Effect of blastocyst shrinkage on assisted reproductive outcomes: a retrospective cohort study describing a new morphological evaluation of blastocyst pre-vitrification and post-warming

BACKGROUND

The failure of frozen-thawed blastocysts to re-expand adequately within a few hours after warming has been reported to have a negative impact on assisted reproductive technology (ART) outcomes. However, the extent to which this failure truly affects ART outcomes has not yet been presented in a manner that is easily understandable to medical practitioners and patients. This study aimed to assess the effects of blastocyst shrinkage on ART outcomes and determine a more effective morphological evaluation approach for use in clinical settings.

METHODS

This retrospective observational cohort study of frozen-thawed blastocyst transfer cycles was conducted from April 2017 to March 2022. Overall, 1,331 cycles were eligible for inclusion, of which 999 were good-quality blastocysts (GQB) and 332 were non-good-quality blastocysts (non-GQB). All frozen-thawed blastocyst transfer cycles performed during the specified study period were included in the study. Exclusion criteria were established to mitigate potential sources of bias as these cycles could impact implantations. We calculated rates and age-adjusted odds ratios of implantation, clinical pregnancy, ongoing pregnancy, and live birth of the re-expansion group, which showed sufficient expansion, and shrinkage group, which showed insufficient expansion. We also calculated the implantation, clinical pregnancy, ongoing pregnancy, and live birth rates of the re-expansion and shrinkage groups for each morphological scoring system parameter.

RESULTS

A reduced ART outcome was observed with use of blastocysts with shrinkage after vitrification/warming. The age-adjusted odds ratios for implantation, clinical pregnancy, ongoing pregnancy, and live birth were lower in the shrinkage group than in the re-expansion group.

CONCLUSIONS

This study examined the adverse effect of blastocyst shrinkage after warming and recovery culturing on reproductive outcomes in a clinically useful manner by retrospectively examining a substantial number of frozen-thawed embryo transfer cycles. The study findings can possibly reduce concerns regarding over- or under-estimation of blastocyst implantation by allowing providers and patients to refer to the data.

Application of 3D Imaging-Assisted Precise Aesthetic Evaluation in Midfacial Depression Treatment

Most Chinese have unpleasant facial profile of midfacial depression, which could be caused by multiple reasons. In the past, LeFort osteotomy and orthodontic methods were applied for surgical treatment of midfacial concavity. As the development of plastic surgery filling techniques, nasal base filling or concurrent comprehensive rhinoplasty has been widely used to improve midfacial depression. However, most of the related studies focus on surgical techniques or filling materials, yet lack accurate and objective aesthetic evaluation. In the current study, we used 3D imaging to collect 3D facial profile of 66 patients suffering from midfacial depression. Related linear distance and angles were measured accurately using 3D software. Patient satisfaction and physician evaluation were also collected in the follow-up period. The results showed that patients' midfacial depression were significantly improved after the surgery and the overall patient satisfaction was 100%. Our study demonstrated the positive role of nasal base filling in improving the midfacial depression, and illustrated the advantages of 3D imaging technology in personalized preoperative communication, surgical simulation and postoperative effect evaluation.Level of evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Inter-centre reliability in embryo grading across several IVF clinics is limited: implications for embryo selection

RESEARCH QUESTION

What is the intra- and inter-centre reliability in embryo grading performed according to the Istanbul Consensus across several IVF clinics?

DESIGN

Forty Day 3 embryos and 40 blastocysts were photographed on three focal planes. Senior and junior embryologists from 65 clinics were invited to grade them according to the Istanbul Consensus (Study Phase I). All participants then attended interactive training where a panel of experts graded the same embryos (Study Phase II). Finally, a second set of pictures was sent to both embryologists and experts for a blinded evaluation (Study Phase III). Intra-centre reliability was reported for Study Phase I as Cohen's kappa between senior and junior embryologists; inter-centre reliability was instead calculated between senior/junior embryologists and experts in Study Phase I versus III to outline improvements after training (i.e. upgrade of Cohen's kappa category according to Landis and Koch).

