Non-invasive evaluation of embryos using mid-infrared attenuated total reflection spectrometry of incubation medium: a preliminary study

RESEARCH QUESTION

Can mid-infrared attenuated total reflection (MIR ATR) spectroscopy combined with machine learning methods be used as an additional tool to predict embryo quality and IVF treatment outcomes?

DESIGN

Spent culture media was collected and analysed. MIR ATR absorbance spectra were measured using an ALPHA II spectrometer equipped with an attenuated total reflection (ATR) spectrometry accessory. Patient and treatment data and results were collected and analysed in combination with machine learning techniques to identify possible correlations. The main outcome measures were to define the characteristics of absorbance spectra of spent culture media and to distinguish the difference in absorbance between top- and low-quality embryos, day 3 and day 5 embryos and implanting embryos versus non-implanting embryos.

RESULTS

Spent culture media of 227 embryos was collected and analysed. Absorbance peaks in the culture media were different between day 3 and day 5 embryos. Moreover, significant differences in P-values, spanning from 0.014 to 0.044 in absorbance peaks for day 3 embryos and 0.024 up to 0.04 for day 5 embryos, were seen between implanting and non-implanting embryos. Machine learning techniques offered a pregnancy prediction value of 84.6% for day 3 embryos.

CONCLUSIONS

MIR ATR may offer an additional parameter for better selection of embryos based on the spectrometric absorbance and secretions of metabolites in the culture media.

P–565 Does length really matter? The impact of lifestyle on granulosa cell telomeres length and IVF outcome

Study question

Is the relative telomere length in granulosa cells associated with an abnormal metabolic profile of IVF patients and treatment outcome?

Summary answer

Longer telomeres and higher pregnancy rates have been observed in women with higher follicular fluid glucose levels.

What is known already

Telomeres may serve as a biomarker of cell senescence; their length varies depending on two factors: genetic predisposition and shortening processes related to cell division. In several studies, telomere shortening in granulosa cells has been shown to be correlated with ovarian aging. However, these findings are still limited in applicability, and more research is required to define the factors involved.

Study design, size, duration

Women undergoing IVF participated in a prospective cohort study between 2018 and 2019. Peripheral blood was obtained on the day of oocyte retrieval. Pooled samples of follicular fluid were collected for a comprehensive telomere length analysis in granulosa and cumulus cells by quantitative PCR (qPCR).

Participants/materials, setting, methods

DNA was extracted from granulosa cells and assessed for relative telomere length by monochrome multiplex quantitative PCR (qPCR). Telomere length was then analyzed relative to a single copy gene (36B4) to evaluate possible metabolic profile’s impact on telomere length and treatment outcome. Hormonal profile, chemistry, and inflammation factors were analyzed in the follicular fluid and serum.

Main results and the role of chance

Out of forty-nine women recruited for the study, forty-one cases were eligible for a comprehensive analysis. Follicular fluid CRP and triglyceride levels in BMI-based analysis were significantly lower in women with BMI <25 compared to those with BMI >30 (0.5 (0.2–1.5) vs. 6.6 (3.6–10.6); p < 0.0001 and 21.04 ± 8.04 vs. 28.18 ± 8.97; p = 0.011, respectively). Interestingly, a significant correlation between the relative lengths of telomeres and pregnancy rate was observed (p < 0.001), with a higher pregnancy rate in women with longer telomeres (88%) than in women with shorter telomeres (38%). Relatively longer telomeres (0.96 (0.94–0.99) vs. 0.91 (0.82–0.95), p = 0.02) and higher levels of follicular fluid glucose (63±11.12 vs. 50.67±15.69, p = 0.006) were observed in those who conceived. No statistically significant differences were detected in the levels of the other hormones measured in the blood or follicular fluid on the day of oocyte retrieval or other clinical parameters, including follicle size and number, embryo quality, and the number of OHSS cases.

Limitations, reasons for caution

As a preliminary study, there were few participants. Further implications can be reached by increasing the sample size, but telomerase activity evaluation is required to confirm telomere length measurements without question. Whether short telomeres associate with infertility as a cause or consequence of BMI warrant more research.

Wider implications of the findings: The relative length of telomeres in granulosa cells at the time of oocyte retrieval may serve as a predictive biomarker for oocyte competence and subsequent pregnancy. Moreover, healthy lifestyle behavior is recommended.

Trial registration number

Not applicable

Obesity results with smaller oocyte in in vitro fertilization/intracytoplasmic sperm injection cycles-a prospective study

BACKGROUND

Obesity is associated with several fertility disorders. This prospective cohort study was designed to evaluate the effect of body mass index (BMI) (kg/m2) on oocyte diameter and treatment.

