Abstract
BackgroundEarly cumulus cell removal combined with early rescue intracytoplasmic sperm injection (ICSI) has been widely practiced in many in vitro fertilization (IVF) centers in China in order to avoid total fertilization failure. However, uncertainty remains whether the pregnancy and neonatal outcomes are associated with early cumulus cell removal.ObjectivesTo investigate if early cumulus cell removal alone after 4 hours co-incubation of gametes (4 h group), has detrimental effect on the pregnancy and neonatal outcomes in patients undergoing IVF, through a comparison with conventional cumulus cell removal after 20 hours of insemination (20 h group).MethodsThis retrospective cohort study included 1784 patients who underwent their first fresh cleavage stage embryo transfer at the Centre for Assisted Reproduction of Shanghai First Maternity and Infant Hospital from June 2016 to December 2018 (4 h group, n=570; 20 h group, n=1214). A logistic regression analysis was performed to examine the independent association between early cumulus cell removal and pregnancy outcomes after adjustment for potential confounders. The neonatal outcomes between the two groups were compared.ResultsWhen compared with the 20 h group, the 4 h group had similar pregnancy outcomes, including rates for biochemical pregnancy, clinical pregnancy, ongoing pregnancy, miscarriage, ectopic pregnancy, multiple pregnancy, live birth. There were 1073 infants delivered after embryo transfer (4 h group, n=337; 20 h group, n=736). Outcomes in both groups were similar for both singleton and twin gestations, including preterm birth rate and very preterm birth rate, mean birth weight, mean gestational age, sex ratio at birth and rate of congenital birth defects. In addition, findings pertaining to singleton gestations were also similar in the two groups for Z-scores (gestational age- and sex-adjusted birth weight), rates of small for gestational age, very small for gestational age, large for gestational age and very large for gestational age infants.ConclusionsIn this study early cumulus cell removal alone was not associated with adverse pregnancy and neonatal outcomes. From this perspective, early cumulus cell removal to assess for a potential early rescue ICSI is therefore considered to be a safe option in patients undergoing IVF.
Highlights
Total fertilization failure after conventional in vitro fertilization (IVF) is one of the most frustrating experiences in assisted reproductive technology (ART)
There were no significant differences between the two groups in terms of age, BMI, basal FSH level, stimulation protocol, serum estradiol levels on the day of hCG administration, number of
The released cortical granule proteins induce zona pellucida reaction, blocking both the entry of other spermatozoa [23] and the bi-directional communication between the oocyte and the cumulus cells. In this large retrospective cohort study, no detrimental effects on pregnancy and neonatal outcomes in patients undergoing IVF treatment as a result of early cumulus cell removal 4 h after insemination could be demonstrated when compared with conventional cumulus cell removal 20 h after insemination
Summary
Total fertilization failure after conventional in vitro fertilization (IVF) is one of the most frustrating experiences in assisted reproductive technology (ART). In order to recognize unfertilized oocytes and to perform early ICSI, early cumulus cell removal is required to establish the existence of a second polar body in oocytes 4 hours (4 h) after insemination [10] It remains unclear whether this early cumulus cell removal has any detrimental effects on the subsequent embryonic development after IVF. Early cumulus cell removal blocks inter-communication between cumulus cell and oocytes, which is essential for the formation of a competent oocyte This may affect the development potential of the resultant embryos and the chance of successful pregnancies [14]. Cumulus cell removal combined with early rescue intracytoplasmic sperm injection (ICSI) has been widely practiced in many in vitro fertilization (IVF) centers in China in order to avoid total fertilization failure. Uncertainty remains whether the pregnancy and neonatal outcomes are associated with early cumulus cell removal
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