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Clua E, Rodríguez I, Arroyo G, Racca A, Martínez F, Polyzos N. Blastocyst transfer increases cumulative-live-birth-rates and reduces time and cost to livebirth compared with cleavage stage in recipients of donated oocytes. A randomized controlled trial. Reprod Biomed Online 2022; 44:995-1004. [DOI: 10.1016/j.rbmo.2022.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 12/17/2021] [Accepted: 01/05/2022] [Indexed: 11/16/2022]
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2
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Li Y, Liu S, Lv Q. Single blastocyst stage versus single cleavage stage embryo transfer following fresh transfer: A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2021; 267:11-17. [PMID: 34689021 DOI: 10.1016/j.ejogrb.2021.10.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 08/15/2021] [Accepted: 10/03/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To compare the available evidence of the effectiveness of single blastocyst stage transfer against the effectiveness of single cleavage stage embryo transfer. STUDY DESIGN A systematic research based on Pubmed, Embase and the Cochrane Library was performed until May 2, 2020 to identify all relevant studies. The Cochrane Collaboration's Review Manager (RevMan) 5.0.2 software was used for statistical analysis. RESULTS Five randomized controlled trials (RCTs) were included in analysis, involving 1784 patients in total, who were divided into 2 groups, which were the single blastocyst stage transfer (SBT) group of 932, and the single cleavage stage transfer (SCT) group of 852. Our meta-analysis concluded that SBT group had a significantly higher clinical pregnancy rate (RR 1.26; 95%CI: 1.14-1.39), ongoing pregnancy rate (RR 1.19; 95%CI: 1.05-1.35) and delivery rate (RR 1.4; 95%CI: 1.13-1.75) than SCT group during the fresh transfer. While miscarriage rate (RR 0.93; 95% CI: 0.66-1.33), multiple pregnancy rate (RR, 1.12; 95% CI, 0.51-2.45) and ectopic pregnancy rate (RR, 0.5; 95% CI: 0.13-1.90) between two groups showed no significant difference. However, the SCT group contained notably more cryopreserved embryos than the SBT group. (RR -0.68, 95% CI: -0.95 to -0.41). CONCLUSIONS Our results indicate that single blastocyst stage transfer is associated with higher ongoing pregnancy rate and delivery rate comparing to single cleavage stage transfer in the clinical practice. Due to the low quality of the evidence of the primary outcomes, other higher-quality lager RCTs are necessary before a fully informed decision is made.
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Affiliation(s)
- Yutao Li
- Department of Assisted Reproduction Center, Eastern Hospital, Sichuan Academy of Medical Science & Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu 610101, China.
| | - Siqiao Liu
- Department of Urology, Sichuan Academy of Medical Science & Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu 611731, China
| | - Qun Lv
- Department of Assisted Reproduction Center, Eastern Hospital, Sichuan Academy of Medical Science & Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu 610101, China
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3
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Hsieh HC, Lee CI, Lai EY, Su JY, Huang YT, Zheng WL, Chen CH, Huang CC, Lin PY, Lee MS, Liu M, Huang YT. Estimating the causal effect of embryo transfer day on clinical in vitro fertilization outcomes using propensity score matching. BMC Pregnancy Childbirth 2021; 21:554. [PMID: 34388966 PMCID: PMC8364091 DOI: 10.1186/s12884-021-04013-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 07/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND For women undergoing in vitro fertilization (IVF), the clinical benefit of embryo transfer at the blastocyst stage (Day 5) versus cleavage stage (Day 3) remains controversial. The purpose of this study is to compare the implantation rate, clinical pregnancy rate and odds of live birth of Day 3 and Day 5 embryo transfer, and more importantly, to address the issue that patients were chosen to receive either transfer protocol due to their underlying clinical characteristics, i.e., confounding by indication. METHODS We conducted a retrospective cohort study of 9,090 IVF cycles collected by Lee Women's Hospital in Taichung, Taiwan from 1998 to 2014. We utilized the method of propensity score matching to mimic a randomized controlled trial (RCT) where each patient with Day 5 transfer was matched by another patient with Day 3 transfer with respect to other clinical characteristics. Implantation rate, clinical pregnancy rate, and odds of live birth were compared for women underwent Day 5 transfer and Day 3 transfer to estimate the causal effects. We further investigated the causal effects in subgroups by stratifying age and anti-Mullerian hormone (AMH). RESULTS Our analyses uncovered an evidence of a significant difference in implantation rate (p=0.04) favoring Day 5 transfer, and showed that Day 3 and Day 5 transfers made no difference in both odds of live birth (p=0.27) and clinical pregnancy rate (p=0.11). With the increase of gestational age, the trend toward non-significance of embryo transfer day in our result appeared to be consistent for subgroups stratified by age and AMH, while all analyses stratified by age and AMH were not statistically significant. CONCLUSIONS We conclude that for women without strong indications for Day 3 or Day 5 transfer, there is a small significant difference in implantation rate in favor of Day 5 transfer. However, the two protocols have indistinguishable outcomes on odds of live birth and clinical pregnancy rate.
