Assisted Reproductive Technology Laboratory Research Articles

The mammalian sperm factor phospholipase C zeta is critical for early embryo division and pregnancy in humans and mice.

The mammalian sperm factor phospholipase C zeta is critical for early embryo division and pregnancy in humans and mice.

Virtual Based Principal Leadership Model in Increasing Performance and Quality of Middle Education

Purpose: The purpose of this article is to introduce a new analytical lens for examining the role of Assisted Reproductive Technology (ART) in the construction of the human body and motherhood from a post-humanistic perspective. Method: Employing a qualitative methodology, this study conducted in-depth interviews, observations, and analysis of ART laboratory practices, utilizing samples drawn from infertility patients and ART laboratory work. The investigation delved into the spatial dynamics of ART operations within clinical settings, elucidating how technology influences the construction of the human body and the concept of motherhood. Results and conclusion: The findings reveal that ART functions not merely as a corrective measure for physical infertility but as a techno-space that reconfigures the human body to facilitate reproduction and the construction of motherhood. The spatiality enacted by ART disrupts conventional notions of human nature, engendering what is termed as techno-maternity, wherein the ontological understanding of motherhood transcends biological constraints and assumes a technological dimension. Research implications: This study underscores the imperative of adopting a post-humanistic perspective in examining the societal implications of ART. By elucidating the spatial and technological dimensions of ART's influence on human embodiment and motherhood, this research offers insights into broader socio-cultural transformations within current ages. Originality/value: This research contributes to the academic discourse by presenting a novel analytical framework that illuminates the intricate interplay between technology, embodiment, and societal constructions of motherhood. By delineating the techno-spatial dynamics of ART, this study expands the understanding of how technological interventions shape human experiences and identities in the context of reproductive health.

Evaluation of medical equipment of the infertility treatment centers in North western of Libya

Background Cell culture, particularly in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) are both of which assisted reproductive technology (ART) approaches that are most frequently utilized to treat infertility around the world. Objective Highlight the differences and similarities in instruments and equipment in ART laboratories that govern their success, limitations, and potential differences between laboratories by identifying the facilities of laboratories to improve outcomes of ICSI and IVF techniques in clinical centers on the western coast of Libya. Method: descriptive study, comparison of five (5) assisted reproduction laboratories instrument and equipment parameters using the same quality-control application in clinical centers on the western coast of Libya.Result: Among the seven clinical centers specializing in the diagnosis and treatment of infertility that were contacted, four infertility treatment centers and the Medical Research Center (MRC) provided a response. The MRC and four clinical centres had good laboratory facilities for ICSI and IVF techniques compared to Jordan ART laboratory facilities.Conclusion: This study highlights the imperative of enhancing laboratory infrastructure to support optimal implementation of ICSI and IVF procedures.

Microfluidics: The future of sperm selection in assisted reproduction.

Obtaining functional sperm cells is the first step to treat infertility. With the ever-increasing trend in male infertility, clinicians require access to effective solutions that are able to single out the most viable spermatozoa, which would max out the chance for a successful pregnancy. The new generation techniques for sperm selection involve microfluidics, which offers laminar flow and low Reynolds number within the platforms can provide unprecedented opportunities for sperm selection. Previous studies showed that microfluidic platforms can provide a novel approach to this challenge and since then researchers across the globe have attacked this problem from multiple angles. In this review, we seek to provide a much-needed bridge between the technical and medical aspects of microfluidic sperm selection. Here, we provide an up-to-date list on microfluidic sperm selection procedures and its application in assisted reproductive technology laboratories. A literature search was performed in Web of Science, PubMed, and Scopus to select papers reporting microfluidic sperm selection using the keywords: microfluidic sperm selection, self-motility, non-motile sperm selection, boundary following, rheotaxis, chemotaxis, and thermotaxis. Papers published before March 31, 2023 were selected. Our results show that most studies have used motility-based properties for sperm selection. However, microfluidic platforms are ripe for making use of other properties such as chemotaxis and especially rheotaxis. We have identified that low throughput is one of the major hurdles to current microfluidic sperm selection chips, which can be solved via parallelization. Future work needs to be performed on numerical simulation of the microfluidics chip prior to fabrication as well as relevant clinical assessment after the selection procedure. This would require a close collaboration and understanding among engineers, biologists, and medical professionals. It is interesting that in spite of two decades of microfluidics sperm selection, numerical simulation and clinical studies are lagging behind. It is expected that microfluidic sperm selection platforms will play a major role in the development of fully integrated start-to-finish assisted reproductive technology systems.

