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Peregrino PFM, Bonetti TCDS, Gomes AP, de Martin H, Soares Júnior JM, Baracat EC, Monteleone PAA. One Plus One is Better than Two: An Approach Towards a Single Blastocyst Transfer Policy for All IVF Patients. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRICIA : REVISTA DA FEDERACAO BRASILEIRA DAS SOCIEDADES DE GINECOLOGIA E OBSTETRICIA 2022; 44:578-585. [PMID: 35576968 PMCID: PMC9948105 DOI: 10.1055/s-0042-1743096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE It is known that the single embryo transfer (SET) is the best choice to reduce multiples and associated risks. The practice of cryopreserving all embryos for posterior transfer has been increasingly performed for in vitro fertilization (IVF) patients at the risk of ovarian hyperstimulation syndrome or preimplantation genetic testing for aneuploidy. However, its widespread practice is still controverse. The aim of this study was to evaluate how effective is the transfer of two sequential SET procedures compared with a double embryo transfer (DET) in freeze-only cycles. METHODS This retrospective study reviewed 5,156 IVF cycles performed between 2011 and 2019, and 506 cycles using own oocytes and freeze-only policy with subsequent elective frozen-thawed embryo transfers (eFET) were selected for this study. Cycles having elective SET (eSET, n = 209) comprised our study group and as control group we included cycles performed with elective DET (eDET, n = 291). In the eSET group, 57 couples who had failed in the 1st eSET had a 2nd eFET, and the estimated cumulative ongoing pregnancy rate was calculated and compared with eDET. RESULTS After the 1st eFET, the ongoing pregnancy rates were similar between groups (eSET: 35.4% versus eDET: 38.5%; p = 0.497), but the estimated cumulative ongoing pregnancy rate after a 2nd eFET in the eSET group (eSET + SET) was significantly higher (48.8%) than in the eDET group (p < 0.001). Additionally, the eSET + SET group had a 2.7% rate of multiple gestations, which is significantly lower than the eDET group, with a 30.4% rate (p < 0.001). CONCLUSION Our study showed the association of freeze-only strategy with until up to two consecutive frozen-thawed eSETs resulted in higher success rates than a frozen-thawed DET, while drastically reducing the rate of multiple pregnancies.
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Affiliation(s)
- Pedro Felipe Magalhães Peregrino
- Centro de Reprodução Humana Monteleone, São Paulo, SP, Brazil.,Centro de Reprodução Humana "Governador Mario Covas", Discipline of Gynecology, Department of Obstetrics and Gynecology, Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Tatiana Carvalho de Souza Bonetti
- Centro de Reprodução Humana Monteleone, São Paulo, SP, Brazil.,Molecular Gynecology Laboratory, Department of Gynecology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil.,Centro de Neurociências e Saúde da Mulher "Professor Geraldo Rodrigues de Lima", Neuroscience Discipline of the Department of Neurology and Neurosurgery, Escola Paulista de Medicina - Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | | | - Hamilton de Martin
- Centro de Reprodução Humana Monteleone, São Paulo, SP, Brazil.,Centro de Reprodução Humana "Governador Mario Covas", Discipline of Gynecology, Department of Obstetrics and Gynecology, Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - José Maria Soares Júnior
- Centro de Reprodução Humana "Governador Mario Covas", Discipline of Gynecology, Department of Obstetrics and Gynecology, Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Edmund Chada Baracat
- Centro de Reprodução Humana "Governador Mario Covas", Discipline of Gynecology, Department of Obstetrics and Gynecology, Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Pedro Augusto Araújo Monteleone
- Centro de Reprodução Humana Monteleone, São Paulo, SP, Brazil.,Centro de Reprodução Humana "Governador Mario Covas", Discipline of Gynecology, Department of Obstetrics and Gynecology, Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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Maris E, Ferrieres-Hoa A, Gala A, Coffy A, Vintejoux E, Ranisavljevic N, Hamamah S. [Comparison of birth weights of children born after slow frozen embryo replacement versus fresh embryo transfer]. ACTA ACUST UNITED AC 2019; 47:305-310. [PMID: 30745159 DOI: 10.1016/j.gofs.2019.01.011] [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: 05/24/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE It is already known that children born after slow frozen embryo replacement have a significantly higher birth weight compared to children born after fresh embryo transfer. Similar data have been reported related to frozen embryo transfer using an open vitrification system. However, few data relative to birth weight using a complete embryo closed vitrification system has been reported. The purpose of this study was to know if frozen embryo in closed vitrification system is associated with a higher birth weight compared to fresh embryo replacement. DESIGN This was a monocentric retrospective cohort study, 371 children were issued from fresh embryo replacement and 127 from vitrified embryo transfer. MATERIALS AND METHODS All singletons born after fresh or vitrified embryo transfer between January 2011 and April 2015 were included. Births from the vitrified or fresh transfers of egg or sperm donation, and preimplantation genetic diagnosis were excluded. In addition, pregnancies with more than one gestational sac at the first ultrasound were excluded. An analysis of covariance (ANCOVA) was used for multivariate analysis. RESULTS Mean birth weight was 205g higher in the frozen embryo compared with fresh embryos transfer groups (3368g vs. 3163g respectively, P<0.001). This difference remained after multivariate analysis adjusted on confounding factors such as gestational age, maternal age, maternal body mass index (BMI), tobacco exposure, number of embryo transferred and birth order (P<0.001).. CONCLUSIONS Embryo frozen in closed vitrification system is associated with a higher birth weight compared to fresh embryo replacement. Our findings are consistent with the previous studies related to slow freezing and open vitrification systems data. The effects of controlled ovarian stimulation (COS), ex vivo culture conditions and cryopreservation systems on birth weight of children born should be further explored.
