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Cimadomo D, Innocenti F, Taggi M, Saturno G, Campitiello MR, Guido M, Vaiarelli A, Ubaldi FM, Rienzi L. How should the best human embryo in vitro be? Current and future challenges for embryo selection. Minerva Obstet Gynecol 2024; 76:159-173. [PMID: 37326354 DOI: 10.23736/s2724-606x.23.05296-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
In-vitro fertilization (IVF) aims at overcoming the causes of infertility and lead to a healthy live birth. To maximize IVF efficiency, it is critical to identify and transfer the most competent embryo within a cohort produced by a couple during a cycle. Conventional static embryo morphological assessment involves sequential observations under a light microscope at specific timepoints. The introduction of time-lapse technology enhanced morphological evaluation via the continuous monitoring of embryo preimplantation in vitro development, thereby unveiling features otherwise undetectable via multiple static assessments. Although an association exists, blastocyst morphology poorly predicts chromosomal competence. In fact, the only reliable approach currently available to diagnose the embryonic karyotype is trophectoderm biopsy and comprehensive chromosome testing to assess non-mosaic aneuploidies, namely preimplantation genetic testing for aneuploidies (PGT-A). Lately, the focus is shifting towards the fine-tuning of non-invasive technologies, such as "omic" analyses of waste products of IVF (e.g., spent culture media) and/or artificial intelligence-powered morphologic/morphodynamic evaluations. This review summarizes the main tools currently available to assess (or predict) embryo developmental, chromosomal, and reproductive competence, their strengths, the limitations, and the most probable future challenges.
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Affiliation(s)
- Danilo Cimadomo
- IVIRMA Global Research Alliance, GENERA, Clinica Valle Giulia, Rome, Italy -
| | - Federica Innocenti
- IVIRMA Global Research Alliance, GENERA, Clinica Valle Giulia, Rome, Italy
| | - Marilena Taggi
- IVIRMA Global Research Alliance, GENERA, Clinica Valle Giulia, Rome, Italy
- Lazzaro Spallanzani Department of Biology and Biotechnology, University of Pavia, Pavia, Italy
| | - Gaia Saturno
- IVIRMA Global Research Alliance, GENERA, Clinica Valle Giulia, Rome, Italy
- Lazzaro Spallanzani Department of Biology and Biotechnology, University of Pavia, Pavia, Italy
| | - Maria R Campitiello
- Department of Obstetrics and Gynecology and Physiopathology of Human Reproduction, ASL Salerno, Salerno, Italy
| | - Maurizio Guido
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Alberto Vaiarelli
- IVIRMA Global Research Alliance, GENERA, Clinica Valle Giulia, Rome, Italy
| | - Filippo M Ubaldi
- IVIRMA Global Research Alliance, GENERA, Clinica Valle Giulia, Rome, Italy
| | - Laura Rienzi
- IVIRMA Global Research Alliance, GENERA, Clinica Valle Giulia, Rome, Italy
- Department of Biomolecular Sciences, Carlo Bo University of Urbino, Urbino, Italy
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Taggi M, Capponi C, Bertani N, Saturno G, Innocenti F, Dovere L, Fabozzi SM, Alesiani O, Arena V, Cimadomo D, Mazzilli R, Rienzi L, Ubaldi FM, Canipari R, Vicini E, Apa R. Role of thyroid stimulating hormone in the maintenance and functioning of the human corpus luteum. J Endocrinol Invest 2024:10.1007/s40618-023-02269-z. [PMID: 38190029 DOI: 10.1007/s40618-023-02269-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 12/02/2023] [Indexed: 01/09/2024]
Abstract
PURPOSE To evaluate the impact of high thyroid stimulating hormone (TSH) levels on human granulosa-luteal (hGL) cells. METHODS hGL cells were isolated from follicular aspirates derived from patients undergoing IVF treatment without any thyroid disorder (serum TSH 0.5-2 mU/L). Cells were cultured at 37 °C in DMEM, supplemented with 5% FBS. The cells were treated with 1 nM LH and increasing concentrations of TSH. At the end of culture, conditioned medium and cells were collected to analyze progesterone production, cell viability, and mRNA levels of genes involved in the steroidogenesis process. Human ovarian tissues were analyzed for TSH receptor (TSHR) expression by IHC. RESULTS The expression of TSHR was detected in human corpus luteum by IHC and in hGL by RT-PCR. In hGL cells, TSH treatment did not modulate progesterone production nor the expression of steroidogenic genes, such as p450scc and HSD3b 1/2. However, TSH induced a dose-dependent increase in cell death. Finally, TSH did not affect LH-induced p450scc and HSD3b1/2 expression while LH partially reverted TSH negative effect on cell death in hGL. CONCLUSIONS Elevated TSH levels in hypothyroid women may be associated with impaired CL functioning and maintenance. These findings open a new line of research for the importance of the treatment of women with thyroid dysfunction that could contribute to the onset of infertility.
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Affiliation(s)
- M Taggi
- DAHFMO, Unit of Histology and Medical Embryology, Sapienza, University of Rome, Rome, Italy
- IVIRMA Global Research Alliance, GENERA, Clinica Valle Giulia, Rome, Italy
| | - C Capponi
- DAHFMO, Unit of Histology and Medical Embryology, Sapienza, University of Rome, Rome, Italy
| | - N Bertani
- DAHFMO, Unit of Histology and Medical Embryology, Sapienza, University of Rome, Rome, Italy
| | - G Saturno
- DAHFMO, Unit of Histology and Medical Embryology, Sapienza, University of Rome, Rome, Italy
- IVIRMA Global Research Alliance, GENERA, Clinica Valle Giulia, Rome, Italy
| | - F Innocenti
- IVIRMA Global Research Alliance, GENERA, Clinica Valle Giulia, Rome, Italy
| | - L Dovere
- IVIRMA Global Research Alliance, GENERA, Clinica Valle Giulia, Rome, Italy
| | - S M Fabozzi
- IVIRMA Global Research Alliance, GENERA, Clinica Valle Giulia, Rome, Italy
| | - O Alesiani
- Department Tutela della Salute della Donna, del Bambino e di Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - V Arena
- Department of Woman and Child Health and Public Health, Area of Pathology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - D Cimadomo
- IVIRMA Global Research Alliance, GENERA, Clinica Valle Giulia, Rome, Italy
| | - R Mazzilli
- IVIRMA Global Research Alliance, GENERA, Clinica Valle Giulia, Rome, Italy
- Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - L Rienzi
- IVIRMA Global Research Alliance, GENERA, Clinica Valle Giulia, Rome, Italy
- Department of Biomolecular Sciences, University of Urbino "Carlo Bo", Urbino, Italy
| | - F M Ubaldi
- IVIRMA Global Research Alliance, GENERA, Clinica Valle Giulia, Rome, Italy
| | - R Canipari
- DAHFMO, Unit of Histology and Medical Embryology, Sapienza, University of Rome, Rome, Italy.
| | - E Vicini
- DAHFMO, Unit of Histology and Medical Embryology, Sapienza, University of Rome, Rome, Italy.
| | - R Apa
- Department Tutela della Salute della Donna, del Bambino e di Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
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Innocenti F, Palmieri V. Editorial: Cardiovascular involvement during sepsis: therapeutic and prognostic consequences. Front Cardiovasc Med 2023; 10:1314834. [PMID: 38028501 PMCID: PMC10647882 DOI: 10.3389/fcvm.2023.1314834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Affiliation(s)
- F. Innocenti
- High-Dependency Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy
| | - V. Palmieri
- Cardiosurgery Unit, Cardiovascular Department, “Sant’Anna e San Sebastiano” National Hospital, Caserta, Italy
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Chiappetta V, Innocenti F, Coticchio G, Ahlström A, Albricci L, Badajoz V, Hebles M, Gallardo M, Benini F, Canosa S, Kumpošt J, Milton K, Montanino Oliva D, Maggiulli R, Rienzi L, Cimadomo D. Discard or not discard, that is the question: an international survey across 117 embryologists on the clinical management of borderline quality blastocysts. Hum Reprod 2023; 38:1901-1909. [PMID: 37649342 DOI: 10.1093/humrep/dead174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/02/2023] [Indexed: 09/01/2023] Open
Abstract
STUDY QUESTION Do embryologists from different European countries agree on embryo disposition decisions ('use' or 'discard') about Day 7 (>144 h post-insemination) and/or low-quality blastocysts (LQB; SUMMARY ANSWER The prevalence of 'discard' answers was 38.7%; nevertheless, embryologists' agreement was overall just fair (Fleiss-k = 0.26). WHAT IS KNOWN ALREADY The utilization of LQBs and adoption of culture beyond 144 h post-insemination is increasing worldwide. Although morphology and morphokinetics are associated with embryo developmental competence, previous studies demonstrated significant interobserver variability among embryologists regarding embryo quality assessment and disposition decisions for borderline quality blastocysts. STUDY DESIGN, SIZE, DURATION An anonymous survey was run in a large network of IVF centers. A total of 117 embryologists from 6 European countries and 29 IVF centers filled in the survey. Randomly selected anonymous time-lapse videos of 50 Day 7 and/or LQB whole embryo preimplantation development were assessed by the embryologists. The key information on patients/cycles was provided along with each video. All cycles entailed preimplantation genetic testing for aneuploidies. Each embryologist specified whether he/she would have discarded or used ('transfer-fresh'/'cryopreserve'/'biopsy') any embryo. Inter-rater agreement was measured with Fleiss-k. PARTICIPANTS/MATERIALS, SETTING, METHODS Examiners were asked about their years of experience, center location, average number of cycles and average maternal age, number of colleagues, and use of time-lapse incubators at their centers. All participants were blinded to artificial intelligence (AI) scores generated by two commercially available software packages, chromosomal diagnosis (all blastocysts were tested for aneuploidies), and clinical outcomes after vitrified-warmed euploid single blastocyst transfer. These data were known only by one embryologist not involved in the survey. MAIN RESULTS AND THE ROLE OF CHANCE Participants were Italian (40%, N = 47), Spanish (24%, N = 28), Portuguese (5%, N = 6), Czech (5%, N = 6), Swedish (23%, N = 27), and Icelandic (3%, N = 3). In total, 2263 (38.7%) 'discard' and 3587 (61.3%) 'use' decisions were recorded. Czech, Portuguese, and Italian embryologists expressed lower 'discard' decision rates (mean ± SD 17 ± 7%, range 8-24%; 23 ± 14% range 4-46%; and 27 ± 18% range 2-72%, respectively), while Spanish gave intermediate (37 ± 16% range 4-66%) and Nordic gave higher (67 ± 11% range 40-90%) rates. The prevalence of 'discard' answers was 38.7% out of 5850 choices (mean per embryologist: 39 ± 23% range 2-90%). Only embryologists' country and IVF group were associated with this rate. Overall agreement among embryologists was fair (Fleiss-k = 0.26). The prevalence of 'discard' responses per embryo was 37 ± 24% (range 2-87%). Only the number of sibling blastocysts influenced this rate (i.e. the larger the cohort, the higher the inclination to 'discard'). No difference was shown for the two scores between euploid and aneuploid borderline quality blastocysts, while the embryologists were, by chance, more prone to 'discard' the latter (28.3 ± 21% range 9-71% versus 41.6 ± 24.8% range 2-87%, respectively). LIMITATIONS, REASONS FOR CAUTION The survey included only private IVF clinics located in Europe. Moreover, a key variable is missing, namely patients' access to care. Indeed, all embryologists involved in the survey were part of the same network of private IVF clinics, while the embryo disposition decisions might be different in a public setting. WIDER IMPLICATIONS OF THE FINDINGS Decision-making by European embryologists regarding Day 7 embryos or LQBs is inconsistent with putative clinical consequences, especially in patients with low prognosis. Although the embryologists could make decisions independent from their local regulations, their mindset and clinical background influenced their choices. In the future, AI tools should be trained to assess borderline quality embryos and empowered with cost-effectiveness information to support embryologists' decisions with more objective assessments. STUDY FUNDING/COMPETING INTEREST(S) No external funding was obtained for this study. The authors have no conflict of interest to declare. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Viviana Chiappetta
- IVIRMA Global Research Alliance, GENERA, Clinica Valle Giulia, Rome, Italy
| | - Federica Innocenti
- IVIRMA Global Research Alliance, GENERA, Clinica Valle Giulia, Rome, Italy
| | | | | | - Laura Albricci
- IVIRMA Global Research Alliance, GENERA, Clinica Valle Giulia, Rome, Italy
| | | | - Maria Hebles
- IVIRMA Global Research Alliance, GINEMED, Sevilla, Spain
| | | | | | | | - Jiří Kumpošt
- IVIRMA Global Research Alliance, FERTICARE, Prague, Czech Republic
| | - Katarina Milton
- IVIRMA Global Research Alliance, CARL VON LINNÈ KLINIKEN, Uppsala, Sweden
| | - Diletta Montanino Oliva
- Department of Biology and Biotechnology "Lazzaro Spallanzani", University of Pavia, Pavia, Italy
| | - Roberta Maggiulli
- IVIRMA Global Research Alliance, GENERA, Clinica Valle Giulia, Rome, Italy
| | - Laura Rienzi
- IVIRMA Global Research Alliance, GENERA, Clinica Valle Giulia, Rome, Italy
- Department of Biomolecular Sciences, University of Urbino "Carlo Bo", Urbino, Italy
| | - Danilo Cimadomo
- IVIRMA Global Research Alliance, GENERA, Clinica Valle Giulia, Rome, Italy
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Cimadomo D, Rienzi L, Conforti A, Forman E, Canosa S, Innocenti F, Poli M, Hynes J, Gemmell L, Vaiarelli A, Alviggi C, Ubaldi FM, Capalbo A. Opening the black box: why do euploid blastocysts fail to implant? A systematic review and meta-analysis. Hum Reprod Update 2023; 29:570-633. [PMID: 37192834 DOI: 10.1093/humupd/dmad010] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 03/22/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND A normal chromosomal constitution defined through PGT-A assessing all chromosomes on trophectoderm (TE) biopsies represents the strongest predictor of embryo implantation. Yet, its positive predictive value is not higher than 50-60%. This gap of knowledge on the causes of euploid blastocysts' reproductive failure is known as 'the black box of implantation'. OBJECTIVE AND RATIONALE Several embryonic, maternal, paternal, clinical, and IVF laboratory features were scrutinized for their putative association with reproductive success or implantation failure of euploid blastocysts. SEARCH METHODS A systematic bibliographical search was conducted without temporal limits up to August 2021. The keywords were '(blastocyst OR day5 embryo OR day6 embryo OR day7 embryo) AND (euploid OR chromosomally normal OR preimplantation genetic testing) AND (implantation OR implantation failure OR miscarriage OR abortion OR live birth OR biochemical pregnancy OR recurrent implantation failure)'. Overall, 1608 items were identified and screened. We included all prospective or retrospective clinical studies and randomized-controlled-trials (RCTs) that assessed any feature associated with live-birth rates (LBR) and/or miscarriage rates (MR) among non-mosaic euploid blastocyst transfer after TE biopsy and PGT-A. In total, 41 reviews and 372 papers were selected, clustered according to a common focus, and thoroughly reviewed. The PRISMA guideline was followed, the PICO model was adopted, and ROBINS-I and ROB 2.0 scoring were used to assess putative bias. Bias across studies regarding the LBR was also assessed using visual inspection of funnel plots and the trim and fill method. Categorical data were combined with a pooled-OR. The random-effect model was used to conduct the meta-analysis. Between-study heterogeneity was addressed using I2. Whenever not suitable for the meta-analysis, the included studies were simply described for their results. The study protocol was registered at http://www.crd.york.ac.uk/PROSPERO/ (registration number CRD42021275329). OUTCOMES We included 372 original papers (335 retrospective studies, 30 prospective studies and 7 RCTs) and 41 reviews. However, most of the studies were retrospective, or characterized by small sample sizes, thus prone to bias, which reduces the quality of the evidence to low or very low. Reduced inner cell mass (7 studies, OR: 0.37, 95% CI: 0.27-0.52, I2 = 53%), or TE quality (9 studies, OR: 0.53, 95% CI: 0.43-0.67, I2 = 70%), overall blastocyst quality worse than Gardner's BB-grade (8 studies, OR: 0.40, 95% CI: 0.24-0.67, I2 = 83%), developmental delay (18 studies, OR: 0.56, 95% CI: 0.49-0.63, I2 = 47%), and (by qualitative analysis) some morphodynamic abnormalities pinpointed through time-lapse microscopy (abnormal cleavage patterns, spontaneous blastocyst collapse, longer time of morula formation I, time of blastulation (tB), and duration of blastulation) were all associated with poorer reproductive outcomes. Slightly lower LBR, even in the context of PGT-A, was reported among women ≥38 years (7 studies, OR: 0.87, 95% CI: 0.75-1.00, I2 = 31%), while obesity was associated with both lower LBR (2 studies, OR: 0.66, 95% CI: 0.55-0.79, I2 = 0%) and higher MR (2 studies, OR: 1.8, 95% CI: 1.08-2.99, I2 = 52%). The experience of previous repeated implantation failures (RIF) was also associated with lower LBR (3 studies, OR: 0.72, 95% CI: 0.55-0.93, I2 = 0%). By qualitative analysis, among hormonal assessments, only abnormal progesterone levels prior to transfer were associated with LBR and MR after PGT-A. Among the clinical protocols used, vitrified-warmed embryo transfer was more effective than fresh transfer (2 studies, OR: 1.56, 95% CI: 1.05-2.33, I2 = 23%) after PGT-A. Lastly, multiple vitrification-warming cycles (2 studies, OR: 0.41, 95% CI: 0.22-0.77, I2 = 50%) or (by qualitative analysis) a high number of cells biopsied may slightly reduce the LBR, while simultaneous zona-pellucida opening and TE biopsy allowed better results than the Day 3 hatching-based protocol (3 studies, OR: 1.41, 95% CI: 1.18-1.69, I2 = 0%). WIDER IMPLICATIONS Embryo selection aims at shortening the time-to-pregnancy, while minimizing the reproductive risks. Knowing which features are associated with the reproductive competence of euploid blastocysts is therefore critical to define, implement, and validate safer and more efficient clinical workflows. Future research should be directed towards: (i) systematic investigations of the mechanisms involved in reproductive aging beyond de novo chromosomal abnormalities, and how lifestyle and nutrition may accelerate or exacerbate their consequences; (ii) improved evaluation of the uterine and blastocyst-endometrial dialogue, both of which represent black boxes themselves; (iii) standardization/automation of embryo assessment and IVF protocols; (iv) additional invasive or preferably non-invasive tools for embryo selection. Only by filling these gaps we may finally crack the riddle behind 'the black box of implantation'.