#73 : Common Problems Faced by Indian Assisted Reproductive Technologies Laboratory Professionals

Background and Aims: There has been tremendous growth in the offering of Assisted Reproductive Technologies (ART) in India creating a critical shortage of experienced clinical embryologists thus inevitably leading reduced training opportunities. The aim of this study was to investigate problems faced by laboratory professionals in the ART industry in India. Method: An online questionnaire survey was distributed to ART laboratory professionals globally through professional societies, social media, and email databases. The questionnaire included demographic questions and open-ended questions on problems faced by ART laboratory professionals at the clinic level, professional level, and personal level. The survey was active from May 2016 until February 2017. The Indian data was collected and analysed as a global sub-population. The identified common problems were used to categorise the responses and the percentage distribution was calculated. Results: Among 136 survey responders, 79 provided responses on problems faced by ART laboratory professionals, including 11 junior embryologists, 19 embryologists, 31 senior embryologists, 18 managers and directors. The problems identified from the responses were ‘overworking’ (18%), ‘respect / recognition’ (16%), ‘clinician and embryologist relationship’ (14%), ‘management’ (12%), ‘lack of training’ (11%), ‘regulation / certification’ (7%), ‘blamed for clinical outcomes’ (7%), ‘decision making’ (6%), ‘salary’ (5%), ‘staffing’ (3%). When stratified into roles, the top problems for junior embryologists were ‘overworking’ (21%), ‘respect / recognition’ (21%), and ‘lack of training’ (21%), for embryologists was ‘overworking’ (21%), for senior embryologists was ‘respect / recognition’ (18%) and ‘management’ (18%), for managers and directors was ‘respect / recognition’ (21%). Conclusion: The problems faced in the Indian ART industry are broad but are prioritised differently by staff members depending on their roles. Future research should investigate reasons underlining these problems and strategies to improve staff wellbeing particularly considering the recently introduced government regulations on ART in India.

Shedding light on the ART laboratory

This commentary examines the impact of light conditions in the assisted reproductive technology (ART) laboratory, specifically considering gametes and embryo culture. While these processes traditionally occur in the absence of light within the female reproductive tract, laboratory conditions often involve exposure to varying wavelengths, intensities and light sources. Although literature reports describe potential detrimental effects of certain wavelengths of light on biological material, these findings are often based on experiments that might not reflect actual laboratory conditions. Current ART laboratory practices aim to minimize light exposure; however, some procedures necessitate light exposure, typically involving microscopy. Results from the authors’ cross-sectional survey on light-intensity practices in ART laboratories revealed the frequent use of inadequate lighting, leading to errors and impacting staff well-being. A failure mode and effects analysis was used to identify potential failure modes and their impacts due to poor lighting. Overall, this manuscript stresses the importance of maintaining proper ambient lighting in the ART laboratory, balancing the potentially detrimental effects of light on gametes and embryos against the need for proper lighting for accurate procedures and staff well-being. Adequate lighting not only ensures the safety of reproductive cells, but also improves process management and the operators’ psychological conditions.

Risk for Congenital Anomalies in Children Conceived With Medically Assisted Fertility Treatment : A Population-Based Cohort Study.