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Affiliation(s)
- Han-Chih Hsieh
- Institute of Statistical Science, Academia Sinica, No. 128 Academia Road, Taipei, 11529, Taiwan
| | - Chun-I Lee
- Institute of Medicine, Chung Shan Medical University, No.110,Sec.1,Jianguo N.Rd., Taichung, 40201, Taiwan.,Department of Obstetrics and Gynecology, Chung Shan Medical University, No.110,Sec.1,Jianguo N.Rd., Taichung, 40201, Taiwan.,Division of Infertility, Lee Women's Hospital, No. 30-6, Section 1, Changping Road, Taichung, 406, Taiwan
| | - En-Yu Lai
- Institute of Statistical Science, Academia Sinica, No. 128 Academia Road, Taipei, 11529, Taiwan
| | - Jia-Ying Su
- Institute of Statistical Science, Academia Sinica, No. 128 Academia Road, Taipei, 11529, Taiwan
| | - Yi-Ting Huang
- Institute of Statistical Science, Academia Sinica, No. 128 Academia Road, Taipei, 11529, Taiwan.,Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Room 501, No. 17, Xu-Zhou Road, Taipei, 100, Taiwan
| | - Wei-Lin Zheng
- Binflux Inc, 4F.-1, No. 9, Dehui St., Taipei, 104, Taiwan
| | - Chien-Hong Chen
- Division of Infertility, Lee Women's Hospital, No. 30-6, Section 1, Changping Road, Taichung, 406, Taiwan
| | - Chun-Chia Huang
- Division of Infertility, Lee Women's Hospital, No. 30-6, Section 1, Changping Road, Taichung, 406, Taiwan
| | - Pin-Yao Lin
- Division of Infertility, Lee Women's Hospital, No. 30-6, Section 1, Changping Road, Taichung, 406, Taiwan
| | - Maw-Sheng Lee
- Institute of Medicine, Chung Shan Medical University, No.110,Sec.1,Jianguo N.Rd., Taichung, 40201, Taiwan.,Department of Obstetrics and Gynecology, Chung Shan Medical University, No.110,Sec.1,Jianguo N.Rd., Taichung, 40201, Taiwan.,Division of Infertility, Lee Women's Hospital, No. 30-6, Section 1, Changping Road, Taichung, 406, Taiwan
| | - Mark Liu
- Binflux Inc, 4F.-1, No. 9, Dehui St., Taipei, 104, Taiwan
| | - Yen-Tsung Huang
- Institute of Statistical Science, Academia Sinica, No. 128 Academia Road, Taipei, 11529, Taiwan.
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4
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Romanelli V, Poli M, Capalbo A. Preimplantation genetic testing in assisted reproductive technology. Panminerva Med 2018; 61:30-41. [PMID: 29962185 DOI: 10.23736/s0031-0808.18.03506-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Preimplantation genetic testing is a methodology aimed at the assessment of the genetic composition of an embryo. This diagnostic approach has been used in assisted reproduction for almost thirty years. During these years, the technologies used for embryo's genetic analysis have been continuously improved allowing the development of more precise, comprehensive and robust strategies that are clinically employed nowadays. In this review, the main diagnostic approaches used for embryo genetic and chromosomal assessment are described and discussed both from an embryological and genetic standpoint.
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Affiliation(s)
| | - Maurizio Poli
- Igenomix, Marostica, Vicenza, Italy.,Reproomics, Amsterdam, The Netherlands
| | - Antonio Capalbo
- Igenomix, Marostica, Vicenza, Italy - .,Section of Histology and Embryology, Department of Musculoskeletal Anatomy, Histology, and Legal Medicine, Sapienza University, Rome, Italy
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5
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Holden EC, Kashani BN, Morelli SS, Alderson D, Jindal SK, Ohman-Strickland PA, McGovern PG. Improved outcomes after blastocyst-stage frozen-thawed embryo transfers compared with cleavage stage: a Society for Assisted Reproductive Technologies Clinical Outcomes Reporting System study. Fertil Steril 2018; 110:89-94.e2. [PMID: 29908769 DOI: 10.1016/j.fertnstert.2018.03.033] [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] [Received: 12/22/2017] [Revised: 03/02/2018] [Accepted: 03/19/2018] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To investigate whether there is a difference in obstetrical and perinatal outcomes in blastocyst frozen-thawed embryo transfers (FETs) compared with cleavage-stage FET. DESIGN A retrospective cohort study. SETTING Not applicable. PATIENT(S) Women undergoing autologous FETs at either the blastocyst stage (n = 118,572) or the cleavage stage (n = 117,619) reported to the Society for Assisted Reproductive Technology in the years 2004-2013. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Live birth, gestational age, birth weight, miscarriage. RESULT(S) After controlling for confounders, there were a 49% increased odds of live birth after blastocyst-stage FET compared with cleavage-stage FET (odds ratio [OR] = 1.49; 95% confidence interval [CI], 1.44, 1.54). Additionally, blastocyst FET was associated with a 68% (OR = 1.68; 95% CI, 1.63, 1.74) increased odds of clinical pregnancy and an 7% (OR = 0.93; 95% CI, 0.88, 0.92) decreased odds of miscarriage. There was also a 16% increased odds of preterm delivery (OR = 1.16; 95% CI, 1.06, 1.27) after blastocyst FET but no difference in birth weights. CONCLUSION(S) In patients undergoing FET, blastocyst-stage transfer is associated with higher live-birth rates when compared with cleavage-stage transfers. Furthermore, perinatal outcomes are similar between the groups.
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Affiliation(s)
- Emily C Holden
- Obstetrics, Gynecology and Women's Health, Rutgers-New Jersey Medical School, Newark, New Jersey.
