Zygote intrafallopian transfer in patients with tubal factor infertility after repeated failure of implantation with in vitro fertilization-embryo transfer

Magnetic Resonance Imaging Feature Analysis and Evaluation of Tubal Patency under Convolutional Neural Network in the Diagnosis of Infertility

To explore the diagnostic value of MRI image features based on convolutional neural network for tubal unobstructed infertility, 30 infertile female patients were first selected as the research objects, who admitted to the hospital from May 2018 to January 2020. They all underwent routine MRI examinations and CNN-based MR-hysteron-salpingography (HSG) examinations, in order to discuss the diagnostic accuracy of the two examinations. In the research, it was necessary to observe the patients' imaging results, calculate the diagnosis rate of the two examination results, and analyze the application effect of the CNN algorithm, thereby selecting the best reconstruction method. In this study, the analysis was conducted on the basis of no statistical difference in the baseline data of the included patients. The results of undersampling reconstruction at 2-fold, 4-fold, and 6-fold showed that CNN for data consistency layer (CNN_DC) had a better effect, and its peak signal-to-noise ratio (PSNR) was lower sharply than that of the other two reconstruction methods, while the normalized mean square error (NMSE) and structural similarity index measure (SSIM) were higher markedly than the values of the other two reconstruction methods. The diagnostic rate of routine MRI examination of the fallopian tube and other parts of the uterus was lower than or equal to that of MR-HSG examination by CNN. Routine MRI examinations of fallopian tube imaging artifacts were large, and the definition was reduced, which increased the difficulty of identification. However, MR-HSG examination by CNN indicated that the imaging artifacts were low, the clarity was high, and the influence of noise was small, which was conducive to clinical diagnosis and identification. For endometriosis, the accuracy of MR-HSG was 33.33% and the accuracy of MRI was 46.67%. CNN MR-HSG inspection method was significantly better than the conventional MRI inspection method (P < 0.05). Therefore, the results of this study revealed that MR-HSG examination by CNN had a clear imaging effect and obvious inhibition effect on background signals and rapid image generation without the need for reconstruction with the same spatial resolution, which improved the imaging quality and could provide a reference value for clinical diagnosis and subsequent related studies.

Extracellular Vesicles and the Oviduct Function

In mammals, the oviduct (or the Fallopian tube in humans) can be divided into the infundibulum (responsible for oocyte pick-up), ampulla (site of fertilization), isthmus (where preimplantation embryos develop), and uterotubal junction (where embryos transit to the uterus). The oviductal fluid, as well as extracellular vesicles produced from the oviduct epithelial cells, referred to as oEVs, have been shown to improve the fertilization process, prevent polyspermy, and aid in embryo development. oEVs contain molecular cargos (such as miRNAs, mRNAs, proteins, and lipids) that can be delivered and fuse to recipient cells. oEVs produced from the ampulla appear to be functionally distinct from those produced from the isthmus. In multiple species including mice, cats, dogs, pigs, and cows, oEVs can be incorporated into the oocytes, sperm, and embryos. In this review, we show the positive impact of oEVs on gamete function as well as blastocyst development and how they may improve embryo quality in in vitro conditions in an assisted reproductive technology setting for rodents, domestic animals, farm animals, and humans.

Difficult Embryo Transfer: A Systematic Review

We performed a systematic review on the clinical epidemiology and outcome of difficult embryo transfers (ETs) in infertility patients who present with difficult ET. We searched PubMed, ScienceDirect, and Elsevier journals from 1980 to June 2017. We aimed to determine the most successful method resulting in highest pregnancy rates (PRs) in patients with difficult ET. We identified 50 articles, in which 36 were reviewed and 15 were included. Analysis of the data collected showed that the majority of the difficult ETs were caused by cervical stenosis and the most common treatment was cervical dilation. We concluded that cervical dilation was effective at managing difficult ET. Hegar dilators used a minimum of 3 weeks before ET showed to have higher PR.