More than 2 million children are conceived annually using assisted reproductive technologies (ARTs), with a similar number conceived using ovulation induction and intrauterine insemination (OI/IUI). Previous studies suggest that ART-conceived children are at increased risk for congenital anomalies (CAs). However, the role of underlying infertility in this risk remains unclear, and ART clinical and laboratory practices have changed drastically over time, particularly there has been an increase in intracytoplasmic sperm injection (ICSI) and cryopreservation. To investigate the role of underlying infertility and fertility treatment on CA risks in the first 2 years of life. Propensity score-weighted population-based cohort study. New South Wales, Australia. 851 984 infants (828099 singletons and 23885 plural children) delivered between 2009 and 2017. Adjusted risk difference (aRD) in CAs of infants conceived through fertility treatment compared with 2 naturally conceived (NC) control groups-those with and without a parental history of infertility (NC-infertile and NC-fertile). The overall incidence of CAs was 459 per 10 000 singleton births and 757 per 10 000 plural births. Compared with NC-fertile singleton control infants (n= 747 018), ART-conceived singleton infants (n= 31256) had an elevated risk for major genitourinary abnormalities (aRD, 19.0 cases per 10 000 births [95% CI, 2.3 to 35.6]); the risk remained unchanged (aRD, 22 cases per 10 000 births [CI, 4.6 to 39.4]) when compared with NC-infertile singleton control infants (n= 36251) (that is, after accounting for parental infertility), indicating that ART remained an independent risk. After accounting for parental infertility, ICSI in couples without male infertility was associated with an increased risk for major genitourinary abnormalities (aRD, 47.8 cases per 10 000 singleton births [CI, 12.6 to 83.1]). There was some suggestion of increased risk for CAs after fresh embryo transfer, although estimates were imprecise and inconsistent. There were no increased risks for CAs among OI/IUI-conceived infants (n= 13574). This study measured the risk for CAs only in those children who were born at or after 20 weeks' gestation. Observational study design precludes causal inference. Many estimates were imprecise. Patients should be counseled on the small increased risk for genitourinary abnormalities after ART, particularly after ICSI, which should be avoided in couples without problems of male infertility. Australian National Health and Medical Research Council.

Guidelines for Best Practice for Staffing of ART Laboratories and Professional Development of IVF Scientists

Research Question: To establish recommendations for optimal staffing levels, training, and professional development in assisted reproductive technology (ART) laboratories in Australia and New Zealand. Design: Exploration by Scientists in Reproductive Technology (SIRT) subcommittee representing 10 different ART centers of the time requirements and complexity of ART procedures and to define training and continuing professional development (CPD) requirements. Results: The Staffing Model for ART (smART) “plug and play” calculator was developed by the SIRT subcommittee. Twelve routine procedures were examined IVF, ICSI, ICSI + PGT, ICSI + TESE, FET, FET from PGT, oocyte vitrification, oocyte warming, intrauterine insemination (IUI), semen freeze, TESE with semen freeze, and semen analysis. Based on a cycle with 10 eggs, the average time taken to do each procedure was considered as well as the complexity of the task. Laboratory quality control (QC), other administrative tasks, and leave days are reflected in the calculator. Recommendations for years of experience were determined as a trained scientist (24 months), a senior scientist (5 years), and Scientific Director (10 years). CPD is strongly recommended to improve the skills, knowledge, and ability of scientific staff. Conclusions: The risks in the IVF laboratory primarily associated with lower staffing levels have been reviewed, and the smART calculator is designed to assist clinics to tailor adequate staffing levels for their specific needs. The smART calculator is an invaluable tool for clinics to use going forward. Key Message We have reviewed the risks in the IVF laboratory primarily associated with lower staffing levels, and created the smART calculator designed to assist clinics in being able to tailor adequate staffing levels for their specific needs. We believe the smART calculator will be an invaluable tool moving forward for all ART clinics and accreditors.

Editorial Vol.2, No.2

The enduring growth in both readership and submissions underscores the escalating interest in our journal as a platform for disseminating scientific insights and updates from pharmaceutical and assisted reproductive technology laboratories across the globe.