| | - Banafsheh N Kashani
- Obstetrics, Gynecology and Women's Health, Rutgers-New Jersey Medical School, Newark, New Jersey
| | - Sara S Morelli
- Obstetrics, Gynecology and Women's Health, Rutgers-New Jersey Medical School, Newark, New Jersey; University Reproductive Associates, Hasbrouck Heights, New Jersey
| | - Donald Alderson
- Rutgers University Biostatistics and Epidemiology Services Center, Rutgers University, Newark, New Jersey
| | - Sangita K Jindal
- Montefiore's Institute for Reproductive Medicine and Health, Hartsdale, New York
| | | | - Peter G McGovern
- Obstetrics, Gynecology and Women's Health, Rutgers-New Jersey Medical School, Newark, New Jersey; University Reproductive Associates, Hasbrouck Heights, New Jersey
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6
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Azzarello A, Hoest T, Hay-Schmidt A, Mikkelsen AL. Live birth potential of good morphology and vitrified blastocysts presenting abnormal cell divisions. Reprod Biol 2017; 17:144-150. [DOI: 10.1016/j.repbio.2017.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 03/03/2017] [Accepted: 03/19/2017] [Indexed: 11/16/2022]
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7
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Martins WP, Nastri CO, Rienzi L, van der Poel SZ, Gracia C, Racowsky C. Blastocyst vs cleavage-stage embryo transfer: systematic review and meta-analysis of reproductive outcomes. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2017; 49:583-591. [PMID: 27731533 DOI: 10.1002/uog.17327] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 10/04/2016] [Indexed: 05/26/2023]
Abstract
OBJECTIVES Blastocyst transfer in assisted reproduction techniques could be advantageous because the timing of exposure of the embryo to the uterine environment is more analogous to a natural cycle and permits embryo self-selection after activation of the embryonic genome on day 3. Conversely, the in-vitro environment is likely to be inferior to that in vivo, and in-vitro culture beyond embryonic genomic activation could potentially harm the embryo. Our objective was to identify, appraise and summarize the available evidence comparing the effectiveness of blastocyst vs cleavage-stage embryo transfer. METHODS This was a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing the transfer of blastocysts (days 5-6) with the transfer of cleavage-stage embryos (days 2-3) in women undergoing in-vitro fertilization or intracytoplasmic sperm injection. The last electronic searches were run on 1 August 2016. Abstracts and studies with a mean difference between the two study groups of > 0.5 for the number of embryos transferred were excluded. RESULTS We screened 1187 records and assessed 33 potentially eligible studies. Twelve studies were included, comprising a total of 1200 women undergoing blastocyst transfer and 1218 undergoing cleavage-stage embryo transfer. We observed low-quality evidence of no significant difference of blastocyst transfer on live birth/ongoing pregnancy (relative risk (RR), 1.11 (95% CI, 0.92-1.35), 10 RCTs, 1940 women, I2 = 54%), clinical pregnancy (RR, 1.10 (95% CI, 0.93-1.31), 12 RCTs, 2418 women, I2 = 64%), cumulative pregnancy (RR, 0.89 (95% CI, 0.67-1.16), four RCTs, 524 women, I2 = 63%) and miscarriage (RR, 1.08 (95% CI, 0.74-1.56), 10 RCTs, 763 pregnancies, I2 = 0%). There was moderate-quality evidence of a decrease in the number of women with surplus embryos after the blastocyst-stage embryo transfer (RR, 0.78 (95% CI, 0.66-0.91)). Overall, the quality of the evidence was limited by the quality of the included studies and by unexplained inconsistency across studies. CONCLUSIONS Current evidence shows no superiority of blastocyst compared with cleavage-stage embryo transfer in clinical practice. As the quality of the evidence for the primary outcomes is low, additional well-designed RCTs are still needed before robust conclusions can be drawn. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- W P Martins
- SEMEAR Fertilidade, Reproductive Medicine, Ribeirão Preto, Brazil
- Department of Obstetrics and Gynecology, Ribeirão Preto Medical School, University of Sao Paulo, Ribeirão Preto, Brazil
| | - C O Nastri
- SEMEAR Fertilidade, Reproductive Medicine, Ribeirão Preto, Brazil
| | - L Rienzi
- GENERA Centre for Reproductive Medicine, Clinica Valle Giulia, Rome, Italy
| | - S Z van der Poel
- HRP (the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction), Geneva, Switzerland
- Population Council, Reproductive Health Program, New York, NY, USA
| | - C Gracia
- Division of Reproductive Endocrinology, University of Pennsylvania, Philadelphia, PA, USA
| | - C Racowsky
- Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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8
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De Vos A, Van Landuyt L, Santos-Ribeiro S, Camus M, Van de Velde H, Tournaye H, Verheyen G. Cumulative live birth rates after fresh and vitrified cleavage-stage versus blastocyst-stage embryo transfer in the first treatment cycle. Hum Reprod 2016; 31:2442-2449. [DOI: 10.1093/humrep/dew219] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 07/04/2016] [Accepted: 08/04/2016] [Indexed: 11/13/2022] Open
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9
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Sifer C. [Culture to blastocyst-stage: Is it valid to observe cleaved embryos? Yes]. GYNECOLOGIE, OBSTETRIQUE & FERTILITE 2016; 44:441-443. [PMID: 27451062 DOI: 10.1016/j.gyobfe.2016.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 05/29/2016] [Indexed: 06/06/2023]
Affiliation(s)
- C Sifer
- Service d'histologie-embryologie-cytogénétique, CECOS, CHU Jean-Verdier, AP-HP, avenue du 14-Juillet, 93143 Bondy, France.
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10
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Basile N, Vime P, Florensa M, Aparicio Ruiz B, García Velasco J, Remohí J, Meseguer M. The use of morphokinetics as a predictor of implantation: a multicentric study to define and validate an algorithm for embryo selection. Hum Reprod 2014; 30:276-83. [DOI: 10.1093/humrep/deu331] [Citation(s) in RCA: 141] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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11
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Fernández-Shaw S, Cercas R, Braña C, Villas C, Pons I. Ongoing and cumulative pregnancy rate after cleavage-stage versus blastocyst-stage embryo transfer using vitrification for cryopreservation: impact of age on the results. J Assist Reprod Genet 2014; 32:177-84. [PMID: 25403438 DOI: 10.1007/s10815-014-0387-9] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 11/04/2014] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To determine if blastocyst transfer increases the ongoing and cumulative pregnancy rates, compared with day 3 embryo transfer, in women of all ages when at least 4 zygotes are obtained. METHODS Prospective study including patients undergoing a first IVF/ICSI treatment and assigned to cleavage stage (n = 46) or blastocyst (n = 58) embryo transfer. Supernumerary embryos were vitrified and patients failing to achieve an ongoing pregnancy after fresh embryo transfer would go through cryopreserved cycles. The main outcome measure was the ongoing pregnancy rate after the fresh IVF/ICSI transfer and the cumulative ongoing pregnancy rate. Results were also analyzed according to age (under 35 and 35 or older). RESULTS A majority of patients (96.6 %) had a blastocyst transfer when at least 4 zygotes were obtained. The ongoing pregnancy rate was significantly higher in the day-5 group compared with the day-3 group (43.1 % vs. 24 %, p = 0.041). The cumulative ongoing pregnancy rate was higher (but not significantly) with blastocyst than with cleavage stage embryos (56.8 % vs. 43.4 %, p = 0.174). When analysed by age, patients 35 or older showed significantly higher ongoing pregnancy rate (48.4 % vs. 19.3 %, p = 0.016) and cumulative ongoing pregnancy rate (58 % vs. 25.8 %, p = 0.01) in the day-5 group compared to the day-3 group, while no such differences were observed in women under 35. CONCLUSIONS Blastocyst transfer can be suggested whenever there are at least 4 zygotes. While there are no differences in women under 35, the benefit of this option over cleavage stage transfer could be significant in women 35 or older.
