
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Abstract
This is a retrospective study over a 5-year period. In total, 3139 embryos were individually cryopreserved (Cryotop®) and warmed using the Kitazato vitrification/warming kit. They were classified into three categories based on their expansion degree. Transfer, implantation and pregnancy rates were assessed for each embryo category and compared using SPSS (Statistical Package for the Social Sciences) software. In total, 1139 couples enrolled in infertility treatment programme benefitted from embryo vitrification at day 5. After warming, embryos belonging to the three categories showed similar success rates. Although there was a trend towards better outcomes when grade 3 embryos were transferred, the differences did not reach statistical significance: implantation rates (n fetal sac/n embryo transferred) grade 1: 21.9%, grade 2: 22.7% and grade 3: 30.3% (=0.19). Pregnancy rate (n clinical pregnancy/n transfer) (21.9%, 22.7%, 30.3%, respectively; P=0.11). Miscarriage rate was not statistically different in the three categories (14.5%, 20.4%, 20%, respectively, P=0.51). Our overall results show that it is worth vitrifying slow kinetics embryos as they provide a non-negligible chance to give rise to a pregnancy.
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Live birth rate following frozen–thawed blastocyst transfer is higher with blastocysts expanded on Day 5 than on Day 6. Hum Reprod 2018; 33:390-398. [DOI: 10.1093/humrep/dey004] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 01/08/2018] [Indexed: 11/15/2022] Open
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Kaye L, Marsidi A, Rai P, Thorne J, Nulsen J, Engmann L, Benadiva C. Frozen blastocyst transfer outcomes in immediate versus delayed subsequent cycles following GnRH agonist or hCG triggers. J Assist Reprod Genet 2018; 35:669-675. [PMID: 29297113 DOI: 10.1007/s10815-017-1111-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 12/22/2017] [Indexed: 11/30/2022] Open
Abstract
PURPOSE The aim of this study is to analyze clinical pregnancy rates (CPR) and ongoing pregnancy rates (OPR) for frozen embryo transfers (FET) performed with blastocysts in the cycle immediately after GnRH agonist (GnRHa) versus human chorionic gonadotropin (hCG) triggers, with outcomes of delayed FET for comparison. METHODS Retrospective cohort study at a university-affiliated in vitro fertilization (IVF) clinic, including patients undergoing IVF between 2013-16 with a blastocyst FET performed within two menstrual cycles of a previous stimulation cycle and vaginal oocyte retrieval (VOR). FETs included programmed and natural endometrial preparation. Outcome measures were clinical and ongoing pregnancy rates. RESULTS CPR and OPR for 344 FET cycles were similar when comparing immediate and delayed transfer overall (crude CPR 67.5 versus 76.5%, p = 0.11; OPR 57.5 versus 66.7%, p = 0.13), and after stratifying by cycles following hCG trigger (OPR 62.5 versus 66.3%, p = 0.61) and GnRHa trigger (OPR 55.6 versus 64.5%, p = 0.17). When considering a number of predictors for OPR, an adjusted odds ratio (OR) of 1.74 [95% CI 1.00-3.03] approached significance in favor of delayed FET. CONCLUSIONS Regardless of trigger modality, patients can be reassured that pregnancy rates with FET are high in immediate and delayed cycles. However, our study suggests a potential benefit in delaying a cycle before proceeding with FET.
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Affiliation(s)
- Leah Kaye
- Department of Obstetrics and Gynecology, University of Connecticut, 263 Farmington Avenue, Farmington, CT, 06030, USA
| | - Audrey Marsidi
- Department of Obstetrics and Gynecology, University of Connecticut, 263 Farmington Avenue, Farmington, CT, 06030, USA
| | - Puja Rai
- Department of Obstetrics and Gynecology, University of Connecticut, 263 Farmington Avenue, Farmington, CT, 06030, USA
| | - Jeffrey Thorne
- Department of Obstetrics and Gynecology, University of Connecticut, 263 Farmington Avenue, Farmington, CT, 06030, USA
| | - John Nulsen
- Center for Advanced Reproductive Services, 2 Batterson Park Road, Farmington, CT, 06032, USA
| | - Lawrence Engmann
- Center for Advanced Reproductive Services, 2 Batterson Park Road, Farmington, CT, 06032, USA
| | - Claudio Benadiva
- Center for Advanced Reproductive Services, 2 Batterson Park Road, Farmington, CT, 06032, USA.
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Tubbing A, Shaw-Jackson C, Ameye L, Colin J, Rozenberg S, Autin C. Increased live births after day 5 versus day 6 transfers of vitrified-warmed blastocysts. J Assist Reprod Genet 2017; 35:417-424. [PMID: 29204868 DOI: 10.1007/s10815-017-1097-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 11/27/2017] [Indexed: 01/28/2023] Open
Abstract
PURPOSE An investigation into the clinical implications of delayed blastulation (day 5 versus day 6) was carried out for cryo cycles, as heterogeneous results persist in the current literature. METHODS We performed a retrospective study comparing clinical pregnancies and live births between 178 blastocysts vitrified and warmed on day 5 versus 149 on day 6. The stage of blastocyst development was taken into account and adjustment for confounding factors was performed. RESULTS Our results demonstrate a significant difference in clinical pregnancy (43 versus 23% p value < 0.001) and live birth rates (34 versus 16% p value < 0.001) regarding the day of vitrification, in favour of day 5. This difference persisted after adjustment for confounding factors. The adjusted odds ratio for clinical pregnancies and deliveries for the day 5 group compared to that of the day 6 group was 2.83 (95%CI, 1.48 to 5.41) and 2.94 (95%CI, 1.39 to 6.22), respectively. When the stage of development of the blastocyst was taken into consideration, we still observed a significant advantage of day 5 versus day 6 vitrification. CONCLUSIONS Day of vitrification (day 5 versus day 6) appears to be an independent predictor of clinical outcomes. Stratification of our cohort was carried out according to the developmental stage, and significant differences persisted. Although the transfer of day 6 cryopreserved embryos remains a viable option, giving priority to a day 5 embryo would reduce the time to pregnancy.
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Affiliation(s)
- Alice Tubbing
- Department of Gynaecology, CHU St-Pierre (Université Libre de Bruxelles), Rue Haute 322, 1000, Brussels, Belgium
| | - Chloë Shaw-Jackson
- Department of Gynaecology, CHU St-Pierre (Université Libre de Bruxelles), Rue Haute 322, 1000, Brussels, Belgium.
| | - Lieveke Ameye
- Data Centre, Jules Bordet Institute (Université Libre de Bruxelles), Rue Hégèr Bordet 1, 1000, Brussels, Belgium
| | - Jérôme Colin
- Department of Gynaecology, CHU St-Pierre (Université Libre de Bruxelles), Rue Haute 322, 1000, Brussels, Belgium
| | - Serge Rozenberg
- Department of Gynaecology, CHU St-Pierre (Université Libre de Bruxelles), Rue Haute 322, 1000, Brussels, Belgium
| | - Candice Autin
- Department of Gynaecology, CHU St-Pierre (Université Libre de Bruxelles), Rue Haute 322, 1000, Brussels, Belgium
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