Clinical Outcomes Of Day Research Articles

Effect of Day 3 cell number on the live birth rate of vitrified-warmed Day 5 single blastocyst transfer in young women.

Previous studies have reported inconsistent results regarding blastocyst selection with a high day 3 (D3) cell number and the eventual pregnancy outcomes. Thus, in this study, the relationship between the D3 cell number and clinical outcomes of day 5 single blastocyst transfer (SBT) in vitrified-warmed transfer cycles was investigated. Our retrospective study included 1144day 5 SBT in vitrified-warmed cycles between February 2016 and February 2021. All cycles were the first vitrified-warmed cycles, and the female patients were less than 35 years of age. Based on the D3 cell number, the cycles were divided into four groups, as follows: group A (3-7 cells, n = 130); group B (8-9 cells, n = 621); group C (10-12 cells, n = 328); and group D (13-16 cells, n = 65). The differences in the live birth rate (LBR), clinical pregnancy rate, and miscarriage rate were examined among the four groups. The LBR and clinical pregnancy rate increased with the D3 cell number (P < 0.01). No significant difference was found in the miscarriage rate among the groups (P = 0.055). After adjusting for confounding factors, the LBR was significantly higher in groups C (odds ratio [OR] = 1.477, 95% confidence interval [CI]: 1.124-1.941, P = 0.005) and D (OR = 2.000, 95% CI: 1.166-3.429, P = 0.012) than in group B. A high D3 cell number (> 9 cells) was associated with a high LBR in the vitrified-warmed day 5 SBT cycles of patients < 35 years of age. The cell number of D3 embryos can be an important reference indicator for blastocyst selection. Among blastocysts with the same morphological score, those with > 9 cells on D3 can be preferentially selected for transplantation.

Single Blastocyst-Stage Embryo Transfer should be Promoted for IVF Cycles Using Donor Sperm (IVFD)

Background: Twin pregnancies carry significant fetal, perinatal and maternal risks. Thus, it is important to evaluate clinical outcomes of in vitro fertilization with donor sperm (IVFD) in the first attempt with double cleavage-stage embryos and explore optimal number of day 3 high-quality embryos for the blastocyst transfer on day 5. Methods: We retrospectively identified all IVFD embryo transfers (IVFD-ETs) for the initial time between 2014 and 2021 at our hospital. We mainly analyzed the twin pregnancy rates for double day 3 embryo transfers and clinical outcomes of day 5 blastocyst transfers by prolonged culture with different numbers of day 3 high-quality embryos. Results: Among 1512 IVFD-ETs, 834 were day 3 embryo transfers and 678 were day 5 blastocyst transfers. Our data indicated that the twin pregnancy rates reached up to 40% in the 674 double cleavage-stage embryo transfers and it was not due to the quality of the transferred embryos. For prolonged culture with 2, 3 and 4 day 3 high-quality embryos, the cycle rates of no high-quality blastocysts obtained were 30.43%, 19.80% and 7.91%, respectively. The clinical pregnancy rates were 56.52%, 74.26% and 72.32%, respectively. The twin pregnancies rates were 7.69%, 14.67% and 6.77%, respectively. Conclusions: Transferring double cleavage-stage embryos had high risks of twin pregnancies in the IVFD-ETs. Blastocyst transfer was safe and recommended for the patients with three or more high-quality embryos on day 3.

Clinical outcome analysis of frozen-thawed embryo transfer on Day 7.

To investigate the clinical outcomes of Day 7 (D7) frozen-thawed embryo transfer (FET) and to provide a reference value for clinical work. This was a retrospective cohort study. Patients undergoing FET cycles in the Reproductive Medicine Center of the Third Affiliated Hospital of Zhengzhou University between December 2015 and January 2021 were included. According to the developmental stage of the embryos at transfer, the embryos were divided into three groups: Day (D) 5, D6 and D7 blastocysts. Group D7 was compared with Groups D5 and D6. Simultaneously, the preimplantation genetic testing (PGT) and non-PGT cycles in Group D7 were analyzed and compared. The main outcomes were the clinical pregnancy, live birth and miscarriage rates. The secondary outcomes were the implantation and euploidy rates. In total, 5945, 4094 and 137 FET cycles were included in the D5, D6 and D7 groups, respectively. The clinical pregnancy rate was significantly lower in Group D7 than in Groups D5 (13.9% vs 62.9%, P <0.001) and D6 (13.9% vs 51.4%, P <0.001). Additionally, the live birth rate was significantly lower in Group D7 than in Groups D5 (7.3% vs 50.7%, P <0.001) and D6 (7.3% vs 40.5%, P <0.001). However, the miscarriage rate was significantly higher in Group D7 than in Groups D5 (47.4% vs 18.2%, P =0.001) and D6 (47.4% vs 20.6%, P =0.004). The clinical pregnancy and live birth rates for D7 blastocysts were significantly higher in the PGT group than in the non-PGT group (41.7% vs 13.9%, P=0.012; 33.3% vs 7.3%, P =0.003). D7 blastocyst transfer can yield a live birth rate that is lower than that for D5 and D6 blastocysts but has value for transfer. PGT for D7 blastocysts may reduce the number of ineffective transfers and improve the outcome of D7 blastocyst transfer, which can be performed according to a patient's situation.