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12
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Sifer C. [Contribution of embryo vitrification procedure to ART efficiency]. ACTA ACUST UNITED AC 2014; 42:721-4. [PMID: 25192924 DOI: 10.1016/j.gyobfe.2014.07.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 05/26/2014] [Indexed: 11/27/2022]
Abstract
This work aims to show, from data available in the literature and our own experience, how embryos' vitrification change and/or improve the management of infertile couples. In all, 652 cycles of frozen-thawed embryo transfers (FET) following vitrification were prospectively included and compared with 1126 FETs from slow freezing (SF) method. Primary end points were the (i) survival rate (SR) (% of embryos with>50% post-thaw intact blastomeres) and (ii) intact survival rate (ISR) (% of embryos with 100% post-thaw intact blastomeres). Secondary end point was the clinical pregnancy rate (CPR) defined as the presence of an intra uterine gestational sac with positive foetal heart beat. In all, 1097 and 2408 embryos have been thawed following vitrification and SF, respectively. We observed a highly significant increase of SR and ISR respectively when thawing concerned vitrified embryos rather than those from SF method (97.0% vs. 72.7%, P<10(-4); 91.5% vs. 49.8%, P<10(-4)). Furthermore, CPR were of 26.5% (73/652) and of 18.1% (204/1126) following FETs performed after vitrification or SF and thawing (P=0.0002), respectively. At the blastocyst stage, ISR was significantly improved following vitrification compared to SF (94.5% vs. 21.4%, P<10(-4)). In the study period, vitrification (i) reduced the mean number of fresh transferred embryos (1.5 vs. 1.6; P=0.08) and (ii) increased the rate of FETs at the blastocyst stage when compared with the control period (18.1% vs 2.5%., P<10(-4)). Embryo vitrification preserves all embryos from an ART cycle because of its excellent results regarding ISR at all stages of embryo development. This procedure allows a significant increase of pregnancy rates after thawing. In addition, there is a trend for increasing ART cycles performed using extended culture embryo and vitrification. The expected improvement of the cumulative birth rate at the blastocyst stage following vitrification remains to be demonstrated in a prospective randomized study.
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Affiliation(s)
- C Sifer
- Service d'histologie-embryologie-cytogénétique-CECOS, centre hospitalier universitaire Jean-Verdier, Assistance Publique-Hôpitaux de Paris, 93140 Bondy, France.
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La morphologie embryonnaire a-t-elle encore un intérêt à l’heure actuelle ? ACTA ACUST UNITED AC 2014; 42:661-4. [DOI: 10.1016/j.gyobfe.2014.07.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 07/18/2014] [Indexed: 11/30/2022]
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14
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[How can we nowadays select the best embryo to transfer?]. ACTA ACUST UNITED AC 2014; 42:515-25. [PMID: 24951187 DOI: 10.1016/j.gyobfe.2014.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Accepted: 04/29/2014] [Indexed: 11/20/2022]
Abstract
Multiple pregnancies stand as the most common adverse outcome of assisted reproduction technologies (ART) and the dangers associated with those pregnancies have been reduced by doing elective single embryo transfers (e-SET). Many studies have shown that e-SET is compatible with a continuously high pregnancy rate per embryo transfer. Yet, it still becomes necessary to improve the selection process in order to define the quality of individual embryos - so that the ones we choose for transfer are more likely to implant. First, analysis of embryo morphology has greatly helped in this identification and remains the most relevant criterion for choosing the embryo. The introduction of time-lapse imaging provides new criteria predictive of implantation potential, but the real contribution of this system - including the benefit/cost ratio - seems to be not yet properly established. In this context, extended culture until blastocyst stage is an essential practice but it appears wise to keep it for a population showing a good prognosis. Then, the failure of aneuploid embryos to implant properly led to achieve preimplantation genetic screening (PGS) in order to increase pregnancy and delivery rates after ART. However, PGS by fluorescence in situ hybridization (FISH) at day 3 is a useless process - and may even be harmful. Another solution involves using comparative genomic hybridisation (CGH) and moving to blastocyst biopsy. Finally, it is envisaged that morphology will also be significantly aided by non-invasive analysis of biomarkers in the culture media that give a better reflection of whole-embryo physiology and function.
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Absalón-Medina VA, Butler WR, Gilbert RO. Preimplantation embryo metabolism and culture systems: experience from domestic animals and clinical implications. J Assist Reprod Genet 2014; 31:393-409. [PMID: 24682781 PMCID: PMC3969471 DOI: 10.1007/s10815-014-0179-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 01/17/2014] [Indexed: 01/09/2023] Open
Abstract
Despite advantages of in vitro embryo production in many species, widespread use of this technology is limited by generally lower developmental competence of in vitro derived embryos compared to in vivo counterparts. Regardless, in vivo or in vitro gametes and embryos face and must adjust to multiple microenvironments especially at preimplantation stages. Moreover, the embryo has to be able to further adapt to environmental cues in utero to result in the birth of live and healthy offspring. Enormous strides have been made in understanding and meeting stage-specific requirements of preimplantation embryos, but interpretation of the data is made difficult due to the complexity of the wide array of culture systems and the remarkable plasticity of developing embryos that seem able to develop under a variety of conditions. Nevertheless, a primary objective remains meeting, as closely as possible, the preimplantation embryo requirements as provided in vivo. In general, oocytes and embryos develop more satisfactorily when cultured in groups. However, optimization of individual culture of oocytes and embryos is an important goal and area of intensive current research for both animal and human clinical application. Successful culture of individual embryos is of primary importance in order to avoid ovarian superstimulation and the associated physiological and psychological disadvantages for patients. This review emphasizes stage specific shifts in embryo metabolism and requirements and research to optimize in vitro embryo culture conditions and supplementation, with a view to optimizing embryo culture in general, and culture of single embryos in particular.