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Affiliation(s)
- E Maris
- Département de médecine de la reproduction, CHU de Montpellier, 34000 Montpellier France; Département de gynécologie obstétrique, CHU de Nîmes, 30000 Nîmes, France.
| | - A Ferrieres-Hoa
- Département de biologie de la reproduction, CHU de Montpellier, 34000 Montpellier, France; Inserm, U1203, institut de médecine régénératrice et de biothérapie, CHU de Montpellier, 34000 Montpellier, France
| | - A Gala
- Département de biologie de la reproduction, CHU de Montpellier, 34000 Montpellier, France; Inserm, U1203, institut de médecine régénératrice et de biothérapie, CHU de Montpellier, 34000 Montpellier, France
| | - A Coffy
- Laboratoire de biostatistiques et d'épidémiologie, institut universitaire de recherche clinique, 34000 Montpellier, France
| | - E Vintejoux
- Département de médecine de la reproduction, CHU de Montpellier, 34000 Montpellier France
| | - N Ranisavljevic
- Département de médecine de la reproduction, CHU de Montpellier, 34000 Montpellier France
| | - S Hamamah
- Département de biologie de la reproduction, CHU de Montpellier, 34000 Montpellier, France; Inserm, U1203, institut de médecine régénératrice et de biothérapie, CHU de Montpellier, 34000 Montpellier, France
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Anav M, Ferrières-Hoa A, Gala A, Fournier A, Zaragoza S, Vintejoux E, Vincens C, Hamamah S. [Birth weight and frozen embryo transfer: State of the art]. ACTA ACUST UNITED AC 2018; 46:489-496. [PMID: 29680508 DOI: 10.1016/j.gofs.2018.03.012] [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: 11/29/2017] [Indexed: 11/26/2022]
Abstract
The aim of this study was to update our acknowledgment if there is a link between assisted embryo cryopreservation and epigenetics in human? Animal studies have demonstrated epigenetics consequence and especially imprinting disorders due to in vitro culture. In human, it is important to note that after frozen embryo transfer birth weight is significantly increased by 81 to 250g. But these studies cannot identify the reasons of such difference. This review strongly suggests that embryo cryopreservation is responsible for birth weight variations but mechanisms not yet elucidated. Epigenetics is probably one of these but to date, none study is able to prove it. We have to be attentive on a possible link between assisted reproductive technology (ART) and epigenetics reprogrammation.
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Affiliation(s)
- M Anav
- Département biologie de la reproduction/DPI, hôpital Arnaud-de-Villeneuve, 371, avenue du Doyen-Gaston-Giraud, 34295, Montpellier, France
| | - A Ferrières-Hoa
- Département biologie de la reproduction/DPI, hôpital Arnaud-de-Villeneuve, 371, avenue du Doyen-Gaston-Giraud, 34295, Montpellier, France
| | - A Gala
- Département biologie de la reproduction/DPI, hôpital Arnaud-de-Villeneuve, 371, avenue du Doyen-Gaston-Giraud, 34295, Montpellier, France
| | - A Fournier
- Département biologie de la reproduction/DPI, hôpital Arnaud-de-Villeneuve, 371, avenue du Doyen-Gaston-Giraud, 34295, Montpellier, France
| | - S Zaragoza
- Département biologie de la reproduction/DPI, hôpital Arnaud-de-Villeneuve, 371, avenue du Doyen-Gaston-Giraud, 34295, Montpellier, France
| | - E Vintejoux
- Service de gynécologie obstétrique, CHU Arnaud-de-Villeneuve, 371, avenue du Doyen-Gaston-Giraud, 34295, Montpellier, France
| | - C Vincens
- Service de gynécologie obstétrique, CHU Arnaud-de-Villeneuve, 371, avenue du Doyen-Gaston-Giraud, 34295, Montpellier, France
| | - S Hamamah
- Département biologie de la reproduction/DPI, hôpital Arnaud-de-Villeneuve, 371, avenue du Doyen-Gaston-Giraud, 34295, Montpellier, France.
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Schatten H, Sun QY. Cytoskeletal Functions, Defects, and Dysfunctions Affecting Human Fertilization and Embryo Development. Hum Reprod 2016. [DOI: 10.1002/9781118849613.ch10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Heide Schatten
- Department of Veterinary Pathobiology; University of Missouri; Columbia MO USA
| | - Qing-Yuan Sun
- State Key Laboratory of Reproductive Biology, Institute of Zoology; Chinese Academy of Sciences; Beijing China
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Dupont C, Hafhouf E, Sermondade N, Sellam O, Herbemont C, Boujenah J, Faure C, Levy R, Poncelet C, Hugues J, Cedrin-Durnerin I, Sonigo C, Grynberg M, Sifer C. Delivery rates after elective single cryopreserved embryo transfer related to embryo survival. Eur J Obstet Gynecol Reprod Biol 2015; 188:6-11. [DOI: 10.1016/j.ejogrb.2015.02.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2014] [Revised: 12/31/2014] [Accepted: 02/19/2015] [Indexed: 10/23/2022]
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Bottin P, Achard V, Courbiere B, Paci M, Gnisci A, Jouve E, Grillo JM, Paulmyer-Lacroix O. Politique de transfert électif d’un embryon à 48/72h : quels résultats après transferts frais et transferts d’embryons congelés ? ACTA ACUST UNITED AC 2015; 43:297-303. [DOI: 10.1016/j.gyobfe.2015.02.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 02/03/2015] [Indexed: 10/23/2022]
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Sifer C, Herbemont C, Adda-Herzog E, Sermondade N, Dupont C, Cedrin-Durnerin I, Poncelet C, Levy R, Grynberg M, Hugues JN. Clinical predictive criteria associated with live birth following elective single embryo transfer. Eur J Obstet Gynecol Reprod Biol 2014; 181:229-32. [PMID: 25171268 DOI: 10.1016/j.ejogrb.2014.08.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 07/30/2014] [Accepted: 08/04/2014] [Indexed: 01/23/2023]
Abstract
OBJECTIVE We aimed to define clinical criteria from the patients related to the occurrence of live birth in case of elective single embryo transfer (eSET). STUDY DESIGN We analyzed retrospectively 409 eSET at day 2/3 between March 2005 and July 2012, proposed in case of (i) woman's age <37 years, (ii) first/second IVF0 cycle, (iii) ≥2 good quality embryos obtained (3-5/6-10 blastomeres at day 2/3 and <20% fragmentation), including one top embryo (4/8 cells). In all, 124/409 live births (30.3%) were obtained, separating patients into groups of women who had birth or not. Different clinical parameters of interest were compared between each group, using appropriate statistical tests at p<0.05 significance level. RESULTS By comparing Body Mass Index (BMI), we report a statistically higher BMI among women who did not deliver (24.6 vs. 23.4kg/m(2); p=0.014). Using an analysis by BMI categories, we also precise a threshold of BMI≥30kg/m(2), negatively associated with the occurrence of live birth. CONCLUSION BMI appears to be the only clinical parameter statistically associated with delivery following eSET strategy in a good prognosis infertile population.
