Frozen Embryo Research Articles

New Zealand Policy on Frozen Embryo Disputes.

Disputes between separated couples over whether frozen embryos can be used in an attempt to create a child create a moral dilemma for public policy. When a couple create embryos intending to parent any resulting children, New Zealand's current policy requires the consent of both people at every stage of the ART process. New Zealand's Advisory Committee on Assisted Reproductive Technology has proposed a policy change that would give ex-partners involved in an embryo dispute twelve months to come to an agreement before the embryos are destroyed. New Zealand's current policy and the proposed policy both favour the person who wishes to avoid procreation. Two alternative policy approaches that do not favour procreative avoidance are considered. Using pre-fertilisation contracts to determine the decision reached in embryo disputes allows the couple's wishes at the time the embryos are created to determine what happens to the embryos if they separate. However, pre-fertilisation contracts are agreements about healthcare and personal relationships, and changing circumstances can make enforcing such agreements unjust. Finally, it is argued that New Zealand's Family Court system should be used to reach decisions that balance the interests of those involved in the dispute.

Assessment of Endometrial and Sub-endometrial Vascularity Before and After PRP Infusion in Frozen Embryo Transfer Cycles

Assessment of Endometrial and Sub-endometrial Vascularity Before and After PRP Infusion in Frozen Embryo Transfer Cycles

Evaluation of the effect of the elective blastocyst-stage embryo transfer and freezing strategy on the abandonment of frozen embryos under the Taiwan National Assisted Reproduction Act

PurposeTo evaluate the relationship between elective blastocyst transfer, freezing strategy, and the abandonment of frozen embryos with a storage time limit of 10 years as specified in the National Assisted Reproduction Act of Taiwan.MethodsThis two-phase retrospective cohort study was conducted at a single tertiary center, Kaohsiung Chang Gung Memorial Hospital (KCGMH), in 2019. Participants were selected from a data registry containing 4167 fresh IVF cycles, including phase 1 cycles from 1999 to 2009 and phase 2 cycles from 2010 to 2014, at KCGMH.ResultsIn phase 1, embryo abandonment was associated with the production of more mature oocytes and embryos, the freezing of more embryos, young female age, blastocyst transfer, and positive pregnancy results. After adjustment for confounding factors, only positive pregnancy results (adjusted odds ratio [aOR] 4.38, 95% confidence interval [CI] 3.17, 6.04), the freezing of ≥ 2 embryos (aOR 3.68, 95% CI 3.10, 4.38), the production of ≥ 6 embryos (aOR 1.68, 95% CI 1.03, 2.73), and the use blastocyst transfer (aOR 2.46, 95% CI 1.64, 3.69) remained significantly associated with embryo abandonment. The factors associated with embryo abandonment or possible abandonment were similar in phase 2.ConclusionFor elective blastocyst stage transfer and a freezing strategy performed according to the Taiwan National Assisted Reproduction Act, a young female age ≤ 35 with positive pregnancy status due to the original IVF treatment, the production of ≥ 6 embryos, and the cryopreservation of ≥ 2 blastocysts may increase the likelihood of abandoning embryos in the future.

Pregnancy Outcome in Fresh and Frozen Embryo Transfer in Women with High Estradiol Levels

Pregnancy Outcome in Fresh and Frozen Embryo Transfer in Women with High Estradiol Levels

At-Home IVF Kit: application during the COVID-19 pandemic

The guidelines, at the time of writing this manuscript, recommend withholding fertility treatments due to fear of the COVID-19. However, many fertility doctors and many patients, especially those with diminished ovarian reserve (DOR), strongly suggest that their fertility treatment including oocyte and/or embryo freezing is a time-sensitive matter due to fear of losing all their ovarian reserve. This report presents a novel approach for ovarian stimulation at home in women with DOR for oocyte/embryo cryopreservation using At-HOME IVF kit mailed to the patients’ home, and without the need for blood hormones and transvaginal ultrasounds monitoring. In this study, women (n = 22) diagnosed with DOR who underwent either oocyte (n = 6) or embryo freezing (n = 16) were included. Each patient took the medications included in the kit without the frequent visits to the office for monitoring and presented only once to the fertility clinic on the day of the oocyte retrieval. Upon presentation on the day of oocyte retrieval, none of the patients had ovulated. All patients underwent oocyte retrieval with 21 out of 22 patients having had at least one or more oocytes collected, with the number of mature oocytes retrieved ranging from 1 to 7. Eight out of 16 patients (50%) who underwent IVF, had embryos cryopreserved at either the cleavage-stage or blastocyst stage. This report suggests that, during the COVID-19 pandemic, At-HOME IVF kit presents a novel solution for women with DOR, or in situations where time is of essence, limiting office visits and thus minimizing the risk of coronavirus infection.