METHODS

Women undergoing in vitro fertilization (IVF) with intracytoplasmic sperm injection (ICSI) were enrolled in the study. They were divided into two groups according to BMI: obese (BMI > 30) and normal weight (BMI < 25). Mature oocytes were evaluated according to total diameter, zona pellucida, and oolema diameters.

RESULTS

A total of 387 oocytes were obtained from the 46 women who participated. Significantly more mature oocytes (M2) were retrieved from normal weight patients compare to obese women (15.1 ± 6.8 vs. 9.7 ± 3.9, respectively, P < 0.001). Oocytes from women in the obese group were significantly smaller than those in the normal weight group, including oocyte diameter (157.9 ± 7.9 vs. 164.3 ± 5.1 μm, P < 0.0001), oolema diameter (110.3 ± 4.5 vs. 113.5 ± 3.5 μm, P < 0.0001), and zona pellucida thickness (17.9 ± 2.6 vs. 19.0 ± 2.4 μm, P < 0.000), respectively. Multivariate logistic regression analysis, including oolema diameter, female age, BMI, number of M2 oocytes, and zona pellucida, was conducted to predict pregnancy. Small oolema diameter in obese patient adversely correlated with pregnancy. Larger oolema diameter was positively associated with the probability of pregnancy in the obese group as well as thinner zona pellucida.

CONCLUSION

Obesity is associated with smaller oocytes, which adversely affect fertility outcomes.

TRIAL REGISTRATION

NIH number NCT01672931.

Can we alter pregnancy outcome by adjusting progesterone treatment at mid-luteal phase: a randomized controlled trial

Our study aimed to determine whether mid-luteal serum P concentrations can serve as a predictive factor for in vitro fertilization (IVF) outcomes and whether increasing P dosage for patients with low levels at mid-luteal phase may improve pregnancy rates. It was a prospective, randomized controlled study. A total of 146 patients undergoing IVF treatment were prospectively enrolled and received routine luteal phase support (LPS) regimen of Endometrin® (progesterone) 200 mg/day. Serum P levels were measured 7 days after embryo transfer (ET). Considering a cutoff level of 15 ng/ml on this day, patients with higher levels continued the same dosage until pregnancy test (control group). Patients with lower levels were randomly allocated to continue Endometrin® 200 mg/day (Group A) or to increase Endometrin® dosage to 300 mg/day (Group B). The Main Outcome Measures were pregnancy rates. Both biochemical and clinical pregnancy and live birth rates were comparable between all groups regardless of P level on day 7 of luteal phase and regardless of dose adjustment. ROC analysis determined that mid-luteal P levels of 17 ng/ml can be a better predictor of cycle outcome. In conclusion raising the P dose at mid-luteal phase to 300 mg daily did not improve cycle outcomes.

Late follicular progesterone to estradiol ratio is not influenced by protocols or gonadotropins used

OBJECTIVE

Increased progesterone level during follicular phase seemed to be associated with decreased pregnancy rate.

STUDY DESIGN AND METHODS

A prospective cohort study, 1.1.2012 - 31.8.13. The Progesterone (P) and Progesterone/Estrogen (P/E2) level on ovulation induction day were compared between the protocols and the different gonadotropins used. Roc analysis was calculated to determine the cutoff of P/E2 to predict delivery rates. P/E2 ratio was calculated as PX1000/e2 level.

MAIN RESULTS

One hundred thirty-nine patients were enrolled to the study. No difference in the P level at hCG stimulation day between different protocols, however, E2 and P/E2 ratio were significantly lower in the long protocol compare with antagonist protocol 1757.7 ± 923.2 vs. 1342.9 ± 1223; P = 0.003 and 0.48 ± 0.31 vs. 0.83 ± 0.87; P = 0.038). The endometrium was significantly thicker in the long group compare with short and antagonist. Significantly more top-quality embryos (TOP) were achieved in the antagonist group. Comparable results between the types of gonadotropins used in regards with cycle characteristics and pregnancy and delivery rates. The P/E2 ratio which can predict live birth rate was found to be 0.45, AUC = 0.632, p = 0.02 and 95 % CI 0.525-0.738 and a significantly higher pregnancy and delivery rates at a P/E2 bellow 0.45.

CONCLUSION

Endometrial receptivity is determined by the complex interactions of E2 and P.

Can intra cytoplasmatic morphologically selected sperm injection (IMSI) technique improve outcome in patients with repeated IVF-ICSI failure? a comparative study

OBJECTIVE

Spermatozoal morphology was reported to effect fertilization, embryo quality and pregnancy results in spontaneous conception and ART. Intracytoplasmic morphologically selected sperm injection (IMSI) is an innovative, not invasive technique, which examines the sperm with no harm at a magnification of 6000 × in order to obtain optimal sperm to perform IVF-ICSI. We evaluated the efficiency of IMSI technique in patients with repeated IVF-ICSI failure of at least three cycles with no viable pregnancy and/or very poor sperm quality.