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Affiliation(s)
- V. A. Absalón-Medina
- Department of Animal Science, College of Agricultural Life Sciences, Cornell University, Ithaca, NY 14853 USA
| | - W. R. Butler
- Department of Animal Science, College of Agricultural Life Sciences, Cornell University, Ithaca, NY 14853 USA
| | - R. O. Gilbert
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853 USA
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16
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Bhattacharya S, Kamath MS. Reducing multiple births in assisted reproduction technology. Best Pract Res Clin Obstet Gynaecol 2014; 28:191-9. [DOI: 10.1016/j.bpobgyn.2013.11.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 11/26/2013] [Indexed: 10/25/2022]
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17
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Guerif F, McKeegan P, Leese HJ, Sturmey RG. A simple approach for COnsumption and RElease (CORE) analysis of metabolic activity in single mammalian embryos. PLoS One 2013; 8:e67834. [PMID: 23967049 PMCID: PMC3744531 DOI: 10.1371/journal.pone.0067834] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Accepted: 05/22/2013] [Indexed: 11/18/2022] Open
Abstract
Non-invasive assay of the consumption and release of metabolites by individual human embryos could allow selection at the cleavage stage of development and facilitate Single Embryo Transfer in clinical IVF but will require simple, high throughput, sensitive methods applicable to small volume samples. A rapid, simple, non-invasive method has therefore been devised using a standard fluorescence plate reader, and used to measure the consumption of pyruvate and glucose, and release of lactate by single bovine embryos at all stages of preimplantation development in culture; amino acid profiles have been determined using HPLC. Early embryos with an 'intermediate' level (6.14±0.27 pmol/embryo/h) of pyruvate uptake were associated with the highest rate (68.3%) of blastocyst development indicating that a mid "optimum" range of pyruvate consumption correlates with high viability in this bovine model.
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Affiliation(s)
- Fabrice Guerif
- Centre for Cardiovascular and Metabolic Research, Hull York Medical School, University of Hull, Hull, United Kingdom
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Xin ZM, Zhu H, Jin HX, Song WY, Sun YP. Pregnancy outcomes of day 5 embryo transfer in patients at high risk of developing ovarian hyperstimulation syndrome and analysis of factors affecting blastocyst formation. J Int Med Res 2013; 41:1127-34. [PMID: 23847293 DOI: 10.1177/0300060513485910] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To investigate the effects of day 5 embryo transfer (D5ET) compared with day 3 embryo transfer (D3ET) in patients at high risk of developing ovarian hyperstimulation syndrome (OHSS); to analyse factors affecting blastocyst formation. METHODS Patients at high risk of developing OHSS underwent either D3ET or D5ET. RESULTS A total of 253 patients received D3ET; 263 received D5ET. The number of embryos transferred was lower in the D5ET group than in the D3ET group. There were no between-group differences in pregnancy or live birth rates. Implantation rate was higher, and multifetation rate lower, in the D5ET group compared with the D3ET group. In addition, the incidence of moderate or severe OHSS was lower in the D5ET group than in the D3ET group. The woman's age, gonadotrophin dosage and insemination method were associated with the quality of blastocyst formation. CONCLUSIONS In patients with a high risk of developing OHSS, compared with D3ET, D5ET decreased the multifetation rate and the incidence of moderate or severe OHSS, but did not affect the pregnancy or live birth rate. Women of a younger age, who have had an appropriate gonadotrophin dose and insemination by in vitro fertilization, are suitable candidates for blastocyst transfer.
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Affiliation(s)
- Zhi-min Xin
- Reproductive Medical Centre, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Kang SM, Lee SW, Yoon SH, Kim JC, Lim JH, Lee SG. Comparison of clinical outcomes between single and double vitrified-warmed blastocyst embryo transfer according to the day of vitrification. J Assist Reprod Genet 2013; 30:779-85. [PMID: 23715875 PMCID: PMC3696441 DOI: 10.1007/s10815-013-0017-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Accepted: 05/17/2013] [Indexed: 10/26/2022] Open
Abstract
PURPOSE To compare the efficacy of single vitrified-warmed blastocyst embryo transfer (SVBT) versus double vitrified-warmed blastocyst embryo transfer (DVBT) according to the day of vitrification. METHODS This retrospective study included a total of 1,051 cycles in women less than 37 years of age with their autologous SVBT cryopreserved on day 5 (5d-SVBT, n = 737) or day 6 (6d-SVBT, n = 154) and DVBT on day 5 (5d-DVBT, n = 129) or day 6 (6d-DVBT, n = 31) from January 2009 to December 2011. RESULTS The clinical pregnancy rate (41.8 % vs. 48.1 %, p = 0.184) and ongoing pregnancy rate (36.6 % vs. 45.0 %, p = 0.072) were not significantly different between the 5d-SVBT group and the 5d-DVBT group. However, the clinical pregnancy (29.9 % vs. 58.1 %, p = 0.003) and ongoing pregnancy rates (23.4 % vs. 51.6 %, p = 0.001) were significantly lower in the 6d-SVBT group compared with those in the 6d-DVBT group. The implantation rate (42.2 % vs. 34.5 %, p = 0.03) of the 5d-SVBT group was significantly higher than that of the 5d-DVBT group, while the implantation rate (29.9 % vs. 37.1 %, p = 0.303) of the 6d-SVBT group was not statistically different compared with that in the 6d-DVBT group. The multiple pregnancy rates (1.0 % in the 5d-SVBT group vs. 38.7 % in the 5d-DVBT group, p < 0.001 and 0 % in the 6d-SVBT group vs. 22.2 % in the 6d-DVBT group, p = 0.001) were statistically significantly lower in the SVBT group compared with those in the DVBT group regardless of the day of vitrification. CONCLUSIONS This study showed that the 5d-SVBT resulted in comparable clinical outcomes compared to the 5d-DVBT while the 6d-SVBT yielded significantly lower clinical outcomes compared to the 6d-DVBT.