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Affiliation(s)
- Christophe Sifer
- Service d'Histologie-Embryologie-Cytogénétique-CECOS, Centre Hospitalier Universitaire Jean Verdier, Assistance Publique - Hôpitaux de Paris, Avenue du 14 Juillet, 93140 Bondy, France; Université Paris 13, Sorbonne Paris Cité, Unité de Recherche en Epidémiologie Nutritionnelle, UMR U557 Inserm, U1125 Inra, Cnam, CRNH IdF, 93017 Bobigny, France.
| | - Charlène Herbemont
- Service d'Histologie-Embryologie-Cytogénétique-CECOS, Centre Hospitalier Universitaire Jean Verdier, Assistance Publique - Hôpitaux de Paris, Avenue du 14 Juillet, 93140 Bondy, France
| | - Elodie Adda-Herzog
- Service de Médecine de la Reproduction, Centre Hospitalier Universitaire Jean Verdier, Assistance Publique - Hôpitaux de Paris, Avenue du 14 Juillet, 9340 Bondy, France
| | - Nathalie Sermondade
- Service d'Histologie-Embryologie-Cytogénétique-CECOS, Centre Hospitalier Universitaire Jean Verdier, Assistance Publique - Hôpitaux de Paris, Avenue du 14 Juillet, 93140 Bondy, France; Université Paris 13, Sorbonne Paris Cité, Unité de Recherche en Epidémiologie Nutritionnelle, UMR U557 Inserm, U1125 Inra, Cnam, CRNH IdF, 93017 Bobigny, France
| | - Charlotte Dupont
- Service d'Histologie-Embryologie-Cytogénétique-CECOS, Centre Hospitalier Universitaire Jean Verdier, Assistance Publique - Hôpitaux de Paris, Avenue du 14 Juillet, 93140 Bondy, France; Université Paris 13, Sorbonne Paris Cité, Unité de Recherche en Epidémiologie Nutritionnelle, UMR U557 Inserm, U1125 Inra, Cnam, CRNH IdF, 93017 Bobigny, France
| | - Isabelle Cedrin-Durnerin
- Service de Médecine de la Reproduction, Centre Hospitalier Universitaire Jean Verdier, Assistance Publique - Hôpitaux de Paris, Avenue du 14 Juillet, 9340 Bondy, France
| | - Christophe Poncelet
- Service de Médecine de la Reproduction, Centre Hospitalier Universitaire Jean Verdier, Assistance Publique - Hôpitaux de Paris, Avenue du 14 Juillet, 9340 Bondy, France
| | - Rachel Levy
- Service d'Histologie-Embryologie-Cytogénétique-CECOS, Centre Hospitalier Universitaire Jean Verdier, Assistance Publique - Hôpitaux de Paris, Avenue du 14 Juillet, 93140 Bondy, France; Université Paris 13, Sorbonne Paris Cité, Unité de Recherche en Epidémiologie Nutritionnelle, UMR U557 Inserm, U1125 Inra, Cnam, CRNH IdF, 93017 Bobigny, France
| | - Michael Grynberg
- Service de Médecine de la Reproduction, Centre Hospitalier Universitaire Jean Verdier, Assistance Publique - Hôpitaux de Paris, Avenue du 14 Juillet, 9340 Bondy, France
| | - Jean-Noël Hugues
- Service de Médecine de la Reproduction, Centre Hospitalier Universitaire Jean Verdier, Assistance Publique - Hôpitaux de Paris, Avenue du 14 Juillet, 9340 Bondy, France
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A randomized controlled trial comparing two vitrification methods versus slow-freezing for cryopreservation of human cleavage stage embryos. J Assist Reprod Genet 2013; 31:241-7. [PMID: 24317854 PMCID: PMC3933602 DOI: 10.1007/s10815-013-0145-4] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Accepted: 11/29/2013] [Indexed: 12/02/2022] Open
Abstract
Purpose To compare two different vitrification methods to slow freezing method for cryopreservation of human cleavage stage embryos. Design: Prospective randomised trial. Setting: University assisted reproduction centre. Patient(s): 568 patients (mean age 33.4 ± 5.2) from April 2009 to April 2011. Methods 1798 supernumerary good-quality cleavage stage embryos in 645 IVF cycles intended to be cryopreserved were randomly allocated to three groups: slow freezing, vitrification with the Irvine® method, vitrification with the Vitrolife® method. Main Outcome Measure(s): Embryo survival and cleavage rates, implantation rate. Results A total of 1055 embryos were warmed, 836 (79.2 %) survived and 676 were finally transferred (64.1 %). Post-warming embryos survival rate was significantly higher after vitrification (Irvine: 89.4 %; Vitrolife: 87.6 %) than after slow freezing (63.8 %) (p < 0.001). No differences in survival rates were observed between the two vitrification methods, but a significant higher cleavage rate was observed using Irvine compared to Vitrolife method (p < 0.05). Implantation rate (IR) per embryo replaced and per embryo warmed were respectively 15.8 % (41/259) and 12.4 % (41/330) for Irvine, 17.0 % (40/235) and 12.1 % (40/330) for Vitrolife, 21.4 % (39/182) and 9.9 % (39/395) for slow-freezing (NS). Conclusions Both vitrification methods (Irvine and Vitrolife) are more efficient than slow freezing for cryopreservation of human cleavage stage embryos in terms of post-warming survival rate. No significant difference in the implantation rate was observed between the three cryopreservation methods.
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Singh N, Malhotra N, Shende U, Tiwari A. Successful live birth after rescue ICSI following failed fertilization. J Hum Reprod Sci 2013; 6:77-8. [PMID: 23869158 PMCID: PMC3713584 DOI: 10.4103/0974-1208.112388] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Revised: 09/14/2012] [Accepted: 02/27/2013] [Indexed: 11/22/2022] Open
Abstract
In a conventional IVF cycle unexpected complete fertilization failure may occur in 10-25% of infertile women. To overcome this barrier of fertilization failure, some investigators have suggested intracytoplasmic sperm injection (ICSI) on day 1 of an unfertilized mature oocyte, the so called “rescue ICSI”. We report a case of fertilization failure followed by rescue ICSI resulting in a live birth. Although the success of rescue ICSI is still questionable, this procedure is worth an attempt in order to give the best chance to the couple in that cycle.
