Practice Of Assisted Reproduction Research Articles

Ceria Nanoparticle Systems Alleviate Degenerative Changes in Mouse Postovulatory Aging Oocytes by Reducing Oxidative Stress and Improving Mitochondrial Functions.

Postovulatory aging oocytes usually feature diminished potential for fertilization and poor embryonic development due to enhanced oxidative damage to the subcellular organelles and macromolecules, which stands as a formidable obstacle in assisted reproductive technologies (ART). Here, we developed lipoic acid (LA) and polyethylene glycol (PEG)-modified CeO2 nanoparticles (LA-PEG-CeNPs) with biocompatibility, enzyme-like autocatalytic activity, and free radical scavenging capacity. We further investigated the LA-PEG-CeNPs effect in mouse postovulatory oocytes during in vitro aging. The results showed that LA-PEG-CeNPs dramatically reduced the accumulation of ROS in aging oocytes, improving mitochondrial dysfunction; they also down-regulated the pro-apoptotic activity by rectifying cellular caspase-3, cleaved caspase-3, and Bcl-2 levels. Consistently, this nanoenzyme prominently alleviated the proportion of abnormalities in spindle structure, chromosome alignment, microtubule stability, and filamentous actin (F-actin) distribution in aging oocytes, furthermore decreased oocyte fragmentation, and improved its ability of fertilization and development to blastocyst. Taken together, our finding suggests that LA-PEG-CeNPs can alleviate oxidative stress damage on oocyte quality during postovulatory aging, implying their potential value for clinical practice in assisted reproduction.

Surrogacy at the Fertility Frontier

Abstract Surrogacy is a popular assisted reproductive practice in Israel, and it has been legal since 1996, albeit, until recently, only for married heterosexual couples. Same-sex couples who aspired to genetic parenthood were therefore “forced” to look for available surrogates abroad, in countries such as the United States, India, Nepal, Mexico, and Russia. This resulted in the emergence of a lucrative transnational surrogacy industry in Israel that relies on the reproductive labor power of racialized egg cell providers and surrogates in the global South, East, and North. While much of the existing research on surrogacy in Israel explains its ubiquity by centering cultural accounts of Jewishness, this article rethinks contemporary policies, practices, and markets of assisted reproduction from the vantage point of the “colonial episteme,” by unpacking the complex “intimacies” and reproductive afterlives of settler colonialism and racial capitalism in Israel/Palestine. The article argues that surrogacy operates both as a demographic frontier in the consolidation of a Jewish state in Israel/Palestine and as a commodity frontier for the accumulation of capital in a booming surrogacy industry. Surrogacy and other reproductive technologies also emerge as sites of reproductive resistance through practices of surrogacy strikes and sperm smuggling.

Legal and ethical challenges in assisted reproductive technology practice in Ghana.

Infertility remains a global challenge, with assisted reproductive technology (ART) progressively gaining relevance in developing countries, including Ghana. However, associated ethico-legal challenges have not received the needed policy attention. This study explored the legal and ethical challenges of ART practice in Ghana. The study employed an exploratory phenomenological approach to examine ART in Ghana, focusing on ethics and law governing this practice. Respondents were ART practitioners, managers, facility owners, representatives of surrogacy/gamete donor agencies, and regulatory body representatives. A semi-structured interview guide was used to collect data.The in-depth interviews were audiotaped, and responses transcribed for analysis through coding, followed by generation of themes and sub-themes, supported with direct quotes. It emerged that there are no ethical and legal frameworks for ART practice in Ghana, and this adversely affects ART practice. Ethical challenges identified border on informed consent, clients' privacy and clinical data protection, gamete donation issues, multiple gestations, single parenting, and social and religious issues. The legal challenges identified include the non-existence of a legal regime for regulating ART practice and the absence of a professional body with clear-cut guidelines on ART practice. In the absence of legal and ethical frameworks in Ghana, practitioners intimated they do comply with internationally accepted principles and general ethics in medical practice. There are no regulations on ART in Ghana. Legal and ethical guidelines are essential to the provision of safe and successful ART practices to protect providers and users. Governmental efforts to regulate Ghana need to be prioritized. This study had no external funding support. It was funded privately from researchers' contributions.

40 years of AETE: the contribution of scientists and practitioners to the progress of reproductive biotechnologies in Europe.