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Affiliation(s)
- Sang Min Kang
- />Maria Fertility Clinic, 9th floor, Samsung Fire Bldg. 2-1 Beomeo 3-Dong, Suseong-Gu, Daegu, 706-743 Republic of Korea
| | - Sang Won Lee
- />Maria Fertility Clinic, 9th floor, Samsung Fire Bldg. 2-1 Beomeo 3-Dong, Suseong-Gu, Daegu, 706-743 Republic of Korea
| | - San Hyun Yoon
- />Seoul Maria Fertility Hospital, 103-11 Shinseol-Dong, Dongdaemun-Gu, Seoul, 130-812 Republic of Korea
| | - Joo Cheol Kim
- />Maria Fertility Clinic, 9th floor, Samsung Fire Bldg. 2-1 Beomeo 3-Dong, Suseong-Gu, Daegu, 706-743 Republic of Korea
| | - Jin Ho Lim
- />Seoul Maria Fertility Hospital, 103-11 Shinseol-Dong, Dongdaemun-Gu, Seoul, 130-812 Republic of Korea
| | - Seong Goo Lee
- />Maria Fertility Clinic, 9th floor, Samsung Fire Bldg. 2-1 Beomeo 3-Dong, Suseong-Gu, Daegu, 706-743 Republic of Korea
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Liu SY, Teng B, Fu J, Li X, Zheng Y, Sun XX. Obstetric and neonatal outcomes after transfer of vitrified early cleavage embryos. Hum Reprod 2013; 28:2093-100. [DOI: 10.1093/humrep/det104] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Blastocyst culture and transfer in clinical-assisted reproduction: a committee opinion. Fertil Steril 2013; 99:667-72. [DOI: 10.1016/j.fertnstert.2013.01.087] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Accepted: 01/04/2013] [Indexed: 01/31/2023]
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[Reduction of multiple pregnancies in ART with large SET procedures over the period 2001-2010]. ACTA ACUST UNITED AC 2013; 41:20-6. [PMID: 23291055 DOI: 10.1016/j.gyobfe.2012.09.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Accepted: 09/19/2012] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To evaluate delivery rate and multiple pregnancy rates in ART (assisted reproductive techniques) following introduction of an elective single embryo tranfer (eSET) policy. This strategy was started in 2002 including transfer of one embryo for women less than 35 years with a least two good quality embryo during their first or second attempts. PATIENTS AND METHODS Retrospective study including all IVF cycles performed in the IVF centre of Clermont-Ferrand University Hospital from 01/01/2001 to 31/12/2010. Main outcome measures were number of embryos transferred, cumulative delivery and multiple pregnancy rates (including fresh and frozen embryo transfers). A subgroup analysis including patients' age was done. RESULTS Cumulative delivery rate reached 27,3% in 2010 with a significant drop in multiple pregnancy rate: from 30% in 2001 to 7,9% in 2010. The average number of transferred embryo decreased from 2.29 to 1.55 in the same period. In our centre, eSET was performed in 85% of first IVF attempt and in 34,4% of second attempts for women less than 35 years. CONCLUSION The implementation of an eSET policy does not change the delivery rate but significantly decrease the number of multiple pregnancies compared to double embryo transfer. eSET should be carried out during the 1st and 2nd attempts in patients under 35 years when at least two good quality embryos were obtained.
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Tong GQ, Cao SR, Wu X, Zhang JQ, Cui J, Heng BC, Ling XF. Clinical outcome of fresh and vitrified-warmed blastocyst and cleavage-stage embryo transfers in ethnic Chinese ART patients. J Ovarian Res 2012; 5:27. [PMID: 23039212 PMCID: PMC3506538 DOI: 10.1186/1757-2215-5-27] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Accepted: 09/25/2012] [Indexed: 11/30/2022] Open
Abstract
Objectives This study sought to evaluate the outcome of fresh and vitrified-warmed cleavage-stage and blastocyst-stage embryo transfers in patients undergoing ART treatment within an ethnic Chinese population. Study design We compared the clinical results of embryo transfer on the 3rd (cleavage stage) or 5th (blastocyst stage) day after oocyte retrieval, including clinical pregnancy rates, implantation rates and multiple pregnancy rates. Results Our data showed that blastocyst transfer on day 5 did not significantly increase clinical pregnancy rate (41.07% vs 47.08%, p>0.05) and implantation rate (31.8% vs 31.2%, p>0.05) in patients under 35 years of age, in comparison with day 3 cleavage stage embryo transfer. In patients older than 35 years of age, the clinical pregnancy rate after blastocyst transfer was slightly decreased compared with cleavage stage embryo transfer (33.33% vs 42.31%, p>0.05). Unexpectedly, It was found that vitrified-warmed blastocyst transfer resulted in significantly higher clinical pregnancy rate (56.8%) and implantation rate (47%) compared with fresh blastocyst transfer in controlled stimulation cycles (41.07% and 31.8%, respectively). For patients under 35 years of age, the cumulative clinical pregnancy rate combining fresh and vitrified-warmed blastocyst transfer cycles were significantly higher compared to just cleavage-stage embryo transfer (70.1% versus 51.8%, p<0.05). However, the cumulative multiple pregnancy rates showed no significant difference between the two groups. Conclusions In an ethnic Chinese patient population, fresh blastocyst transfer does not significantly increase clinical pregnancy rate. However, subsequent vitrified-warmed blastocyst transfer in a non-controlled ovarian hyperstimulation cycle dramatically improves clinical outcomes. Therefore, blastocyst culture in tandem with vitrified-warmed blastocyst transfer is recommended as a favourable and promising protocol in human ART treatment, particularly for ethnic Chinese patients.
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Affiliation(s)
- Guo Qing Tong
- Reproductive Medicine Center, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, 528, Zhangheng Rd, Shanghai 201203, PR China.
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Martin L, Frapsauce C, Royère D, Guérif F. Devenir des grossesses uniques après transfert au stade blastocyste : comparaison avec les transferts précoces. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.sagf.2012.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Bergh C, Wennerholm UB. Obstetric outcome and long-term follow up of children conceived through assisted reproduction. Best Pract Res Clin Obstet Gynaecol 2012; 26:841-52. [PMID: 22677311 DOI: 10.1016/j.bpobgyn.2012.05.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Revised: 04/15/2012] [Accepted: 05/02/2012] [Indexed: 10/28/2022]
Abstract
Most children born after assisted reproduction techniques are healthy. The most important risk associated with in-vitro fertilisation is the higher multiple birth rate, which may result in increased child morbidity because several embryos are transferred at each cycle. Single-embryo transfer reduces this risk dramatically. Large registry studies and meta-analyses have indicated a small but statistically significantly increased risk of congenital malformations among children born after in-vitro fertilisation. Other risks, such as preterm birth and low birth weight seem to be associated more with parental characteristics than the in-vitro fertilisation technique. All knowledge about children conceived through in-vitro fertilisation is based on observational studies, with risks of bias and confounders. It is possible that pregnancies and children resulting from in-vitro fertilisation are more carefully monitored and seek health care more frequently, resulting in more health problems being discovered. Continuous follow up of children after in-vitro fertilisation is of great importance, particularly as new techniques are constantly being introduced.