Comparison of Clinical Outcomes of Day and Night Time Surgery for Rhegmatogenous Retinal Detachment

Other SectionsAbstract서론대상과 방법결과고찰AcknowledgmentsConflicts of InterestAuthor ContributionTableReference

P-261 Morphokinetics-oriented embryo selection for day 2 transfers: adapting transfer strategy to the times of Covid-19

Study questionCan embryo selection oriented by a morphokinetic algorithm developed for day 2 transfers provide pregnancy rates similar to those achieved by elective frozen blastocyst transfers?Summary answerTransfers on day 2 of embryos selected by a morphokinetic algorithm can provide pregnancy rates similar to those achieved with elective frozen blastocyst transfers.What is known alreadyThe comparative efficacy of cleavage stage fresh transfers in relation to blastocyst fresh transfers remains controversial. On the other hand, elective transfers of frozen blastocysts have been found to provide satisfactory implantation and delivery rates, which may result from favourable embryo quality and/or endometrial receptivity associated with freeze-all cycles. The covid-19 pandemic has imposed changes to the ICSI laboratorial routine, particularly pushing for a reduction in embryo culture time. In this context, we developed an algorithm based on fertilization and cleavage morphokinetic parameters, aiming to optimize embryo selection for day 2 transfers.Study design, size, durationThis study aimed to assess the performance of a morphokinetic algorithm to select cleavage stage embryos for day 2 transfers, using as a parameter the outcomes from elective frozen blastocyst transfers. A retrospective analysis of data generated in our clinic during pandemia was performed, comparing patient profiles and clinical outcomes of day 2 transfers following algorithm-oriented embryo selection (n = 128), with those of contemporary elective transfers of frozen blastocysts (n = 230) from freeze-all patients with OHSS risk.Participants/materials, setting, methodsPatients were in their first ICSI cycle, 128 of which underwent a day 2 transfer of a single embryo selected by an algorithm based on fertilization (tPNf) and cleavage (T2 e T4) parameters. The remaining 230 patients had a elective frozen blastocyst selected by morphology transferred after endometrial preparation. Cycle characteristics and outcomes were compared using Fisher’s and Wilcoxon sum rank tests. A multivariate analysis tested the association of treatment and cycle variables with pregnancy.Main results and the role of chancePatients providing embryos transferred on day 2 after algorithm-oriented selection presented lower maternal age (35.5 ± 4.1 vs. 36.4 ± 4.4; p = 0.02), higher basal FSH (8.3 ± 3.6 vs. 6.9 ± 2.1 IU/L; p < 0.001) lower AMH (2.3 ± 2.0 vs. 5.7 ± 6.3 ng/mL; p < 0.0001), different distribution of infertility factors (p < 0.001; male factor: 64.1% vs. 39.6%, tubal: 3.1% vs. 11.3%, unexplained: 15.6% vs. 29.1%, for day 2 and frozen blastocyst transfers, respectively) and lower oocyte yield (6.9 ± 4.0 vs. 17.2 ± 6.5) as compared to patients providing frozen blastocysts.Beta-hCG, clinical pregnancy, ongoing pregnancy and miscarriage rates (assessed until the 12th week of pregnancy) did not differ between algorithm-oriented day 2 and frozen blastocyst transfers (53.1% vs. 50.9%, 40.6% vs. 45.7%, 33.6% vs. 36.5% and 17.3% vs. 20.0%, respectively).The multivariate analysis indicated maternal age as the only variable significantly and independently associated with ongoing pregnancy achievement [OR = 0.89 (0.84-0.94); p,0.001)].Limitations, reasons for cautionOur study is subjected to the limitations of a retrospective analysis and the data may be affected by variables not controlled for that are heterogeneous between groups such as different endometrial conditions and the use embryo cryopreservation.Wider implications of the findingsOur findings indicate that morphokinetic algorithms can be successfully applied to improve outcomes of day 2 transfers to a level similar of that achieved with elective frozen blastocyst transfers. Our data represent a valuable parameter for the improvement or adaptation of ICSI practice in the face of logistic constraints.Trial registration numbernot applicable

P-206 Could day 7 embryo culture become standard practice to improve patients’ treatment and outcome?