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Affiliation(s)
- Danilo Cimadomo
- IVIRMA Global Research Alliance, GENERA, Clinica Valle Giulia, Rome, Italy
| | - Laura Rienzi
- IVIRMA Global Research Alliance, GENERA, Clinica Valle Giulia, Rome, Italy
- Department of Biomolecular Sciences, University of Urbino "Carlo Bo", Urbino, Italy
| | - Alessandro Conforti
- Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University, Naples, Italy
| | - Eric Forman
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Columbia University Irving Medical Centre, New York, NY, USA
| | | | - Federica Innocenti
- IVIRMA Global Research Alliance, GENERA, Clinica Valle Giulia, Rome, Italy
| | - Maurizio Poli
- Centrum voor Kinderwens, Dijklander Hospital, Purmerend, The Netherlands
- Juno Genetics, Rome, Italy
| | - Jenna Hynes
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Columbia University Irving Medical Centre, New York, NY, USA
| | - Laura Gemmell
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Columbia University Irving Medical Centre, New York, NY, USA
| | - Alberto Vaiarelli
- IVIRMA Global Research Alliance, GENERA, Clinica Valle Giulia, Rome, Italy
| | - Carlo Alviggi
- Department of Public Health, Federico II University, Naples, Italy
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Canosa S, Maggiulli R, Cimadomo D, Innocenti F, Fabozzi G, Gennarelli G, Revelli A, Bongioanni F, Vaiarelli A, Ubaldi FM, Rienzi L, Palmer GA, Nijs M. Cryostorage management of reproductive cells and tissues in ART: status, needs, opportunities and potential new challenges. Reprod Biomed Online 2023; 47:103252. [PMID: 37451970 DOI: 10.1016/j.rbmo.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 06/12/2023] [Accepted: 06/14/2023] [Indexed: 07/18/2023]
Abstract
Among the wide range of procedures performed by clinical embryologists, the cryopreservation of reproductive cells and tissues represents a fundamental task in the daily routine. Indeed, cryopreservation procedures can be considered a subspecialty of medically assisted reproductive technology (ART), having the same relevance as sperm injection or embryo biopsy for preimplantation genetic testing. However, although a great deal of care has been devoted to optimizing cryopreservation protocols, the same energy has only recently been spent on developing and implementing strategies for the safe and reliable storage and transport of reproductive specimens. Herein, we have summarized the content of the available guidelines, the risks, the needs and the future perspectives regarding the management of cryopreservation biorepositories used in ART.
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Affiliation(s)
| | | | - Danilo Cimadomo
- IVIRMA Global Research Alliance, Clinica Valle Giulia, Rome, Italy
| | | | - Gemma Fabozzi
- IVIRMA Global Research Alliance, Clinica Valle Giulia, Rome, Italy
| | | | | | | | | | - Flippo M Ubaldi
- IVIRMA Global Research Alliance, Clinica Valle Giulia, Rome, Italy
| | - Laura Rienzi
- IVIRMA Global Research Alliance, Clinica Valle Giulia, Rome, Italy; Department of Biomolecular Sciences, University of Urbino 'Carlo Bo', Urbino, Italy
| | - Giles A Palmer
- International IVF Initiative Inc, New York, NY, USA; Institute of Life, IASO Hospital, Athens, Greece; IVF 2.0 Ltd, London, UK
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Innocenti F, Di Persio S, Taggi M, Maggio R, Lardo P, Toscano V, Canipari R, Vicini E, Stigliano A. Effect of Mitotane on Male Gonadal Function. Cancers (Basel) 2023; 15:3234. [PMID: 37370841 DOI: 10.3390/cancers15123234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/02/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Clinical evidence has shown frequent hypogonadism following mitotane (MTT) treatment in male patients with adrenocortical carcinoma. This study aimed to evaluate the impact of MTT on male gonadal function. METHODS Morphological analysis of testes and testosterone assays were performed on adult CD1 MTT-treated and untreated mice. The expression of key genes involved in interstitial and tubular compartments was studied by real-time PCR. Moreover, quantitative and qualitative analysis of spermatozoa was performed. RESULTS Several degrees of damage to the testes and a significant testosterone reduction in MTT-treated mice were observed. A significant decline in 3βHsd1 and Insl3 mRNA expression in the interstitial compartment confirmed an impairment of androgen production. Fsh-R mRNA expression was unaffected by MTT, proving that Sertoli cells are not the drug's primary target. Sperm concentrations were significantly lower in MTT-treated animals. Moreover, the drug caused a significant increase in the percentage of spermatozoa with abnormal chromatin structures. CONCLUSION MTT negatively affects the male reproductive system, including changes in the morphology of testicular tissue and reductions in sperm concentration and quality.
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Affiliation(s)
- Federica Innocenti
- Department of Anatomy, Histology, Forensic Medicine and Orthopedic, Section of Histology, Sapienza University of Rome, 00185 Rome, Italy
| | - Sara Di Persio
- Department of Anatomy, Histology, Forensic Medicine and Orthopedic, Section of Histology, Sapienza University of Rome, 00185 Rome, Italy
| | - Marilena Taggi
- Department of Anatomy, Histology, Forensic Medicine and Orthopedic, Section of Histology, Sapienza University of Rome, 00185 Rome, Italy
| | - Roberta Maggio
- Endocrinology, Department of Clinical and Molecular Medicine, Sant'Andrea University Hospital, Sapienza University of Rome, 00185 Rome, Italy
| | - Pina Lardo
- Endocrinology, Department of Clinical and Molecular Medicine, Sant'Andrea University Hospital, Sapienza University of Rome, 00185 Rome, Italy
| | - Vincenzo Toscano
- Endocrinology, Department of Clinical and Molecular Medicine, Sant'Andrea University Hospital, Sapienza University of Rome, 00185 Rome, Italy
| | - Rita Canipari
- Department of Anatomy, Histology, Forensic Medicine and Orthopedic, Section of Histology, Sapienza University of Rome, 00185 Rome, Italy
| | - Elena Vicini
- Department of Anatomy, Histology, Forensic Medicine and Orthopedic, Section of Histology, Sapienza University of Rome, 00185 Rome, Italy
| | - Antonio Stigliano
- Endocrinology, Department of Clinical and Molecular Medicine, Sant'Andrea University Hospital, Sapienza University of Rome, 00185 Rome, Italy
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Fiorentino G, Cimadomo D, Innocenti F, Soscia D, Vaiarelli A, Ubaldi FM, Gennarelli G, Garagna S, Rienzi L, Zuccotti M. Biomechanical forces and signals operating in the ovary during folliculogenesis and their dysregulation: implications for fertility. Hum Reprod Update 2023; 29:1-23. [PMID: 35856663 DOI: 10.1093/humupd/dmac031] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 05/12/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Folliculogenesis occurs in the highly dynamic environment of the ovary. Follicle cyclic recruitment, neo-angiogenesis, spatial displacement, follicle atresia and ovulation stand out as major events resulting from the interplay between mechanical forces and molecular signals. Morphological and functional changes to the growing follicle and to the surrounding tissue are required to produce oocytes capable of supporting preimplantation development to the blastocyst stage. OBJECTIVE AND RATIONALE This review will summarize the ovarian morphological and functional context that contributes to follicle recruitment, growth and ovulation, as well as to the acquisition of oocyte developmental competence. We will describe the changes occurring during folliculogenesis to the ovarian extracellular matrix (ECM) and to the vasculature, their influence on the mechanical properties of the ovarian tissue, and, in turn, their influence on the regulation of signal transduction. Also, we will outline how their dysregulation might be associated with pathologies such as polycystic ovary syndrome (PCOS), endometriosis or premature ovarian insufficiency (POI). Finally, for each of these three pathologies, we will highlight therapeutic strategies attempting to correct the altered biomechanical context in order to restore fertility. SEARCH METHODS For each area discussed, a systematic bibliographical search was performed, without temporal limits, using PubMed Central, Web of Science and Scopus search engines employing the keywords extracellular matrix, mechanobiology, biomechanics, vasculature, angiogenesis or signalling pathway in combination with: ovary, oogenesis, oocyte, folliculogenesis, ovarian follicle, theca, granulosa, cumulus, follicular fluid, corpus luteum, meiosis, oocyte developmental competence, preimplantation, polycystic ovary syndrome, premature ovarian insufficiency or endometriosis. OUTCOMES Through search engines queries, we yielded a total of 37 368 papers that were further selected based on our focus on mammals and, specifically, on rodents, bovine, equine, ovine, primates and human, and also were trimmed around each specific topic of the review. After the elimination of duplicates, this selection process resulted in 628 papers, of which 287 were cited in the manuscript. Among these, 89.2% were published in the past 22 years, while the remaining 8.0%, 2.4% or 0.3% were published during the 1990s, 1980s or before, respectively. During folliculogenesis, changes occur to the ovarian ECM composition and organization that, together with vasculature modelling around the growing follicle, are aimed to sustain its recruitment and growth, and the maturation of the enclosed oocyte. These events define the scenario in which mechanical forces are key to the regulation of cascades of molecular signals. Alterations to this context determine impaired folliculogenesis and decreased oocyte developmental potential, as observed in pathological conditions which are causes of infertility, such as PCOS, endometriosis or POI. WIDER IMPLICATIONS The knowledge of these mechanisms and the rules that govern them lay a sound basis to explain how follicles recruitment and growth are modulated, and stimulate insights to develop, in clinical practice, strategies to improve follicular recruitment and oocyte competence, particularly for pathologies like PCOS, endometriosis and POI.
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Affiliation(s)
- Giulia Fiorentino
- Laboratory of Developmental Biology, Department of Biology and Biotechnology "Lazzaro Spallanzani", University of Pavia, Pavia, Italy.,Center for Health Technologies, University of Pavia, Pavia, Italy
| | | | | | - Daria Soscia
- Clinica Valle Giulia, GeneraLife IVF, Rome, Italy
| | | | | | - Gianluca Gennarelli
- Obstetrics and Gynecology, Physiopathology of Reproduction and IVF Unit, Department of Surgical Sciences, Sant'Anna Hospital, University of Torino, Turin, Italy.,Livet, GeneraLife IVF, Turin, Italy
| | - Silvia Garagna
- Laboratory of Developmental Biology, Department of Biology and Biotechnology "Lazzaro Spallanzani", University of Pavia, Pavia, Italy.,Center for Health Technologies, University of Pavia, Pavia, Italy
| | - Laura Rienzi
- Clinica Valle Giulia, GeneraLife IVF, Rome, Italy.,Department of Biomolecular Sciences, University of Urbino "Carlo Bo", Urbino, Italy
| | - Maurizio Zuccotti
- Laboratory of Developmental Biology, Department of Biology and Biotechnology "Lazzaro Spallanzani", University of Pavia, Pavia, Italy.,Center for Health Technologies, University of Pavia, Pavia, Italy
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9
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Vaiarelli A, Cimadomo D, Scarafia C, Innocenti F, Amendola MG, Fabozzi G, Casarini L, Conforti A, Alviggi C, Gennarelli G, Benedetto C, Guido M, Borini A, Rienzi L, Ubaldi FM. Metaphase-II oocyte competence is unlinked to the gonadotrophins used for ovarian stimulation: a matched case-control study in women of advanced maternal age. J Assist Reprod Genet 2023; 40:169-177. [PMID: 36586005 PMCID: PMC9840736 DOI: 10.1007/s10815-022-02684-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 12/04/2022] [Indexed: 01/01/2023] Open
Abstract
PURPOSE An impact of different gonadotrophins selection for ovarian stimulation (OS) on oocyte competence has yet to be defined. In this study, we asked whether an association exists between OS protocol and euploid blastocyst rate (EBR) per metaphase-II (MII) oocytes. METHODS Cycles of first preimplantation genetic testing for aneuploidies conducted by women ≥ 35 years old with their own metaphase-II oocytes inseminated in the absence of severe male factor (years 2014-2018) were clustered based on whether recombinant FSH (rec-FSH) or human menopausal gonadotrophin (HMG) was used for OS, then matched for the number of fresh inseminated eggs. Four groups were outlined: rec-FSH (N = 57), rec-FSH plus rec-LH (N = 55), rec-FSH plus HMG (N = 112), and HMG-only (N = 127). Intracytoplasmic sperm injection, continuous blastocyst culture, comprehensive chromosome testing to assess full-chromosome non-mosaic aneuploidies and vitrified-warmed euploid single embryo transfers (SETs) were performed. The primary outcome was the EBR per cohort of MII oocytes. The secondary outcome was the live birth rate (LBR) per first SETs. RESULTS Rec-FSH protocol was shorter and characterized by lower total gonadotrophin (Gn) dose. The linear regression model adjusted for maternal age showed no association between the Gn adopted for OS and EBR per cohort of MII oocytes. Similarly, no association was reported with the LBR per first SETs, even when adjusting for blastocyst quality and day of full blastulation. CONCLUSION In view of enhanced personalization in OS, clinicians shall focus on different endpoints or quantitative effects related to Gn action towards follicle recruitment, development, and atresia. Here, LH and/or hCG was administered exclusively to women with expected sub/poor response; therefore, we cannot exclude that specific Gn formulations may impact patient prognosis in other populations.
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Affiliation(s)
- Alberto Vaiarelli
- Clinica Valle Giulia, GeneraLife IVF, Via G. de Notaris 2B, 00197, Rome, Italy.
| | - Danilo Cimadomo
- Clinica Valle Giulia, GeneraLife IVF, Via G. de Notaris 2B, 00197, Rome, Italy
| | - Carlotta Scarafia
- Clinica Valle Giulia, GeneraLife IVF, Via G. de Notaris 2B, 00197, Rome, Italy
| | - Federica Innocenti
- Clinica Valle Giulia, GeneraLife IVF, Via G. de Notaris 2B, 00197, Rome, Italy
| | | | - Gemma Fabozzi
- Clinica Valle Giulia, GeneraLife IVF, Via G. de Notaris 2B, 00197, Rome, Italy
| | - Livio Casarini
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Center for Genomic Research, University of Modena and Reggio Emilia, Modena, Italy
| | - Alessandro Conforti
- Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Carlo Alviggi
- Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Gianluca Gennarelli
- Obstetrics and Gynecology 1U, Physiology of Reproduction and IVF Unit, Department of Surgical Sciences, Sant'Anna Hospital, University of Turin, Turin, Italy
- Livet, GeneraLife IVF, Turin, Italy
| | - Chiara Benedetto
- Obstetrics and Gynecology 1U, Physiology of Reproduction and IVF Unit, Department of Surgical Sciences, Sant'Anna Hospital, University of Turin, Turin, Italy
| | - Maurizio Guido
- Department of Clinical Medicine, Public Health, Life Sciences and Environment (MeSVA), University of L'Aquila, L'Aquila, Italy
| | | | - Laura Rienzi
- Clinica Valle Giulia, GeneraLife IVF, Via G. de Notaris 2B, 00197, Rome, Italy
- Department of Biomolecular Sciences, University of Urbino "Carlo Bo", Urbino, Italy
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10
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Lastrucci V, Lazzeretti M, Innocenti F, Berti A, Silvestri C, Schirripa A, Paoli S, Lorini C, Voller F, Bonaccorsi G. Trends of risk behaviors in adolescents: a 10-year study in a representative sample of Tuscany, Italy. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac131.459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The aim of the study was to evaluate the trends of prevalence of several health risk behaviors (HRBs) and health conditions over a 10-years period in a representative sample of adolescents of Tuscany Region, Italy.
Methods
The study had a repeated cross-sectional design, data from the last four survey waves of EDIT surveillance (2008-2018) were used. EDIT surveillance investigates HRBs in a representative sample of students attending the upper secondary schools of Tuscany. Prevalence of 17 HRBs and health conditions were considered and analyzed by age, sex, and socioeconomic status (SES).
Results
A total of 21.943 students were surveyed from 2008 to 2018. Declining trends in the participation in smoking, cocaine use, driving under the influence of alcohol and drugs, and problem gambling were observed, while alcohol abuse and at-risk sexual behaviors remained unchanged or increased during the study period. During the most recent survey males resulted more frequently involved in most of the HRBs, while females more frequently reported physical inactivity, regular smoking and not using a condom. Female participation in smoking and alcohol abuse behaviors, fruit and vegetables consumption, and bullying worsened over the study period. Smoking, poor dietary habits, physical inactivity, high distress level, and obesity were more frequently observed in low SES students than in high SES students.
Conclusions
In conclusion findings showed various different tendencies in adolescent participation in HRBs over the course of the last decade; concerning trends in at-risk sexual behaviors and alcohol consumption and females’ risk-taking behavior on the rise require careful monitoring and intervention.
Key messages
• Distinct tendencies according to sex, socio-economic condition and specific health risk behavior were observed in adolescent participation in health risk behaviors over the course of the last decade.
• Health promotion and prevention interventions tailored on specific health risk behaviors and population groups are needed.