RESULTS

Thirty-six embryologists from 18 centres participated (28% participation rate). The intra-centre reliability was (i) substantial (0.63) for blastomere symmetry (range -0.02 to 1.0), (ii) substantial (0.72) for fragmentation (range 0.29-1.0), (iii) substantial (0.66) for blastocyst expansion (range 0.19-1.0), (iv) moderate (0.59) for inner cell mass quality (range 0.07-0.92), (v) moderate (0.56) for trophectoderm quality (range 0.01-0.97). The inter-centre reliability showed an overall improvement from Study Phase I to III, from fair (0.21-0.4) to moderate (0.41-0.6) for all parameters under analysis, except for blastomere fragmentation among senior embryologists, which was already moderate before training.

CONCLUSIONS

Intra-centre reliability was generally moderate/substantial, while inter-centre reliability was just fair. The interactive training improved it to moderate, hence this workflow was deemed helpful. The establishment of external quality assessment services (e.g. UK NEQAS) and the avant-garde of artificial intelligence might further improve the reliability of this key practice for embryo selection.

Morphological and surgical results in sagittal synostosis: early craniectomy versus later cranioplasty

BACKGROUND AND PURPOSE

Morphological correction is one of the main aims of surgery for sagittal synostosis (SSO). Different surgical techniques have been developed; however, few studies have compared the different surgical protocols. The morphological outcome is poorly documented, because a consensual evaluation tool is lacking.

MATERIAL AND METHODS

We performed a prospective study of children operated for SSO in our institution. Children were operated whenever possible at 4 months for craniectomy; by default, children underwent cranioplasty at or after 9 months. The morphological outcome of all children was evaluated using traditional craniometry with head circumference (HC) and the cephalic index (CI), and with the Rotterdam scaphocephaly morphology score (RSMS), a total of semi-quantitative assessments of morphological hallmarks.

RESULTS

Craniectomy was significantly associated with a shorter operation time and hospital stay, and a better impact on HC and CI measurements, compared with cranioplasty. The RSMS was markedly improved after surgery in both groups; however, we found no significant difference in improvement between the two groups. Although the transfusion rate and the prevalence of developmental delay were lower in the craniectomy group, and reoperations for calvarial lacunae or complex craniosynostosis occurred only this group, these differences were not significant.

CONCLUSIONS

Our results support early surgery with craniectomy whenever possible; however, cranioplasty at a later age is a very acceptable by-default indication. In addition to classical craniometry, morphological evaluation using the RSMS or a similar quantitative scale appears highly desirable for future studies.

Morphological evaluation of the calcaneofibular ligament in different ankle positions using a three-dimensional MRI sequence

PURPOSE

Evaluating images of the lateral ligament of the ankle is not easy, and evaluation of the calcaneofibular ligament (CFL) in particular is difficult. We prospectively conducted morphological measurements of the CFL in different ankle positions and obtain basic data for use in functional assessment of the CFL, diagnosis of CFL injury, and determination of treatment effects.

METHODS

The subjects were ten healthy volunteers (ten ankles) with a mean age of 27.8 years and no history of ankle disease. Imaging was done using a 3-T magnetic resonance imaging (MRI) machine and fast imaging employing steady-state acquisition cycled phases (FIESTA-C), a three-dimensional (3D) sequence, with the ankle in a neutral position, maximum dorsiflexion, and maximum plantar flexion. 3D images of the CFL, peroneal muscle tendons, fibula, and calcaneus were prepared at a workstation, and morphological measurements of the CFL were made.

RESULTS

In all positions, the CFL showed a gently curving course with the peroneal muscle tendons as a fulcrum. The tortuosity angle was significantly smaller in plantar flexion (30.0° ± 7.4°) than in the neutral position (41.7° ± 8.3°).

CONCLUSIONS

3D MRI sequences showed that, in all positions, the CFL curved due to the influence of the peroneal muscle tendons. With maximum plantar flexion, the CFL tortuosity angle was small, which was thought to have been due to the tension in the CFL.