Education of the clinical embryology laboratory professional: development of a novel program delivered in a laboratory medicine department

Clinical embryologists are responsible for the handling, evaluation, and care of human gametes and preimplantation embryos within the context of an assisted reproductive technology laboratory. They are integral members of a team of professionals who provide care for fertility patients. Despite the increasing recognition of clinical embryologists as professionals, training requirements, continuing professional development, and appropriate credentialing have lagged in several countries. In many cases, individuals enter the profession with training limited to technical aspects provided by individual laboratory directors through an apprenticeship model. In this article, we present the rationale for rigorous formal training in clinical embryology, introduce CanEMB competencies for practicing professional clinical embryologists that are founded on CanMEDs role principles, and present a nascent Masters of Health Sciences degree program in Laboratory Medicine with a specialization in clinical embryology. This 2-year program has unique features including a Clinical Embryology Skills Development Laboratory, research capstone project, and 200-hour placement within a practicing assisted reproductive technology laboratory. Importantly, this program is delivered through a university-based Department of Laboratory Medicine and Pathobiology in partnership with a Department of Obstetrics and Gynecology. Thus, this program represents a formal acceptance of clinical embryology as a clinical laboratory science. It can be adopted elsewhere to provide a relevant, robust education that will meet current and future needs of the profession.

Common dysmorphic oocytes and embryos in assisted reproductive technology laboratory in association with gene alternations.

Amorphic or defected oocytes and embryos are commonly observed in assisted reproductive technology (ART) laboratories. It is believed that a proper gene expression at each stage of embryo development contributes to the possibility of a decent-quality embryo leading to successful implantation. Many studies reported that several defects in embryo morphology are associated with gene expressions during in vitro fertilization (IVF) treatment. There is lacking literature review on summarizing common morphological defects about gene alternations. In this review, we summarized the current literature. We selected 64 genes that have been reported to be involved in embryo morphological abnormalities in animals and humans, 30 of which were identified in humans and might be the causes of embryonic changes. Five papers focusing on associations of multiple gene expressions and embryo abnormalities using RNA transcriptomes were also included during the search. We have also reviewed our time-lapse image database with over 3000 oocytes/embryos to show morphological defects possibly related to gene alternations reported previously in the literature. This holistic review can better understand the associations between gene alternations and morphological changes. It is also beneficial to select important biomarkers with strong evidence in IVF practice and reveal their potential application in embryo selection. Also, identifying genes may help patients with genetic disorders avoid unnecessary treatments by providing preimplantation genetic testing for monogenic/single gene defects (PGT-M), reduce embryo replacements by less potential, and help scientists develop new methods for oocyte/embryo research in the near future.

P-758 Evaluating mismatch categories and true errors using an electronic witnessing system

Abstract Study question What are the types and frequency of errors occurring in the laboratory identified by an electronic witnessing system (EWS)? Summary answer Several types of mismatch categories were identified, and the rate of a potentially catastrophic true mismatch error was < 1%. What is known already Mix-ups in the IVF laboratory have been recently highlighted in the media. These errors can have devastating long-term consequences for the fertility clinics and families involved. Prevention of these errors should be paramount in the laboratory. Study design, size, duration A retrospective analysis was conducted using 15 months of electronic witnessing data from two IVF laboratories in the United States. A total of 11,357 witnessed procedures were evaluated to determine the type and frequency of mismatches that occurred. Participants/materials, setting, methods All procedure match and mismatch data was recorded by an EWS (Matcher, IMT International). The mismatch data from two laboratories was evaluated to determine the category and occurrence of mismatches taking place in the assisted reproductive technology (ART) laboratory. Main results and the role of chance The overall mismatch rate was 0.78% (89/11,357). The types of mismatches were identified as: 1) Program: duplicate barcodes scanned, barcode misread by program, non-Matcher barcode picked up during scan, connectivity issues; 2) Wrong patient selected; 3) Transcription error; 4) Cycle set up: treatment cycle not set up correctly, donor not linked to treatment cycle; 5) True error: dishes and/or tubes from two different patients were in the same workstation at the same time. Program error happened most frequently at 0.30% (34/11,357). The wrong patient selected and cycle set up errors occurred 0.18% (20/11,357), followed by transcription error at 0.11% (12/11,357). A true error occurred 0.03% (3/11,357) and was rectified in < 10 seconds meaning there was no time for actual mixing of gametes to occur. These findings agree with previously published reports worldwide where the occurrence of a true mismatch is < 1%. Limitations, reasons for caution The present study retrospectively analyzed mismatch data gathered over a 15-month period after implementation of EWS. Further investigation is warranted to determine if mismatches occur more or less frequently after long term use of an EWS. Wider implications of the findings Failure to identify a true mismatch error may lead to a catastrophic error. Continued evaluation of EWS may provide insight into how and why a true error occurs. This information can then be utilized to improve laboratory protocols and procedures for enhanced patient protection. Trial registration number Not applicable