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Affiliation(s)
- Neeta Singh
- Department of Obstetrics and Gynaecology, AIIMS, Ansari Nagar, New Delhi 110 029, India
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Kashir J, Sermondade N, Sifer C, Oo SL, Jones C, Mounce G, Turner K, Child T, McVeigh E, Coward K. Motile sperm organelle morphology evaluation-selected globozoospermic human sperm with an acrosomal bud exhibits novel patterns and higher levels of phospholipase C zeta. Hum Reprod 2012; 27:3150-60. [PMID: 22940771 DOI: 10.1093/humrep/des312] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION Does motile sperm organelle morphology examination (MSOME) affect levels and localization patterns of the oocyte activation factor phospholipase C zeta (PLCζ) in globozoospermic sperm with and without an acrosomal bud? SUMMARY ANSWER MSOME identified round-headed globozoospermic sperm with increased levels of PLCζ relative to sperm from the same sample that did not undergo MSOME, and identified novel patterns of PLCζ localization in sperm exhibiting an acrosomal bud. WHAT IS KNOWN ALREADY Absence or reduction in the level of PLCζ in the sperm head, abnormal localization patterning, or defective functional ability as a result of PLCζ gene mutation, have been linked to certain types of human male factor infertility in which oocyte activation is deficient. It has been determined that a subpopulation of sperm (1%) from a patient exhibiting 100% globozoospermia presented with an acrosome bud upon MSOME. A cycle of intracytoplasmic morphologically selected sperm injection, carried out with sperm exhibiting an acrosomal bud led to pregnancy and birth of a healthy baby boy, without the use of assisted oocyte activation (AOA). STUDY DESIGN, SIZE, DURATION Immunofluorescent analysis of PLCζ in globozoospermic sperm from three patients, before and after MSOME. PARTICIPANTS/MATERIALS, SETTING, METHODS Quantitative immunofluorescence was used to investigate PLCζ levels and localization patterns in individual sperm (n = 1 patient) identified by MSOME and isolated by micromanipulation, and presenting with and without the acrosomal bud. A secondary aim was to investigate levels and localization patterns of PLCζ in sperm before and after MSOME from two other globozoospermic men. MAIN RESULTS AND THE ROLE OF CHANCE Non-globozoospermic control sperm exhibited characteristic localization patterns of PLCζ immunofluorescence. Completely round-headed globozoospermic sperm from patients 1-3 were either devoid of PLCζ immunofluorescence, or exhibited an abnormal, punctate, pattern of PLCζ localization. PLCζ immunofluorescence in sperm exhibiting an acrosomal bud was observed in the midpiece with varying fluorescent intensity and was detected in 28.5% of such sperm. The majority of sperm with an acrosomal bud (43.0%) exhibited punctate patterns of PLCζ localization within the sperm head. A further 28.5% of sperm exhibited PLCζ in both the head and the midpiece. Total levels of PLCζ, and the proportions of sperm exhibiting PLCζ immunoreactivity, showed significant variance (P ≤ 0.05) amongst control [45.8 arbitrary units (a.u.) and 95.7%, respectively], non-MSOME-selected (25.9 a.u. and 46.1%, respectively) and MSOME-selected globozoospermic sperm (33.4 a.u. and 65.0%, respectively). Total levels of PLCζ immunofluorescence, and proportions of sperm exhibiting PLCζ immunoreactivity, in control sperm was significantly higher (P≤ 0.05) compared with non-MSOME-selected sperm, but not significantly different from MSOME-selected sperm. LIMITATIONS, REASONS FOR CAUTION The low numbers of sperm analysed may not be ideal for conclusive statistical analysis. Evaluation of the effects of MSOME on morphologically normal sperm would confirm conclusions. WIDER IMPLICATIONS OF THE FINDINGS The present findings provide hope for the future treatment of globozoospermia without the need for AOA, and provide further evidence for the clinical application of PLCζ as a therapeutic and prognostic tool. STUDY FUNDING/COMPETING INTEREST(S) The research described herein was funded by the Nuffield Department of Obstetrics and Gynaecology, University of Oxford. The authors report no conflict of interest.
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Affiliation(s)
- Junaid Kashir
- Nuffield Department of Obstetrics and Gynaecology, Level 3, Women's Centre, John Radcliffe Hospital, Headington, Oxford OX3 9DU, UK
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Yang Z, Liu J, Collins GS, Salem SA, Liu X, Lyle SS, Peck AC, Sills ES, Salem RD. Selection of single blastocysts for fresh transfer via standard morphology assessment alone and with array CGH for good prognosis IVF patients: results from a randomized pilot study. Mol Cytogenet 2012; 5:24. [PMID: 22551456 PMCID: PMC3403960 DOI: 10.1186/1755-8166-5-24] [Citation(s) in RCA: 397] [Impact Index Per Article: 33.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Accepted: 05/02/2012] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Single embryo transfer (SET) remains underutilized as a strategy to reduce multiple gestation risk in IVF, and its overall lower pregnancy rate underscores the need for improved techniques to select one embryo for fresh transfer. This study explored use of comprehensive chromosomal screening by array CGH (aCGH) to provide this advantage and improve pregnancy rate from SET. METHODS First-time IVF patients with a good prognosis (age <35, no prior miscarriage) and normal karyotype seeking elective SET were prospectively randomized into two groups: In Group A, embryos were selected on the basis of morphology and comprehensive chromosomal screening via aCGH (from d5 trophectoderm biopsy) while Group B embryos were assessed by morphology only. All patients had a single fresh blastocyst transferred on d6. Laboratory parameters and clinical pregnancy rates were compared between the two groups. RESULTS For patients in Group A (n = 55), 425 blastocysts were biopsied and analyzed via aCGH (7.7 blastocysts/patient). Aneuploidy was detected in 191/425 (44.9%) of blastocysts in this group. For patients in Group B (n = 48), 389 blastocysts were microscopically examined (8.1 blastocysts/patient). Clinical pregnancy rate was significantly higher in the morphology + aCGH group compared to the morphology-only group (70.9 and 45.8%, respectively; p = 0.017); ongoing pregnancy rate for Groups A and B were 69.1 vs. 41.7%, respectively (p = 0.009). There were no twin pregnancies. CONCLUSION Although aCGH followed by frozen embryo transfer has been used to screen at risk embryos (e.g., known parental chromosomal translocation or history of recurrent pregnancy loss), this is the first description of aCGH fully integrated with a clinical IVF program to select single blastocysts for fresh SET in good prognosis patients. The observed aneuploidy rate (44.9%) among biopsied blastocysts highlights the inherent imprecision of SET when conventional morphology is used alone. Embryos randomized to the aCGH group implanted with greater efficiency, resulted in clinical pregnancy more often, and yielded a lower miscarriage rate than those selected without aCGH. Additional studies are needed to verify our pilot data and confirm a role for on-site, rapid aCGH for IVF patients contemplating fresh SET.