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Affiliation(s)
- V Lastrucci
- Meyer Children’s Hospital Epidemiology Unit, , Firenze, Italy
- Department of Health Sciences, University of Florence , Firenze, Italy
| | - M Lazzeretti
- Epidemologic Observatory, Regional Health Agency of Tuscany , Firenze, Italy
| | - F Innocenti
- Epidemologic Observatory, Regional Health Agency of Tuscany , Firenze, Italy
| | - A Berti
- Epidemologic Observatory, Regional Health Agency of Tuscany , Firenze, Italy
| | - C Silvestri
- Epidemologic Observatory, Regional Health Agency of Tuscany , Firenze, Italy
| | - A Schirripa
- Medical Specialization School of Hygiene and Preventive Medicine, University of Florence , Firenze, Italy
| | - S Paoli
- Medical Specialization School of Hygiene and Preventive Medicine, University of Florence , Firenze, Italy
| | - C Lorini
- Department of Health Sciences, University of Florence , Firenze, Italy
| | - F Voller
- Epidemologic Observatory, Regional Health Agency of Tuscany , Firenze, Italy
| | - G Bonaccorsi
- Department of Health Sciences, University of Florence , Firenze, Italy
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11
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Innocenti F, De Paris A, Lagomarsini A, Pelagatti L, Casalini L, Gianno A, Montuori M, Bernardini P, Caldi F, Tassinari I, Pini R. Stratification of patients admitted for SARS-CoV2 infection: prognostic scores in the first and second wave of the pandemic. Intern Emerg Med 2022; 17:2093-2101. [PMID: 35733074 PMCID: PMC9216296 DOI: 10.1007/s11739-022-03016-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 05/23/2022] [Indexed: 01/08/2023]
Abstract
To test the prognostic performance of different scores, both specifically designed for patients with COVID-19 and generic, in predicting in-hospital mortality and the need for mechanical ventilation (MV). We retrospectively collected clinical data of patients admitted to the Emergency Department of the University Hospital AOU Careggi, Florence, Italy, between February 2020 and January 2021, with a confirmed infection by SARS-CoV2. We calculated the following scores: Sequential Organ Failure Assessment (SOFA) score, CALL score, 4C Mortality score, QUICK score, CURB-65 and MuLBSTA score. The end-points were in-hospital mortality and the need for MV. We included 1208 patients, mean age 60 ± 17 years, 57% male sex. Compared to survivors, non-survivors showed significantly higher values of all the prognostic scores (4C: 13 [10-15] vs 8 [4-10]; CALL: 11 [10-12] vs 9 [7-11]; QUICK: 4 [1-6] vs 0 [0-3]; SOFA: 5 [4-6] vs 4 [4-5]; CURB: 2 [1-3] vs 1 [0-1]; MuLBSTA: 11 [9-13] vs 9 [7-11], all p < 0.001). Discriminative ability evaluated by the Receiver Operating Curve analysis showed the following values of the Area under the Curve: 0.83 for 4C, 0.74 for CALL, 0.70 for QUICK, 0.68 for SOFA, 0.76 for CURB and 0.64 for MuLBSTA. The mortality rate significantly increased in increasing quartiles of 4C and CALL score (respectively, 2, 8, 24 and 54% for the 4C score and 1, 17, 33 and 68% for the CALL score, both p < 0.001). 4C and CALL score allowed an early and good prognostic stratification of patients admitted for pneumonia induced by SARS-CoV2.
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Affiliation(s)
- F Innocenti
- High-Dependency Unit, Department of Clinical and Experimental Medicine, Careggi University Hospital, Lg. Brambilla 3, 50134, Florence, Firenze, Italy.
| | - A De Paris
- High-Dependency Unit, Department of Clinical and Experimental Medicine, Careggi University Hospital, Lg. Brambilla 3, 50134, Florence, Firenze, Italy
| | - A Lagomarsini
- High-Dependency Unit, Department of Clinical and Experimental Medicine, Careggi University Hospital, Lg. Brambilla 3, 50134, Florence, Firenze, Italy
| | - L Pelagatti
- High-Dependency Unit, Department of Clinical and Experimental Medicine, Careggi University Hospital, Lg. Brambilla 3, 50134, Florence, Firenze, Italy
| | - L Casalini
- High-Dependency Unit, Department of Clinical and Experimental Medicine, Careggi University Hospital, Lg. Brambilla 3, 50134, Florence, Firenze, Italy
| | - A Gianno
- High-Dependency Unit, Department of Clinical and Experimental Medicine, Careggi University Hospital, Lg. Brambilla 3, 50134, Florence, Firenze, Italy
| | - M Montuori
- High-Dependency Unit, Department of Clinical and Experimental Medicine, Careggi University Hospital, Lg. Brambilla 3, 50134, Florence, Firenze, Italy
| | - P Bernardini
- High-Dependency Unit, Department of Clinical and Experimental Medicine, Careggi University Hospital, Lg. Brambilla 3, 50134, Florence, Firenze, Italy
| | - F Caldi
- High-Dependency Unit, Department of Clinical and Experimental Medicine, Careggi University Hospital, Lg. Brambilla 3, 50134, Florence, Firenze, Italy
| | - I Tassinari
- High-Dependency Unit, Department of Clinical and Experimental Medicine, Careggi University Hospital, Lg. Brambilla 3, 50134, Florence, Firenze, Italy
| | - R Pini
- High-Dependency Unit, Department of Clinical and Experimental Medicine, Careggi University Hospital, Lg. Brambilla 3, 50134, Florence, Firenze, Italy
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12
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Cimadomo D, Fiorentino G, Innocenti F, Merico V, Taggi M, Angotzi M, Venturella R, Albricci L, Vaiarelli A, Sproviero D, Cereda C, Gagliardi S, Ubaldi F, Garagna S, Rienzi L, Zuccotti M. Cumulus cells secrete micro-vesicles carrying miRNAs: their role in the acquisition of mouse and human oocyte's developmental competence. Reprod Biomed Online 2022. [DOI: 10.1016/j.rbmo.2022.08.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2022]
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13
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Cimadomo D, Marconetto A, Trio S, Chiappetta V, Innocenti F, Albricci L, Erlich I, Ben-Meir A, Har-Vardi I, Kantor B, Sakov A, Coticchio G, Borini A, Ubaldi FM, Rienzi L. Human blastocyst spontaneous collapse is associated with worse morphological quality and higher degeneration and aneuploidy rates: a comprehensive analysis standardized through artificial intelligence. Hum Reprod 2022; 37:2291-2306. [PMID: 35939563 DOI: 10.1093/humrep/deac175] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 07/12/2022] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION What are the factors associated with human blastocyst spontaneous collapse and the consequences of this event? SUMMARY ANSWER Approximately 50% of blastocysts collapsed, especially when non-viable, morphologically poor and/or aneuploid. WHAT IS KNOWN ALREADY Time-lapse microscopy (TLM) is a powerful tool to observe preimplantation development dynamics. Lately, artificial intelligence (AI) has been harnessed to automate and standardize such observations. Here, we adopted AI to comprehensively portray blastocyst spontaneous collapse, namely the phenomenon of reduction in size of the embryo accompanied by efflux of blastocoel fluid and the detachment of the trophectoderm (TE) from the zona pellucida (ZP). Although the underlying causes are unknown, blastocyst spontaneous collapse deserves attention as a possible marker of reduced competence. STUDY DESIGN, SIZE, DURATION An observational study was carried out, including 2348 TLM videos recorded during preimplantation genetic testing for aneuploidies (PGT-A, n = 720) cycles performed between January 2013 and December 2020. All embryos in the analysis at least reached the time of starting blastulation (tSB), 1943 of them reached full expansion, and were biopsied and then vitrified. PARTICIPANTS/MATERIALS, SETTING, METHODS ICSI, blastocyst culture, TE biopsy without Day 3 ZP drilling, comprehensive chromosome testing and vitrification were performed. The AI software automatically registered tSB and time of expanding blastocyst (tEB), start and end time of each collapse, time between consecutive collapses, embryo proper area, percentage of shrinkage, embryo:ZP ratio at embryo collapse, time of biopsy (t-biopsy) and related area of the fully (re-)expanded blastocyst before biopsy, time between the last collapse and biopsy. Blastocyst morphological quality was defined according to both Gardner's criteria and an AI-generated implantation score. Euploidy rate per biopsied blastocyst and live birth rate (LBR) per euploid single embryo transfer (SET) were the main outcomes. All significant associations were confirmed through regression analyses. All couple, cycle and embryo main features were also investigated for possible associations with blastocyst spontaneous collapse. MAIN RESULTS AND THE ROLE OF CHANCE At least one collapsing embryo (either viable or subsequently undergoing degeneration) was recorded in 559 cycles (77.6%) and in 498 cycles (69.2%) if considering only viable blastocysts. The prevalence of blastocyst spontaneous collapse after the tSB, but before the achievement of full expansion, was 50% (N = 1168/2348), irrespective of cycle and/or couple characteristics. Blastocyst degeneration was 13% among non-collapsing embryos, while it was 18%, 20%, 26% and 39% among embryos collapsing once, twice, three times or ≥4 times, respectively. The results showed that 47.3% (N = 918/1943) of the viable blastocysts experienced at least one spontaneous collapse (ranging from 1 up to 9). Although starting from similar tSB, the number of spontaneous collapses was associated with a delay in both tEB and time of biopsy. Of note, the worse the quality of a blastocyst, the more and the longer its spontaneous collapses. Blastocyst spontaneous collapse was significantly associated with lower euploidy rates (47% in non-collapsing and 38%, 32%, 31% and 20% in blastocysts collapsing once, twice, three times or ≥4 times, respectively; multivariate odds ratio 0.78, 95%CI 0.62-0.98, adjusted P = 0.03). The difference in the LBR after euploid vitrified-warmed SET was not significant (46% and 39% in non-collapsing and collapsing blastocysts, respectively). LIMITATIONS, REASONS FOR CAUTION An association between chromosomal mosaicism and blastocyst collapse cannot be reliably assessed on a single TE biopsy. Gestational and perinatal outcomes were not evaluated. Other culture strategies and media should be tested for their association with blastocyst spontaneous collapse. Future studies with a larger sample size are needed to investigate putative impacts on clinical outcomes after euploid transfers. WIDER IMPLICATIONS OF THE FINDINGS These results demonstrate the synergistic power of TLM and AI to increase the throughput of embryo preimplantation development observation. They also highlight the transition from compaction to full blastocyst as a delicate morphogenetic process. Blastocyst spontaneous collapse is common and associates with inherently lower competence, but additional data are required to deepen our knowledge on its causes and consequences. STUDY FUNDING/COMPETING INTEREST(S) There is no external funding to report. I.E., A.B.-M., I.H.-V. and B.K. are Fairtility employees. I.E. and B.K. also have stock or stock options of Fairtility. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
| | - Anabella Marconetto
- University Institute of Reproductive Medicine, National University of Córdoba, Córdoba, Argentina
| | | | | | | | | | | | - Assaf Ben-Meir
- Fairtilty Ltd, Tel Aviv, Israel.,IVF Unit, Department of Obstetrics and Gynecology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Iris Har-Vardi
- Fairtilty Ltd, Tel Aviv, Israel.,Fertility and IVF unit, Department of Obstetrics and Gynecology, Soroka University Medical Center and the Faculty of Health Sciences Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | | | | | | | | | | | - Laura Rienzi
- GeneraLife IVF, Clinica Valle Giulia, Rome, Italy.,Department of Biomolecular Sciences, University of Urbino "Carlo Bo", Urbino, Italy
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14
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Casciani V, Cimadomo D, Trio S, Chiappetta V, Innocenti F, Iussig B, Alviggi E, Canosa S, Barnocchi N, Maggiulli R, Berntsen J, Kragh M, Larman M, Ubaldi F, Rienzi L. P-189 Association between iDAScore v1.0, senior embryologists’ grading and euploidy in 546 blastocysts obtained during 189 PGT-A cycles. Hum Reprod 2022. [DOI: 10.1093/humrep/deac107.182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Study question
Is (intelligent data analysis) iDAScore v1.0 associated with euploidy at the blastocyst stage?
Summary answer
iDAScore v1.0 significantly correlated with euploidy (maternal age-adjusted OR:1.3 and AUC:0.72). Euploid blastocysts were ranked highest in ca.70% of the cohorts with both diagnoses.
What is known already
With machine learning and artificial intelligence (AI) implementation in IVF, several studies have been published mostly aimed at providing standardized and reproducible tools for gamete/embryo assessment and selection. Several of the proposed models might not be generally applicable due to their development on only a single center, small sample size and poor representation of the numerous clinical scenarios. Furthermore, the evidence has been rarely confirmed prospectively and/or in multicenter studies. Lately, the EmbryoScope+ has incorporated the iDAScore v1.0. This algorithm scores the chance of embryo implantation based on the video of blastocyst development and with no need for timing annotations.
Study design, size, duration
Interim analysis of a prospective study. Between April-December 2021, 189 preimplantation-genetic-testing (PGT) cycles (maternal age:38.4±4yr) with ≥1 blastocyst (N = 546 blastocysts, mean±SD:2.9±1.8, range:1-13) were included. We aimed at blindly analyzing the correlation between iDAScore v1.0 and (i) blastocyst quality estimated by senior embryologists, (ii) day of blastocyst full-expansion, (iii) chromosomal constitution diagnosed by NGS on a trophectoderm biopsy, (iv) the blastocyst to prioritize for transfer within cohorts with ≥2 blastocysts.
Participants/materials, setting, methods
Undisturbed culture was conducted in the EmbryoScope+. Assisted hatching was not performed and only fully-expanded blastocysts were biopsied. Morphology was assessed by 2 senior embryologists based on Gardner criteria. Average iDAScores were reported for the following groups: (i)excellent (AA)/good (AB,BA)/average (BB,AC,CA)/poor-quality (CC,BC,CB) blastocysts, (ii)day5/6/7 blastocysts, (iii)euploid/aneuploid/complex aneuploid blastocysts. Lastly, we reported how often the highest iDAScore corresponded to the highest ranked morphology (N = 143 cycles with ≥2 blastocysts) and/or euploid blastocysts (N = 79 cycles with both diagnoses).
Main results and the role of chance
In the study period, 546 blastocysts (iDAScore: 6.9±2.0, 2-9.7) were biopsied. The iDAScore was significantly different (Kruskal-Wallis<0.01) across blastocysts graded excellent (N = 256,46.9%; 8.1±1.3, 2.5-9.7), good (N = 97,17.7%; 6.9±1.6, 2.3-9.5), average (N = 75,13.9%; 5.8±1.4, 2.9-8.7) and poor (N = 118,21.5%; 4.8±1.6, 2-8.8). A significant difference (Kruskal-Wallis<0.01) was also found for the day of full-expansion (day5: N = 184,33.9%, 8.8±0.8, 4.3-9.7; day6: N = 324,59.1%, 6.0±1.6, 2.2-9.1; day7: N = 38,6.9%, 4.6±1.6, 2-7.8). Euploid blastocysts (N = 178,32.6%) had a significantly higher (Kruskal-Wallis<0.01) iDAScore (7.5±1.7, 2.4-9.6) than both simple (N = 209,38.3%, 6.7±2.1, 2.1-9.7) and complex aneuploid blastocysts (N = 159,29.1%, 6.3±2.0, 2-9.4). The logistic regression adjusted for maternal age highlighted a multivariate-OR 1.3, 95%CI 1.18-1.45, adjusted-p<0.01 for the association between iDAScore v1.0 and euploidy. The Receiver-Operating-Characteristic (ROC) curves outlined similar performance in predicting euploidy among the models encompassing iDAScore v1.0 adjusted for maternal age (AUC: 0.72, 95%CI 0.67-0.76, p < 0.01) or blastocyst quality (defined by senior embryologists) plus day of biopsy also adjusted for maternal age (AUC: 0.73, 95%CI 0.69-0.78, p < 0.01). iDAScore v1.0 and embryologists ranked the same blastocyst highest in 123 of 143 cycles with ≥2 blastocysts (86%). The highest ranked blastocyst according to iDAScore was a euploid blastocyst in 54 of the 79 cycles (68%) containing both euploid and aneuploid blastocysts.
Limitations, reasons for caution
The main purpose of iDAScore v1.0, for which the algorithm was trained, is implantation prediction of untested blastocysts. Thus, once the sample size of this blinded prospective study will be large enough, we will also examine the association between iDAScore v1.0 and the implantation of euploid blastocysts.
Wider implications of the findings
The similar predictivity on euploidy reported between subjective senior embryologists’ grading and objective AI-powered iDAscores is promising in view of IVF automation and standardization. This is especially relevant since iDAScore v1.0 has not been trained yet to specifically predict euploidy, and its future versions could be fine-tuned accordingly.
Trial registration number
Not Applicable
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Affiliation(s)
- V Casciani
- Clinica Valle Giulia, GeneraLife IVF , Rome, Italy
| | - D Cimadomo
- Clinica Valle Giulia, GeneraLife IVF , Rome, Italy
| | - S Trio
- GeneraLife Milan, GeneraLife IVF , Milan, Italy
| | - V Chiappetta
- Clinica Valle Giulia, GeneraLife IVF , Rome, Italy
| | - F Innocenti
- Clinica Valle Giulia, GeneraLife IVF , Rome, Italy
| | - B Iussig
- Genera Veneto, GeneraLife IVF , Marostica, Italy
| | - E Alviggi
- Clinica Ruesch, GeneraLife IVF , Naples, Italy
| | - S Canosa
- Livet, GeneraLife IVF , Turin, Italy
| | - N Barnocchi
- Genera Umbria, GeneraLife IVF , Umbertide, Italy
| | - R Maggiulli
- Clinica Valle Giulia, GeneraLife IVF , Rome, Italy
| | - J Berntsen
- Vitrolife, Vitrolife A/S , Aarhus, Denmark
| | - M.F Kragh
- Vitrolife, Vitrolife A/S , Aarhus, Denmark
| | - M Larman
- Vitrolife, Vitrolife Sweden AB , Göteborg, Sweden
| | - F.M Ubaldi
- Clinica Valle Giulia, GeneraLife IVF , Rome, Italy
| | - L Rienzi
- Clinica Valle Giulia, GeneraLife IVF , Rome, Italy
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15
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Maggiulli R, Cimadomo D, Innocenti F, Soscia D, Giancani A, Canosa S, Albricci L, Fabozzi G, Stoppa M, Sanges F, Vereczkey A, Holte J, Vaiarelli A, Ubaldi F, Rienzi L. P-773 Assessment of the putative impact of culture strategies, oocyte/embryo manipulations, and operators: a retrospective analysis of 3705 blastocyst culture cycles and 2604 single blastocyst transfers. Hum Reprod 2022. [DOI: 10.1093/humrep/deac107.713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Study question
Do the culture strategies, oocyte/embryo manipulations, and operators impact blastulation-rates per cohort of metaphase-II oocytes (BR per MII-oocytes) and/or live-birth-rates per single-embryo-transfer (LBR per SET)?
Summary answer
Undisturbed culture improved the BR per MII-oocytes, while culture drop volumes ≥80ml in the well-of-the-well system were associated with increased LBR per untested/euploid blastocyst SET.
What is known already
IVF lab performance is critical to achieve success in IVF. Yet, while a consensus exists on the main key-performance-indicators (KPIs), namely BR and LBR, and their inherent benchmark values, the strategies to fulfil them are still poorly standardized. The plasticity of human embryos along with the disparities in the patient populations might mask even largely different outcomes across clinics. Therefore, clear guidelines shall outline which procedures to standardize and carefully monitor in IVF laboratories. Here we investigated different embryo culture strategies, manipulations, and operators for their effect on BR and LBR per SET, adjusting the results for all main confounders.