Abstract Study question What are the clinical outcomes following transfer of day 7 embryos; could day 7 embryo culture become part of standard embryology practice? Summary answer Although clinical outcomes remain low, success has been seen following transfer of day 7 embryos. Extended culture plays an important role in standard embryology practice. What is known already In vitro culture conditions and cryopreservation techniques have improved greatly in recent years, allowing for extended culture, and freezing of embryos at the blastocyst stage. Optimally, embryos should develop to the blastocyst stage on day 5, however deviation from normal development can sometimes occur due to problems in either the embryonic intrinsic factors or imprinting timings. Live births have been reported from slower developing day 7 embryos. Extended culture to day 6 is standard practice in most IVF laboratories, however the aim of this study is to investigate the outcomes following prolonged embryo culture to day 7. Study design, size, duration This is a retrospective analysis study of 47 patients who underwent frozen embryo transfers (FETs) with a cryopreserved day 7 embryo at a UK licensed centre between 2017-2021. Patients were split into two groups: those transferring untested (non-PGT-A) day 7 embryos, and those transferring euploid PGT-A tested day 7 embryos. Clinical pregnancy (CPR) was analysed to study the clinical outcome of day 7 embryo culture followed by a frozen transfer. Participants/materials, setting, methods All patients who had FET with a day 7 embryo between 2017-2021 were included in this study. A total of 49 FETs (48 eSET,1 DET) involving 47 patients took place: 38 with untested embryos and 11 with euploid embryos. Clinical pregnancy rate (CPR) and live birth (LBR) was analysed to study the efficacy in transfer of day 7 embryos and the two groups of patients (untested and PGT-A tested) were compared. Main results and the role of chance The overall CPR per embryo transfer was 8% (47 patients, 49 ETs, 50 embryos transferred) and the LBR per embryo transfer was 4%. In the PGT-A group, a total of 201 day 7 embryos were biopsied over the 5-year study period; 28 were euploid following testing (14% euploidy rate). Of these, 11 have been transferred; 4 resulted in a pregnancy and 2 in a live birth. (LBR 18%) There is a significant difference in CPR between the PGT-A group (11 patients, 11 FETs; 11 embryos transferred, 4 foetal hearts seen, CPR=36%) and the untested group (36 patients, 38 ETs; 39 embryos transferred, CPR=0%) Chi square test performed and confirmed (p &amp;lt; 0.001). The mean age of the patient at the time of embryo transfer was 38.6 ± 0.5 and the mean age of the embryo transferred was 35.6± 0.5 (this was the patient’s age at the time of embryo freezing). Limitations, reasons for caution Limiting factors include the retrospective study design and the small sample size. It is also worth noting the high number of day 7 embryos required to undergo PGT-A testing to result in a low number of euploid embryos suitable for embryo transfer. Wider implications of the findings This study indicates the value of day 7 embryo culture as it has resulted in some patients achieving an ongoing pregnancy and a live birth. However, care must be taken to counsel patients appropriately around the chance of success when transferring day 7 embryos, particularly patients using untested embryos. Trial registration number Not Applicable

Comparison of day 5 blastocyst with day 6 blastocyst: Evidence from NGS-based PGT-A results.

Aneuploidy is one genetic factor leading to the failure of embryo implantation. This study aimed to investigate the relationship between the day of embryo blastulation and the ploidy status of embryo, to aid in selecting embryos with the most likelihood of of beingeuploid in anoninvasive way. This retrospective study recruited women undergoing preimplantation genetic testing (PGT) for aneuploidy (PGT-A) with trophectoderm biopsy from January 2019 to December 2020. The ploidy status of embryos was determined by next-generation sequencing (NGS). Altogether, 2531 blastocysts from 839 PGT-A cycles were evaluated. The euploid rate of day 5 blastocysts was significantly higher than that of day 6 blastocysts, either from the same ovarian stimulation (OS) cycles (49.9% vs 35.7%, P < 0.001) or from different OS cycles (48.2% vs 27.8%, P < 0.001). This effect of increasing time to embryo blastulation significantly reducing the prevalence of euploidy was not seen in women at age 38 or older. However, after single euploid embryo transfer, the clinical outcomes of day 5 blastocysts were comparable to those of day 6 blastocysts. In non-PGT cycles, our data support the selection of day 5 blastocysts for transfer over day 6 blastocysts. Further, women with poor ovarian reserve incline to obtain only day 6 blastocysts, and PGT-A is valuable for identifying the ploidy status of embryos, especially for those with advanced age. However, the stage of blastocysts will not affect the clinical outcome after transfer when they are identified as euploid.