Taking a closer look at the key performance indicators in an assisted reproductive technology laboratory: a guide for reproductive professionals.

Over the years, laboratories performing assisted reproductive technologies have been tasked with a growing number of procedures of increased complexity. New technologies, including hardware and software innovations, are constantly evolving, and evaluated as potential tools to improve laboratory and clinical outcomes. The assisted reproductive technology (ART) laboratory plays a crucial role in fertility treatments and, therefore, it is often under intense scrutiny with regards to performance and success rates. As the reproductive medicine field strives to deliver improved clinical outcomes to patients, in-vitro fertilization (IVF) clinics - including the ART laboratories - are required to monitor their performance and seek improvement in the many different aspects related to patient care. Key performance indicators (KPIs) and benchmarking are important tools to support performance monitoring and quality improvement processes. The concept and potential benefits of KPI utilization is generally accepted. However, its adoption poses some challenges that may discourage ART practices from pursuing it as part of their quality management systems (QMS). Properly selecting and using KPIs will allow laboratories to successfully manage their performance and set up realistic target goals to consistently deliver high rates. Existing literature can guide reproductive medicine professionals to embark on their journey to successfully select, implement, and manage KPI and benchmarking as part of their ART programs. This article discusses the concept and essentials of KPI and benchmarking applied to the ART laboratory, as well as potential challenges and how to overcome them.

An expert commentary on essential equipment, supplies and culture media in the assisted reproductive technology laboratory

The assisted reproductive technology (ART) laboratory is a complex system designed to sustain the fertilization, survival, and culture of the preimplantation embryo to the blastocyst stage. ART outcomes depend on numerous factors, among which are the equipment, supplies and culture media used. The number and type of incubators also may affect ART results. While large incubators may be more suitable for media equilibration, bench-top incubators may provide better embryo culture conditions in separate or smaller chambers and may be coupled with time-lapse systems that allow continuous embryo monitoring. Microscopes are essential for observation, assessment, and micromanipulation. Workstations provide a controlled environment for gamete and embryo handling and their quantity should be adjusted according to the number of ART cycles treated in order to provide a steady and efficient workflow. Continuous maintenance, quality control and monitoring of equipment are essential and quality control devices such as the thermometer, and pH-meter are necessary to maintain optimal culture conditions. Tracking, appropriate delivery and storage conditions, and quality control of all consumables are recommended so that adequate quantity and quality are available for use. Embryo culture media have evolved: preimplantation embryos are cultured either by sequential media or single-step media that can be used for interrupted or uninterrupted culture. There is currently no sufficient evidence that any individual commercially-available culture system is better than others in terms of embryo viability. In this review, we aim to analyze the various parameters that should be taken into account when choosing the essential equipment, consumables and culture media systems that will create optimal culture conditions and provide the most effective patient treatment.

Optimizing embryological aspects of oocyte retrieval, oocyte denudation, and embryo loading for transfer.