Study design, size, duration
Retrospective analysis of 3705 cycles with ≥1 MII-oocyte and 2604 SETs (January2019-March2021). BR per MII-oocytes and LBR per SET were the main outcomes. Embryo-twinning was also assessed. The putative impact of culture strategies, manipulations, and operators’ expertise (0-5yr,6-11yr or > 12yr) was determined via regression analyses adjusted for possible confounders (autologous/donated oocytes, age, primary/secondary infertility and duration, sperm factor; for SET: also endometrial preparation, age at transfer, number of consecutive transfer, untested/euploid blastocyst, quality, and day).
Participants/materials, setting, methods
In donation cycles, only vitrified oocytes were used. In Preimplantation-Genetic-Testing (PGT) cycles, no assisted-hatching was performed and only euploid non-mosaic vitrified-warmed blastocysts were transferred. The culture strategies assessed were undisturbed (Embryoscope, Geri and Embryoscope-plus)/disturbed (KSystems), volume and approach (drops ≤30ml with single-culture or ≥ 80ml with well-of-the-well approaches), humidified/non-humidified atmosphere and media refreshed/not-refreshed. The manipulations assessed were oocyte/blastocyst vitrification (performed/not-performed), oocyte retrieval and denudation performed with oil overlay (yes/not), laser-assisted artificial-shrinkage (performed/not-performed), trophectoderm biopsy (performed/not-performed).
Main results and the role of chance
The only confounders on BR per MII-oocytes (overall:39.1±26.6%) were sperm factor and oocyte age. The linear regressions showed benefits for humidified atmosphere (unstandardized B-coefficient:+2.9%, p = 0.01), manipulations with oil overlay (+3.9%, p = 0.03) and drops≥80ml with a well-of-the-well approach (+4.3%, p < 0.01). However, only the positive effect of undisturbed incubators was significant when adjusting for confounders [41.7±27.8% (N = 1440 cycles) versus 37.5±25.7% in a disturbed incubator (N = 2265 cycles); unstandardized B-coefficient:+5.6%, 95%CI +3.9% to + 7.3%, standardized beta-coefficient:-0.103,p<0.01].
The main confounders on LBR per SET (overall: N = 1044/2604, 40.1%) were oocyte age, number of consecutive transfer, blastocyst chromosomal status (untested/euploid), quality and day. The univariate logistic regressions showed a benefit for undisturbed incubators (OR:1.3, 95%CI 1.1-1.5, p < 0.01), humidified atmosphere (OR:1.4, 95%CI 1.1-1.7, p < 0.01) and media refresh (OR:1.3, 95% 1.01-1.8, p = 0.05). However, only the use of drops ≥80ml with a well-of-the-well approach rather than drops ≤30ml with a single-culture approach involved an improvement when adjusting for confounders (untested SETs: N = 71/171, 41.5% versus N = 434/1284, 33.8%; euploid SETs: N = 170/316, 53.8% versus N = 369/833, 44.3%; multivariate-OR:1.33, 95%CI 1.12-1.58, adjusted p-value<0.01). This result was confirmed in a sub-analysis across only first patients’ SETs.
Lastly, no feature under investigation was associated with embryo-twinning (overall: N = 23/1243, 1.9% and N = 14/1044, 1.3% per pregnancy and delivery, respectively).
Limitations, reasons for caution
Retrospective single center study. Only ICSI cycles and continuous culture media were assessed. Cleavage stage SETs were excluded. All operators had at least 3yr of experience. Perinatal and gestational outcomes were not evaluated.
Wider implications of the findings
Real-life data adjusted for confounders may unveil fluctuations in critical KPIs mainly imputable to culture strategies. An impact seldom derives from oocyte/embryo manipulations if experienced operators adopt validated protocols. An accurate interpretation of these evidence shall lead to properly designed studies with problem-solving/progress-building purposes, and guidelines to standardize culture practices.
Trial registration number
Not applicable
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Affiliation(s)
- R Maggiulli
- Clinica Valle Giulia, GeneraLife IVF , Rome, Italy
| | - D Cimadomo
- Clinica Valle Giulia, GeneraLife IVF , Rome, Italy
| | - F Innocenti
- Clinica Valle Giulia, GeneraLife IVF , Rome, Italy
| | - D Soscia
- Clinica Valle Giulia, GeneraLife IVF , Rome, Italy
| | - A Giancani
- Clinica Valle Giulia, GeneraLife IVF , Rome, Italy
| | - S Canosa
- Livet, GeneraLife IVF , Turin, Italy
| | - L Albricci
- Clinica Valle Giulia, GeneraLife IVF , Rome, Italy
| | - G Fabozzi
- Clinica Valle Giulia, GeneraLife IVF , Rome, Italy
| | - M Stoppa
- Clinica Valle Giulia, GeneraLife IVF , Rome, Italy
| | - F Sanges
- Clinica Valle Giulia, GeneraLife IVF , Rome, Italy
| | - A Vereczkey
- Versys Clinics, Human Reproduction Institute , Budapest, Hungary
| | - J Holte
- Carl von Linnè clinic, GeneraLife IVF , Uppsala, Sweden
| | - A Vaiarelli
- Clinica Valle Giulia, GeneraLife IVF , Rome, Italy
| | - F.M Ubaldi
- Clinica Valle Giulia, GeneraLife IVF , Rome, Italy
| | - L Rienzi
- Clinica Valle Giulia, GeneraLife IVF , Rome, Italy
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Cimadomo D, Marconetto A, Innocenti F, Trio S, Chiappetta V, Soscia D, Albricci L, Dovere L, Giancani A, Maggiulli R, Erlich I, Ben-Meir A, Har-Vardi I, Ubaldi F, Rienzi L. O-101 Elucidation of blastocyst collapse and its consequences: a comprehensive artificial intelligence-powered analysis of 1943 embryos from 643 couples. Hum Reprod 2022. [DOI: 10.1093/humrep/deac105.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Study question
What are the causes and consequences of blastocyst collapse?
Summary answer
∼50% of blastocysts collapsed, especially if they are aneuploid and/or morphologically-poor. Yet, no impact on the live-birth-rate (LBR) per vitrified-warmed euploid single-embryo-transfer (SET) was reported.
What is known already
Time-lapse-microscopy (TLM) is a powerful tool to describe the peculiar dynamics of preimplantation development. Lately, artificial intelligence (AI) has been also implemented to automatize and standardize such description. Here, we adopted AI to comprehensively portray blastocyst collapse, namely the phenomenon of embryo contraction with an efflux of blastocoel fluid and the detachment of the trophectoderm (TE) from the Zona Pellucida (ZP). Although, the causes of this event are still undetermined, small blastocyst contractions have been reported beneficial for the hatching process, while a full collapse has been associated with lower competence.
Study design, size, duration
Observational study including 1943 blastocysts from 643 couples cultured in the Embryoscope between January-2013 and December-2020. TE biopsy without day3 ZP drilling and comprehensive-chromosome-testing were performed. The Fairtility® software automatically registered: (i)time of starting-blastulation (tSB), (ii)starting and ending time of each collapse (tSC and tEC), (iii)blastocysts’ areas, (iv)shrinkage% [(area at SC – area at EC)/area at SC)], (v)embryo:ZP ratio at EC (area of the collapsed embryo/area of the ZP), and (vi)time of biopsy (t-biopsy).
Participants/materials, setting, methods
Blastocyst quality was defined according to Istanbul Consensus (11, excellent; 12-21, good; 22-13-31, average; 33-23-32, poor) and with the Fairtility implantation score (IS) as well, i.e., a continuous variable from 0 to 1 generated by the KID+ software based on the TLM videos of preimplantation development. The main outcome was the LBR per euploid SET adjusted for confounders through logistic regressions. All couple and embryo features were also investigated for their association with blastocyst collapse.
Main results and the role of chance
47.3% of the blastocysts collapsed 1- to 9-times (interval between collapses: 4-8hr), and 73% of the couples had ≥1 collapsed blastocyst (1.8±1.1, range:1-8). No couple feature, though, was associated with blastocyst collapse. The longest collapses lasted 1.5±1.1 (0.13-5.1)hr, while the largest shrinkage% and embryo:ZP ratio at EC were 35±14% (10-78%) and 81±9% (33-90%), respectively. In ∼50-60% of collapses a 20-40% blastocyst volume reduction was registered, 40-60% or 20-40% in ∼15-30%, 60-80% in 0-4%. In case of multiple collapses, the first three involved smaller shrinkages. Blastocysts undergoing ≥1 collapse showed similar tSB as not-collapsing blastocysts, but progressively longer tEB and t-biopsy. The earlier the first event, the more the consecutive collapses. Notably, the poorer the morphology, the higher the risk (excellent, good, average, and poor not-collapsing blastocysts were 64%,50%,44% and 37%), number (e.g.,≥4 collapses were 0.4%,2%,4% and 8%) and duration (1.2±1.0,1.4±1.0,1.6±1.1 and 1.9±1.3hr) of blastocyst collapse. Collapsing blastocysts were significantly less euploid than non-collapsing (35% vs 47%; multivariate-OR:0.75,95%CI 0.6-0.92,p<0.01); conversely, their LBR per euploid SET (39% vs 46%) and miscarriage rate per clinical pregnancy (17% vs 11%), were not significantly different (adjusted-OR:1.0,95%CI 0.69-1.48,p=0.96 and adjusted-OR:1.65,95%CI 0.79-3.42,p=0.18, respectively). All data were confirmed also by defining blastocyst quality through the Fairtility IS.
Limitations, reasons for caution
Gestational and perinatal outcomes were not assessed. Other culture strategies and media shall be assessed for their association with blastocyst collapse. Perhaps, future studies from other groups and with a larger sample size might unveil a significant impact on the clinical outcomes.
Wider implications of the findings
Collapse is common and delays blastocyst full-expansion. Moreover, poor morphology and aneuploidies involve a higher risk of collapse(s); however, no impact was reported on the clinical outcomes after euploid SET. AI appears to increase the throughput of the analysis, but additional data are required to research the causes of collapse.
Trial registration number
Not applicable
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Affiliation(s)
- D Cimadomo
- Clinica Valle Giulia, GeneraLife IVF, Roma , Italy
| | - A Marconetto
- National University of Córdoba, University Institute of Reproductive Medicine, Córdoba , Argentina
| | - F Innocenti
- Clinica Valle Giulia, GeneraLife IVF, Roma , Italy
| | - S Trio
- GeneraLife Milan, GeneraLife IVF, Milan , Italy
| | - V Chiappetta
- Clinica Valle Giulia, GeneraLife IVF, Roma , Italy
| | - D Soscia
- Clinica Valle Giulia, GeneraLife IVF, Roma , Italy
| | - L Albricci
- Clinica Valle Giulia, GeneraLife IVF, Roma , Italy
| | - L Dovere
- Clinica Valle Giulia, GeneraLife IVF, Roma , Italy
| | - A Giancani
- Clinica Valle Giulia, GeneraLife IVF, Roma , Italy
| | - R Maggiulli
- Clinica Valle Giulia, GeneraLife IVF, Roma , Italy
| | - I Erlich
- Fairtility Ltd., Fairtility, Tel Aviv , Israel
| | - A Ben-Meir
- Fairtility Ltd., Fairtility, Tel Aviv , Israel
| | - I Har-Vardi
- Fairtility Ltd., Fairtility, Tel Aviv , Israel
| | - F.M Ubaldi
- Clinica Valle Giulia, GeneraLife IVF, Roma , Italy
| | - L Rienzi
- Clinica Valle Giulia, GeneraLife IVF, Roma , Italy
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17
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Trabucco E, Vaiarelli A, Cimadomo D, Innocenti F, Alfano S, Malagisi F, Della Ragione A, Benini F, Livi C, Colamaria S, Argento C, Bruno G, Conforti A, Rienzi L, Ubaldi FM. O-072 Can preimplantation genetic testing for monogenic conditions represent an indication for DuoStim? A multicenter case series. Hum Reprod 2022. [DOI: 10.1093/humrep/deac104.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Study question
Is double stimulation in the same ovarian cycle (DuoStim) a valuable strategy to improve the chance of success in couples carrier of monogenic conditions?
Summary answer
DuoStim is advantageous in patients indicated for preimplantation genetic testing for monogenic diseases and aneuploidy testing (PGT-M/-A) and obtaining ≤5 blastocysts after the I-stimulation.
What is known already
PGT-M is a well-established strategy to identify unaffected blastocysts in a cohort of embryos produced from couples carrier of single gene disorders. When PGT-M is conducted in poor prognosis and/or advanced maternal age (POR/AMA) patients, also aneuploidy-testing among unaffected blastocysts is suggested on a single biopsy. The Poseidon group stated that retrieving an adequate number of oocytes to produce ≥1 euploid blastocyst should be considered the main goal of controlled-ovarian-stimulation (COS). This task is even more complex when PGT-M is required in POR/AMA patients. Therefore, lately we started suggesting DuoStim to these couples to maximize their chance of success.
Study design, size, duration
Multicenter case series (2016-2021). Comprehensive description of IVF outcomes derived from DuoStim application in POR/AMA patients undergoing PGT-M. Aneuploidy-testing was also conducted on unaffected blastocysts. All results were compared between the two stimulations in the same ovarian cycle, and we reported the contribution of II-stimulations to higher chances of success.
Participants/materials, setting, methods
GnRH-antagonist COS was performed with recombinant-gonadotrophins and agonist-trigger. Based on the expected risk each embryo would be affected-aneuploid, DuoStim was suggested to all patients obtaining ≤5 blastocysts (day5-7 from I-retrieval). 61 patients accepted and underwent II-stimulations with the same protocol. Only ICSI, trophectoderm-biopsy, qPCR, and vitrified-warmed unaffected-euploid single-blastocyst-transfer(s) were conducted.
Main results and the role of chance
90 patients (36.7±3.7yr) indicated to PGT-M/-A and obtaining ≤5 blastocysts after I-stimulations were suggested starting a II-stimulation in the same ovarian cycle. Among them, 61 accepted (67%). 7.2±4.4 and 7.4±4.2 cumulus-oocyte-complexes were retrieved after I- and II-stimulations, respectively (p = 0.7). 5.1±3.0 and 5.8±3.4 were metaphase-II oocytes (p = 0.2), resulting in 75±21% and 77±25% maturation-rates (p = 0.6). 3.6±2.1 and 4.6±2.9 2PN-zygotes were obtained (p = 0.04), resulting in 75±27% and 81±20% fertilization-rates (p = 0.19). 1.6±1.3 and 2.2±1.8 blastocysts were obtained (p = 0.04), resulting in 43±32% and 46±32% blastulation-rates (p = 0.6). Lastly, 0.5±0.7 and 0.7±1.0 blastocysts were diagnosed unaffected-euploid (p = 0.3), resulting in 35±40% and 30±36% transferable blastocyst rates per biopsied embryo, respectively (p = 0.53), and identical 10±16% transferable blastocyst rates per metaphase-II oocyte in both groups (p = 0.9). 23 (38%) and 24 (39%) patients obtained ≥1 transferable blastocyst after the I- and II-simulation, respectively. Overall, 36 (59%) patients obtained ≥1 transferable blastocyst thanks to DuoStim. To date, 57 (93%) cycles were concluded, and the cumulative live birth rate (CLBR) was 37% (N = 21/57). The patients with a LB have 1.7 surplus transferable blastocysts, and 3 patients already delivered 2 singleton healthy-LBs. The CLBR among patients undergoing the conventional strategy was 21%, no surplus transferable blastocyst is available, and no patient delivered >1 LB.
Limitations, reasons for caution
Observational case series based on real-life data. Of note, the adoption of DuoStim (or any other oocyte/embryo accumulation strategy) in PGT-M/-A is valuable also to amortize the costs of PGT-M set-up and genetic testing through a larger number of blastocysts. In this context, cost-effectiveness analyses in different settings are desirable.
Wider implications of the findings
DuoStim is a fully-personalized strategy advisable any time lower chance of success and higher treatment costs could be balanced by a larger number of blastocysts produced in a short time-frame. Adopting GnRH-antagonist protocols in these patients allows to suggest DuoStim even in progress, based on the embryological outcomes after I-stimulations.
Trial registration number
Not applicable
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Affiliation(s)
- E Trabucco
- Clinica Ruesch, GeneraLife IVF, Naples , Italy
| | - A Vaiarelli
- Clinica Valle Giulia, GeneraLife IVF, Rome , Italy
| | - D Cimadomo
- Clinica Valle Giulia, GeneraLife IVF, Rome , Italy
| | - F Innocenti
- Clinica Valle Giulia, GeneraLife IVF, Rome , Italy
| | - S Alfano
- Clinica Ruesch, GeneraLife IVF, Naples , Italy
| | - F Malagisi
- Clinica Ruesch, GeneraLife IVF, Naples , Italy
| | | | - F Benini
- Demetra, GeneraLife IVF, Florence , Italy
| | - C Livi
- Demetra, GeneraLife IVF, Florence , Italy
| | - S Colamaria
- Clinica Valle Giulia, GeneraLife IVF, Rome , Italy
| | - C Argento
- Clinica Valle Giulia, GeneraLife IVF, Rome , Italy
| | - G Bruno
- Clinica Valle Giulia, GeneraLife IVF, Rome , Italy
| | - A Conforti
- University of Naples Federico II, Department of Neuroscience- Reproductive Science and Odontostomatology, Naples , Italy
| | - L Rienzi
- Clinica Valle Giulia, GeneraLife IVF, Rome , Italy
| | - F M Ubaldi
- Clinica Valle Giulia, GeneraLife IVF, Rome , Italy
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18
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Innocenti F, Cimadomo D, Soscia D, Casciani V, Trio S, Chiappetta V, Albricci L, Maggiulli R, Fabozzi G, Erlich I, Ben-Meir A, Har-Vardi I, Vaiarelli A, Ubaldi F, Rienzi L. O-121 Uncovering the value of day 7 blastocysts using artificial intelligence on time lapse videos. Hum Reprod 2022. [DOI: 10.1093/humrep/deac105.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Study question
Which is the clinical value of day 7 blastocysts?
Summary answer
Ending embryo culture at 144 hours-post-insemination (hpi) would involve7.3%- and 4.4%-relative reductions in the patients obtaining euploid blastocysts and live birth(s)(LBs), respectively.