Rescuing the Good Samaritan in Embryo Adoption and Beyond

Embryo adoption, when oriented to the rescue of a dignified human person, is a merciful and morally licit response to an evil consequence of in vitro fertilization and the freezing of embryos. Those who object to embryo adoption not only misconstrue the relevant moral reasoning but exhibit confusion among the object, intention, and circumstances and between two very different potential objects. Because the mercy and charity effected through embryo adoption are at the very heart of moral action, juridical arguments that undermine people’s confidence in these priorities have far-reaching, harmful implications.

Abstracts of the 24th Annual Congress of the SBRA, 2020 (Virtual Meeting).

Objective:Osteogenesis Imperfecta (OI) is a disease characterized by fragile bones and a decrease in bone mass. There are approximately nineteen types of OI differing from each other by morbidity, mortality and causative mutation. The OI Type IV occurs in most cases of deleterious variant in heterozygosis (autosomal dominant) in the COL1A1 or COL1A2 genes. Those genes are responsible for the production of procollagen chains that are part of type I collagen molecule. Patients with OI type IV have a high risk (50%) of transmitting the pathogenic variant to their offspring being recommendable genetic counseling to discuss family planning alternatives. The use of assisted human reproduction techniques followed by analysis of Pre-implantation Genetic Test for Monogenic Diseases (PGT-M) in embryos has proven to be an effective alternative to reduce the risk of recurrence. Objective: Family planning with In Vitro Fertilization (IVF) cycles and cumulation of frozen embryos followed by PGT-M as an alternative to reduce the risk of transmission of the pathogenic variant that causes OI Type IV.Methods:The case reported a couple in which the male patient has a diagnosis of OI Type IV caused by a deleterious variant in COL1A2. Informative study was conducted with the carrier and his wife before the IVF cycle and the PGT-M. The previous test was designed to find the informative polymorphic Short Tandem Repeats (STR) markers linked to mutations or genomic regions. For the IVF treatment three cycles were made with the same stimulation protocol. It was used clomiphene citrate, gonadotropin, antagonist GnRh and trigger with agonist GnRh. In the first cycle, six embryos were produced and frozen on the third day of development (D3). In the following cycle three embryos had vitrified in the same development day. In the third cycle six embryos were developed and after they reached cleavage state (D3), all other embryos, from the previous cycles, were thawed, survived the technique and developed until the blastocyst stage. From the total fifteen embryos in the cleavage stage, nine evolved to the blastocyst stage. The PGT-M was performed at all blastocysts followed by embryo cryopreservation. Regarding the genetic analysis of embryo cells, for those samples that the deleterious variant in COL1A2 was not found, the research advanced with Pre-implantation Genetic Test for Aneuploidy (PGT-A). The antagonist protocol used for the endometrial preparation in the embryo thaw cycle, from the third day of menstrual flow progressive doses of estradiol were used until the appropriate thickness and pattern was reached. It was administered 10.000 UI of urinary HCG subcutaneous. After 48 hours, 75 mg of intramuscular progesterone was started. On the sixth day of administration, the euploid embryo without the mutation searched was thawed and transferred to the uterine cavity.Results:In this cohort of nine embryos, there were five embryos with COL1A2 mutation present. From the four embryos without the mutation, three of them were aneuploids. One embryo did not present the haplotype with the mutation in COL1A2 and was euploid. This embryo was thawed and followed by transfer and resulted in an unaffected live birth. Conclusion:This article evidences an IVF cycle with a multidisciplinary approach with genetic counseling, serial ovarian stimulation, cumulative IVF cycles with embryo freezing, PGT-M, PGT-A and cycle of thawing can be a viable treatment to reduce recurrence risk of autosomal-dominant disease (50%).

Factors associated with embryo splitting and clinical outcome of monozygotic twins in pregnancies after IVF and ICSI.

What factors are associated with monozygotic twins (MZT) after autologous IVF/ICSI with fresh and frozen/thawed single embryo transfer (SET) and what is the outcome of MZT?Factors associated with increased MZT were blastocyst transfer and elective single embryo transfer (eSET), with MZT showing a lower gestational age at birth and neonatal weight but higher perinatal mortality only after fresh transfer.ART is associated with an increased incidence of MZT, which carries higher perinatal mortality. However, risk factors associated with MZT are still controversial.A population-based retrospective analysis of data extracted from ART cycles reported to the Latin American Registry of ART between January 2012 and December 2016 was used in order to study the frequency and outcome of MZT after SET.In total, 2925 clinical pregnancies obtained after autologous IVF/ICSI with fresh SET were used to study biomedical factors possibly associated with MZT, such as maternal age, type of insemination, use of assisted hatching, stage of embryo development at transfer, elective or non-elective SET and preimplantation genetic testing. Another group of 3085 clinical pregnancies obtained after SET of frozen-thawed embryo transfer (FET) was also used to study the possible association between embryo freezing and MZT. Only pregnancies with complete follow-up until birth were included in this analysis. The diagnosis of MZT was established by transvaginal ultrasound performed at 6–8 weeks of amenorrhea. The rate of MZT for each potential risk factor was obtained and a multivariable logistic regression was performed in order to account for the above-mentioned factors. Pregnancies were followed until birth and the early neonatal period in order to assess the rate of miscarriage and stillbirths, gestational age at birth, neonatal weight and early neonatal mortality.There were 76 MZT out of 2925 clinical pregnancies with fresh SET (2.6%) and 69 MZT out of 3085 clinical pregnancies after FET (2.2%) (odds ratio (OR) = 0.85, 95% CI 0.61–1.19). A statistically significantly increase in MZT rate was observed with blastocyst compared with cleavage stage ET (3.4 versus 2.0%, respectively; OR = 1.70, 95% CI 1.05–2.76). When confounding variables were considered, eSET was also significantly associated with an increase in the odds of MZT (OR = 1.74, 95% CI 1.04–2.92). Overall perinatal mortality was higher in MZT compared with singletons, but this rise was only significant after fresh ET.Limitations of the current study result from the fact that MZT were diagnosed with ultrasound performed at 6–8 weeks of amenorrhea; therefore, spontaneous embryo reductions taking place earlier were missed.Reproductive health providers must inform their patients that blastocyst transfer and eSET of fresh embryos are associated with a statistically significantly increase in the odds of MZT and that perinatal mortality after fresh ET is significantly higher in MZT than in singletons.The Latin American Registry of ART receives direct funding from Ferring Pharmaceuticals, but no specific funding was received to undertake this study. None of the authors declare conflict of interest.