This conference celebrates the 40th anniversary of AETE. Over the past 40 years, AETE has served as a forum for scientists, practitioners, and students working in assisted animal reproduction in livestock species. AETE conferences have reflected developments in the field, from basic to applied science, as well as regulatory changes in assisted animal reproduction practices. Europe has led the way in these developments for many years, progressing from artificial insemination, embryo transfer, and cryopreservation to semen sexing, in vitro production of embryos, cloning by nuclear transfer, genomic selection, and the rescue of highly endangered species. These significant contributions were made possible by the support of funding agencies, both at the national and European levels, promoting cooperation between scientists and practitioners. Assisted reproduction, and animal breeding more generally, face opposition from various groups, including animal rights activists, vegetarians, proponents of organic farming, environmentalists, certain political parties, and increasing regulatory burdens. These challenges seriously affect funding for scientific research, the work of practitioners, and the breeding industry as a whole. It is crucial to invest time and resources in communication to remind the public, politicians, and regulators of the achievements in this field and the contributions made to the food supply chain and the care of the rural and natural environment.

The use of typologies as heuristic devices in assisted reproductive technology practice: A qualitative analysis of patients and created typologies

Typologies are classification systems often used by people in social settings. Typologies are often developed by people to make sense of complexity and difference (Loeb et al., 2015; Wrede-Sach et al., 2013). In healthcare, patients may use typologies to characterise practitioners (e.g., as empathic or authoritarian) (Timmerman et al., 2021) and different kinds of practices (Senn et al., 2016). They may also be used by practitioners. Semi-structured interviews were conducted with patients and with health care professionals working in the Assisted Reproductive Technology (ART) sector. We identified six typologies that were often drawn upon by healthcare professionals. These are: the patient as consumer; the hopeful patient; the misinformed patient; the expert patient; the demanding patient and the resolved patient. Typologies bring with them some risk being that they may reinforce dominant models of care/methods of operating such as close adherence to protocols; obscure individuality and entrench stereotypes. They may also privilege particular kinds of knowledge and diminish other information which may be important to patients. This paper considers how typologies may be used in the assisted reproductive technology setting by health care practitioners when considering how to care for their patients.

A-310 Infections Associated With Infertility and Success of In Vitro Fertilization

Abstract Background Preimplantation genetic analysis aims selecting the best embryo to transfer increasing the chance of a successful pregnancy. However, failure in the implantation of euploid embryos is frequent in the practice of assisted human reproduction, observed in approximately 30 to 50% of transfers, with no cause found in most cases. Previous or active infectious may be associated with infertility, but this topic still lacks deeper studies. Our aim was to analyze the occurrence of sexually transmitted infections in women who underwent the transfer of euploid embryos with different gestational outcomes. Methods A prospective cohort study was carried out for which 36 plasma (EDTA) samples and 17 endocervical smears (Digene HC2 DNA Collection Device) were collected from patients who would be submitted to assisted reproduction cycles (using euploid blastocysts) shortly after the collections, at a private assisted reproduction center. The collections were performed on the 3rd day after the start of luteal phase support with progesterone (clinic protocol). After collection, the samples were placed in a freezer at -80°C until the time of analysis. Women with signs of cervicitis at the time of collection, deep endometriosis, patients over 40 years of age, cases of severe male factor, chronic pelvic pain, patients who would transfer more than one embryo, transfer of aneuploid embryos or with chromosomal mosaicism were also excluded. Samples were submitted to IIFT (EUROIMMUN) to diagnostic specific anti-IgG antibodies against Chlamydia trachomatis (MIF), Neisseria gonorrhoeae, Herpes simplex virus 1 and 2, Mycoplasma hominis, Ureaplasma urealyticum and Treponema pallidum. Active infection was verified by Microrray technic using EUROArray STI 11 kit (EUROIMMUN) to detect Chlamydia trachomatis, Neisseria gonorrhoeae, Herpes simplex virus 1 and 2, Haemophilus ducreyi, Mycoplasma genitalium, Mycoplasma hominis, Ureaplasma parvum, Ureaplasma urealyticum, Treponema pallidum and Trichomonas vaginalis. Results From the 36 plasma samples analyzed for IgG antibodies presence, the following were seropositive: 30 anti-herpes simplex 1 and 2, 3 anti-Treponema pallidum, 10 anti-Chlamydia MIF and 32 anti-Mycoplasma hominis and anti-Ureaplasma urealyticum. From the 16 endocervical smears samples analyzed, Ureaplasma parvum was detected in 3 women, who failed to get pregnant. No other infectious agent was detected in the samples. For the statistical analysis of the descriptive results, Fisher's exact test was used, the qualitative variables were presented by absolute and relative frequency, the confidence interval level adopted was 95%. The P value was calculated using the statistical program Stata version 14.0, and no statistic difference was observed between the group got pregnant through IVF and the group didn't. Conclusion Although, a high prevalence of IST specific antibodies anti-IgG in this cohort and 3 patients with active infection was found, a statistical significant difference was no obtained between groups who have succeed on IVF and not, against to the bibliography. In another hand all the patients with active infection of Ureaplasma parvum didn't have success on IVF which suggests that infection increase the unsuccess IVF. On this context, a larger sampling will clarify the hypotheses of associations of STIs as a cause of failed IVF.