What is known already
Many studies showed that day 7 blastocysts are clinically valuable although less euploid and less competent than faster growing embryos. Nevertheless, a large variability exists in: (i) the definition of “day 7”; (ii) the criteria to culture embryos to day 7; (iii)the clinical setting; (iv) the local regulation; and/or (v) the culture strategies and incubators. Here,we aimed at ironing out these differences and portray day 7 blastocysts with the lowest possible risk of bias. To this end, we have also adopted an artificial intelligence (AI)-powered software to automatize developmental timings annotations and standardize embryo morphological assessment.
Study design, size, duration
Observational study including 1966 blastocysts obtained from 681 patients cultured in a time lapse incubator between January 2013 and December 2020 at a private Italian IVF center.
Participants/materials, setting, methods
Trophectoderm biopsy without hatching and comprehensive-chromosome-testing were performed. Blastocysts were clustered in six groups based on the time-of-biopsy every 12hr from <120hpi (control) to > 168hpi. Blastocyst quality, time-of-expanding-blastocyst (tEB) and duration of expansion were annotated through AI and confirmed manually. The main outcomes were euploidy-rate and LB-rate (LBR) per transfer. Lastly, patients obtaining (euploid) blastocysts, LBs, and supernumerary blastocysts, were reported based on a hypothetical 144hpi cut-off, and all relative reductions calculated.
Main results and the role of chance
14.6% of the blastocysts reached full expansionbeyond 144hpi (5.9% between 144-156hpi, 7.9% between 156-168hpi, and 0.8% >168hpi). Slower blastocysts were of a worse quality based on the evaluation of both embryologists and AI. Both longer tEB and a longer duration of expansion concurred to day7 development, quite independently of embryo quality. The lower euploidy rate among day7 blastocysts is due to their worse morphology and more advanced oocyte age, rather than to a slower development per se. Conversely, the lower LBR was significant even after adjusting for confounders, with a first relevant decrease for blastocysts biopsied in the range 132-144hpi (N = 76/208, 36.5% versus N = 114/215, 53.0% in the control, multivariate-OR: 0.61, 95%CI 0.40-0.92, adjusted-p=0.02), and a second step for blastocysts biopsied in the range 156-168hpi (N = 3/21, 14.3%, multivariate-OR:0.24, 95%CI 0.07-0.88, adjusted-p=0.03). Nevertheless, when the cut-off was set at 144hpi, no significant difference was reported. In this patient population, ending embryo culture at 144hpi would have caused 10.6%-, 7.3%-, 4.4%-, 13.7%-, and 5.2%-relative reductions in the number ofpatients obtaining blastocysts, euploid blastocysts, LBs, supernumerary blastocysts without a LB and after a LB, respectively.
Limitations, reasons for caution
Gestational and perinatal outcomes were not assessed, and a cost-effectiveness analysis was not performed. We encourage the production of these data in other clinical settings and regulatory contexts.
Wider implications of the findings
Day7 culture shall be supported following a careful case-by-case evaluation. Patients shall be aware of their lower competence, yet day7 blastocysts are valuable for poor-prognosis couples, couples less compliant towards other attempts in case of failures, and couples wishing for second children. AI may improve the generalizability of these evidence.
Trial registration number
Not applicable
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Affiliation(s)
- F Innocenti
- Clinica Valle Giulia, GeneraLife IVF , Rome, Italy
| | - D Cimadomo
- Clinica Valle Giulia, GeneraLife IVF , Rome, Italy
| | - D Soscia
- Clinica Valle Giulia, GeneraLife IVF , Rome, Italy
| | - V Casciani
- Clinica Valle Giulia, GeneraLife IVF , Rome, Italy
| | - S Trio
- GeneraLife Milan, GeneraLife IVF , Rome, Italy
| | - V Chiappetta
- Clinica Valle Giulia, GeneraLife IVF , Rome, Italy
| | - L Albricci
- Clinica Valle Giulia, GeneraLife IVF , Rome, Italy
| | - R Maggiulli
- Clinica Valle Giulia, GeneraLife IVF , Rome, Italy
| | - G Fabozzi
- Clinica Valle Giulia, GeneraLife IVF , Rome, Italy
| | - I Erlich
- Fairtility Ltd ., Fairtility, Tel Aviv, Israel
| | - A Ben-Meir
- Fairtility Ltd ., Fairtility, Tel Aviv, Israel
| | - I Har-Vardi
- Fairtility Ltd ., Fairtility, Tel Aviv, Israel
| | - A Vaiarelli
- Clinica Valle Giulia, GeneraLife IVF , Rome, Italy
| | - F.M Ubaldi
- Clinica Valle Giulia, GeneraLife IVF , Rome, Italy
| | - L Rienzi
- Clinica Valle Giulia, GeneraLife IVF , Rome, Italy
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19
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Innocenti F, Fiorentino G, Cimadomo D, Soscia D, Garagna S, Rienzi L, Ubaldi FM, Zuccotti M. Maternal effect factors that contribute to oocytes developmental competence: an update. J Assist Reprod Genet 2022; 39:861-871. [PMID: 35165782 PMCID: PMC9051001 DOI: 10.1007/s10815-022-02434-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 02/09/2022] [Indexed: 11/30/2022] Open
Abstract
Oocyte developmental competence is defined as the capacity of the female gamete to be fertilized and sustain development to the blastocyst stage. Epigenetic reprogramming, a correct cell division pattern, and an efficient DNA damage response are all critical events that, before embryonic genome activation, are governed by maternally inherited factors such as maternal-effect gene (MEG) products. Although these molecules are stored inside the oocyte until ovulation and exert their main role during fertilization and preimplantation development, some of them are already functioning during folliculogenesis and oocyte meiosis resumption. This mini review summarizes the crucial roles played by MEGs during oocyte maturation, fertilization, and preimplantation development with a direct/indirect effect on the acquisition or maintenance of oocyte competence. Our aim is to inspire future research on a topic with potential clinical perspectives for the prediction and treatment of female infertility.
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Affiliation(s)
- Federica Innocenti
- GeneraLife IVF, Clinica Valle Giulia, via G. de Notaris, 2b, 00197, Rome, Italy
| | - Giulia Fiorentino
- Laboratory of Developmental Biology, Department of Biology and Biotechnology "Lazzaro Spallanzani", University of Pavia, Pavia, Italy.,Center for Health Technologies, University of Pavia, Pavia, Italy
| | - Danilo Cimadomo
- GeneraLife IVF, Clinica Valle Giulia, via G. de Notaris, 2b, 00197, Rome, Italy.
| | - Daria Soscia
- GeneraLife IVF, Clinica Valle Giulia, via G. de Notaris, 2b, 00197, Rome, Italy
| | - Silvia Garagna
- Laboratory of Developmental Biology, Department of Biology and Biotechnology "Lazzaro Spallanzani", University of Pavia, Pavia, Italy.,Center for Health Technologies, University of Pavia, Pavia, Italy
| | - Laura Rienzi
- GeneraLife IVF, Clinica Valle Giulia, via G. de Notaris, 2b, 00197, Rome, Italy
| | | | - Maurizio Zuccotti
- Laboratory of Developmental Biology, Department of Biology and Biotechnology "Lazzaro Spallanzani", University of Pavia, Pavia, Italy.,Center for Health Technologies, University of Pavia, Pavia, Italy
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20
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Cimadomo D, Fabozzi G, Dovere L, Maggiulli R, Albricci L, Innocenti F, Soscia D, Giancani A, Vaiarelli A, Guido M, Ubaldi FM, Rienzi L. Clinical, obstetric and perinatal outcomes after vitrified-warmed euploid blastocyst transfer are independent of cryo-storage duration. Reprod Biomed Online 2021; 44:221-227. [PMID: 34862135 DOI: 10.1016/j.rbmo.2021.09.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 08/24/2021] [Accepted: 09/26/2021] [Indexed: 02/02/2023]
Abstract
RESEARCH QUESTION The study aimed to retrospectively evaluate the impact of cryo-storage duration on clinical, obstetric and perinatal outcomes after vitrified-warmed euploid blastocyst transfer. DESIGN This was an observational study including 2688 vitrified-warmed euploid single blastocyst transfers that was conducted at a private IVF centre between May 2013 and March 2020. It included a total of 1884 women (age 38 ± 3 years) undergoing at least one transfer after preimplantation genetic testing for aneuploidies. The euploid blastocysts transferred were clustered into seven groups according to the cryo-storage duration between vitrification and warming: ≤60 days (n = 646; control group), 61-90 days (n = 599), 91-180 days (n = 679), 181-360 days (n = 405), 361-720 days (n = 144), 721-1080 days (n = 118) and >1080 days (n = 97). The primary outcome was the live birth rate (LBR) per transfer. The secondary outcomes were miscarriage rate, obstetric and perinatal issues. The data were adjusted for confounders through logistic or linear regressions. RESULTS A significantly lower LBR was reported for transfers performed within 91-180 days (n = 291/679, 42.9%; P = 0.017), 181-360 days (n = 169/405, 41.7%; P = 0.016) and 361-720 days (n = 57/144, 39.6%; P = 0.034) versus ≤60 days (n = 319/646, 49.4%). However, this was mainly due to top-quality embryos being transferred first when more euploid blastocysts were available, thereby leaving lower quality ones for subsequent procedures. Indeed, the multivariate odds ratios adjusted for confounders showed similar results across all cryo-storage duration clusters. No difference was reported also for all secondary outcomes. CONCLUSIONS Cryo-storage duration even beyond 3 years from blastocyst vitrification does not affect clinical, obstetric and perinatal outcomes.
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Affiliation(s)
| | | | - Lisa Dovere
- GeneraLife IVF, Clinica Valle Giulia, Rome, Italy
| | | | | | | | - Daria Soscia
- GeneraLife IVF, Clinica Valle Giulia, Rome, Italy
| | | | | | - Maurizio Guido
- MeSVA Department, University of L'Aquila, L'Aquila, Italy
| | | | - Laura Rienzi
- GeneraLife IVF, Clinica Valle Giulia, Rome, Italy
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21
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Maggiulli R, Cimadomo D, Dovere L, Innocenti F, Albricci L, Soscia D, Giancani A, Sanges F, Amendola MG, Tacconi L, Nastri G, Morgante V, Vaiarelli A, Ubaldi F, Rienzi L. P–783 Clinical, obstetric and perinatal outcomes after vitrified-warmed euploid blastocyst transfer are independent of cryo-storage duration. Hum Reprod 2021. [DOI: 10.1093/humrep/deab130.782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Study question
Is cryo-storage duration associated with the outcomes after vitrified-warmed euploid single blastocyst transfer?
Summary answer
Lower live-birth-rates from blastocysts cryo-stored for periods longer than 3-months are mostly imputable to the worse quality of the embryos being warmed across sequential transfers.
What is known already
Blastocyst vitrification is crucial in modern IVF. Given its widespread application, a constant comprehensive monitoring of its effect on reproductive outcomes is pivotal. For instance, the effect of cryo-storage duration on embryo implantation potential, gestational and perinatal outcomes is object of a still ongoing investigation. The evidence in this regard are contrasting especially with regard to similar or decreased live birth rates among blastocysts subject to long-term cryo-storage. When investigating the neonatal outcomes, instead, no impact of blastocyst cryo-storage duration has ever been reported to date. Yet, data on euploid blastocysts and adjusted for quality and full-blastulation day are needed.
Study design, size, duration
Retrospective observational study. We included 2688 vitrified-warmed euploid single blastocyst transfers. The primary outcome was the live-birth-rates (LBR) according to cryo-storage duration clustered as ≤ 60, 61–90, 91–180, 181–360, 361–720, 721–1080 and >1080-days. The secondary outcomes were the miscarriage rate, the rates of gestational and perinatal issues among the deliveries, and the mean gestational age and birthweight among the babies born. All data were adjusted for confounders through linear or logistic regression analyses. Participants/materials, setting, methods: We included all vitrified-warmed transfers (range:1–8) conducted between May–2013 and March–2020 by 1884 patients (age:38±3yr) undergoing one blastocyst stage PGT-A cycle and obtaining ≥1 euploid embryo at our private clinic. Among putative confounders, only the number of sequential transfer from the same patient, blastocyst quality (Gardner’s scheme) and full-blastulation day (5–7) significantly associated with the LBR through univariate regressions. No association was reported for sperm factor, maternal age, incubator, and culture media.
Main results and the role of chance
The LBR of euploid blastocysts cryo-stored for ≤60-days was 49.4% (N = 319/646) versus 48.7% (N = 292/599; OR:0.98,95%CI:0.78–1.21,p=0.82) between 61–90-days, 42.9% (N = 291/679; OR:0.77,95%CI:0.62–0.96,p=0.02) between 91–180-days, 41.7% (N = 169/405; OR:0.73,95%CI:0.57–0.94,p=0.02) between 181–360-days, 34.7% (N = 50/144; OR:0.55,95%CI:0.37–0.79,p<0.01) between 361–720-days, 53.4% (N = 63/118; OR:1.17,95%CI:0.79–1.74,p=0.42) between 721–1080-days, and 50.5% (N = 49/97; OR:1.05,95%CI:0.68–1.60,p=0.83) for >1080-days. However, when these data were adjusted for blastocyst quality and full-blastulation day, all the multivariate-OR were not-significant. Indeed, the longer the cryo-storage period the worse the quality of the euploid blastocysts transferred (e.g. AA-blastocysts were 74% among embryos cryo-stored for ≤90-days, but always <70% for embryos cryo-stored for longer periods, p < 0.01; similarly, day5-blastocysts were ∼50% among embryos cryo-stored for ≤90-days, but always <50% for embryos cryo-stored for longer periods, p = 0.02). The miscarriage-rate (overall 14%, ranging 7–18%) was not associated with cryo-storage duration already from univariate regressions. Also the gestational (overall 6%, ranging 0–8%) and perinatal issues rates (overall 3%, ranging 0–5%) were not associated with cryo-storage duration already from the univariate regressions. Neither the gestational age nor the birthweight showed significant associations with cryo-storage duration, as confirmed by linear regressions. In fact the rate of newborns whose weight was normal-for-gestational-age was similar across all cryo-storage duration groups (overall 81%, ranging 80–83%).
Limitations, reasons for caution
The prevalence of first transfers decreases from ≥95% for procedures conducted ≤90-days from vitrification to 71%, 39%, 22% and 4% for procedures conducted between 91–180, 181–360, 361–720 and >720-days, respectively. However, also the sequential number of transfer was not associated with the LBR when adjusted for blastocyst-quality and full-blastulation day.
Wider implications of the findings: Cryo-storage by vitrification is confirmed safe in the hands of experienced operators, and its duration does not impact any outcome. This information is valuable for freeze-all cycles, but also for women cryo-preserving surplus embryos for second pregnancies; in this regard, 6.8% of the patients in this study delivered ≥2 LBs.
Trial registration number
Not applicable
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Affiliation(s)
- R Maggiulli
- Clinica Valle Giulia, GeneraLife IVF, Rome, Italy
| | - D Cimadomo
- Clinica Valle Giulia, GeneraLife IVF, Rome, Italy
| | - L Dovere
- Clinica Valle Giulia, GeneraLife IVF, Rome, Italy
| | - F Innocenti
- Clinica Valle Giulia, GeneraLife IVF, Rome, Italy
| | - L Albricci
- Clinica Valle Giulia, GeneraLife IVF, Rome, Italy
| | - D Soscia
- Clinica Valle Giulia, GeneraLife IVF, Rome, Italy
| | - A Giancani
- Clinica Valle Giulia, GeneraLife IVF, Rome, Italy
| | - F Sanges
- Clinica Valle Giulia, GeneraLife IVF, Rome, Italy
| | - M G Amendola
- Clinica Valle Giulia, GeneraLife IVF, Rome, Italy
| | - L Tacconi
- Clinica Valle Giulia, GeneraLife IVF, Rome, Italy
| | - G Nastri
- Clinica Valle Giulia, GeneraLife IVF, Rome, Italy
| | - V Morgante
- Clinica Valle Giulia, GeneraLife IVF, Rome, Italy
| | - A Vaiarelli
- Clinica Valle Giulia, GeneraLife IVF, Rome, Italy
| | - F Ubaldi
- Clinica Valle Giulia, GeneraLife IVF, Rome, Italy
| | - L Rienzi
- Clinica Valle Giulia, GeneraLife IVF, Rome, Italy
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22
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Cimadomo D, Innocenti F, Soscia D, Giancani A, Maggiulli R, Stoppa M, Dovere L, Albricci L, Fabozzi G, Scepi E, Chimienti F, Capalbo A, Ubaldi FM, Rienzi L. P–210 Abnormal cleavage patterns during embryo preimplantation development and their effect on blastulation: an overview from IVF patients with multiple IVF cycles in a time-lapse incubator. Hum Reprod 2021. [DOI: 10.1093/humrep/deab130.209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Study question
How common abnormal cleavage patterns (ACP) are in IVF and what are their consequences on embryo developmental competence?
Summary answer
ACP might affect up to 25% of the 2PN-zygotes, independently from patients’/cycles’ characteristics, and mostly cause embryo developmental arrest around the 4-to–8-cell transition.
What is known already
Since its implementation in IVF, time-lapse-microscopy (TLM) allowed the standardization of embryo culture within undisturbed incubators, but it has not improved embryo selection especially if blastocyst transfer is performed. Nevertheless, TLM holds the potential for boosting our knowledge of embryo preimplantation development. In particular, a continuous observation of embryo morpho-dynamics unveiled peculiar blastomere cleavage patterns previously unidentifiable with a static morphological assessment. These events are possibly associated with massive mitotic errors, affecting both chromosomes and cytoskeletal components, as well as downstream metabolic imbalances. Still, the causes of ACP and their consequences on embryo developmental/reproductive competence require further investigation.
Study design, size, duration
Observational study including 75 patients (age:38.6±3.7yr, FSH:8.8±3.6IU/l, AMH:1.7±1.3ng/ml; BMI:21.4±2.4) who conducted multiple IVF cycles (N = 160; 8.7±5.0 cumulus-oocyte-complexes and 6.3±3.6 metaphase-II collected; 201±245 days between first and second cycles) in a time-lapse incubator between 2014–2020. All annotations were performed blindly by two operators and confirmed by a third in case of discordance. The outcomes were the blastulation rate after any ACP, their association between each other and with patients’/cycles’ characteristics.