Obstetric, Neonatal, and Clinical Outcomes of Day 6 vs. Day 5 Vitrified-Warmed Blastocyst Transfers: Retrospective Cohort Study With Propensity Score Matching

Despite the large number of studies on blastocyst transfers, it is unclear whether day 6 blastocysts have similar pregnancy rates and safety with day 5 blastocysts. Thus, this study aimed to compare the obstetric, neonatal, and clinical outcomes of day 5 and day 6 vitrified blastocyst transfers (VBT). In this retrospective cohort study with propensity score matching, we evaluated 1,313 cycles of VBT performed between January 2014 and December 2015 at the Fertility Center of CHA Gangnam Medical Center. All cycles underwent natural endometrial preparation. We used propensity score matching to compare day 5 and day 6 VBTs in a matched comparison. After propensity score matching, there were 465 cycles of day 5 VBT and 155 cycles of day 6 VBT. Implantation rate (IR), clinical pregnancy rate (CPR), and live birth rate (LBR) were significantly lower in day 6 VBTs (44.2 vs. 53.1%, p = 0.023; 48.4 vs. 60.4%, p = 0.009; 33.5 vs. 51.8%, p < 0.001). Miscarriage rate was significantly higher in day 6 VBTs (29.3 vs. 10.7%, p < 0.001). Rate of multiple gestations was similar between the two groups (29.3 vs. 30.2%, p = 0.816). Assessing 241 and 52 babies from day 5 and day 6 VBTs, no differences were found in neonatal outcomes including rates of low birth weight, preterm birth, and congenital malformations. In propensity score-matched analysis, obstetric, and neonatal outcomes between day 5 and day 6 VBTs were similar so that day 6 VBTs are as safe as day 5 VBTs. IR, CPR, and LBR were are all significantly lower in day 6 VBTs. Therefore, if there are no differences in the morphological grade between day 5 and day 6 blastocysts, transfer of day 5 vitrified blastocysts should be considered first.

Correlation between Serum Vitamin A and D Levels in Acute Phase Ischemic Stroke and Clinical Outcome

Background: In the last decade, a number of studies have examined the relationship between serum vitamin D concentration and the risk of cerebrovascular events. Besides vitamin D, the latest evidence shows that vitamin A is also a risk factor for cerebrovascular disease. Vitamin A and its derivatives act biologically via specific nuclear receptors that regulate gene transcription. Vitamin A receptors can also interact with other nuclear receptors that have neuroprotective effects such as vitamin D, against stroke. Although many studies suggested the synergism of vitamin A and D, there is still no study that evaluates their levels simultaneously in acute phase ischemic stroke, and the relationship to outcome. Objective: The objective of this study was to analyze the correlation between serum vitamin A and D levels on admission in Acute Ischemic Stroke patients and clinical outcome by using the National Institutes of Health Stroke Scale (NIHSS). Methods: A prospective cohort study was conducted, and samples were followed since the diagnosis of acute-phase Ischemic Stroke was established until the clinical outcome of day 14 after stroke onset. A total of 50 subjects enrolled for this study would be examined for serum levels of vitamins A and D on admission, and on the 14th day were assessed for NIHSS as a clinical outcome. Results: From 50 research subjects, the mean of vitamin A and D level in the acute phase of Ischemic Stroke was 463.35 ± 116.97 µg/L and 21.65 ± 6.51 ng/mL, respectively. By using the Spearman’s correlation test, it was found that the acute phase vitamin A level and NIHSS on day 14 had a significant and strong correlation with p = 0.045 (r = -0.672). Along with it, vitamin D serum levels and NIHSS also had a significant and strong correlation with p = 0.026 (r = -0.754). Both of these results showed that vitamin A and D had an inverse association with NIHSS, meaning that the higher vitamin A and D serum levels, the better the clinical outcome would be. Conclusion: Both serum vitamin A and D levels in the acute phase of Ischemic Stroke was correlated strongly with short time clinical outcome. The higher vitamin A and D serum levels in the acute phase, the better the clinical outcome would be for Ischemic Stroke patients.

Busting the myth of extended blastocyst culture until Day 7: Protocol for systematic review and meta-analysis.

Background:The prolonged culture of embryos to the blastocyst stage represents an increasing procedure in Assisted Reproductive Technology (ART) laboratories. Generally, only blastocysts developing on Day 5 and Day 6 are considered suitable embryos for transfer, cryopreservation or biopsy while embryos developed at a slower rate after Day 6 are routinely discarded. However, also blastocysts developing on Day 7 can be viable and result in a healthy live birth. Unfortunately, data regarding the clinical outcomes of Day 7 blastocysts compared to blastocysts developing on Day 5 or Day 6 are controversial. In this systematic review and aggregate data meta-analysis, we aim to evaluate the real reproductive potential of delayed blastocysts on Day 7 in frozen cycles.Methods:We will include all studies, with no restriction regarding the study design (randomized and observational trials, including cohort and case-control), investigating the clinical success of blastocysts developed on Day 7 compared to Day 5 and Day 6 blastocysts. The primary outcomes are the clinical pregnancy rate (CPR) and ongoing pregnancy rate (OPR) following frozen-thawed embryo transfer (Day 7 vs Day 6, and Day 5); secondary outcomes are: live birth rate (LBR) following frozen-thawed embryo transfer, euploid rate and survival rate of thawed blastocyst. Two reviewers independently will judge the methodological quality of studies included in the meta-analysis using the criteria reported in the Cochrane Handbook for Systematic Reviews of Interventions or the Newcastle-Ottawa Scale according to the design of the trials. The meta-analysis will be performed using random effects models and heterogeneity will be assessed using Higgins I2 value. Summary estimate of the proportion of each outcome will be expressed as pooled proportion with 95% confidence interval (CI). The effect of the day on each outcome will be evaluated using a multilevel mixed-effects model with a moderator (the day). The effect will be expressed as odds ratio (OR) with 95% confidence interval (CI). A P value less than .05 will be considered statistically significant.Ethics and dissemination:This is a systematic review not requiring an ethical approval. Findings derived from this systematic review and meta-analysis will be published in a peer-reviewed journal.