Natural cycle frozen embryo transfer: a survey of current assisted reproductive technology practices in the U.S.

Emerging data suggests improved obstetric outcomes with frozen embryo transfer (FET) in an ovulatory or natural cycle (NC-FETs), as compared to programmed endometrial preparation. The objective of this study is to better understand practice patterns and provider attitudes regarding the use of NC-FETs in the United States (U.S.). In this cross-sectional study, an anonymous 22-question survey was emailed to 441 U.S. Assisted Reproductive Technology (ART) clinics to assess the utilization of NC endometrial preparation for FET, protocols used, restrictions to offering NC-FET, and providers' perspectives on advantages and disadvantages of NC-FET. Descriptive statistics were used to analyze survey responses. The survey response rate was 49% (216/441). Seventeen percent of responding clinics did not offer NC-FET. Of the clinics that did not offer NC-FET, 65% had only 1-2 physicians in their practice. Common reasons for not offering NC-FET included "lack of timing predictability for transfer" (81%) and "increased burden on staff/laboratory personnel on holidays and weekends" (54%). Of clinics offering NC-FET, 76% reported < 25% of cycles used the NC for endometrial preparation. Over half (52%) of clinics that offered NC-FET reported having eligibility restrictions for NC-FET. Reported benefits of NC-FET were "patient satisfaction" (18%), "decreased cost of medications" (18%), and "avoidance of intramuscular progesterone" (17%). The attitude towards NC-FET in their clinics was reported as positive by 65% of respondents. NC-FETs are offered by most U.S. ART clinics but are used only in the minority of FET cycles for endometrial preparation, and use is often restricted.

Multicentre study on rates and reasons for treatment discontinuation in patients with remaining cryopreserved embryos

Research questionWhat is the discontinuation rate among patients with remaining cryopreserved embryos in Belgium and what are the reasons for discontinuation? DesignMulticentre, cross-sectional study across 11 Belgian fertility clinics. Patients were eligible (n = 1917) if they had previously undergone an unsuccessful fresh embryo transfer (fresh group) or frozen embryo transfer (FET) (in-between group) and did not start a subsequent FET cycle within 1 year despite having remaining cryopreserved embryos. The denominator was all patients with embryos cryopreserved during the same period (2012–2017) (n = 21,329). Data were collected through an online anonymous questionnaire. ResultsThe discontinuation rate for patients with remaining cryopreserved embryos was 9% (1917/21329). For the final analysis, 304 completed questionnaires were included. The most important reasons for discontinuing FET cycles were psychological (50%) and physical (43%) burden, effect on work (29%), woman's age (25%) and effect on the relationship (25%). In 69% of cases, the patient themselves made the decision to delay FET treatment. In 16% of respondents, the decision to delay FET was determined by external factors: treating physician (9%), social environment (4%), close family (3%) and society (3%). Suggested improvements were psychological support before (41%), during (51%) and after (51%) treatment, as well as lifestyle counselling (44%) and receiving digital information (43%). ConclusionsThe discontinuation rate is remarkably high in patients with remaining cryopreserved embryos who have a good prognosis. Respondents stressed the need to improve the integration of psychological and patient-tailored care into daily assisted reproductive technology practice.