STUDY DESIGN AND METHODS

All couples who performed IMSI between the years 2009 to 2012 were enrolled retrospectively to the study. Couples with male infertility who were treated with IMSI were included in the study. All their treatments were evaluated and divided into two subgroups: conventional IVF-ICSI treatment and their subsequent IMSI treatment. Demographic data, clinical parameters and outcome were recorded. The IMSI treatments were compared to previous non-IMSI treatments in terms of fertilization rates, cleavage rates, number of embryos and their quality, number of embryos transferred and pregnancy outcome.

MAIN RESULTS

Forty-two couples were reviewed. Basic characteristics of the groups were comparable. Fertilization and cleavage rates of the two groups were comparable. The embryos quality demonstrated a trend toward superior quality (grade 1-2) embryos in the IMSI versus ICSI (60% versus 47%; p = 0.07 and 53% versus 40%; p = 0.07), respectively. Implantation and clinical pregnancy rates were significantly superior in IMSI group (19.2% versus 7.8%; p = 0.042 and 41.3% versus 10.5%; p = 0.02, respectively). Miscarriage rate was significantly higher in conventional IVF-ICSI group (100% versus 15.8%; p = 0.04), and live birth rate was significantly higher in IMSI group (0 in conventional IVF-ICSI and 34.7% per transfer in IMSI group; p = 0.003).

CONCLUSION

IVF outcome of IMSI resulted in a higher implantation rate, pregnancy rate and most importantly delivery rate compare to non IMSI treated cycles.

[In vitro maturation of oocytes: a novel method of treatment of patients with polycystic ovarian syndrome undergoing in vitro fertilization]

BACKGROUND

In vitro maturation of oocytes (IVM) was developed to make in vitro fertilization (IVF) safer and simpler mainly for women with poLycystic ovarian syndrome (PCOS). The major benefits of IVM treatment include avoidance of hormone administration and risk of ovarian hyperstimulation syndrome (OHSS).

OBJECTIVE

Results of IVM from our unit in patients with PCOS.

METHODS

In this study 85 PCOS patients underwent 102 IVF cycles of IVM and were treated with one of the following protocols: (1) Priming with 150 units of recombinant FSH for 3 days, from the 3rd day of menses, following follicle development up to 10-12 mm. (2) Administration of 17beta estradiol (estrofem) on second day of menses, followed by ultrasound endometrial measurement up to > or =6 mm. thickness. Oocytes were collected 38 hours post recombinant human chorionic gonadotropin (rhCG) administration. Luteal phase support was achieved by estrofem and progesterone. Oocytes were matured either 6-30 hours (protocol 1) or 24-48 hours (protocol 2) in IVM medium and fertilized by intracytoplasmatic sperm injection (ICSI). Mean number of immature oocytes collected, maturation, fertilization, cleavage and pregnancy rates were assessed.

RESULTS

Total number of retrieved oocytes was 1224 (mean 12 +/- 6.2 per cycle); 820 (64.9%) underwent maturation after 6-48 hours of culture while 128 of them (15.6%) after 6 hours and 20.2% of transferred embryos originated from those oocytes. FertiLization rate was 47.2%. Pregnancy and implantation rates were 28.4% and 11.25% respectively.

CONCLUSIONS

IVM appears to be a simpler and tolerable treatment method in patients with PCOS undergoing IVF treatment. Favorable results were obtained.

Correlation between tps and cea in patients with colorectal-cancer

Serum TPS and CEA levels were measured in 173 cancer patients with various disease stages. The patients were divided into 4 groups: preoperative group, 16 patients in whom TPS and CEA were measured pre- and postoperatively; group I, 66 newly diagnosed patients up to 40 days post surgery; group II, 86 patients whose blood was taken 40-365 days post surgery, and group III, 47 patients on long-term follow-up in whom blood was taken more than one year after surgery. The median preoperative TPS levels were significantly higher (p<0.01) than the postoperative levels. Patients with Dukes' D had significantly higher TPS (p<0.01) and CEA levels as compared to patients with Dukes' B or C. For both Dukes' B and C stages there was a significant increase in median TPS level between group I and II and III. There was no similar increase in median CEA level. Serial measurements in individual patients show a significant increase in TPS levels between groups I, II and III. In Dukes' D patients, individual TPS levels decreased in response to therapy. There was a significant correlation between TPS and CEA levels. These results suggest that TPS measurement is additive to CEA in follow-up of asymptomatic patients, and to monitor response to therapy in patients with metastatic disease.