Abstract 176: HERMES: Collaterals at Angiography Guide Clinical Outcomes

Background: Collateral circulation is a key factor in the pathophysiology of ischemic stroke. We conducted detailed analyses of angiography acquired immediately prior to endovascular therapy in the HERMES collaboration of recent landmark thrombectomy trials to determine predictors of collateral status and assess impact on clinical outcomes. Methods: The HERMES Imaging Core, blind to all other clinical and imaging data, independently interpreted conventional angiography acquired immediately prior to endovascular therapy. Collaterals were graded with the ASITN scale, based on available data for the site of arterial occlusion defined on initial injections. The statistical core analyzed the association of collateral grade with demographics, baseline NIHSS, site of arterial occlusion and clinical outcomes of day 90 mRS. Results: Angiography of collaterals was available in 376/605 (62%), including ASITN grades 0 in 7 (2%), 1 in 40 (10%), 2 in 182 (48%), 3 in 129 (34%) and 4 in 18 (5%). Elevated blood glucose (p=0.011) and diabetes (p=0.048) were associated with worse collateral grades, but age and NIHSS were unrelated. Better collateral grade was strongly associated with the degree of subsequent TICI reperfusion (p&lt;0.001). The limited numbers of symptomatic intracranial hemorrhage (14/376 or 3.7%) or parenchymal hematomas (18/376 or 4.8%) precluded analysis of association with collateral status. Collaterals had strong impact on mRS shift from baseline to 90 days (p&lt;0.001). Multivariable regression revealed that better collateral status was a potent determinant (OR 1.37 per grade, p=0.028) of outcomes, equivalent to 4.5 points of NIHSS and 14 years of age in terms of impact on mRS outcomes. Conclusions: Collaterals at angiography were a potent determinant of clinical outcomes in recent landmark thrombectomy trials.

The clinical outcomes of day 3 4-cell embryos after extended in vitro culture.

To evaluate the development potential and clinical significance of day 3 4-cell embryos after extended in vitro culture. This study was a retrospective cohort study for patients with infertility treatment between January 2011 and July 2013. Patients undergoing blastocyst culture in controlled ovarian hyperstimulation cycles using surplus embryos were analyzed in the study. A total of 764 women undergoing blastocyst culture with 1,522 surplus 4-cell embryos on day 3 were analyzed. An additional 2,391 patients with embryos undergoing blastocyst culture during the same period with embryos having more blastomeres were chosen as control. After extended culture, 253 embryos from 183 cycles in the study group which developed to blastocysts were frozen, and 118 embryos were warmed in subsequent frozen embryo transfer cycles. Implantation rates, clinical pregnancy rates (PRs) and ongoing PRs were 33.3 %, 38.4 % and 31.4 %, respectively, which were similar to those of the control group. The singleton birth weights of newborns using these blastocysts showed no significant difference to that seen in the control group. Surplus 4-cell embryos on day 3 displayed lower blastulation rates. However, once a blastocyst is obtained, it has equivalent clinical outcomes. Embryos that are developmentally lagging on day 3 can be observed in extended culture to increase the cumulative chances of a successful pregnancy.

Comparison of the clinical outcomes of day 4 and 5 embryo transfer cycles

ObjectiveThe majority of embryo transfers (ETs) to date have been performed on day 3 to reduce the potential risk of developmental arrest of in vitro cultured embryos before ET. Development of sequential media has significantly improved culture conditions and allowed blastocyst transfer on day 5. While day 5 ET provides higher clinical pregnancy outcomes with reduced risks of multiple pregnancies, it still has potential risks of developmental arrest of IVF embryos. The aim of this study was to evaluate the clinical outcomes of day 4 ETs and compare the efficacy of day 4 ET with day 5 ET.MethodsFrom 2006 to 2009, a total of 747 fresh IVF-ET cycles were retrospectively analyzed (day 4, n=440 or and day 5, n=307). The cycles with any genetic factors were excluded. The rates of matured oocytes, fertilization, good embryos, and clinical pregnancy of the two groups were compared. The chi-square test and t-test were used for statistical analysis.ResultsThere were no significant differences between the two groups with respect to the mean age of the females and rates of matured oocytes. The pregnancy outcomes of day 4 ET (40.7%) were similar to those of day 5 ET (44.6%). The implantation rate of day 5 ET (24.2%) was significantly higher than that of day 4 ET (18.4%) (p=0.003).ConclusionDay 4 ET can be chosen to avoid ET cancellation in day 5 ET resulting from suboptimal circumstances in the IVF laboratory, but the decremented quality of embryos for transfer and the decreased pregnancy rate must be taken into consideration.