Oocyte retrieval, oocyte denudation, and embryo transfer are crucial processes during assisted reproduction technology (ART). Air quality in the ART laboratory, temperature, pH of the media used and the time interval between oocyte retrieval and insemination are all critical factors. Anesthesia is required for oocyte retrieval, however, evidence regarding the potential impact of different methods (general anesthesia, conscious sedation, and local anesthesia) on the clinical outcomes is unclear. The optimal timing of oocyte denudation following retrieval has not been established. Regarding the mechanical denudation process, there is a lack of evidence to demonstrate the safest minimum inner diameter of denuding pipettes used to complete the removal of granulosa cells surrounding the oocytes. During embryo transfer, many clinics worldwide flush the catheter before embryo loading, in an attempt to potentially rinse off any toxic agents; however, there is insufficient evidence to show that flushing the embryo transfer catheter before loading increases the success of ART outcome. Considering the serious gaps in knowledge in ART practice, the aim of this review is to provide an updated overview of the current knowledge regarding the various steps and techniques involved in oocyte retrieval, oocyte denudation, and embryo loading for transfer.

P–238 Impaired oocyte fertilization is associated with a proinflammatory M1 phenotype of macrophages and the activation of the NLRC4 inflammasome

Abstract Study question Are inflammatory signatures in the blood of clinically asymptomatic patients predictive for oocyte fertilization success in ART treatment? Summary answer The proinflammatory M1 phenotype of macrophages combined with increasing numbers of cytotoxic T-cells and an upregulated inflammasome NLRC4 is associated with impaired oocyte fertilization. What is known already Oocyte fertilization is an indispensable step towards embryogenesis and reproductive success. Patients with acute or chronic inflammation are at risk of reduced fertilization rates and failure of assisted reproductive technology (ART) treatment. Inflammasomes are intracellular multiprotein complexes that mediate inflammatory tissue remodeling. They can be activated by endogenous and exogenous stimuli and result in maturation of the cytokines IL–1βand IL–18. Appropriate inflammasome activation serves for pathogen defense and tissue damage repair, while aberrant activation of inflammasomes can enhance uncontrolled tissue damage. Study design, size, duration This a prospective study including 39 patients stratified by fertilization rate (cut off 66%) of mature M II oocytes after ICSI procedure, compares 20 patients with high (mean 84,8%, range 67 –100%) versus 19 patients with low (mean 29.4%, range 0–65%) rates. Participants/materials, setting, methods We performed FACS analysis of immune cell composition (leukocytes, neutrophils, monocytes, macrophage types M1 and M2, cytotoxic T-cells, T-helper cells) and utilized RT-qPCR analysis of three inflammasomes (AIM 2, NLRP3 and NLRC4) and their down-streaming proteins caspase 1 and IL–1ß. We focused on an initial and a late state during controlled ovarian stimulation (COS) procedure. Main results and the role of chance This study reports a cellular and molecular inflammatory signature associated with reduced oocyte fertilization rates after ICSI treatment in clinically asymptomatic patients. On a cellular level proinflammatory M1 macrophages were significantly elevated in the low fertilization group (p < 0.01), additionally the ratio of proinflammatory M1 macrophages to anti-inflammatory M2 phenotype was inversely associated with oocyte fertilization rate (p < 0.001). Cytotoxic T cells (p < 0.05) and the inflammasome NLRC4 (p < 0.01) revealed identical patterns of association with fertilization rates in the group comparison. In line with this pattern, there was a significant upregulation of Caspase 1 with a consecutive increase in IL–1ß activity in women with low fertilization rates (p < 0.05). No significant association was shown for the other tested immune cells (leukocytes, neutrophils, monocytes, T-helper cells) and inflammasomes (NLRC3, AIM2). Limitations, reasons for caution The preliminary results in this small study indicate an activation of the inflammasome NLRC4. This, however, has to be assessed on the protein level in a larger group of patients. Wider implications of the findings: Systemic macrophage augmentation of M1 phenotype and cytotoxic T cell presence in combination with upregulated inflammasome NLRC4 are associated with impaired oocyte fertilization. The predictive information of the identified immunologic signature could indicate targeted treatment to down regulate systemic inflammation and the use of oocyte activators in the ART laboratory. Trial registration number none