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Affiliation(s)
- Zhihong Yang
- Division of Reproductive Endocrinology Research, Pacific Reproductive Center, Torrance, CA, 90505, USA
| | - Jiaen Liu
- IVF Division, Beijing Jia En De Yun Hospital, Beijing, 100083, People's Republic of China
| | - Gary S Collins
- Centre for Statistics in Medicine, Wolfson College Annexe, University of Oxford, Oxford, UK
| | - Shala A Salem
- Division of Reproductive Endocrinology Research, Pacific Reproductive Center, Torrance, CA, 90505, USA
| | - Xiaohong Liu
- IVF Division, Beijing Jia En De Yun Hospital, Beijing, 100083, People's Republic of China
| | - Sarah S Lyle
- Division of Reproductive Endocrinology Research, Pacific Reproductive Center, Torrance, CA, 90505, USA
| | - Alison C Peck
- Division of Reproductive Endocrinology Research, Pacific Reproductive Center, Torrance, CA, 90505, USA
| | - E Scott Sills
- Division of Reproductive Endocrinology Research, Pacific Reproductive Center, Torrance, CA, 90505, USA
| | - Rifaat D Salem
- Division of Reproductive Endocrinology Research, Pacific Reproductive Center, Torrance, CA, 90505, USA
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Gremeau AS, Brugnon F, Bouraoui Z, Pekrishvili R, Janny L, Pouly JL. Outcome and feasibility of elective single embryo transfer (eSET) policy for the first and second IVF/ICSI attempts. Eur J Obstet Gynecol Reprod Biol 2012; 160:45-50. [DOI: 10.1016/j.ejogrb.2011.09.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2011] [Revised: 07/08/2011] [Accepted: 09/17/2011] [Indexed: 10/14/2022]
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Cabry-Goubet R, Lourdel E, Brzakowski M, Urrutiaguer-Grenier N, Brasseur F, Demailly P, Devaux A, Copin H, Merviel P. [Pregnancy predictive factors in case of double embryo transfer during "Top Quality" attempts]. ACTA ACUST UNITED AC 2011; 41:168-72. [PMID: 22019742 DOI: 10.1016/j.gyobfe.2011.07.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2010] [Accepted: 01/06/2011] [Indexed: 10/16/2022]
Abstract
OBJECTIVES To identify IVF±ICSI pregnancy predictive factors during "Top Quality" attempts in case of double embryo transfer. PATIENTS AND METHODS Three years retrospective study (2007, 2008 and 2009) on parameters and results obtained during IVF±ICSI defined as "Top Quality" attempts: first or second attempts on less than 35years old women (age inferior or equal to) with one or two "Top Quality" embryo transfer. RESULTS In case of double embryo transfer, pregnancy predictive factors are (OR [IC 95%], P): average endometrial thickness on start (4.6 [2.9-5.5], P<0.01), women smoking (4.2 [3.5-4.9], P<0.01), average stimulation duration (3.4 [2.7-3.9], P<0.01), average men age (2.2 [1.7-2.5], P<0.05), gonadotrophins total dose (2.1 [1.1-3.2], P<0.05) and first rank's attempts (1.6 [1.2-2.5], P<0.05). DISCUSSION AND CONCLUSION Age patient, rank attempts and quality embryo are criteria, which used to guide to a single embryo transfer. Our results incite us to consider other parameters, in particular men age and women smoking status.
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Affiliation(s)
- R Cabry-Goubet
- Laboratoire de cytogénétique et de biologie de la reproduction, CHU d'Amiens, 124, rue Camille-Desmoulins, 80000 Amiens, France.
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[How present ART' results: questions' list to French ART professionals and application on Amiens' ART results]. ACTA ACUST UNITED AC 2011; 40:24-30. [PMID: 21903441 DOI: 10.1016/j.gyobfe.2011.07.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Accepted: 05/31/2011] [Indexed: 11/21/2022]
Abstract
OBJECTIVES ART transparency of results and ways to submit are in centre of present biologists and clinical cares. This work aims at identifying ART results' presentation pertinent tests. PATIENTS AND METHODS At first time, we propose a questions' list to French ART professionals. Next, we apply results on Amiens' ART center 2006, 2007 and 2008 IVF parameters. RESULTS One hundred and twenty questions' lists were analysed. Ninety percent of interrogated people were in favour of the results' center public communication. Most quoting criterions hold to define a reference population are (percentage of favourable opinions): IVF/ICSI treatment (96%), first of second rank's attempts (71%), women age less than 35 years old (68%), one or two top embryos quality transfer (60%). In 2007, 2008 and 2009, we made 1123 tentative IVF±ICSI in Amiens' ART center. Pregnancy rates were analysed for these years with criterions next quoting as most pertinent (women's age and rank's attempt), and in function of puncture retrieval oocytes number and indications. DISCUSSION AND CONCLUSION Most of professionals are in favour of ART transparency of results. All would like that results presentation holds to special criterions to allow a fair comparison. Pregnancy predictive factors, which are women age, rank attempt, puncture retrieval oocytes number, seem to be main criterions for evaluation. These criterions pertinence has been shown thanks to Amiens ART center results.
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Sermondade N, Hafhouf E, Dupont C, Bechoua S, Palacios C, Eustache F, Poncelet C, Benzacken B, Lévy R, Sifer C. Successful childbirth after intracytoplasmic morphologically selected sperm injection without assisted oocyte activation in a patient with globozoospermia. Hum Reprod 2011; 26:2944-9. [PMID: 21857011 DOI: 10.1093/humrep/der258] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
We here report a successful pregnancy and healthy childbirth obtained in a case of total globozoospermia after intracytoplasmic morphologically selected sperm injection (IMSI) without assisted oocyte activation (AOA). Two semen analyses showed 100% globozoospermia on classic spermocytogram. Motile sperm organelle morphology examination (MSOME) analysis at ×10,000 magnification confirmed the round-headed aspect for 100% of sperm cells, but 1% of the spermatozoa seemed to present a small bud of acrosome. This particular aspect was confirmed by transmission electron microscopy and anti-CD46 staining analysis. Results from sperm DNA fragmentation and fluorescence in situ hybridization analyses were normal. The karyotype was 46XY, and no mutations or deletions in SPATA16 and DPY19L2 genes were detected. Considering these results, a single IMSI cycle was performed, and spermatozoa were selected for the absence of vacuoles and the presence of a small bud of acrosome. A comparable fertilization rate with or without calcium-ionophore AOA was observed. Two fresh top-quality embryos obtained without AOA were transferred at Day 2 after IMSI, leading to pregnancy and birth of a healthy baby boy. This successful outcome suggests that MSOME may be useful in cases of globozoospermia in order to carefully evaluate sperm morphology and to maximize the benefit of ICSI/IMSI.
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Affiliation(s)
- N Sermondade
- Service d'Histologie-Embryologie-Cytogénétique-CECOS, Hôpital Jean Verdier (AP-HP), Avenue du 14 Juillet, 93143 Bondy, France.