Participants/materials, setting, methods
We included only ICSI-cycles after ovarian-stimulation with blastocyst culture conducted in the Embryoscope. Overall, 981 metaphase-II were inseminated and 677 2PN-zygotes annotated. The ACP investigated were: (i)cytokinesis-failure, formation of cytoplasmic septa without cell division; (ii)Chaotic-cleavage, disordered and uneven cleavages; (iii)Direct-unequal-cleavage (DUC), cleavage of zygotes or single blastomeres directly into 3; (iv)Rapid-cleavage, t3-t2<5hr; (v)Reverse-cleavage, fusion of 2 blastomeres into 1; (vi)Fragmentation, presence of numerous non-nucleated fragments; (vii)Blastomeres’ exclusion/extrusion, nucleated cells excluded/extruded from the morula.
Main results and the role of chance
Among the 2PN-zygotes, the prevalence of cytokinesis-failure was 5.9% (N = 40/677), 15.7% for chaotic-cleavage (N = 106/677), 18.6% for DUC (N = 126/677), 4.1% for rapid-cleavage (N = 28/677), 3.5% for reverse-cleavage (N = 24/677) and 24.1% for fragmentation (N = 163/677). Among the morulae, the prevalence of blastomere exclusion/extrusion was 27% (N = 109/410;1.5±1.2 excluded/extruded cells,range:1–7). The risk for reverse-cleavage was higher among 2PN-zygotes facing failed-cytokinesis (N = 8/40,20% versus N = 16/637,2.5%, OR:9.7,95%CI:3.9–24.3,p<0.01). Fragmentation was instead higher among 2PN-zygotes undergoing chaotic cleavage (N = 47/106,44.3% versus N = 116/571,20.3%, OR:3.1,95%CI:2–4.8,p<0.01) or DUC (N = 46/126,36.5% versus N = 117/551,21.2%, OR:2.1,95%CI:1.4–3.2,p<0.01). Lastly, higher prevalence of blastomeres’ exclusion/extrusion were reported among morulae obtained after chaotic-cleavage (N = 17/29,58.6% versus N = 92/381,24.1%, OR:4.4,95%CI:2–9.7,p<0.01), DUC (N = 26/37,70.3% versus N = 83/373,22.3%, OR:8.3,95%CI:3.9–17.4,p<0.01) and in presence of fragmentation (N = 79/195,75.2% versus N = 30/305,9.8%, OR:27.8,95%CI:15.6–49.8,p<0.01); only a higher trend after rapid-/reverse-cleavage.
No predictive factor of ACP was identified among patients’ and cycles’ characteristics, except for higher risks of fragmentation (OR:2.6,95%CI:1.1–6.3,p= 0.04) and blastomeres’ exclusion/extrusion (OR:2.7,95%CI:1.1–7.2,p=0.04) among patients with previous experience with these events.
The viable-blastocyst rate per 2PN-zygote was 45.1% (N = 305/677). It was lower in case of failed-cytokinesis (N = 12/40,30% versus N = 293/637,46%, OR:0.5,95%CI:0.25–0.99,p=0.05), chaotic cleavage (N = 20/106,18.9% versus N = 285/571,49.9%, OR:0.23,95%CI:0.14–0.39,p<0.01), DUC (N = 27/126,21.4% versus N = 278/551,50.5%, OR:0.27,95%CI:0.17–0.42,p<0.01), rapid-cleavage (N = 6/22,21.4% versus N = 299/649,46.1%, OR:0.32,95%CI:0.13–0.8,p=0.02), and reverse-cleavage (N = 5/19,20.8% versus N = 300/653,45.9%, OR:0.31, 95%CI:0.11–0.84,p=0.02). No difference was instead shown in case of fragmentation and/or blastomeres’ exclusion/extrusion.
Limitations, reasons for caution
The patients included were poor-prognosis women undergoing ≥2 cycles. We are expanding the sample size to account for all cycles conducted in time-lapse incubators. Larger sample size will provide also statistical-power to investigate the effect of ACP on blastocysts’ chromosomal and implantation competence, and more visualizations of rapid-/reverse-cleavage events.
Wider implications of the findings: After ACP,developmental-arrest mostly occurs around the 4-to–8-cell transition (50–70% versus ∼30%), when embryonic-genome-activation takes place. Surviving embryos often fragment and/or exclude/extrude blastomeres at morulation, without further impact on blastulation-rates. Moreover, ACP seem independent from patients’/cycles’ characteristics. These evidence incite future Research on the biological/genetic mechanisms triggering ACP and their consequences.
Trial registration number
None
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Affiliation(s)
- D Cimadomo
- GeneraLife IVF, Clinica Valle Giulia, Roma, Italy
| | - F Innocenti
- GeneraLife IVF, Clinica Valle Giulia, Roma, Italy
| | - D Soscia
- GeneraLife IVF, Clinica Valle Giulia, Roma, Italy
| | - A Giancani
- GeneraLife IVF, Clinica Valle Giulia, Roma, Italy
| | - R Maggiulli
- GeneraLife IVF, Clinica Valle Giulia, Roma, Italy
| | - M Stoppa
- GeneraLife IVF, Clinica Valle Giulia, Roma, Italy
| | - L Dovere
- GeneraLife IVF, Clinica Valle Giulia, Roma, Italy
| | - L Albricci
- GeneraLife IVF, Clinica Valle Giulia, Roma, Italy
| | - G Fabozzi
- GeneraLife IVF, Clinica Valle Giulia, Roma, Italy
| | - E Scepi
- GeneraLife IVF, Clinica Valle Giulia, Roma, Italy
| | - F Chimienti
- GeneraLife IVF, Clinica Valle Giulia, Roma, Italy
| | - A Capalbo
- GeneraLife IVF, Clinica Valle Giulia, Roma, Italy
| | - F M Ubaldi
- GeneraLife IVF, Clinica Valle Giulia, Roma, Italy
| | - L Rienzi
- GeneraLife IVF, Clinica Valle Giulia, Roma, Italy
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23
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Maggiulli R, Cimadomo D, Dovere L, Innocenti F, Albricci L, Soscia D, Giancani A, Sanges F, Amendola MG, Tacconi L, Nastri G, Morgante V, Vaiarelli A, Ubaldi F, Rienzi L. P-783 Clinical, obstetric and perinatal outcomes after vitrified-warmed euploid blastocyst transfer are independent of cryo-storage duration. Hum Reprod 2021. [DOI: 10.1093/humrep/deab125.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Study question
Is cryo-storage duration associated with the outcomes after vitrified-warmed euploid single blastocyst transfer?
Summary answer
Lower live-birth-rates from blastocysts cryo-stored for periods longer than 3-months are mostly imputable to the worse quality of the embryos being warmed across sequential transfers.
What is known already
Blastocyst vitrification is crucial in modern IVF. Given its widespread application, a constant comprehensive monitoring of its effect on reproductive outcomes is pivotal. For instance, the effect of cryo-storage duration on embryo implantation potential, gestational and perinatal outcomes is object of a still ongoing investigation. The evidence in this regard are contrasting especially with regard to similar or decreased live birth rates among blastocysts subject to long-term cryo-storage. When investigating the neonatal outcomes, instead, no impact of blastocyst cryo-storage duration has ever been reported to date. Yet, data on euploid blastocysts and adjusted for quality and full-blastulation day are needed.
Study design, size, duration
Retrospective observational study. We included 2688 vitrified-warmed euploid single blastocyst transfers. The primary outcome was the live-birth-rates (LBR) according to cryo-storage duration clustered as ≤ 60, 61-90, 91-180, 181-360, 361-720, 721-1080 and >1080-days. The secondary outcomes were the miscarriage rate, the rates of gestational and perinatal issues among the deliveries, and the mean gestational age and birthweight among the babies born. All data were adjusted for confounders through linear or logistic regression analyses.
Participants/materials, setting, methods
We included all vitrified-warmed transfers (range:1-8) conducted between May-2013 and March-2020 by 1884 patients (age:38±3yr) undergoing one blastocyst stage PGT-A cycle and obtaining ≥1 euploid embryo at our private clinic. Among putative confounders, only the number of sequential transfer from the same patient, blastocyst quality (Gardner’s scheme) and full-blastulation day (5-7) significantly associated with the LBR through univariate regressions. No association was reported for sperm factor, maternal age, incubator, and culture media.
Main results and the role of chance
The LBR of euploid blastocysts cryo-stored for ≤60-days was 49.4% (N = 319/646) versus 48.7% (N = 292/599; OR:0.98,95%CI:0.78-1.21,p = 0.82) between 61-90-days, 42.9% (N = 291/679; OR:0.77,95%CI:0.62-0.96,p = 0.02) between 91-180-days, 41.7% (N = 169/405; OR:0.73,95%CI:0.57-0.94,p = 0.02) between 181-360-days, 34.7% (N = 50/144; OR:0.55,95%CI:0.37-0.79,p < 0.01) between 361-720-days, 53.4% (N = 63/118; OR:1.17,95%CI:0.79-1.74,p = 0.42) between 721-1080-days, and 50.5% (N = 49/97; OR:1.05,95%CI:0.68-1.60,p = 0.83) for >1080-days. However, when these data were adjusted for blastocyst quality and full-blastulation day, all the multivariate-OR were not-significant. Indeed, the longer the cryo-storage period the worse the quality of the euploid blastocysts transferred (e.g. AA-blastocysts were 74% among embryos cryo-stored for ≤90-days, but always < 70% for embryos cryo-stored for longer periods, p < 0.01; similarly, day5-blastocysts were ∼50% among embryos cryo-stored for ≤90-days, but always < 50% for embryos cryo-stored for longer periods, p = 0.02). The miscarriage-rate (overall 14%, ranging 7-18%) was not associated with cryo-storage duration already from univariate regressions. Also the gestational (overall 6%, ranging 0-8%) and perinatal issues rates (overall 3%, ranging 0-5%) were not associated with cryo-storage duration already from the univariate regressions. Neither the gestational age nor the birthweight showed significant associations with cryo-storage duration, as confirmed by linear regressions. In fact the rate of newborns whose weight was normal-for-gestational-age was similar across all cryo-storage duration groups (overall 81%, ranging 80-83%).
Limitations, reasons for caution
The prevalence of first transfers decreases from ≥95% for procedures conducted ≤90-days from vitrification to 71%, 39%, 22% and 4% for procedures conducted between 91-180, 181-360, 361-720 and >720-days, respectively. However, also the sequential number of transfer was not associated with the LBR when adjusted for blastocyst-quality and full-blastulation day.
Wider implications of the findings
Cryo-storage by vitrification is confirmed safe in the hands of experienced operators, and its duration does not impact any outcome. This information is valuable for freeze-all cycles, but also for women cryo-preserving surplus embryos for second pregnancies; in this regard, 6.8% of the patients in this study delivered ≥2 LBs.
Trial registration number
not applicable
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Affiliation(s)
- R Maggiulli
- Clinica Valle Giulia, GeneraLife IVF, Rome, Italy
| | - D Cimadomo
- Clinica Valle Giulia, GeneraLife IVF, Rome, Italy
| | - L Dovere
- Clinica Valle Giulia, GeneraLife IVF, Rome, Italy
| | - F Innocenti
- Clinica Valle Giulia, GeneraLife IVF, Rome, Italy
| | - L Albricci
- Clinica Valle Giulia, GeneraLife IVF, Rome, Italy
| | - D Soscia
- Clinica Valle Giulia, GeneraLife IVF, Rome, Italy
| | - A Giancani
- Clinica Valle Giulia, GeneraLife IVF, Rome, Italy
| | - F Sanges
- Clinica Valle Giulia, GeneraLife IVF, Rome, Italy
| | - M G Amendola
- Clinica Valle Giulia, GeneraLife IVF, Rome, Italy
| | - L Tacconi
- Clinica Valle Giulia, GeneraLife IVF, Rome, Italy
| | - G Nastri
- Clinica Valle Giulia, GeneraLife IVF, Rome, Italy
| | - V Morgante
- Clinica Valle Giulia, GeneraLife IVF, Rome, Italy
| | - A Vaiarelli
- Clinica Valle Giulia, GeneraLife IVF, Rome, Italy
| | - F Ubaldi
- Clinica Valle Giulia, GeneraLife IVF, Rome, Italy
| | - L Rienzi
- Clinica Valle Giulia, GeneraLife IVF, Rome, Italy
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24
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Fabozzi G, Cimadomo D, Allori M, Vaiarelli A, Colamaria S, Argento C, Amendola MG, Innocenti F, Soscia D, Maggiulli R, Mazzilli R, Marchetti M, Ubaldi N, Rienzi L, Ubaldi FM. P–519 Investigation of embryo chromosomal constitution and live birth rate after vitrified-warmed euploid single blastocyst transfer across ranges of maternal body-mass-index. Hum Reprod 2021. [DOI: 10.1093/humrep/deab130.518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Study question
Does maternal body-mass-index (BMI) associate with blastocysts’ chromosomal constitution and clinical outcomes in infertile patients undergoing preimplantation genetic testing for aneuploidies (PGT-A)?
Summary answer
A higher euploidy rate per biopsied blastocyst was reported among underweight women. Overweight women were instead subject to higher miscarriage (MR) and lower live-birth-rates (LBR).
What is known already
Different studies in the literature revealed an association between BMI and infertility, suggesting a J-shaped relationship: both underweight and overweight women can suffer from infertility issues. Even if IVF might increase the success rate in both these categories of patients, it seems insufficient per se to overcome the complex and multifactorial fertility impairment derived from unbalanced nutritional intakes. Miscarriage, in particular, is common in both underweight and overweight women. However, most of the literature is based on chromosomally-untested embryos. Study design, size, duration: Retrospective observational study. Only the first IVF cycle with ≥1 biopsied blastocyst from each woman was included. The primary outcome was the association between maternal BMI (underweight, BMI<18.5, n = 160; normal-weight, BMI=18–25, N = 1392; overweight, BMI>25, N = 259) and the mean euploidy rate per cohort of biopsied blastocysts (m-ER). The secondary outcomes were the association between maternal BMI with clinical (mainly MR and LBR), gestational and perinatal outcomes after first vitrified-warmed single euploid blastocyst transfers.
Participants/materials, setting, methods
We included 1811 women undergoing PGT-A at a private IVF center between April–2013 and March–2020. The secondary outcomes were investigated on 1125 first vitrified-warmed single euploid blastocyst transfers from all patients obtaining ≥1 transferable blastocyst. Only ICSI with ejaculated sperm and continuous culture in standard incubators were performed. Logistic regressions were conducted to identify putative confounders and adjust the results accordingly.
Main results and the role of chance
Except for a lower maternal age among underweight women (38.3±3.1 versus 38.9±3.4 yr, p < 0.01) and higher among overweight ones (39.3±3.6 yr, p = 0.04), no difference was reported with respect to normal-weight women in terms of duration of infertility, hormonal levels, main cause of infertility, sperm quality, and reproductive history. The mean number of biopsied blastocysts was ∼3 in all groups. The m-ER shows a decreasing trend as the maternal BMI increases between 17 and 22–23, to then plateau. In fact, a significant difference was reported between underweight (50.8%±36.4%) and normal-weight women (41.4%±37.5%, p < 0.01). A linear regression adjusted for maternal age confirmed this moderate association between increasing BMI and m-ER (unstandardized-coefficient-B –0.6%, 95%CI:–1.1% to –0.1%, p = 0.02).
Morphological quality and day of full-blastulation among transferred euploid blastocysts was similar in the three groups. Overweight women showed higher MR per pregnancy (N = 20/75, 26.7%, 95%CI:17.4%–38.3% versus N = 67/461, 14.5%, 95%CI:11.5%–18.2%; OR 2.0, 95%CI:1.1–3.6, p = 0.01) and lower LBR per transfer (N = 55/154, 35.7%, 95%CI:28.3%–43.8% versus N = 388/859, 45.2%, 95%CI:41.8%–48.6%; OR adjusted for euploid blastocysts’ features 0.67, 95%CI:0.46–0.96, p = 0.03). Clinical outcomes were instead similar among underweight and normal-weight women. All gestational and perinatal outcomes were comparable in the tree groups.
Limitations, reasons for caution
Our study is limited by its retrospective nature, and the fact that maternal BMI was measured only before oocyte retrieval and not before embryo transfer. Moreover, the reduced sample size did not allow for further relevant sub-analyses among solely obese women.
Wider implications of the findings: When possible nutritional/lifestyle modifications should be encouraged to adjust maternal BMI before IVF. Overweight patients should be especially informed of their higher risk for miscarriage. Yet, BMI is just a gross marker, future studies based on body fat localization and percentage (e.g. by bioelectrical impedance analyses) are desirable.
Trial registration number
None
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Affiliation(s)
- G Fabozzi
- Clinica Valle Giulia, GeneraLife IVF, Rome, Italy
| | - D Cimadomo
- Clinica Valle Giulia, GeneraLife IVF, Rome, Italy
| | - M Allori
- University Carlo Bo, Faculty of Biology, Urbino, Italy
| | - A Vaiarelli
- Clinica Valle Giulia, GeneraLife IVF, Rome, Italy
| | - S Colamaria
- Clinica Valle Giulia, GeneraLife IVF, Rome, Italy
| | - C Argento
- Clinica Valle Giulia, GeneraLife IVF, Rome, Italy
| | - M G Amendola
- Clinica Valle Giulia, GeneraLife IVF, Rome, Italy
| | - F Innocenti
- Clinica Valle Giulia, GeneraLife IVF, Rome, Italy
| | - D Soscia
- Clinica Valle Giulia, GeneraLife IVF, Rome, Italy
| | - R Maggiulli
- Clinica Valle Giulia, GeneraLife IVF, Rome, Italy
| | - R Mazzilli
- Clinica Valle Giulia, GeneraLife IVF, Rome, Italy
| | - M Marchetti
- University of Rome Tor Vergata, Biomedicine and Prevention, Rome, Italy
| | - N Ubaldi
- Catholic University of the Sacred Heart, Faculty of Medicine and Surgery, Rome, Italy
| | - L Rienzi
- Clinica Valle Giulia, GeneraLife IVF, Rome, Italy
| | - F M Ubaldi
- Clinica Valle Giulia, GeneraLife IVF, Rome, Italy
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25
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Simon C, Campbell A, Gardner DK, Meseguer M, Miller KA, Montag M, Palermo GD, Cheung S, Keating D, Xie P, Rosenwaks Z, Rienzi L, Innocenti F, Cimadomo D, Ubaldi FM, Sakkas D, Tucker MJ, Nel-Themaat L. In vitro fertilization and andrology laboratories in 2030. Fertil Steril 2021; 116:2-3. [PMID: 34148585 DOI: 10.1016/j.fertnstert.2021.05.089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 05/12/2021] [Indexed: 10/21/2022]
Abstract
The in vitro fertilization and andrology laboratories are at the center of assisted reproductive technologies and the place where technicians and embryologists manipulate gametes and preimplantation-stage embryos with the goal of achieving the best embryo for transfer. Through the years, these laboratories have seen developments in technique, technology, and testing. The goal of this Views and Interviews series is to bring together the thought leaders in the field and envision what the laboratories will look like in the next 10 years.