Potential effects of COVID-19 on reproductive systems and fertility; assisted reproductive technology guidelines and considerations: a review.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) employs the angiotensin-converting enzyme 2 (ACE2) receptor in the renin-angiotensin system for viral entry. The ACE2 receptor is present in both female and male reproductive systems, and reports of multi-organ involvement have led to uncertainty regarding its effects on the reproductive system and fertility. We review the existing literature regarding the function of ACE2 and the renin-angiotensin system in the female and male reproductive systems to postulate the possible implications of SARS-CoV-2 regarding fertility. Because of the presence of ACE2 in the ovaries, SARS-CoV-2 infection may disrupt ovarian function and hence oocyte quality. Higher expression of ACE2 in the endometrium with age and during the secretory phase raises concern about increased susceptibility to infection during periods of high ACE2 expression. The possibility of vertical transmission and the presence of ACE2 in the placenta and during pregnancy are also discussed. The presence of SARS-CoV-2 RNA in semen is controversial, but impaired semen quality has been found in men with moderate coronavirus disease 2019 infection. Evidence of orchitis and hormonal changes seen in male coronavirus disease 2019 infection may lead to infertility. The implications of these effects on assisted reproductive technology (ART) outcomes are also explored. The ART guidelines from different fertility societies for the management of patients treated with ART are provided. The importance of prioritising 'time-sensitive' patients for ART, counselling patients about the uncertainty and risks of ART, and pregnancy during the pandemic is discussed. Recommendations are also provided for infection control and safe regulation of ART centres and laboratories.

Fertility technologies and how to optimize laboratory performance to support the shortening of time to birth of a healthy singleton: a Delphi consensus.

To explore how the assisted reproductive technology (ART) laboratories can be optimized and standardized to enhance embryo culture and selection, to bridge the gap between standard practice and the new concept of shortening time to healthy singleton birth. A Delphi consensus was conducted (January to July 2018) to assess how the ART laboratory could be optimized, in conjunction with existing guidelines, to reduce the time to a healthy singleton birth. Eight experts plus the coordinator discussed and refined statements proposed by the coordinator. The statements were distributed via an online survey to 29 participants (including the eight experts from step 1), who voted on their agreement/disagreement with each statement. Consensus was reached if ≥ 66% of participants agreed/disagreed with a statement. If consensus was not achieved for any statement, that statement was revised and the process repeated until consensus was achieved. Details of statements achieving consensus were communicated to the participants. Consensus was achieved for all 13 statements, which underlined the need for professional guidelines and standardization of lab processes to increase laboratory competency and quality. The most important points identified were the improvement of embryo culture and embryo assessment to shorten time to live birth through the availability of more high-quality embryos, priority selection of the most viable embryos and improved cryosurvival. The efficiency of the ART laboratory can be improved through professional guidelines on standardized practices and optimized embryo culture environment, assessment, selection and cryopreservation methodologies, thereby reducing the time to a healthy singleton delivery.

Minimum standards for practices offering assisted reproductive technologies: a committee opinion

This document is designed to provide a framework for assisted reproductive technology (ART) programs that meet or exceed the requirements suggested by the Centers for Disease Control and Prevention for certification of ART laboratories. This document replaces the document "Revised Minimum Standards for Practices Offering Assisted Reproductive Technologies: A Committee Opinion" published in2019.

The COVID-19 pandemic and reproductive health

This introduction tees off an outstanding collection of Views and Reviews articles on the effects of the SARS-CoV-2 and COVID-19 on human reproductive health. These articles written by the experts in the field review the current literature on COVID-19 and male reproductive health, female reproductive health, and the assisted reproductive technology laboratory. Despite the prolonged nature of the pandemic and the number of people infected worldwide, there still are limited data on the effects of the virus and infection on human reproductive health and human fertility. The investigators distill a vast and often conflicting series of reports into a digestible summary to guide patient counseling and institute the safest practices into the assisted reproductive technology laboratory.