Acute graft-versus-host disease biomarkers measured during therapy can predict treatment outcomes: a Blood and Marrow Transplant Clinical Trials Network study

AbstractAcute graft-versus-host disease (GVHD) is the primary limitation of allogeneic hematopoietic cell transplantation, and once it develops, there are no reliable diagnostic tests to predict treatment outcomes. We hypothesized that 6 previously validated diagnostic biomarkers of GVHD (IL-2 receptor-α; tumor necrosis factor receptor-1; hepatocyte growth factor; IL-8; elafin, a skin-specific marker; and regenerating islet–derived 3-α, a gastrointestinal tract–specific marker) could discriminate between therapy responsive and nonresponsive patients and predict survival in patients receiving GVHD therapy. We measured GVHD biomarker concentrations from samples prospectively obtained at the initiation of treatment, day 14, and day 28, on a multicenter, randomized, 4-arm phase 2 clinical trial for newly diagnosed acute GVHD. We found that at each of 3 time points, GVHD onset, 2 weeks into treatment, and 4 weeks into treatment, a 6-protein biomarker panel predicted for the important clinical outcomes of day 28 posttherapy nonresponse and mortality at day 180 from onset. GVHD biomarker panels can be used for early identification of patients at high or low risk for treatment nonresponsiveness or death, and they may provide opportunities for early intervention and improved survival after hematopoietic cell transplantation. The study was registered in clinicaltrials.gov as NCT00224874.

Clinical outcomes of elective single morula embryo transfer versus elective single blastocyst embryo transfer in IVF-ET

To compare the clinical outcomes of elective single morula embryo transfer (eSMET) versus elective single blastocyst embryo transfer (eSBET) in selected patients. This study was a retrospective study which analyzed for 271 cycles in women under 37 years of age who are undergoing their first or second trial of in vitro fertilization-embryo transfer (IVF-ET) from January 2008 to December 2009. The eSMET was performed on day 4 (n = 130) and the eSBET was conducted on day 5 (n = 141). The clinical pregnancy rate (51.5% vs. 51.8%, p = 0.97), implantation rate (52.3% vs. 52.5%, p = 0.98), and live birth rate (39.2% vs. 44.7%, p = 0.36) were similar in the eSMET and eSBET groups, respectively. The miscarriage rate of the eSMET group (23.9%) was slightly higher than that of the eSBET group (13.7%) (p = 0.12), without reaching statistical significance. There was only one case of monozygotic twin pregnancy in each group. The clinical outcomes of day 4 eSMET were comparable to those of day 5 eSBET. Therefore, day 4 eSMET is a viable option or an alternative to day 5 eSBET, with no difference in success rates.