DISTINCT CYTOKINE SECRETION PROFILES UPON IMMUNOMODULATION OF PERIPHERAL BLOOD MONONUCLEAR CELLS (PBMC) WITH INTERFERON TAU (IFNT) AND HUMAN CHORIONIC GONADOTROPIN (HCG)

Uterine administration of PBMC has been shown to improve endometrial receptivity and has become routine practice in assisted reproduction. Modulation of these cells’ activity with various trophoblast-derived signals is an active area of research. The present study aimed to investigate and compare the effect of immunomodulation with IFNt and hCG on the cytokine secretion from cultivated PBMC.

Transcriptomic analysis shows that surgical treatment is likely to influence the endometrial receptivity of patients with stage III/IV endometriosis.

BackgroundEndometriosis negatively affects fertility, and it is a common disease in assisted reproductive practice. Surgical removal of endometriotic lesions is widely carried out to relieve symptoms and promote fertility. But it is not intensively investigated what changes in the secretory eutopic endometrium of patients with endometriosis after surgery.MethodsEighteen patients with stage III/IV endometriosis were included in the study, and they were divided into the untreated group and the treated group (6 vs. 12). Basic clinical data were compared, and transcriptomic data of the secretory eutopic endometrium were analyzed with DESeq2, Cytoscape, ClueGO, CluePedia, and Gene Set Enrichment Analysis (GSEA). CIBERSORT was used to calculate the relative abundance of 22 immune cells in the samples.ResultsWe determined 346 differentially expressed genes (DEGs) using DESeq2. These DEGs were used to enrich seven Gene Ontology terms including three associated with immune processes and one correlated to prostaglandin using ClueGO and CluePedia. GSEA enriched 28 Gene Ontology terms in the treated group mainly associated with immune and blood pressure regulation process. Compared to the untreated group, the relative abundance of resting CD4+ memory T cells [0.218 (0.069, 0.334) vs. 0.332 (0.181, 0.429), P = 0.022] and the even less abundant memory B cells [0.001 (0.000, 0.083) vs. 0.033 (0.007, 0.057), P = 0.049] are significantly decreased in the treated group.ConclusionSurgical treatment of stage III/IV endometriosis influences some genes and biological processes related to endometrial receptivity, but more evidence is needed.

Neddylation Inhibition Causes Impaired Mouse Embryo Quality and Blastocyst Hatching Failure Through Elevated Oxidative Stress and Reduced IL-1β.

Mammalian blastocyst hatching is an essential prerequisite for successful embryo implantation. As the rate-limiting step of current assisted reproductive technology, understanding the key factors regulating blastocyst hatching would be significantly helpful to improve the performance of the assisted reproductive practice. In early embryo development, the fine-tuned elimination of maternal materials and the balanced protein turnover are inevitable for the competent to hatch and implant into endometrium. Neddylation, a ubiquitination-like protein modification, has been shown to be involved in oocyte maturation and early embryo development. In this study, aiming to discover an unknown role of neddylation in the blastocyst hatching process, we provided functional evidence of neddylation in mammalian embryo quality and blastocyst hatching. Treatment with MLN4924, a specific neddylation inhibitor, lowered the embryo quality and dramatically reduced the hatching rate in mouse blastocysts. The transcriptional profile showed the upregulation of oxidative stress-related genes and aberrant expression of immune-related genes. The elevated oxidative stress was validated by qPCR and markers of apoptosis, DNA damage, reactive oxygen species, and cytoskeleton. Moreover, we found the secreted IL-1β level was reduced in an NF-κB-independent manner, leading to the final poor embryo quality and blastocyst hatching failure. This is the first report of neddylation being of great importance in the mammalian blastocyst hatching process. Further investigations uncovering more detailed molecular mechanisms of neddylation regulation in blastocyst hatching would greatly promote not only the understanding of this crucial biological process but also the clinical application in reproductive centers.