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Affiliation(s)
- Christina Bergh
- Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Reproductive Medicine, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden.
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Devenir des grossesses uniques après transfert au stade blastocyste : comparaison avec les transferts précoces. ACTA ACUST UNITED AC 2012; 40:291-5. [DOI: 10.1016/j.gyobfe.2011.10.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2011] [Accepted: 10/26/2011] [Indexed: 11/19/2022]
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Diamond MP, Willman S, Chenette P, Cedars MI. The clinical need for a method of identification of embryos destined to become a blastocyst in assisted reproductive technology cycles. J Assist Reprod Genet 2012; 29:391-6. [PMID: 22426513 DOI: 10.1007/s10815-012-9732-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Accepted: 02/15/2012] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To provide a rationale for continuation of efforts to improve the outcome of Assisted Reproductive Technology outcomes, thereby increasing the likelihood of the live birth of healthy neonates. METHODS Description of rationale and a framework leading to improvement in Assisted Reproductive Technology outcomes. RESULTS The opportunity for improvement in the success rate for Assisted Reproductive Technology outcome is predicated on selection of the highest quality embryo(s) for transfer. However, such approaches must be balanced by a limit to the number of embryos transferred so as to reduce the risk for multiple births and particularly higher order multiple gestations. Blastocyst transfer offers one such successful approach, but is confounded by suggestions of an increased risk of both pregnancy complications and epigenetic disorders. CONCLUSION There is a need for development of approaches which, individually or in combination, may assist in the early detection of embryos destined to develop into blastocysts.
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Clinical outcomes of elective single morula embryo transfer versus elective single blastocyst embryo transfer in IVF-ET. J Assist Reprod Genet 2012; 29:423-8. [PMID: 22382643 DOI: 10.1007/s10815-012-9736-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Accepted: 02/21/2012] [Indexed: 10/28/2022] Open
Abstract
PURPOSE To compare the clinical outcomes of elective single morula embryo transfer (eSMET) versus elective single blastocyst embryo transfer (eSBET) in selected patients. METHODS This study was a retrospective study which analyzed for 271 cycles in women under 37 years of age who are undergoing their first or second trial of in vitro fertilization-embryo transfer (IVF-ET) from January 2008 to December 2009. The eSMET was performed on day 4 (n = 130) and the eSBET was conducted on day 5 (n = 141). RESULTS The clinical pregnancy rate (51.5% vs. 51.8%, p = 0.97), implantation rate (52.3% vs. 52.5%, p = 0.98), and live birth rate (39.2% vs. 44.7%, p = 0.36) were similar in the eSMET and eSBET groups, respectively. The miscarriage rate of the eSMET group (23.9%) was slightly higher than that of the eSBET group (13.7%) (p = 0.12), without reaching statistical significance. There was only one case of monozygotic twin pregnancy in each group. CONCLUSIONS The clinical outcomes of day 4 eSMET were comparable to those of day 5 eSBET. Therefore, day 4 eSMET is a viable option or an alternative to day 5 eSBET, with no difference in success rates.
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Abstract
The aim of this study was to evaluate the advantages of the two-step embryo transfer (ET) strategy combining a day 2/3 ET with a day 5/6 blastocyst transfer. In an observational comparative study, 400 infertile women were enrolled from two assisted reproductive technology (ART) units according to inclusion criteria: age below 42 years and at least three embryos obtained on day 2 thus allowing an extended in vitro culture. Two groups were defined according to the ET strategy adopted: group 1 had a two-step ET; and group 2 had a day 2/3 ET with (subgroup 2a) or without (subgroup 2b) blastocysts cryopreserved on day 5/6. Live birth rate was significantly higher in group 1 than in subgroups 2a and 2b (36.5% versus 29.4% and 13.4%, respectively; p < 10(-3)). Multiple pregnancy rates were comparable between groups. After adjusting on major prognostic factors, the two-step ET strategy was still associated with a significantly higher live birth rate than the day 2/3 ET (OR = 2.23; 95% CI: 1.32-3.77). The two-step ET provides better live birth rates than the cleavage-stage ET. It does not increase multiple pregnancy rates if the number of embryos transferred is limited. It also prevents cycle loss when embryos fail to develop into blastocysts.
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Stoop D, Van Landuyt L, Van den Abbeel E, Camus M, Verheyen G, Devroey P. Should a single blastocyst transfer policy be a clinical decision or should it depend on the embryological evaluation on day 3? Reprod Biol Endocrinol 2011; 9:60. [PMID: 21545714 PMCID: PMC3113931 DOI: 10.1186/1477-7827-9-60] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2010] [Accepted: 05/05/2011] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Single blastocyst transfer has the advantage of maximizing the fresh single pregnancy rate. However, in patients with a low number of good quality embryos on day 3, it remains unclear whether immediate embryo transfer or further embryo culture with blastocyst transfer is the most preferable option. METHODS A retrospective cohort study was carried out in which the outcome of 590 fresh in vitro fertilization (IVF) cycles over a 15 months period and their cryo cycles were analyzed. A total of 341 patients cycles had an elective day 5 strategy independent of intermediate embryo evaluation while another 249 patients underwent a day 5 embryo transfer only if at least four embryos were available on day 3. Blastocyst vitrification was performed using a closed high security system. RESULTS Demographics, stimulation parameters and embryological data were comparable in the two groups. Patients in the elective day 5 group had a lower fresh transfer rate (90.62% vs. 95.18%, p < 0.05) as compared to patients with a day 3 or day 5 embryo transfer policy. No difference was observed in the fresh live birth rate and multiple pregnancy rate per initiated cycle (32.84% vs. 28.92%; 1.17% vs 0%) The projected cumulative ongoing pregnancy rate compensating for double counting in case subjects have more than one pregnancy is not different (42.58% vs. 39.84%). CONCLUSIONS Despite lower fresh transfer rates, elective single blastocyst transfer yields a similar projected cumulative ongoing pregnancy rate as in a policy with cleavage stage or blastocyst transfer depending on a good quality embryo count on day 3.