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Affiliation(s)
- Carlos Simon
- Department of Pediatrics, Obstetrics and Gynecology, University of Valencia, Valencia, Spain; Igenomix Foundation-Instituto de Investigación Sanitaria INCLIVA, Valencia, Spain; Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Massachusetts.
| | | | - David K Gardner
- School of BioSciences, University of Melbourne, Parkville, Victoria, Australia; Melbourne IVF, East Melbourne, Victoria, Australia
| | - Marcos Meseguer
- In Vitro Fertilization Laboratory, Instituto Valenciano de Infertilidad, Reproductive Medicine Associates Valencia, Valencia, Spain; Instituto Valenciano de Infertilidad Foundation, Valencia, Spain; Health Research Institute la Fe, Valencia, Spain
| | | | | | - Gianpiero D Palermo
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, New York
| | - Stephanie Cheung
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, New York
| | - Derek Keating
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, New York
| | - Philip Xie
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, New York
| | - Zev Rosenwaks
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, New York
| | - Laura Rienzi
- GeneraLife IVF, Clinica Valle Giulia, Rome, Italy
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26
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Cimadomo D, Rienzi L, Capalbo A, Rubio C, Innocenti F, García-Pascual CM, Ubaldi FM, Handyside A. The dawn of the future: 30 years from the first biopsy of a human embryo. The detailed history of an ongoing revolution. Hum Reprod Update 2020; 26:453-473. [PMID: 32441746 DOI: 10.1093/humupd/dmaa019] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 03/25/2020] [Indexed: 01/20/2023] Open
Abstract
Following early studies showing no adverse effects, cleavage stage biopsy by zona drilling using acid Tyrode's solution, and removal of single blastomeres for preimplantation genetic testing (PGT) and identification of sex in couples at risk of X-linked disease, was performed by Handyside and colleagues in late 1989, and pregnancies reported in 1990. This method was later used for specific diagnosis of monogenic conditions, and a few years later also for chromosomal structural and/or numerical impairments, thereby establishing a valuable alternative option to prenatal diagnosis. This revolutionary approach in clinical embryology spread worldwide, and several other embryo biopsy strategies developed over three decades in a process that is still ongoing. The rationale of this narrative review is to outline the different biopsy approaches implemented across the years in the workflow of the IVF clinics that provided PGT: their establishment, the first clinical experiences, their downsides, evolution, improvement and standardization. The history ends with a glimpse of the future: minimally/non-invasive PGT and experimental embryo micromanipulation protocols. This grand theme review outlines a timeline of the evolution of embryo biopsy protocols, whose implementation is increasing worldwide together with the increasing application of PGT techniques in IVF. It represents a vade mecum especially for the past, present and upcoming operators and experts in this field to (re)live this history from its dawn to its most likely future.
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Affiliation(s)
- Danilo Cimadomo
- Clinica Valle Giulia, Genera Center for Reproductive Medicine, Rome, Italy
| | - Laura Rienzi
- Clinica Valle Giulia, Genera Center for Reproductive Medicine, Rome, Italy
| | - Antonio Capalbo
- Igenomix Italy, Marostica, Italy.,Dipartimento di Scienze Anatomiche, Istologiche, Medico Legali e dell'Apparato Locomotore, Sezione Istologia ed Embriologia Medica, University of Rome 'Sapienza', Rome, Italy
| | - Carmen Rubio
- R&D Department, Igenomix and Incliva, Valencia, Spain
| | - Federica Innocenti
- Clinica Valle Giulia, Genera Center for Reproductive Medicine, Rome, Italy
| | | | | | - Alan Handyside
- School of Biosciences, University of Kent, Canterbury, UK
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27
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Lastrucci V, Innocenti F, Lorini C, Berti A, Silvestri C, Gnaulati L, Voller F, Bonaccorsi G. Patterns of risky driving behaviors among Tuscan adolescent drivers: a cluster analysis. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.1111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Adolescents have a high risk of road traffic accident (RTA) because of their high engagement in risky driving behaviors (RDBs); to date, very few studies have investigated the patterns of RDBs. The aim of the study is to identify distinctive RDBs patterns and to examine their associations with RTAs in a sample of adolescent drivers
Methods
The EDIT project is a cross-sectional survey carried out in a representative sample (6.824) of Tuscany Region students aged 14-19 years. The study analyses a subsample of students who reported to drive/ride at least once a week (2764). Self-reported frequency in the last year of the following RDBs was determined: talking on phone; texting; using GPS; talking to passengers; smoking; eating; listening to loud music; fatigued driving; speeding; and driving under the influence (DUI) of alcohol or drugs. A cluster analysis was conducted to identify RDBs patterns. A multivariate model was used to evaluate the difference in the risk of RTA across clusters; ANOVA and post-hoc pairwise comparisons were used to further characterize cluster membership
Results
Four distinct RDBs clusters were identified: “safe”(45.6%), “average”(21.8%), “careless but not DUI”(21.5%) and “reckless and DUI”(11.2%) drivers. When compared with “safe” drivers, “careless but not DUI” and “reckless and DUI” drivers showed a significantly higher risk of RTA (respectively, OR 1.68, 95%CI 1.29-2.18, p < 0.001; OR 2.88; 95%CI 2.10-3.95, p < 0.001). Clusters were characterized by several significant differences in sociodemographic variables, cell-phone use, quality of the relationships with parents, school performances, mental health and well-being, health behaviors, gaming, bullying and risky sexual behaviors
Conclusions
RDBs evidently occur in typical patterns that are linked with different RTA risks. Several domains of adolescent life seem to be involved in cluster membership. An awareness of this clustering enables to better targeting adolescents at higher risk of RTA
Key messages
RDBs occur in patterns in adolescents, and indicators of risky behaviors and of mental and social well-being may help to identify RDBs clusters at high risk of road traffic accidents. Multimodal prevention approaches in risky driving behaviors are likely to be more successful than targeting a single behavior in adolescents.
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Affiliation(s)
- V Lastrucci
- Global Health Center, Azienda Ospedaliero Universitaria Meyer, Florence, Italy
| | - F Innocenti
- Observatory of Epidemiology, Regional Health Agency of Tuscany, Florence, Italy
| | - C Lorini
- Department of Health Science, University of Florence, Florence, Italy
| | - A Berti
- Observatory of Epidemiology, Regional Health Agency of Tuscany, Florence, Italy
| | - C Silvestri
- Observatory of Epidemiology, Regional Health Agency of Tuscany, Florence, Italy
| | - L Gnaulati
- Observatory of Epidemiology, Regional Health Agency of Tuscany, Florence, Italy
| | - F Voller
- Observatory of Epidemiology, Regional Health Agency of Tuscany, Florence, Italy
| | - G Bonaccorsi
- Department of Health Science, University of Florence, Florence, Italy
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28
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Bisordi C, Mariotti T, Fornili M, De Vita E, Innocenti F, Baglietto L, Tavoschi L, Lopalco P. Impact of immunization campaign triggered by meningococcal outbreak – Tuscany, 2014-2018. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
In 2015-2016, an outbreak of invasive meningococcal disease due to Neisseria meningitidis C/cc11 occurred in Tuscany, Italy, and caused 62 cases. Regional Health Authority launched an immunization campaign using quadrivalent meningococcal conjugate vaccine (MEN) in April 2015. We assessed the impact of meningococcal outbreak on population vaccination coverage, considering a pre-outbreak (2014), outbreak (2015-2016) and a post-outbreak period (2017-2018) for MEN and other vaccinations (HPV and MMR). We included all individuals (>1 year) resident in Tuscany, who received at least one vaccination dose (MEN, HPV, MMR) in the study period. We sourced anonymous data from the regional centralised register on vaccine administered, date, place and dose (for multiple-dose vaccines); birth cohort; city of residence. We analysed vaccine administration by age, time, vaccine type. We modelled MEN vaccination rate as a function of number of cases in the previous month by a quasi-Poisson model (2015-2018), and HPV and MMR vaccination using an interrupted time series analysis (2014-2018).
MEN vaccinations increased significantly in 2015-2016 (average doses/month were 3400 in 2014; 25492 in 2015; 47290 in 2016). MEN immunization coverage increased during the outbreak period, peaking for age class 20-45: from 3,7% in 2014 to 10,7% in 2015 and 20,7% in 2016. MEN vaccination uptake showed a 50% increase (95% CI = 37 to 65%, P < 0.001) in the rate for each new case diagnosed in the previous month. HPV vaccination rate showed statistically significant decreasing trend in before the campaign (-3% per month, 95% CI = -1 to -5%, P = 0.004) disappearing afterwards (0%, 95% CI = -2 to 1%, P = 0.96); with no trend for MMR.
The campaign successfully increased MEN coverage mostly among young adults, although vaccination demand was associated with occurrence of cases. The campaign did not affect routine vaccination programmes, and likely contributed positively to HPV uptake.
Key messages
The immunization campaign triggered by meningococcal outbreak in Tuscany in 2015-2016 successfully increased coverage, mostly among young adults, without affecting routine vaccination programmes. During response campaign triggered by meningitis outbreak in Tuscany in 2015-2016, meningococcal vaccine uptake was influenced by the occurrence of cases.
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Affiliation(s)
- C Bisordi
- Department of Translational Research, University of Pisa, Pisa, Italy
| | - T Mariotti
- Department of Translational Research, University of Pisa, Pisa, Italy
| | - M Fornili
- Department of biostatics, University of Pisa, Pisa, Italy
| | - E De Vita
- Department of Translational Research, University of Pisa, Pisa, Italy
| | - F Innocenti
- Regional Agency of Health of Tuscany, Florence, Italy
| | - L Baglietto
- Department of biostatics, University of Pisa, Pisa, Italy
| | - L Tavoschi
- Department of Translational Research, University of Pisa, Pisa, Italy
| | - P Lopalco
- Department of Translational Research, University of Pisa, Pisa, Italy
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29
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Quintanilha J, Racioppi A, Wang J, Denning S, Etheridge A, Peña C, Crona D, Lin D, Innocenti F. PIK3R5 genetic predictors of hypertension induced by VEGF-pathway inhibitors. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz239.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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30
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Innocenti F, Rashid N, Wancen M, Ou FS, Qu X, Denning S, Bertagnolli M, Blanke C, Venook A, Kabbarah O, Lenz H. Next-generation sequencing (NGS) in metastatic colorectal cancer (mCRC): Novel mutated genes and their effect on response to therapy (Alliance). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz246.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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31
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Das R, Ou F, Washburn C, Innocenti F, Nixon A, Lenz H, Blanke C, Niedzwiecki D, Khalil I, Harms B, Venook A. Bayesian machine learning on CALGB/SWOG 80405 (Alliance) and PEAK data identify a heterogeneous landscape of clinical predictors of overall survival (OS) in different populations of metastatic colorectal cancer (mCRC). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz156.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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32
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Bourn M, Robinson R, Innocenti F, Scheutz C. Regulating landfills using measured methane emissions: An English perspective. Waste Manag 2019; 87:860-869. [PMID: 29937100 DOI: 10.1016/j.wasman.2018.06.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 05/18/2018] [Accepted: 06/15/2018] [Indexed: 06/08/2023]
Abstract
Methane emissions from landfills are an important source of greenhouse gases in the UK and worldwide. This paper considers how measurements of methane emissions could be used to regulate landfills in England in order to reduce the contribution of landfilling to climate change. The paper presents the results of a number of UK studies undertaken to quantify methane emissions from landfills. The methods used have included the DIAL (Differential Absorption Lidar) technique and a tracer gas dispersion method. A method based on aerial measurements has been developed. Methane emission rates were measured at 15 biodegradable waste landfills. All of the landfills where measurements took place had an active landfill gas extraction system. A methane collection index (MCI) is calculated for each landfill using the ratio of the methane collection rate to the sum of the collection and emission rates. The values of the index in the campaigns reported here ranged from 0.28 to 0.90. The modern operational landfills surveyed achieved MCI values with a much narrower range of between 0.64 and 0.90 with an average of 0.76. This has demonstrated that it is possible for these landfills to collect a high proportion of the landfill gas. A proposed approach is presented for regulating landfills using the measured MCI. This would involve an annual measurement campaign to quantify the methane emissions and the use of the data provided by these surveys to develop an achievable but challenging MCI limit. A limit value of 0.75 for the MCI is used to illustrate the approach. An MCI that falls below the limit would trigger actions to reduce the methane emissions from the landfill.
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Affiliation(s)
- M Bourn
- Environment Agency, Horizon House, Deanery Road, Bristol BS1 5AH, United Kingdom.
| | - R Robinson
- National Physical Laboratory (NPL), Hampton Road, Teddington, Middlesex TW11 0LW, United Kingdom
| | - F Innocenti
- National Physical Laboratory (NPL), Hampton Road, Teddington, Middlesex TW11 0LW, United Kingdom
| | - C Scheutz
- Department of Environmental Engineering, Technical University of Denmark, Bygningstorvet, Building 115, DK-2800 Kongens Lyngby, Denmark
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33
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Innocenti F, Jiang C, Sibley A, Denning S, Etheridge A, Watson D, Niedzwiecki D, Hatch A, Hurwitz H, Nixon A, Furukawa Y, Kubo M, Crona D, Kindler H, McLeod H, Ratain M, Owzar K. A genetic analysis of gemcitabine-induced high-grade neutropenia in pancreatic cancer patients. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy303.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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34
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Das R, Furchtgott L, Ou FS, Swanson D, Hayete B, Harms B, Cunha D, Latourelle J, Wuest D, Khalil I, Washburn C, Rich K, Blanke C, Meyerhardt J, Niedzwiecki D, Nixon A, O’Reilly E, Innocenti F, Lenz HJ, Venook A. Causal modeling of CALGB/SWOG 80405 (Alliance) identifies primary (1°) side-related angiogenic drivers of metastatic colorectal cancer (mCRC). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy281.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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35
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Fuchs MA, Yuan C, Sato K, Niedzwiecki D, Ye X, Saltz LB, Mayer RJ, Mowat RB, Whittom R, Hantel A, Benson A, Atienza D, Messino M, Kindler H, Venook A, Innocenti F, Warren RS, Bertagnolli MM, Ogino S, Giovannucci EL, Horvath E, Meyerhardt JA, Ng K. Predicted vitamin D status and colon cancer recurrence and mortality in CALGB 89803 (Alliance). Ann Oncol 2018; 28:1359-1367. [PMID: 28327908 DOI: 10.1093/annonc/mdx109] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Background Observational studies suggest that higher levels of 25-hydroxyvitamin D3 (25(OH)D) are associated with a reduced risk of colorectal cancer and improved survival of colorectal cancer patients. However, the influence of vitamin D status on cancer recurrence and survival of patients with stage III colon cancer is unknown. Patients and methods We prospectively examined the influence of post-diagnosis predicted plasma 25(OH)D on outcome among 1016 patients with stage III colon cancer who were enrolled in a National Cancer Institute-sponsored adjuvant therapy trial (CALGB 89803). Predicted 25(OH)D scores were computed using validated regression models. We examined the influence of predicted 25(OH)D scores on cancer recurrence and mortality (disease-free survival; DFS) using Cox proportional hazards. Results Patients in the highest quintile of predicted 25(OH)D score had an adjusted hazard ratio (HR) for colon cancer recurrence or mortality (DFS) of 0.62 (95% confidence interval [CI], 0.44-0.86), compared with those in the lowest quintile (Ptrend = 0.005). Higher predicted 25(OH)D score was also associated with a significant improvement in recurrence-free survival and overall survival (Ptrend = 0.01 and 0.0004, respectively). The benefit associated with higher predicted 25(OH)D score appeared consistent across predictors of cancer outcome and strata of molecular tumor characteristics, including microsatellite instability and KRAS, BRAF, PIK3CA, and TP53 mutation status. Conclusion Higher predicted 25(OH)D levels after a diagnosis of stage III colon cancer may be associated with decreased recurrence and improved survival. Clinical trials assessing the benefit of vitamin D supplementation in the adjuvant setting are warranted. ClinicalTrials.gov Identifier NCT00003835.