Absence of a Legal Framework, a Limitation to the Practice of Surrogacy in Nigeria

Introduction: The human passion for procreation and perpetration of lineage has remained since existence. Surrogacy implies the use of a substitute mother to gestate a pregnancy for another woman and thereafter relinquishes the child/children and any parental entitlement to the child/children to the commissioning parents. It is a veritable option for couples who have not been successful in their efforts to bear children. Objective: to assess the awareness, practice, and limitations to practice of surrogacy in Igbo Ukwu community of Anambra State, South- East Nigeria. Methodology: A descriptive cross-sectional study which involved 200 male and female community members of Igbo Ukwu in Anambra. Sample size of 200 was calculated for the study using the Kish formula for cross sectional studies. Simple random sampling was used in selecting participants who converged in the community square. A structured self-administered questionnaire was employed in gathering information on socio-demographic characteristics, knowledge, practice, and limitations to practice of surrogacy. Data was analyzed using Statistical Packages for Social Sciences (SPSS) version 23.0. Descriptive statistics was used to summarize the results which were presented with the aid of a pie chart, bar chart and frequency tables. The level of significance was set at 95% probability level (p &lt; 0.05) Result: Most of the research participants were within the age group 28 – 37 years (40.0%), with mean age of 25.3+1yrs. The study population comprised mainly of people who had formal education (93.0%). There was high level of awareness of surrogacy arrangement in the studied population (84%). However, the practice of surrogacy was generally poor; only four (4) respondents out of 120 females that participated in the study (3.3%) had acted as surrogate mother. Financial benefit was mainly the reason for accepting surrogacy as noted in 47.8% of research participants, while fear of victimization due to absence of a legal framework (54.3%) and to a lesser extent, culture (27.1%) and religious inclination (28.6%) were the main reasons limiting the practice of surrogacy among the participants Conclusion: There is an obvious disconnect between the level of awareness and practice of surrogacy mainly due to fear of victimization from lack of a legal framework. This calls for a need to institutionalize a legal framework to control assisted reproductive technology practice in Nigeria which will restore the hope and aspirations of the infertile couple in need of surrogacy and other assisted reproductive techniques. Keywords: surrogacy, awareness, practice, limitations, legal framework.

P-222 Differential regulation of active translation in mouse oocytes and zygotes upon maturation in vitro and in vivo

Abstract Study question What are the differences in the translation of specific transcripts between in vitro matured versus in vivo oocytes and IVF made versus in vivo zygotes Summary answer Our RNA-seq data show a selection of actively translated trancripts up and down regulated respective to total transcript among in vitro and in vivo conditions What is known already Our project wants to address whether there is room for an improvement towards the more physiological aspects of in vitro maturation technology. As the oocyte is transcriptionally silent during meiotic maturation, we want to approach this goal by addressing changes on global translational level. There is not much known about the employment of transcripts during meiotic maturation. Some get degraded, some silent and some recruited to be translated. To the current knowledge, nobody has so far focused on describing changes in active translation on the polysomal level between in vitro and in vivo culture conditions in mouse oocytes. Study design, size, duration Study performed on a mouse model. The following samples in quadruplicates have been analyzed and compared: in vitro meiotically matured denuded MII oocytes, in vitro meiotically matured cumulus-oocyte complexes supplemented with rFSH Gonal and hCG, in vivo meiotically matured MII oocytes, in vitro meiotically matured and IVF fertilized pronuclear zygotes, in vivo matured and fertilized pronuclear zygotes. Culture conditions were optimized according to the conventional clinical IVM technology. Participants/materials, setting, methods Mouse oocytes and zygotes were input material. Collected samples were subjected to a scarce sample profiling (polysomal fractionation on a sucrose gradient, total RNA isolation and qPCR). From respective quadruplicate fractionated samples, cDNA library was prepared and NGS deep RNA-sequencing performed. Raw data were analysed by Illumina DRAGEN software and differential gene expression was performed on Qiagen CLC Genomics. Candidate validation process is undergoing at the moment. Main results and the role of chance Results show a list of differentially regulated actively translated trancripts with implications for in vitro matured oocyte's ability to become fertilized. Similar pattern regarding developmental competence can be seen between in vitro and in vivo matured zygotes. Some candidate genes are in accordance with the latest publications regarding in vitro maturation. However due to ongoing validation and unpublished work we prefer not to disclose further and more concrete results. Limitations, reasons for caution First of all, it is a mouse model which is a kind of approximation regarding human oocyte and embryo development. RNA-seq results have to be cautiously interpreted, especially regarding the interpretation and translation of findings for further validation in clinical settings. Wider implications of the findings Place findings in context with the importance of correct translational regulation during oocyte meiotic maturation and present preliminary data for further validation in clinical assisted reproduction practice. Moreover we want to show key regulatory areas affected by in vitro maturation technology and suggest improvements for particular clinical applications. Trial registration number GA19-13491S