Zygote intrafallopian tube transfer versus intrauterine cleavage or blastocyst stage transfer after intracytoplasmic sperm injection cycles in patients with repeated implantation failure: A prospective follow-up study

AIM

This study aimed to compare the outcomes between zygote intrafallopian transfer (ZIFT) with intrauterine day-3 (cleavage stage) embryo transfer and intrauterine day-5 (blastocyst stage) embryo transfer in patients undergoing intracytoplasmic sperm injection.

MATERIAL AND METHODS

This prospective study was performed at Royan Institute, Tehran, Iran, between January 2012 and January 2014. Two hundred fifty women with more than three unexplained implantation failures were divided non-randomly into three groups according to embryonic age and methods used as follows: (i) intrauterine cleavage-stage embryo transfer (n = 100); (ii) intrauterine blastocyst-stage embryo transfer (n = 50); and (iii) ZIFT (n = 100). Implantation, clinical pregnancy, miscarriage and live birth rates were our main outcomes.

RESULTS

Patients' characteristics and ovarian response were comparable among the three groups. Implantation rate (56.1% vs 27.9%) was significantly higher in the blastocyst group as compared to the ZIFT group; however, clinical pregnancy rate (38% vs 23%) was not statistically significantly different between the two groups, but due to the significantly higher miscarriage rate (34.7% vs 5.3%) in the ZIFT group, the live birth rate was significantly higher in the blastocyst group (P = 0.04). No significant differences were found between the cleavage-stage and blastocyst-stage groups in terms of implantation, clinical pregnancy, miscarriage and live birth rates.

CONCLUSION

We do not recommend the use of the ZIFT procedure for patients with repeated implantation failures. It seems that replication of cleavage- or blastocyst-stage embryo transfer is more efficient and affordable.

Advanced scheduling for zygote intrafallopian transfer is possible via the use of a hormone replacement cycle for patients who have experienced repeated implantation failures

PURPOSE

Zygote intrafallopian transfer (ZIFT) is an effective option for patients who have experienced repeated implantation failures (RIF) in assisted reproductive technology (ART) treatment. However, advance planning for the day of the operation can be problematic. Using a hormone replacement cycle (HRC) makes it possible to plan for the day of ZIFT. In the present study, we evaluated whether HRC-ZIFT is useful for RIF patients who have experienced difficulties obtaining morphologically good embryos in vitro.

METHODS

A total of 55 patients with a history of five or more unsuccessful transfers received HRC-ZIFT between June 2008 and June 2013. The oocyte pick-ups were performed and the oocytes showing two pronuclei (2PN) were cryopreserved. After receiving more than five 2PN oocytes, the operation day was scheduled in advance, and as a consequence, a HRC was started and ZIFT was performed. The clinical outcomes were evaluated.

RESULTS

The average age of the patients was 39.3 years, and the previous OPU and ET attempts numbered 7.5 and 6.9, respectively. The number of previously transferred embryos was 11.8, and the number of morphologically good embryos (MGEs) was only 1.2. The number of transferred 2PN oocytes was 6.7, and the subsequent pregnancy rate was 23.6 %. No ectopic or multiple pregnancies were observed, but there were 6 cases of miscarriage.

CONCLUSION

Among RIF patients, in particular those who have difficulty obtaining MGEs in vitro, ZIFT might be a useful option. The HRC allows patients and medical staff to plan for the operation day in advance.

Assessment and treatment of repeated implantation failure (RIF)

Repeated implantation failure (RIF) is determined when embryos of good quality fail to implant following several in vitro fertilization (IVF) treatment cycles. Implantation failure is related to either maternal factors or embryonic causes. Maternal factors include uterine anatomic abnormalities, thrombophilia, non-receptive endometrium and immunological factors. Failure of implantation due to embryonic causes is associated with either genetic abnormalities or other factors intrinsic to the embryo that impair its ability to develop in utero, to hatch and to implant. New methods of time-lapse imaging of embryos and assessment of their metabolic functions may improve selection of embryos for transfer, and subsequent outcomes for IVF patients, as well as for those diagnosed with RIF. This review discusses the various causes associated with RIF and addresses appropriate treatments.

Successful pregnancy in vitrified/warmed blastocyst intrafallopian transfer

OBJECTIVE

To analyze whether the use of blastocyst intrafallopian transfer is a feasible option in a case of repeated difficult ET.