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Affiliation(s)
- Dominic Stoop
- Centre for Reproductive Medicine, University Hospital, Vrije Universiteit Brussel (Free University of Brussels), Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Lisbet Van Landuyt
- Centre for Reproductive Medicine, University Hospital, Vrije Universiteit Brussel (Free University of Brussels), Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Etienne Van den Abbeel
- Centre for Reproductive Medicine, University Hospital, Vrije Universiteit Brussel (Free University of Brussels), Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Michel Camus
- Centre for Reproductive Medicine, University Hospital, Vrije Universiteit Brussel (Free University of Brussels), Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Greta Verheyen
- Centre for Reproductive Medicine, University Hospital, Vrije Universiteit Brussel (Free University of Brussels), Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Paul Devroey
- Centre for Reproductive Medicine, University Hospital, Vrije Universiteit Brussel (Free University of Brussels), Laarbeeklaan 101, 1090 Brussels, Belgium
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Kang SM, Lee SW, Jeong HJ, Yoon SH, Lim JH, Lee SG. Comparison of elective single cleavage-embryo transfer to elective single blastocyst-embryo transfer in human IVF-ET. Clin Exp Reprod Med 2011; 38:53-60. [PMID: 22384419 PMCID: PMC3283049 DOI: 10.5653/cerm.2011.38.1.53] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Revised: 02/18/2011] [Accepted: 02/25/2011] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE This study was carried out to compare the clinical outcome of elective single cleavage-embryo transfer (eSCET) to that of elective single blastocyst-embryo transfer (eSBET) in human IVF-ET. METHODS This study was a retrospective study which analyzed for 614 women who visited the Daegu Maria Clinic from August 2008 to December 2009. All were under 37 years old and had more than 8 mm of endometrial thickness on the day of hCG administration and at least one good quality embryo on day 3. The eSCETs were performed on day 3 (n=450) and the eSBETs were conducted on day 5 (n=164). RESULTS The numbers of retrieved oocytes, fertilized oocytes, and day 3 good quality embryos were significantly lower in the eSCET group (12.1±6.0, 8.2±4.6, and 4.2±3.1, respectively) compared to the eSBET group (16.7±7.2, 12.1±5.0, and 8.5±4.5, respectively; p<0.001). However, the clinical pregnancy, implantation, on-going pregnancy, and live birth rates of the eSCET group (46.7, 46.9, 40.0, and 36.7%, respectively) were not statistically different from those of the eSBET group (51.2, 51.8, 45.1, and 43.9%, respectively; p=0.318, 0.278, 0.254, and 0.103, respectively). CONCLUSION These results suggested that elective single embryo transfer should be performed regardless of the developmental stage to women less than 37 years old who had more than 8 mm of endometrial thickness on the hCG administration day and at least one good quality embryo on day 3 in order to reduce the twin pregnancy rate without reducing the whole pregnancy rate.
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Affiliation(s)
| | | | | | | | - Jin Ho Lim
- Seoul Maria Fertility Hospital, Seoul, Korea
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Dessolle L, Freour T, Ravel C, Jean M, Colombel A, Darai E, Barriere P. Predictive factors of healthy term birth after single blastocyst transfer. Hum Reprod 2011; 26:1220-6. [DOI: 10.1093/humrep/der039] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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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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Roberts SA, McGowan L, Mark Hirst W, Vail A, Rutherford A, Lieberman BA, Brison DR. Reducing the incidence of twins from IVF treatments: predictive modelling from a retrospective cohort. Hum Reprod 2010; 26:569-75. [DOI: 10.1093/humrep/deq352] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Dessolle L, Allaoua D, Fréour T, Le Vaillant C, Philippe HJ, Jean M, Barrière P. Monozygotic triplet pregnancies after single blastocyst transfer: two cases and literature review. Reprod Biomed Online 2010; 21:283-9. [DOI: 10.1016/j.rbmo.2010.04.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2009] [Revised: 03/31/2010] [Accepted: 04/07/2010] [Indexed: 11/29/2022]
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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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Källén B, Finnström O, Lindam A, Nilsson E, Nygren KG, Olausson PO. Blastocyst versus cleavage stage transfer in in vitro fertilization: differences in neonatal outcome? Fertil Steril 2010; 94:1680-3. [PMID: 20137785 DOI: 10.1016/j.fertnstert.2009.12.027] [Citation(s) in RCA: 118] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2009] [Revised: 12/07/2009] [Accepted: 12/07/2009] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To compare neonatal outcome of blastocyst and cleavage stage embryo transfers after IVF. DESIGN Register study. SETTING Births recorded in the Swedish Medical Birth Register after IVF performed, 2002-2006. PATIENT(S) Treatments reported from all Swedish IVF clinics. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Some neonatal characteristics were compared in 1,311 infants born after blastocyst-stage transfer and 12,562 infants born after cleavage-stage transfer. Comparisons were also made with all births, 2002-2007 (n = 598,687). RESULT(S) After adjusting for year of birth, maternal age, parity, smoking habits, and body mass index, the risk of preterm birth among singletons was significantly greater after blastocyst-stage transfer than after cleavage-stage transfer. The risk of congenital malformations was also significantly higher. When the analysis was restricted to clinics where blastocyst transfers were made, the risk estimates increased for preterm birth, low birth weight, low APGAR score, and respiratory diagnoses, but did not change for congenital malformations. CONCLUSION(S) The results indicate a small increase in risk associated with blastocyst transfer, perhaps owing to the longer period of in vitro culture. There is a possibility that this effect is due, at least in part, to a selection of women for blastocyst transfers. Further studies are needed either to verify or to refute the found associations.
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Affiliation(s)
- Bengt Källén
- Tornblad Institute, University of Lund, Lund, Sweden.
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Dessolle L, Freour T, Barriere P, Darai E, Ravel C, Jean M, Coutant C. A cycle-based model to predict blastocyst transfer cancellation. Hum Reprod 2009; 25:598-604. [DOI: 10.1093/humrep/dep439] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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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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