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16
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Sifer C, Sermondade N, Poncelet C, Hafhouf E, Porcher R, Cedrin-Durnerin I, Benzacken B, Levy R, Hugues JN. Biological predictive criteria for clinical pregnancy after elective single embryo transfer. Fertil Steril 2011; 95:427-30. [DOI: 10.1016/j.fertnstert.2010.07.1055] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2010] [Revised: 07/07/2010] [Accepted: 07/08/2010] [Indexed: 10/19/2022]
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17
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Cabry-Goubet R, Lourdel E, Brasseur F, Sanguinet P, Demailly P, Devaux A, Copin H, Merviel P. [Professional Practice Evaluation: How to improve quality management in procreation centers?]. GYNECOLOGIE, OBSTETRIQUE & FERTILITE 2010; 38:581-587. [PMID: 20884269 DOI: 10.1016/j.gyobfe.2010.08.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2010] [Accepted: 05/11/2010] [Indexed: 05/29/2023]
Abstract
OBJECTIVES The Professional Practice Evaluation (PPE) is at the heart of quality management in procreation centers. Hereby, we report 3 years of EPP in Cytogenetics and Reproduction laboratory in Amiens University Hospital. PATIENTS AND METHODS This PPE is based upon prospective analysis of in vitro fertilization techniques regarding two major parameters: clinically in improving embryo transfer and biologically by determining fecundation levels. Clinical pregnancies in "Top Quality" trial is chosen as a major indicator of our results. RESULTS Per transfer, there is an increase of 8% for clinical pregnancies and 31% in "Top quality" trials. DISCUSSION AND CONCLUSION The improvement in our results allowed us to propose, in favourable conditions, single embryo transfer.
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Affiliation(s)
- R Cabry-Goubet
- Laboratoire de Cytogénétique et de Biologie de la Reproduction, CHU d'Amiens, 124, rue Camille-Desmoulins, 80000 Amiens, France.
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18
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Sermondade N, Hugues JN, Cedrin-Durnerin I, Poncelet C, Benzacken B, Lévy R, Sifer C. Should all embryos from day 1 rescue intracytoplasmic sperm injection be transferred during frozen–thawed cycles? Fertil Steril 2010; 94:1157-8. [DOI: 10.1016/j.fertnstert.2009.12.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2009] [Revised: 11/16/2009] [Accepted: 12/01/2009] [Indexed: 10/19/2022]
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Sifer C, Levy R. [Against systematic blastocyst single embryo transfer]. GYNECOLOGIE, OBSTETRIQUE & FERTILITE 2010; 38:361-363. [PMID: 20430674 DOI: 10.1016/j.gyobfe.2010.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- C Sifer
- Service d'histologie-embryologie-cytogénétique, centre hospitalier universitaire Jean-Verdier, AP-HP, avenue du 14-Juillet, 93143 Bondy, France.
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20
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Marikawa Y, Alarcón VB. Establishment of trophectoderm and inner cell mass lineages in the mouse embryo. Mol Reprod Dev 2010; 76:1019-32. [PMID: 19479991 DOI: 10.1002/mrd.21057] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The first cell lineage specification in mouse embryo development is the formation of trophectoderm (TE) and inner cell mass (ICM) of the blastocyst. This article is to review and discuss the current knowledge on the cellular and molecular mechanisms of this particular event. Several transcription factors have been identified as the critical regulators of the formation or maintenance of the two cell lineages. The establishment of TE manifests as the formation of epithelium, and is dependent on many structural and regulatory components that are commonly found and that function in many epithelial tissues. Distinct epithelial features start to emerge at the late 8-cell stage, but the fates of blastomeres are not fixed as TE or ICM until around 32-cell stage. The location of blastomeres at this stage, that is, external or internal of the embryo, in effect defines the commitment towards the TE or ICM lineage, respectively. Some studies implicate the presence of a developmental bias among blastomeres at 2- or 4-cell stage, although it is unlikely to play a decisive role in the establishment of TE and ICM. The unique mode of cell lineage specification in the mouse embryo is further discussed in comparison with the formation of initial cell lineages, namely the three germ layers, in non-mammalian embryos.
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Affiliation(s)
- Yusuke Marikawa
- Institute for Biogenesis Research, Department of Anatomy, Biochemistry and Physiology, John A. Burns School of Medicine, University of Hawaii, 651 Ilalo St. Biosciences Building 163 Honolulu, HI 96813, USA.
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21
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Weghofer A, Klein K, Stammler-Safar M, Worda C, Barad DH, Husslein P, Gleicher N. Can prematurity risk in twin pregnancies after in vitro fertilization be predicted? A retrospective study. Reprod Biol Endocrinol 2009; 7:136. [PMID: 19939246 PMCID: PMC2789085 DOI: 10.1186/1477-7827-7-136] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2009] [Accepted: 11/25/2009] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Assisted reproduction (ART) contributes to world-wide increases of twin pregnancies, in turn raising prematurity risks. Whether characteristics of ART cycles, resulting in twin gestations, can predict prematurity risks was the subject of this study. METHODS One-hundred-and-six women, ages 20 to 39 years, with consecutive dichorionic-diamniotic (DC/DA) twin gestations were retrospectively investigated. All pregnancies investigated followed fresh ART cycles, with use of autologous gamets, and were delivered at a university-based high-risk, maternal-fetal medicine unit. Only premature deliveries (i.e., <37.0 weeks gestational age), with viable neonate(s) of > or = 500 grams, were considered for analysis. RESULTS After 1.8 +/- 1.2 ART cycles, 11.0 +/- 5.4 oocytes were retrieved and 2.4 +/- 0.9 embryos transferred in 106 women aged 31.6 +/- 4.2 years. Indications for ART treatment were male factor in 51.9%, female infertility in 27.4% and combined infertility in 20.8%. Though maternal age significantly influenced prematurity risk (p < 0.05), paternal age, maternal body mass index, indications for fertility treatment, number of previous ART attempts, oocytes retrieved or embryos transferred, as well as stimulation protocols and previous ART pregnancies, were not associated with gestational duration in twin pregnancies. SUMMARY Except for female age, baseline and ART cycle characteristics do not allow for prediction of prematurity risk in dichorionic twin gestations after assisted reproduction.