Planning for the Family in Qatar: Religion, Ethics, and the Politics of Assisted Reproduction

ABSTRACT During research in Qatar with practitioners in assisted reproduction and infertility medicine, I found that across the broad range of views they expressed about their approaches to consulting with patients, there was something shared: that their work with assisted reproductive technologies (ARTs) entailed taking up moral and ethical positions. In this paper, I draw on interviews with medical professionals to analyse the local moral worlds which shape the practice of assisted reproduction. I provide an analysis of how professionals position themselves amid the complex ethical, moral, and cultural landscape in which ARTs in Qatar are situated. In developing my analysis of how these positionings involve a striving to be virtuous, I contribute to anthropological understandings of the complexities of everyday negotiations of moral practice. This is a process, I argue, that reveals both the interplay between self-construction and professional practice and the multidimensionality of the underexplored ART context in Qatar.

An Ethics-Informed, Comparative Analysis of Uterus Transplantation and Gestational Surrogacy for Uterine Factor Infertility in High-Income Countries.

Interest in the future, clinical implementation of uterus transplantation for uterine factor infertility was recently boosted by the demonstration of proof-of-concept for deceased uterus donation/transplantation. The ethical dimensions of living and deceased uterus transplantation are explored and addressed in the paper through their comparison to the ethical elements of an existing, legal, assisted reproduction practice in some high-income countries, i.e., gestational surrogacy. A set of six ethics lenses is used in the comparative analysis: reproductive autonomy and rights, informed choice/consent, relevant critical relational theories, healthequity, theoretical application of the accepted living donation standard, and comparative benefits and burdens considerations. Gestational surrogacy, as currently practiced in some high-income countries, is the assumed, theoretical base-threshold for determination of ethical acceptability in assisted reproduction practices. The analysis demonstrates that (at the present time): 1) the ethical acceptability of living uterus donation/transplantation is less than that of gestational surrogacy in high-income countries, and 2) the ethical acceptability of deceased uterus donation/transplantation is roughly equivalent to that of gestational surrogacy. This leads to the conclusion that, at the present time, only one version of uterus transplantation practice, i.e., deceased uterus transplantation, should be considered ethically acceptable for possible clinical implementation in high-income countries.

Toward embryo cryopreservation-on-a-chip: A standalone microfluidic platform for gradual loading of cryoprotectants to minimize cryoinjuries.

Embryo vitrification is a fundamental practice in assisted reproduction and fertility preservation. A key step of this process is replacing the internal water with cryoprotectants (CPAs) by transferring embryos from an isotonic to a hypertonic solution of CPAs. However, this applies an abrupt osmotic shock to embryos, resulting in molecular damages that have long been a source of concern. In this study, we introduce a standalone microfluidic system to automate the manual process and minimize the osmotic shock applied to embryos. This device provides the same final CPA concentrations as the manual method but with a gradual increase over time instead of sudden increases. Our system allows the introduction of the dehydrating non-permeating CPA, sucrose, from the onset of CPA-water exchange, which in turn reduced the required time of CPA loading for successful vitrification without compromising its outcomes. We compared the efficacy of our device and the conventional manual procedure by studying vitrified-warmed mouse blastocysts based on their re-expansion and hatching rates and transcription pattern of selected genes involved in endoplasmic reticulum stress, oxidative stress, heat shock, and apoptosis. While both groups of embryos showed comparable re-expansion and hatching rates, on-chip loading reduced the detrimental gene expression of cryopreservation. The device developed here allowed us to automate the CPA loading process and push the boundaries of cryopreservation by minimizing its osmotic stress, shortening the overall process, and reducing its molecular footprint.

Triplet pregnancy: What do we tell the prospective parents.