Clinical outcome of day 5 and day 6 blastocyst vitrification

Clinical outcome of day 5 and day 6 blastocyst vitrification

Clinical Outcome Of Day 5 And Day 6 Blastocyst Vitrification

Clinical Outcome Of Day 5 And Day 6 Blastocyst Vitrification

Clinical outcome of day 3 and day 5 vitrified embryo transfer cycles

OBJECTIVE: Clinical outcome of cryopreserved embryo transfer (CET) are comparable to those of fresh IVF-ET. Despite of these advances, there still is considerable disagreement over the optimal embryo stage for cryopreservation. As a routine, our center performs vitrification of embryos on day3 and day 5 according to embryo number and quality. The purpose of this study is evaluated clinical outcomes after transfer of embryos vitrified on day 3 and day 5.DESIGN: Retrospective analysis of data from Jan 2007 to Dec 2009 in a Mirae and Heemang OB/GYN clinic.MATERIALS AND METHODS: A total of 2,646 embryos were thawed in 574 CET cycles. Day 3 and day 5 embryos were equilibrated in 7.5% ethylene glycol (EG) + 7.5% DMSO for 15 ∼ 23min and then vitrified in 15% EG + 15% DMSO + 0.5M sucrose within 1 min. The vitrification solution containing embryos was placed onto the pull and cut (PNC) straw, which was designed and made by pulling and cutting of 0.25ml plastic straw, and immediately plunged into the liquid nitrogen. Vitrified embryos were warmed in 1M sucrose at 37°C for 1min, 0.5M sucrose for 3min, and washed twice in PBS. The two groups evaluated were patients with embryos vitrified at the day 3 cleavage (day 3 group, n=456), or blastocyst (day 5 group, n=118) stage.RESULTS: A total of 2,646 embryos were thawed and the survival rate was 80.5%. The survival rate of the day 3 (81.4%) was not significantly different the day 5 group (75.4%). All patients were statistically similar in terms of age (day 3, 33.7 ± 3.4 vs. day 5, 33.6 ± 3.1, respectively). We found that the mean number of transferred embryos was significantly lower in the day 5 (2.4 ± 0.9) than the day 3 group (4.0 ± 0.9) (p<0.05). Clinical pregnancy rate (CPR) in the day 5 (39.8%) was higher than the day 3 group (33.8%), but it was not statistically significant.CONCLUSION: CPR were not statistically different between embryos vitrified on day 3 or day 5. These data showed that vitrification on either day 3 or day 5 of embryo development is feasible within the human IVF program. OBJECTIVE: Clinical outcome of cryopreserved embryo transfer (CET) are comparable to those of fresh IVF-ET. Despite of these advances, there still is considerable disagreement over the optimal embryo stage for cryopreservation. As a routine, our center performs vitrification of embryos on day3 and day 5 according to embryo number and quality. The purpose of this study is evaluated clinical outcomes after transfer of embryos vitrified on day 3 and day 5. DESIGN: Retrospective analysis of data from Jan 2007 to Dec 2009 in a Mirae and Heemang OB/GYN clinic. MATERIALS AND METHODS: A total of 2,646 embryos were thawed in 574 CET cycles. Day 3 and day 5 embryos were equilibrated in 7.5% ethylene glycol (EG) + 7.5% DMSO for 15 ∼ 23min and then vitrified in 15% EG + 15% DMSO + 0.5M sucrose within 1 min. The vitrification solution containing embryos was placed onto the pull and cut (PNC) straw, which was designed and made by pulling and cutting of 0.25ml plastic straw, and immediately plunged into the liquid nitrogen. Vitrified embryos were warmed in 1M sucrose at 37°C for 1min, 0.5M sucrose for 3min, and washed twice in PBS. The two groups evaluated were patients with embryos vitrified at the day 3 cleavage (day 3 group, n=456), or blastocyst (day 5 group, n=118) stage. RESULTS: A total of 2,646 embryos were thawed and the survival rate was 80.5%. The survival rate of the day 3 (81.4%) was not significantly different the day 5 group (75.4%). All patients were statistically similar in terms of age (day 3, 33.7 ± 3.4 vs. day 5, 33.6 ± 3.1, respectively). We found that the mean number of transferred embryos was significantly lower in the day 5 (2.4 ± 0.9) than the day 3 group (4.0 ± 0.9) (p<0.05). Clinical pregnancy rate (CPR) in the day 5 (39.8%) was higher than the day 3 group (33.8%), but it was not statistically significant. CONCLUSION: CPR were not statistically different between embryos vitrified on day 3 or day 5. These data showed that vitrification on either day 3 or day 5 of embryo development is feasible within the human IVF program.

Day 4 embryo transfer improves IVF outcomes compared with day 3 embryo transfer

OBJECTIVE: Even though the majority of embryos are transferred on day 3 following in vitro fertilization (IVF), the morphological assessment of day 3 embryos may not accurately predict further developmental competency and pregnancy potential. We compared the clinical outcomes of day 4 ET cycles with day 3 ET cycles in both fresh IVF-ET and frozen-thawed ET cycles (FET) to assess whether day 4 ET improves clinical outcomes.DESIGN: Retrospective study.MATERIALS AND METHODS: Total 759 fresh IVF-ET (660 on day 3 and 99 on day 4) cycles and 261 frozen-thawed ET (231 on day 3 and 30 on day 4) cycles were analyzed retrospectively during the period from Jan. 2006 to Aug. 2007. In this study, to avoid unbiased comparison regard to embryo quality, we selected the ET cycles which have at least one good quality 8-cell stage embryo on day 3. Clinical outcomes were evaluated in day 3 and day 4 ET cycles. Chi-square test or t-test was used for statistical analysis, and P values of < 0.05 were considered significant.RESULTS: There were no differences in clinical parameters between two groups. The mean number of transferred embryos on day 4 ET cycles was significantly lower than that of day 3 ET cycles (3.1 ± 0.7 vs. 3.3 ± 0.7, p < 0.01). In fresh IVF-ET cycles, day 4 ET cycles showed significantly higher IR (26.2% vs. 19.8%, p < 0.01) and CPR (56.6% vs. 45.5%) compared with day 3 ET cycles. In frozen-thawed ET cycles, survival rates and mean number of transferred embryos were similar between two groups. CPR and IR of frozen-thawed day 4 ET cycles were significantly higher than those of frozen-thawed day 3 ET cycles (70.0% vs. 45.5% and 31.3% vs. 19.6%, p < 0.05).CONCLUSIONS: Day 4 ET cycles showed higher pregnancy outcomes compared with day 3 ET cycles. These results suggest that day 4 ET more synchronized with in vivo reproductive processes than day 3 ET. OBJECTIVE: Even though the majority of embryos are transferred on day 3 following in vitro fertilization (IVF), the morphological assessment of day 3 embryos may not accurately predict further developmental competency and pregnancy potential. We compared the clinical outcomes of day 4 ET cycles with day 3 ET cycles in both fresh IVF-ET and frozen-thawed ET cycles (FET) to assess whether day 4 ET improves clinical outcomes. DESIGN: Retrospective study. MATERIALS AND METHODS: Total 759 fresh IVF-ET (660 on day 3 and 99 on day 4) cycles and 261 frozen-thawed ET (231 on day 3 and 30 on day 4) cycles were analyzed retrospectively during the period from Jan. 2006 to Aug. 2007. In this study, to avoid unbiased comparison regard to embryo quality, we selected the ET cycles which have at least one good quality 8-cell stage embryo on day 3. Clinical outcomes were evaluated in day 3 and day 4 ET cycles. Chi-square test or t-test was used for statistical analysis, and P values of < 0.05 were considered significant. RESULTS: There were no differences in clinical parameters between two groups. The mean number of transferred embryos on day 4 ET cycles was significantly lower than that of day 3 ET cycles (3.1 ± 0.7 vs. 3.3 ± 0.7, p < 0.01). In fresh IVF-ET cycles, day 4 ET cycles showed significantly higher IR (26.2% vs. 19.8%, p < 0.01) and CPR (56.6% vs. 45.5%) compared with day 3 ET cycles. In frozen-thawed ET cycles, survival rates and mean number of transferred embryos were similar between two groups. CPR and IR of frozen-thawed day 4 ET cycles were significantly higher than those of frozen-thawed day 3 ET cycles (70.0% vs. 45.5% and 31.3% vs. 19.6%, p < 0.05). CONCLUSIONS: Day 4 ET cycles showed higher pregnancy outcomes compared with day 3 ET cycles. These results suggest that day 4 ET more synchronized with in vivo reproductive processes than day 3 ET.