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Affiliation(s)
- Andrea Weghofer
- Department of Obstetrics & Gynecology, Medical University Vienna, Vienna, Austria
- The Center for Human Reproduction and The Foundation for Reproductive Medicine, New York, New York, USA
| | - Katharina Klein
- Department of Obstetrics & Gynecology, Medical University Vienna, Vienna, Austria
| | - Maria Stammler-Safar
- Department of Obstetrics & Gynecology, Medical University Vienna, Vienna, Austria
| | - Christof Worda
- Department of Obstetrics & Gynecology, Medical University Vienna, Vienna, Austria
| | - David H Barad
- The Center for Human Reproduction and The Foundation for Reproductive Medicine, New York, New York, USA
| | - Peter Husslein
- Department of Obstetrics & Gynecology, Medical University Vienna, Vienna, Austria
| | - Norbert Gleicher
- The Center for Human Reproduction and The Foundation for Reproductive Medicine, New York, New York, USA
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale Universiy School of Medicine, New Haven, Connecticut, USA
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22
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An auto-controlled prospective comparison of two embryos culture media (G III series versus ISM) for IVF and ICSI treatments. J Assist Reprod Genet 2009; 26:575-81. [PMID: 19904601 DOI: 10.1007/s10815-009-9357-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2009] [Accepted: 10/08/2009] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To compare the effects of 2 different media on embryo morphology and development at days 2/3. METHOD Six hundred seventy-six attempts from 512 couples were included in this prospective auto-controlled study. Sibling oocytes of all couples undergoing an IVF (n = 286) or ICSI (n = 390) attempt were randomly assigned to either GIII series (Vitrolife) or ISM (Medicult) media. Primary end points were fertilization and embryo morphology rates. RESULTS Fertilization rates in GIII series and ISM (IVF: 59.9 vs 62.0% and ICSI: 65.7 vs 66.8%) respectively were not different. GIII series showed an increase, compared to ISM, of early cleavage rate, (IVF: 25.8 vs 16.2% (p = 0.005); ICSI: 40.8 vs 25.5% (p < 0.0001), and good embryo morphology rate at day 2 [IVF: 64.6 vs 57.3% (p = 0.01); ICSI: 74.2 vs 69.4 (p = 0.03)] and at day 3 [IVF: 57.5 vs 49.0% (p = 0.02); ICSI: 67.2 vs 61.6% (p = 0.01)]. CONCLUSIONS Embryo morphology at days 2/3 was significantly enhanced when the embryos were cultured in GIII series.
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23
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Sifer C, Cédrin-Durnerin I, Hugues JN, Poncelet C. [Views of each member of an Assisted Reproductive Technologies centre on the embryo transfer procedure]. GYNECOLOGIE, OBSTETRIQUE & FERTILITE 2009; 37:645-652. [PMID: 19589713 DOI: 10.1016/j.gyobfe.2009.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2009] [Accepted: 04/27/2009] [Indexed: 05/28/2023]
Abstract
The embryo transfer (ET) is probably the key step of Assisted Reproductive Technologies (ART), end point of the collaboration of a multidisciplinary clinical team and an infertile couple. Thus, a perfect knowledge of available data regarding ET is required to optimize the results of ART. Indeed, numerous published studies demonstrate the impact of defined parameters onto the effectiveness of ET procedure. The aim of this study is to provide views of physicians dealing with ART, i.e. endocrinologist, ultrasound scan specialist, surgeon and biologist to put in perspective questions and answers about ET.
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Affiliation(s)
- C Sifer
- Service d'histologie-embryologie-cytogénétique, CHU Jean-Verdier, AP-HP, avenue du 14-Juillet, 93143 Bondy, France.
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24
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Baruffi RLR, Mauri AL, Petersen CG, Nicoletti A, Pontes A, Oliveira JBA, Franco JG. Single-embryo transfer reduces clinical pregnancy rates and live births in fresh IVF and Intracytoplasmic Sperm Injection (ICSI) cycles: a meta-analysis. Reprod Biol Endocrinol 2009; 7:36. [PMID: 19389258 PMCID: PMC2680863 DOI: 10.1186/1477-7827-7-36] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2009] [Accepted: 04/23/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It has become an accepted procedure to transfer more than one embryo to the patient to achieve acceptable ongoing pregnancy rates. However, transfers of more than a single embryo increase the probability of establishing a multiple gestation. Single-embryo transfer can minimize twin pregnancies but may also lower live birth rates. This meta-analysis aimed to compare current data on single-embryo versus double-embryo transfer in fresh IVF/ICSI cycles with respect to implantation, ongoing pregnancy and live birth rates. METHODS Search strategies included on-line surveys of databases from 1995 to 2008. Data management and analysis were conducted using the Stats Direct statistical software. The fixed-effect model was used for odds ratio (OR). Fixed-effect effectiveness was evaluated by the Mantel Haenszel method. Seven trials fulfilled the inclusion criteria. RESULTS When pooling results under the fixed-effect model, the implantation rate was not significantly different between double-embryo transfer (34.5%) and single-embryo transfer group (34.7%) (P = 0.96; OR = 0.99, 95% CI 0.78, 1.25). On the other hand, double-embryo transfer produced a statistically significantly higher ongoing clinical pregnancy rate (44.5%) than single-embryo transfer (28.3%) (P < 0.0001; OR:2.06, 95% CI = 1.64,2.60). At the same time, pooling results presented a significantly higher live birth rate when double-embryo transfer (42.5%) (P < 0.001; OR: 1.87, 95% CI = 1.44,2.42) was compared with single-embryo transfer (28.4%). CONCLUSION Meta-analysis with 95% confidence showed that, despite similar implantation rates, fresh double-embryo transfer had a 1.64 to 2.60 times greater ongoing pregnancy rate and 1.44 to 2.42 times greater live birth rate than single-embryo transfer in a population suitable for ART treatment.
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Affiliation(s)
- Ricardo LR Baruffi
- Center for Human Reproduction – Prof Franco Junior, Ribeirão Preto, Sao Paolo, Brazil
| | - Ana L Mauri
- Center for Human Reproduction – Prof Franco Junior, Ribeirão Preto, Sao Paolo, Brazil
| | - Claudia G Petersen
- Center for Human Reproduction – Prof Franco Junior, Ribeirão Preto, Sao Paolo, Brazil
| | - Andréia Nicoletti
- Center for Human Reproduction – Prof Franco Junior, Ribeirão Preto, Sao Paolo, Brazil
| | - Anagloria Pontes
- Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University – UNESP, Botucatu, Sao Paolo, Brazil
| | - João Batista A Oliveira
- Center for Human Reproduction – Prof Franco Junior, Ribeirão Preto, Sao Paolo, Brazil
- Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University – UNESP, Botucatu, Sao Paolo, Brazil
| | - José G Franco
- Center for Human Reproduction – Prof Franco Junior, Ribeirão Preto, Sao Paolo, Brazil
- Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University – UNESP, Botucatu, Sao Paolo, Brazil
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Cutting R, Morroll D, Roberts SA, Pickering S, Rutherford A. Elective single embryo transfer: guidelines for practice British Fertility Society and Association of Clinical Embryologists. HUM FERTIL 2009; 11:131-46. [PMID: 18766953 DOI: 10.1080/14647270802302629] [Citation(s) in RCA: 120] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Assisted conception treatment is the single most important cause in the increase in multiple pregnancy and births over the last 25 years. Multiple births are associated with significant peri natal morbidity and mortality. Europe has led the way in reducing multiple births by widespread adoption of an elective single embryo policy, which in Belgium is linked to an increase in state funding. Randomized controlled trials suggest that an eSET policy must include the ability to cryopreserve and transfer any remaining quality embryos to obtain parity with a double embryo transfer. This document provides a review of the available evidence with guidelines for practice, to help facilitate the introduction of an eSET policy in the UK.