Experience managing triplet pregnancies has increased over the past few decades as the incidence has changed related to assisted reproductive practices. Physicians caring for women carrying triplets cannot predict an individual outcome or pregnancy course but must educate patients about the challenges related to these high risk pregnancies. Obstetric providers can describe the wide range of risks associated with triplet gestations, and the general plan for management, but ultimately parents must make decisions with potentially lifelong consequences. Here, we present the diagnostic criteria, common complications, and management options for triplet pregnancies, to help obstetricians counsel patients on the medical and psychosocial consequences of triplet pregnancy, potential complications, and multifetal reduction.

Gestational carrier pregnancy outcomes from frozen embryo transfer depending on the number of embryos transferred and preimplantation genetic testing: a retrospective analysis

To compare gestational age, birth weight (BW), and live birth rates in gestational carriers (GC) after the transfer of 1 or 2 frozen embryo(s) with or without preimplantation genetic testing for aneuploidy (PGT-A), with the understanding that several social and economic factors may motivate intended parents to request the transfer of 2 embryos and/or PGT-A when using a GC. Retrospective cohort study SETTING: An assisted reproductive technology practice. All frozen blastocyst transfers with GCs from 2009-2018. One or 2 embryo frozen embryo transfers with and without PGT-A. Live birth, preterm birth, and low BW. A total of 583 frozen embryo transfer cycles with vitrified high-grade blastocysts (grade BB or higher) to GCs were analyzed. Although the live birth rate was significantly greater in frozen embryo transfers with 2 embryos, after single embryo transfer (SET), the mean gestational age and BW of live births were statistically significantly greater than those of double embryo transfer (DET). The rate of multiple births was 1.9% for SET compared to 20.0% for DET per transfer. Only 3.8% of live births from SET experienced low BW and 0.6% had very low or extremely low BW. By comparison, 12.5% of DET live births were low BW and 5% were very low BW. After SET, 13.4% of live births were preterm, compared with 40% in DET. The analysis also included a total of 194 transfers with PGT-A compared to 389 cycles without. Overall, live births per transfer were not significantly different between these latter 2 subgroups. Frozen embryo transfer cycles in GCs with DET were associated with more preterm births and lower birth weights compared with those of SET. Intended parents and GCs should be counseled that DET is associated with greater risks of adverse pregnancy and perinatal outcomes, which mitigates higher live birth rates. The use of PGT-A did not appear to improve the live birth rate.

PREIMPLANTATION GENETIC TESTING: Single-cell technologies at the forefront of PGT and embryo research.

While chromosomal mosaicism in the embryo was observed already in the 1990s using both karyotyping and FISH technologies, the full extent of this phenomenon and the overall awareness of the consequences of chromosomal instability on embryo development has only come with the advent of sophisticated single-cell technologies. High-throughput techniques, such as DNA microarrays and massive parallel sequencing, have shifted single-cell genome research from evaluating a few loci at a time to the ability to perform comprehensive screening of all 24 chromosomes. The development of genome-wide single-cell haplotyping methods have also enabled for simultaneous detection of single-gene disorders and aneuploidy using a single universal protocol. Today, three decades later haplotyping-based embryo testing is performed worldwide to reliably detect virtually any Mendelian hereditary disease with a known cause, including autosomal-recessive, autosomal-dominant and X-linked disorders. At the same time, these single-cell assays have also provided unique insight into the complexity of embryo genome dynamics, by elucidating mechanistic origin, nature and developmental fate of embryonic aneuploidy. Understanding the impact of postzygotically acquired genomic aberrations on embryo development is essential to determine the still controversial diagnostic value of aneuploidy screening. For that reason, considerable efforts have been put into linking the genetic constitution of the embryo not only to its morphology and implantation potential, but more importantly to its transcriptome using single-cell RNA sequencing. Collectively, these breakthrough technologies have revolutionized single-cell research and clinical practice in assisted reproduction and led to unique discoveries in early embryogenesis.

DONOR-FINDER: A Web Tool for the Automatic Comparison of Genomic Profiles in ART.

The use of genetic tests in assisted reproduction is growing fast. Among potential usages, the selection of the most suitable donor profile stands out. Being able to consider the genomic compatibility between donor and recipient is very important in order to prevent certain diseases. Nevertheless, taking this new factor into account can significantly increase the time needed for donor selection. This paper describes a web-tool designed to automatize the comparison of genomic and phenotypic profiles in assisted reproduction practices, which potentially reduces the chance of error and the time needed in donor-matching processes.