P-191: Optimizing a vitrification protocol for human embryo cryopreservation on day 2; assessing the quality of embryos confirmed with early cleavage and morphological grading

The establishment of a vitrification protocol for any stage embryos with minimal invasion is an immediate need for positive clinical outcome. This study aimed to optimize a vitrification protocol for human day 2-embryo cryopreservation, confirming the quality of embryos with early cleavage and morphological grading. Retrospective clinical study. 263 patients with day 2 embryos that needed cryopreservation for either avoiding OHSS or as supernumerary embryos for subsequent transfer attempts, agreed to cryopreservation of the embryos by vitrification. Embryos were evaluated for early cleavage (EC) or late cleavage (LC) at 27 hours after insemination, and morphological scored on day 2 (poor: <=4 cells with >=50% frag., fair: 4 cells with <50% and >=20% frag., and good: >=4 cells with <20% frag.). A total of 1053 day 2 embryos were vitrified with equilibration solution, an equal mixture of 7.5% DMSO and ethylene glycol (EG) in HTF supplemented with 20% HSA and a vitrification solution, a mixture of 15% DMSO, 15% EG and 0.5 M sucrose in HTF/HSA. Initially, embryos were exposed to the equilibration solution for 5 to 10 min, and to the vitrification solution for 1 min at room temperature. The duration of the equilibration time was adjusted by morphological changes that indicated shrinkage for dehydration and re-expansion for cryoprotectant (CPA) permeation, and was individually recorded for further analysis. Embryos were then loaded onto a minute nylon sheet (cryotop), and plunged into LN2 immediately. For warming, vitrified embryos on the tip of a cryotop were dipped and kept in 1M of sucrose solution for 1 min. and then diluted in 0.5 M of sucrose solution for 3 min. Embryos with 70% or more intact blastomeres were considered as a survival and kept in culture until transfer the following day. The uterine endometrium of patients was prepared with transdermal estrogen and suppository of progesterone (200 mg/day) before embryo-transfer. Pregnancy was defined as the presence of gestational sac(s). Total survival and cleavage rates were 96.3% (1053/1094) and 69.0% (727/1053), respectively. The mean number of embryos transferred was 2.4±0.7, pregnancy rate was 26.1% (112/429), implantation rate was 12.7% (130/1024), and abortion rate was 29.5% (33/112). The cleavage (83%), pregnancy (30.1%) and implantation (15.4%) rates in the EC group were significantly higher than those in the LC group. Also, the equilibration time of vitrified embryos with poor morphological scores was statistically longer than that of vitrified embryos with poor and fair scores. Embryos in both the good score and EC groups statistically had the highest pregnancy rate (33.6%) and implantation rate (17.7%). Fifty-five healthy babies were born from 47 deliveries. We concluded that morphological score combined with EC/LC confirmation was significantly related to survival and clinical outcome of day 2-embryo vitrification. Vitrified embryos with poor morphological score had impaired dehydration and permeation ability because they required longer equilibration of CPA and had poor developmental ability. It is very important to adjust the equilibration time and assess the indications whether embryos are suitable for vitrification or not according to EC/LC and morphological scores. An acceptable pregnancy rate and healthy babies confirmed the usefulness and safety of this vitrification protocol.