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Affiliation(s)
- Rachel Cutting
- Centre for Reproductive Medicine and Fertility, Jessops Wing, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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26
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Yanaihara A, Yorimitsu T, Motoyama H, Ohara M, Kawamura T. Clinical outcome of frozen blastocyst transfer; single vs. double transfer. J Assist Reprod Genet 2008; 25:531-4. [PMID: 18989770 DOI: 10.1007/s10815-008-9275-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2008] [Accepted: 10/22/2008] [Indexed: 10/21/2022] Open
Abstract
PURPOSE Frozen embryo transfer has been established as an indispensable ART procedure for both the effective use of surplus embryos and the prevention of ovarian hyperstimulation syndrome. The frequency of frozen embryo transfer is increasing in our clinic, and we report that frozen embryo transfer is effective for patients with repeat failures. We present our clinical outcome of frozen blastocyst transfer (FBT). METHODS In 2006, 470 patients received FBT (562 cycles (IVF: 354 cycles; ICSI: 208 cycles)). One frozen blastocyst was transferred in 412 cycles (335 patients) and two blastocysts were transferred in 150 cycles (135 patients). Assisted hatching was performed in all cases. RESULTS In 412 cycles (average age: 34.6 years) who received a single FBT, the rate of clinical pregnancy per cycle was 40.7%, the live birth rate was 29.1%, the abortion rate was 21.6%, the ectopic pregnancy rate was 1.2%, the frequency of monochorionic twins was 2.3%, and the cesarean section rate was 38.3%. In 150 cycles (average patient age 34.8 years) who received two FBTs, the clinical pregnancy rate was 46%, the live birth rate was 35.3%, the abortion rate was 16.3%, the ectopic pregnancy rate was 4.4%, the frequency of twins was 15.9% and the cesarean section rate was 39.6%. A significant difference in the ectopic pregnancy rate and the twinning rate was found between single transfers and double transfers (P < 0.05). When IVF and ICSI were compared, there was no statistically significant difference in the abortion rate, the ectopic pregnancy rate, and the cesarean section rate. CONCLUSIONS The clinical pregnancy rate was similar for the transfer of one and two blastocysts. Single FBT decreases obstetrical risk without reducing the pregnancy rate.
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Affiliation(s)
- Atsushi Yanaihara
- Denentoshi Ladies Clinic Reproductive Center, Yokohama-shi, Kanagawa, 227-0062, Japan.
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Elective single embryo transfer: a 6-year progressive implementation of 784 single blastocyst transfers and the influence of payment method on patient choice. Fertil Steril 2008; 92:1895-906. [PMID: 18976755 DOI: 10.1016/j.fertnstert.2008.09.023] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2008] [Revised: 09/03/2008] [Accepted: 09/04/2008] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To evaluate efforts to reduce twin pregnancies through progressive implementation of elective single embryo transfer (eSET) among select patients over a 6-year period. DESIGN Retrospective review. SETTING Private practice IVF center. PATIENT(S) Infertile women undergoing 15,418 consecutive IVF-ET cycles. INTERVENTION(S) IVF-ET, including blastocyst-stage eSET among select patients with good prognosis and high risk of multiple pregnancy. MAIN OUTCOME MEASURE(S) Pregnancy, multiple pregnancy, method of payment. RESULT(S) Pregnancy rates were similar for autologous eSET versus double-blastocyst transfer (65% vs. 63%), while twin rates were much lower (1% vs. 44%). For recipients of donor oocytes, pregnancy rates were slightly lower with eSET (63% vs. 74%), while twin rates were much lower (2% vs. 54%). There was no decrease in overall pregnancy rates, despite a dramatic rise in eSET use over time (1.5% to 8.6% of all autologous transfers and 2.0% to 22.5% of all transfers to donor oocyte recipients between 2002 and 2007). Overall singleton pregnancy rates increased, while twin pregnancy rates declined significantly over time. Use of eSET was significantly more common among patients with insurance coverage or who were participating in our Shared Risk money-back guarantee program. CONCLUSION(S) Selective eSET use among good-prognosis patients can significantly reduce twin pregnancies without compromising pregnancy rates. Patients are more likely to choose eSET when freed from financial pressures to transfer multiple embryos.
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Belaisch-Allart J, Mayenga JM, Grefenstette I, Chouraqui A, Serkine AM, Abirached F, Kulski O. [Single embryo transfer: is Scandinavian model valuable in France?]. ACTA ACUST UNITED AC 2008; 36:1151-7. [PMID: 18922732 DOI: 10.1016/j.gyobfe.2008.08.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2008] [Accepted: 08/11/2008] [Indexed: 11/25/2022]
Abstract
The aim of infertility treatment is clearly to obtain one healthy baby. If the transfer of a top quality single embryo could provide a baby to all the patients, there would be no more discussion. The problem is that, nowadays, French pregnancy rates after fresh embryo or frozen embryo transfer are not the same as in Nordic countries. All studies show that in unselected patients, single embryo transfer decreases twin pregnancy rate but decreases pregnancy rate too. Pregnancy rate is dependent on embryo quality, women's age, rank of IVF attempt (clear data) but also on body mass index, ovarian reserve, smoking habits. All these data cannot be taken into account in a law. That is the reason why a flexible policy of transfer adapted to each couple is preferable. Each couple and each IVF team are unique and must keep the freedom to choose how many embryos must be transferred to obtain healthy babies, and to avoid twin pregnancies but without demonizing them.
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Affiliation(s)
- J Belaisch-Allart
- Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Centre Hospitalier des Quatre-Villes, Site de Sèvres, 92318 Sèvres cedex, France.
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