DESIGN

Case report.

SETTING

Public hospital.

PATIENT(S)

Forty-year old nulliparous patient.

INTERVENTION(S)

Transfer of two vitrified/warmed blastocysts into the right tube by means of laparoscopy.

MAIN OUTCOME MEASURE(S)

Successful ET, clinical pregnancy.

RESULT(S)

Successful ET procedure resulting in positive ß-hCG and clinical pregnancy.

CONCLUSION(S)

In cases of repeated difficult ETs (regardless of whether the patient shows cervical adhesions or any type of genital malformations), blastocyst intrafallopian transfer can be a successful alternative approach.

Repeated implantation failure: clinical approach

Successful embryo implantation depends on a well-functioning endometrium as well as a normal healthy embryo. This process might be hampered if either of these variables is defective. Repeated implantation failure (RIF) is diagnosed when good-quality embryos repeatedly fail to implant after transfer in several IVF treatment cycles. The causes of RIF originate with either the mother or the embryo. The authors discuss factors that are associated with RIF and address various treatment options.

Comparison of unilateral and bilateral transfer of injected oocytes into fallopian tubes: a prospective, randomized clinical trial

OBJECTIVE

To assess whether pregnancy rate differs in unilateral vs. bilateral transfer in "immediate transfer of injected oocytes into the fallopian tubes."

DESIGN

Prospective randomized clinical trial.

SETTING

Tertiary university hospital.

PATIENT(S)

The study population included 160 patients presenting with male factor infertility who fulfilled the criteria for immediate transfer of injected oocytes into tubes.

INTERVENTION(S)

Four injected oocytes were transferred into two tubes (study group) or one tube (control group).

MAIN OUTCOME MEASURE(S)

Implantation rate, clinical pregnancy rate, multiple pregnancy rate, and incidence of pregnancy with unknown location (PUL).

RESULT(S)

A total of 72 (45%) pregnancies were achieved. There were 32 pregnancies (1 PUL, 4 multiple, and 27 singletons) in the bilateral transfer group and 40 pregnancies in the unilateral transfer group (1 PUL, 7 multiple, and 32 singletons). No significant difference was found in the implantation rate, clinical pregnancy rate, multiple pregnancy rate, and incidence of PUL.

CONCLUSION(S)

This study demonstrates that no difference in outcome occurred between unilateral and bilateral transfer in microinjected oocytes intrafallopian transfer (MIFT). Therefore, along with the same outcome parameters, unilateral transfer is the preferred method of MIFT.

Comparison of zygote intrafallopian tube transfer and transcervical uterine embryo transfer in patients with repeated implantation failure

OBJECTIVE

This study was designed to evaluate the role of zygote intrafallopian transfer (ZIFT) procedure in patients with repeated failure of implantation.

STUDY DESIGN

A total of 141 ZIFT cycles of 132 women and 145 embryo transfer (ET) cycles of 97 women in whom five or more embryos were transferred were included in this study. Transcervical uterine embryo transfer and ZIFT cycle outcome in patients with five or more previous implantation failure were compared. Embryos were transferred by laparoscopy into the fallopian tube 24-27 h following oocytes retrieval in the ZIFT group. In the ET group, embryos were transferred transcervically on the third day following oocytes retrieval.

RESULTS

The mean age was 34+/-4.9 and 34.9+/-5.0 years in ZIFT and ET group, respectively. No difference was determined between the two groups regarding the basal FSH, E2 value on the day of HCG injection and the number of oocytes retrieved or fertilized. The implantation rate was 6.5% versus 7.2%, clinical pregnancy rate was 22.7% versus 24.8% and live birth rate was 21.2% versus 16.5% in ZIFT and ET groups, respectively.

CONCLUSIONS

Implementation of ZIFT procedure in patients with repeated implantation failure is not superior to transcervical uterine embryo transfer.

Investigation and current management of recurrent IVF treatment failure in the UK

OBJECTIVE

To determine current practice in the management of recurrent in vitro fertilisation (IVF) treatment failure in licensed UK infertility centres.

DESIGN

National postal questionnaire study and literature review.