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Affiliation(s)
- M A Fuchs
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston
| | - C Yuan
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston
| | - K Sato
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston
| | - D Niedzwiecki
- Alliance Statistics and Data Center, Duke University Medical Center, Durham
| | - X Ye
- Alliance Statistics and Data Center, Duke University Medical Center, Durham
| | - L B Saltz
- Memorial Sloan-Kettering Cancer Center, New York
| | - R J Mayer
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston
| | - R B Mowat
- Toledo Community Hospital Oncology Program, Toledo, USA
| | - R Whittom
- Hôpital du Sacré-Coeur de Montréal, Montreal, Canada
| | - A Hantel
- Edward Cancer Center, Naperville
| | - A Benson
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago
| | - D Atienza
- Virginia Oncology Associates, Norfolk
| | - M Messino
- Southeast Cancer Control Consortium, Mission Hospitals-Memorial Campus, Asheville
| | | | - A Venook
- University of California at San Francisco Comprehensive Cancer Center, San Francisco
| | - F Innocenti
- Division of Pharmacotherapy and Experimental Therapeutics, University of North Carolina at Chapel Hill, Chapel Hill
| | - R S Warren
- University of California at San Francisco Comprehensive Cancer Center, San Francisco
| | - M M Bertagnolli
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston.,Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston
| | - S Ogino
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston.,Division of MPE Molecular Pathological Epidemiology, Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston
| | - E L Giovannucci
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston.,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston
| | - E Horvath
- Alliance Protocol Operations Office, Chicago, USA
| | - J A Meyerhardt
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston
| | - K Ng
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston
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36
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Innocenti F, Cerquetti L, Pezzilli S, Bucci B, Toscano V, Canipari R, Stigliano A. Effect of mitotane on mouse ovarian follicle development and fertility. J Endocrinol 2017; 234:29-39. [PMID: 28450646 DOI: 10.1530/joe-17-0203] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Accepted: 04/27/2017] [Indexed: 11/08/2022]
Abstract
Mitotane (MTT) is an adrenolytic drug used in advanced and adjuvant treatment of adrenocortical carcinoma, in Cushing's disease and in ectopic syndrome. However, knowledge about its effects on the ovary is still scarce. The purpose of this study is to investigate the effect of MTT on the ovary using in vivo and in vitro models. The study was performed in CD1 mice and in the COV-434 human ovarian granulosa cell line. We examined ovarian morphology, follicle development, steroidogenesis and procreative function in mice and the effect of MTT on cell growth in vitro Our results revealed that treatment of CD1 mice with MTT induces a decrease in early antral follicles with a subsequent increase in the secondary follicles, measured by the increased levels of anti-Mullerian Hormone (P < 0.05) and decreased levels of FSH receptor (P < 0.05). Moreover, we observed a significant decrease in Cyp11a1 (P < 0.01) and Cyp17a1 (P < 0.001) mRNA level in MTT-treated animals. Ovulation, induced by PMSG/hCG stimulation, was also significantly impaired, with a reduction in the number of ovulated oocytes (P < 0.01) and fewer corpora lutea in treated animals. Likewise, the mating experiment demonstrated a delay in the time of conception as well as fewer pups per litter in MTT-treated mice (P < 0.05). Experiments performed on the COV-434 cell line showed a significant inhibition of growth followed by apoptosis (P < 0.01). In conclusion, our study highlights the key points of ovarian folliculogenesis affected by MTT and demonstrates impairment of the ovulation process with a negative impact on conception, which is nevertheless preserved.
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Affiliation(s)
- Federica Innocenti
- DAHFMOUnit of Histology and Medical Embryology, Sapienza University of Rome, Rome, Italy
| | - Lidia Cerquetti
- EndocrinologyDepartment of Clinical and Molecular Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Serena Pezzilli
- EndocrinologyDepartment of Clinical and Molecular Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | | | - Vincenzo Toscano
- EndocrinologyDepartment of Clinical and Molecular Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Rita Canipari
- DAHFMOUnit of Histology and Medical Embryology, Sapienza University of Rome, Rome, Italy
| | - Antonio Stigliano
- EndocrinologyDepartment of Clinical and Molecular Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
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Roncato R, Cecchin E, Montico M, De Mattia E, Giodini L, Buonadonna A, Solfrini V, Innocenti F, Toffoli G. Cost Evaluation of Irinotecan-Related Toxicities Associated With the UGT1A1*28 Patient Genotype. Clin Pharmacol Ther 2017; 102:123-130. [PMID: 28074472 DOI: 10.1002/cpt.615] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 01/04/2017] [Accepted: 01/06/2017] [Indexed: 01/08/2023]
Abstract
The adoption of a preemptive UGT1A1*28 genotyping to increase irinotecan safety in clinical practice is still limited. This is the first actual study of costs associated with the management of irinotecan-related toxicities, and their association with UGT1A1*28 genotype. A retrospective analysis of the cost of toxicity management was conducted on 243 metastatic colorectal cancer patients enrolled in a clinical trial and treated with standard of care FOLFIRI (5-fluorouracil combined with irinotecan). The mean predicted cost per patient was higher for *28/*28 (€4,886), vs. *1/*1 (€812), (regression coefficient 1.79, 95% confidence interval (CI) = 1.31-2.28; P < 0.001) and for *1/*28 (€1,119) vs. *1/*1 (regression coefficient 0.32, 95% CI = 0.04-0.60; P = 0.024). This is consistent with a different grade 4 toxicity profile among the three genotypes, and a higher frequency of costly interventions like hospitalization among patients with the *28 allele. A differential toxicity management cost by *28 genotype is herein demonstrated, representing a first step towards the demonstration of the test clinical utility.
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Affiliation(s)
- R Roncato
- Experimental and Clinical Pharmacology, Centro Di Riferimento Oncologico, National Cancer Institute, Aviano, Italy
| | - E Cecchin
- Experimental and Clinical Pharmacology, Centro Di Riferimento Oncologico, National Cancer Institute, Aviano, Italy
| | - M Montico
- Experimental and Clinical Pharmacology, Centro Di Riferimento Oncologico, National Cancer Institute, Aviano, Italy
| | - E De Mattia
- Experimental and Clinical Pharmacology, Centro Di Riferimento Oncologico, National Cancer Institute, Aviano, Italy
| | - L Giodini
- Experimental and Clinical Pharmacology, Centro Di Riferimento Oncologico, National Cancer Institute, Aviano, Italy
| | - A Buonadonna
- Medical Oncology Unit B, Centro Di Riferimento Oncologico, National Cancer Institute, Aviano, Italy
| | - V Solfrini
- Sanitary Direction, Centro Di Riferimento Oncologico, National Cancer Institute, Aviano, Italy
| | - F Innocenti
- Eshelman School of Pharmacy, Center for Pharmacogenomics and Individualized Therapy, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - G Toffoli
- Experimental and Clinical Pharmacology, Centro Di Riferimento Oncologico, National Cancer Institute, Aviano, Italy
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38
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Innocenti F, Karabinos A, Etheridge A, Pena C, Crona D. Novel genetic marker of diarrhea in renal cell carcinoma patients treated with sorafenib. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw363.78] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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39
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Iwanicka M, Lanterna G, Lalli CG, Innocenti F, Sylwestrzak M, Targowski P. On the application of optical coherence tomography as a complimentary tool in an analysis of the 13th century Byzantine Bessarion reliquary. Microchem J 2016. [DOI: 10.1016/j.microc.2015.11.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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40
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Zanobetti M, Coppa A, Nazerian P, Grifoni S, Scorpiniti M, Innocenti F, Conti A, Bigiarini S, Gualtieri S, Casula C, Ticali PF, Pini R. Chest Abdominal-Focused Assessment Sonography for Trauma during the primary survey in the Emergency Department: the CA-FAST protocol. Eur J Trauma Emerg Surg 2015; 44:805-810. [PMID: 26683569 DOI: 10.1007/s00068-015-0620-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 12/07/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the feasibility of a new protocol, Chest Abdominal-Focused Assessment Sonography for Trauma (CA-FAST), during the primary survey and to estimate its diagnostic accuracy when compared with thoracoabdominal computed tomography (CT) scan. METHODS A prospective accuracy study was performed from November 2012 to November 2013 at the Emergency Department. Only adult trauma patients who underwent a CA-FAST examination prior to a thoracoabdominal CT scan were enrolled. In addition to standard patterns detected by Extended-FAST (E-FAST) such as pneumothorax (PTX), hemothorax (HTX), pericardial and intraabdominal effusion, CA-FAST protocol also included the research of lung contusions (LCs). RESULTS Six hundred and one patients were enrolled. The mean time for protocol execution was 7 ± 3 min. Chest ultrasonography showed the following results (all p < 0.001): LCs sensitivity 59 %, specificity 98 %, positive predictive value (PPV) 92 %, negative predictive value (NPV) 86 %, accuracy 87 %; PTX sensitivity 84 %, specificity 98 %, PPV 93 %, NPV 95 %, accuracy 95 %; HTX sensitivity 82 %, specificity 97 %, PPV 87 %, NPV 95 %, accuracy 94 %. The standard 4-views FAST examination showed a diagnostic accuracy of 91 % with a sensitivity of 75 %, specificity of 96 %, PPV of 81 % and NPV of 94 %. CONCLUSION According to our results CA-FAST protocol proved to be a rapid bedside method, with good accuracy and high NPV in detection of ultrasonographic patterns suggestive of serious injury in trauma patients; moreover, the additional research of LCs did not cause a delay in the diagnosis. Ultrasonography should be used as initial investigation during the primary survey, sending to further diagnostic studies (CT scan) only those patients not clearly classified.
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Affiliation(s)
- M Zanobetti
- Emergency Department, Careggi University Hospital, Largo Brambilla, 3, 50134, Florence, Italy.
| | - A Coppa
- Emergency Department, Careggi University Hospital, Largo Brambilla, 3, 50134, Florence, Italy
| | - P Nazerian
- Emergency Department, Careggi University Hospital, Largo Brambilla, 3, 50134, Florence, Italy
| | - S Grifoni
- Emergency Department, Careggi University Hospital, Largo Brambilla, 3, 50134, Florence, Italy
| | - M Scorpiniti
- Emergency Department, Careggi University Hospital, Largo Brambilla, 3, 50134, Florence, Italy
| | - F Innocenti
- Emergency Department, Careggi University Hospital, Largo Brambilla, 3, 50134, Florence, Italy
| | - A Conti
- Emergency Department, Careggi University Hospital, Largo Brambilla, 3, 50134, Florence, Italy
| | - S Bigiarini
- Emergency Department, Careggi University Hospital, Largo Brambilla, 3, 50134, Florence, Italy
| | - S Gualtieri
- Emergency Department, Careggi University Hospital, Largo Brambilla, 3, 50134, Florence, Italy
| | - C Casula
- Emergency Department, Careggi University Hospital, Largo Brambilla, 3, 50134, Florence, Italy
| | - P F Ticali
- Emergency Department, Careggi University Hospital, Largo Brambilla, 3, 50134, Florence, Italy
| | - R Pini
- Emergency Department, Careggi University Hospital, Largo Brambilla, 3, 50134, Florence, Italy
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41
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Posocco B, Buonadonna A, Marangon E, Giodini L, Scalone S, Sharma M, Innocenti F, Toffoli G. Pharmacokinetic analysis of irinotecan administered in FOLFIRI regimen in combination with bevacizumab from patients enrolled in a genotype-driven phase I study. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv348.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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42
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Chen S, Laverdiere I, Tourancheau A, Jonker D, Couture F, Cecchin E, Villeneuve L, Harvey M, Court MH, Innocenti F, Toffoli G, Lévesque E, Guillemette C. A novel UGT1 marker associated with better tolerance against irinotecan-induced severe neutropenia in metastatic colorectal cancer patients. Pharmacogenomics J 2015; 15:513-20. [PMID: 25778466 DOI: 10.1038/tpj.2015.12] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 12/03/2014] [Accepted: 01/28/2015] [Indexed: 12/13/2022]
Abstract
The risk of severe irinotecan-induced neutropenia has been shown to be related to the UGT1 variant UGT1A1*28, which increases exposure to the potent metabolite SN-38. Our goal was to identify a novel UGT1 marker(s) using 28 haplotype-tagged single nucleotide polymorphisms genotyped by mass spectrometry. By characterizing the UGT1 sequence from a cohort of 167 Canadian metastatic colorectal cancer (mCRC) patients and a validation cohort of 250 Italian mCRC patients, we found rs11563250G, located in the intergenic region downstream of UGT1, to be significantly associated with reduced risk of severe neutropenia (odds ratio (OR)=0.21; P=0.043 and OR=0.27; P=0.036, respectively, and OR=0.31 when combined; P=0.001), which remained significant upon correction for multiple testing in the combined cohort (P=0.041). For the two-marker haplotype rs11563250G and UGT1A1*1 (rs8175347 TA6), the OR was of 0.17 (P=0.0004). Genetic testing of this marker may identify patients who might benefit from increased irinotecan dosing.
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Affiliation(s)
- S Chen
- Pharmacogenomics Laboratory, Centre Hospitalier Universitaire de Québec Research Center and Faculty of Pharmacy, Laval University, Québec, Québec, Canada
| | - I Laverdiere
- Pharmacogenomics Laboratory, Centre Hospitalier Universitaire de Québec Research Center and Faculty of Pharmacy, Laval University, Québec, Québec, Canada
| | - A Tourancheau
- Pharmacogenomics Laboratory, Centre Hospitalier Universitaire de Québec Research Center and Faculty of Pharmacy, Laval University, Québec, Québec, Canada
| | - D Jonker
- Division of Medical Oncology, Department of Medicine, Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - F Couture
- Centre Hospitalier Universitaire de Québec Research Center and Faculty of Medicine, Laval University, Québec, Québec, Canada
| | - E Cecchin
- Division of Experimental and Clinical Pharmacology, Department of Molecular Biology and Translational Research, National Cancer Institute and Cancer for Molecular Biomedicine, Aviano, Italy
| | - L Villeneuve
- Pharmacogenomics Laboratory, Centre Hospitalier Universitaire de Québec Research Center and Faculty of Pharmacy, Laval University, Québec, Québec, Canada
| | - M Harvey
- Pharmacogenomics Laboratory, Centre Hospitalier Universitaire de Québec Research Center and Faculty of Pharmacy, Laval University, Québec, Québec, Canada
| | - M H Court
- Individualized Medicine Program, Department of Veterinary Clinical Sciences, Washington State University College of Veterinary Medicine, Pullman, WA, USA
| | - F Innocenti
- Division of Pharmacotherapy & Experimental Therapeutics, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
| | - G Toffoli
- Division of Experimental and Clinical Pharmacology, Department of Molecular Biology and Translational Research, National Cancer Institute and Cancer for Molecular Biomedicine, Aviano, Italy
| | - E Lévesque
- Pharmacogenomics Laboratory, Centre Hospitalier Universitaire de Québec Research Center and Faculty of Pharmacy, Laval University, Québec, Québec, Canada.,Centre Hospitalier Universitaire de Québec Research Center and Faculty of Medicine, Laval University, Québec, Québec, Canada
| | - C Guillemette
- Pharmacogenomics Laboratory, Centre Hospitalier Universitaire de Québec Research Center and Faculty of Pharmacy, Laval University, Québec, Québec, Canada
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Abstract
Pharmacogenetics is an area of research that has potential to greatly benefit patients. However, the routine use of diagnostic pharmacogenetic testing to inform treatment decisions is limited. Here we discuss the determination of clinical utility of pharmacogenetic testing and the level of evidence required to support translation into clinical practice.
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Affiliation(s)
- N K Gillis
- Center for Pharmacogenomics and Individualized Therapy, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina, USA
| | - F Innocenti
- 1] Center for Pharmacogenomics and Individualized Therapy, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina, USA [2] Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
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44
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Innocenti F, Ramirez J, Qiao W, de Graan A, Ratain M, van Schaik R, Mathijssen R, Rosner G, Crona D. 66 Clinical validity of new genetic biomarkers of irinotecan neutropenia: An independent replication study. Eur J Cancer 2014. [DOI: 10.1016/s0959-8049(14)70192-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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45
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Innocenti F, Gillis N, Parker J, Hayes N, Eberhard D, Richards K, Auman J, Seiser E. 163 Interrogation of pharmacogenes in cancer patients using targeted DNA sequencing. Eur J Cancer 2014. [DOI: 10.1016/s0959-8049(14)70289-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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46
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Seiser E, Gillis N, Parker J, Hayes D, Eberhard D, Richards K, Auman J, Innocenti F. Pharmacogenetic Evaluation of Targeted Dna Sequencing in Cancer Patients. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu358.45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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47
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Lenz H, Niedzwiecki D, Innocenti F, Blanke C, Mahony M, O'Neil B, Shaw J, Polite B, Hochster H, Atkins J, Goldberg R, Mayer R, Schilsky R, Bertagnolli M, Venook A. Calgb/Swog 80405: Phase III Trial of Irinotecan/5-Fu/Leucovorin (Folfiri) or Oxaliplatin/5-Fu/Leucovorin (Mfolfox6) with Bevacizumab (Bv) or Cetuximab (Cet) for Patients (Pts) with Expanded Ras Analyses Untreated Metastatic Adenocarcinoma of the Colon Or Rectum (Mcrc). Ann Oncol 2014. [DOI: 10.1093/annonc/mdu438.13] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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48
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Venook A, Niedzwiecki D, Lenz H, Mahoney M, Innocenti F, O'Neil B, Hochster H, Goldberg R, Schilsky R, Mayer R, Polite B, Atkins J, Shaw J, Bertagnolli M, Blanke C. Calgb/Swog 80405: Analysis of Patients Undergoing Surgery As Part of Treatment Strategy. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu438.8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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49
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Robinson RA, Gardiner TD, Innocenti F, Finlayson A, Woods PT, Few JFM. First measurements of a carbon dioxide plume from an industrial source using a ground based mobile differential absorption lidar. Environ Sci Process Impacts 2014; 16:1957-1966. [PMID: 24933364 DOI: 10.1039/c4em00113c] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The emission of carbon dioxide (CO2) from industrial sources is one of the main anthropogenic contributors to the greenhouse effect. Direct remote sensing of CO2 emissions using optical methods offers the potential for the identification and quantification of CO2 emissions. We report the development and demonstration of a ground based mobile differential absorption lidar (DIAL) able to measure the mass emission rate of CO2 in the plume from a power station. To our knowledge DIAL has not previously been successfully applied to the measurement of emission plumes of CO2 from industrial sources. A significant challenge in observing industrial CO2 emission plumes is the ability to discriminate and observe localised concentrations of CO2 above the locally observed background level. The objectives of the study were to modify our existing mobile infrared DIAL system to enable CO2 measurements and to demonstrate the system at a power plant to assess the feasibility of the technique for the identification and quantification of CO2 emissions. The results of this preliminary study showed very good agreement with the expected emissions calculated by the site. The detection limit obtained from the measurements, however, requires further improvement to provide quantification of smaller emitters of CO2, for example for the detection of fugitive emissions. This study has shown that in principle, remote optical sensing technology will have the potential to provide useful direct data on CO2 mass emission rates.
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Affiliation(s)
- R A Robinson
- National Physical Laboratory, Teddington, Middlesex TW11 0LW, UK.
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50
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Venook A, Niedzwiecki D, Lenz H, Innocenti F, Mahoney M, O'Neil B, Shaw J, Polite B, Hochster H, Atkins J, Goldberg R, Mayer R, Schilsky R, Bertagnolli M, Blanke C. CALGB/SWOG 80405: Phase III Trial of Irinotecan/5-FU/Leucovorin (FOLFIRI) or Oxaliplatin/5-FU/Leucovorin (MFOLFOX6) with Bevacizumab (BV) or Cetuximab (CET) for Patients (PTS) with KRAS Wild-Type (WT) Untreated Metastatic Adenocarcinoma of the Colon. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu193.19] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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