SETTING

University Hospital, Centre for Reproductive Medicine, Coventry, UK.

SAMPLE

Human Fertilisation and Embryology Authority licensed centres providing IVF/intracytoplasmic sperm injection (ICSI) in the UK (n = 79).

METHODS

A survey was designed that sought to determine how recurrent treatment failure was defined and which, if any, investigations were initiated. Furthermore, we asked which therapeutic options were subsequently recommended.

MAIN OUTCOME MEASURES

Definition of recurrent treatment failure. Investigations undertaken. Clinical or embryology changes recommended following recurrent treatment failure.

RESULTS

The response rate was 82%. The most common definition was three unsuccessful IVF cycles (range 2-6). Nineteen percent included frozen embryo replacements (FERs) in this figure. Anticardiolipin antibodies and lupus anticoagulant were the most frequent investigations suggested, followed by hysteroscopy and karyotype. A majority of centres would use a different treatment strategy in a subsequent cycle with blastocyst culture and assisted hatching being most popular.

CONCLUSIONS

The results of this survey suggest that there is considerable variation in the approach to investigation and management of recurrent IVF treatment failure in the UK, although in some areas (e.g. the definition) there was broad concordance. Not all of these approaches are evidence based.

Recurrent implantation failure in assisted reproduction: how to counsel and manage. B. Treatment options that have not been proven to benefit the couple

The success of assisted reproduction, although gradually increasing over the years, is still less than satisfactory. Many couples have benefited from this treatment; however, many have also been left frustrated following multiple failed attempts. Couples who fail to conceive after multiple IVF/intracytoplasmic sperm injection (ICSI) treatments often seek treatment options that are new and that have not been offered before. Some of these include immunological testing and treatment, allogenic lymphocyte therapy, intratubal transfer of zygotes and embryos, blastocyst transfer, sequential embryo transfer, assisted hatching, co-cultures, and preimplantation genetic screening for aneuploidy. Although the evidence behind some of these is more robust, most suffer from lack of well designed randomized trials comparing them with other treatment options. Randomized studies are extremely difficult to conduct, as couples will resist being randomized into a treatment group where previously failed procedures will be repeated. In the mean time, assisted reproduction programmes should resist offering treatment options that are not evidence based, or at least they should share with the couple the information that is available and should stress that none of these is a panacea for their problem.

Prospective evaluation of blastocyst stage transfer vs. zygote intrafallopian tube transfer in patients with repeated implantation failure

OBJECTIVE

To compare extended culture with blastocyst stage transfer and zygote intrafallopian transfer (ZIFT) in the management of IVF patients with repeated implantation failure.

DESIGN

Prospective, nonrandomized study.

SETTING

An IVF unit at a university hospital.

PATIENT(S)

Sixty-four infertile patients with more than three previous failed IVF-ET attempts.

INTERVENTION(S)

Patients were allocated to undergo either blastocyst stage transfer (Group 1; n = 32) or ZIFT (Group 2; n = 32).

MAIN OUTCOME MEASURE(S)

Implantation, clinical pregnancy, and live birth rates.

RESULT(S)

Patient characteristics and response to stimulation were comparable for both groups. Totals of 84.3% and 97% of the patients underwent blastocyst transfer and ZIFT, respectively. Significantly more embryos were transferred through ZIFT (5.5+/-0.8) as compared with blastocyst transfer (2.3+/-1.4), and there were significantly more cycles with embryo cryopreservation in the ZIFT group as compared to the blastocyst transfer group (15/32 vs. 4/32, respectively). Implantation rate (13.6% vs. 1.4%), clinical pregnancy rate (40.6% vs. 3.1%), and live birth rates (38.7% vs. 0%) were all significantly higher in the ZIFT group as compared to the blastocyst transfer group, respectively.

CONCLUSION(S)

Zygote intrafallopian transfer is a powerful clinical tool in the management of patients with RIF. In contrast, blastocyst stage transfer fails to improve the outcome in this poor-prognosis group. The pathophysiology of RIF should be the subject of intense investigation to allow the introduction of appropriate therapeutic measures earlier in the course of treatment.