Elective frozen embryo transfer – What is the evidence?

Fresh embryo transfer (ET) has been the norm in Assisted reproductive technology (ART) treatment. However, there has been a concern about decreased implantation and pregnancy rates due to altered endometrial receptivity, resulting from the supra-physiological hormonal levels associated with controlled ovarian stimulation (COS). Improvement in embryo survival rates with vitrification has led to an increase in the use of elective freezing of all good quality embryos and transfer in subsequent cycles, i.e., elective frozen ET (eFET). The use of gonadotropin-releasing hormone (GnRH) agonist trigger and segmental in vitro fertilization (IVF) to prevent ovarian hyperstimulation syndrome in hyper responders, has further enhanced the use of e FET. Significantly higher pregnancy rates after frozen-thawed ET in some reports have encouraged wider use of elective freeze-all cycles in ART. Recent studies have shown that in patients with regular menstrual cycles, a freeze-all strategy with GnRH agonist triggering did not result in higher on-going pregnancy rates and live birth rates (LBRs) as compared to fresh transfers with the use of human chorionic gonadotropin for the trigger. There have been no studies comparing fresh verses eFET in poor responders. Significant benefit of e FET has been documented only in hyperresponders. Despite the potential advantages, it seems that e FET is not designed for all IVF patients and a careful patient selection is advocated to derive true benefit from this strategy.

Neonatal outcome after fresh versus frozen embryo transfer in normogonadotropic healthy young women undergoing IVF

Neonatal outcome after fresh versus frozen embryo transfer in normogonadotropic healthy young women undergoing IVF

To study the effect of autologous platelet-rich plasma instillation on suboptimal endometrium and pregnancy outcomes in infertile women undergoing frozen embryo transfer cycle

Introduction:This pilot study was done to evaluate the effectiveness of intrauterineinstillation of autologous platelet rich plasma in the treatment of infertile woman with ≥2 IVF failures due to thin endometrium not responding to empirical medical therapies. Design: Prospective interventional study. Material and Methods: Intra uterine instillation of PRP was done in 50 women between 23 to 38 years with suboptimal endometrial receptivity, ≥ 2 IVF failures and HRT cycle cancellations over a course of 9 months. Frozen embryo transfer was done when optimal endometrial thickness and vascularity was achieved. Results: The mean endometrial thickness pre PRP was 5.78mm which increased to 7.20mm post-PRP (P value

Uterine cavity assessment prior to IVF: comparison of 2D, 3D ultrasound, and hysteroscopy

There is a conflicting evidence that prior hysteroscopy in IVF treatment is beneficial in terms of successful pregnancy rate and subsequent live birth rate. So a study was planned to compare 2D TVS & 3D USG in detecting uterine anomalies in infertile patients & to know whether prior hysteroscopy has any effect on Clinical Pregnancy and Abortion rate. A sample size of 90 was selected and further randomized into 3 groups. Patients were randomized over 6-month time. All patients underwent same baseline investigations. In group 1 subjects, 2D TVS was done to detect uterine anomalies, in group 2 3D USG was performed and group 3 subjects underwent gold standard diagnostic hysteroscopy. Subjects in group 1 & 2 who tested positive for uterine anomalies were confirmed with diagnostic hysteroscopy and subsequently excluded from the study. Those subjects who had false positive results in group 1 & 2 were included in group 3 for Frozen Embryo transfer. This procedure was done till each of the 3 groups had 30 subjects. Furthermore, subjects in group 1 & 2 who tested negative for uterine anomalies, underwent IVF but did not conceive further underwent diagnostic hysteroscopy to confirm the diagnosis as a part of calculating Sensitivity and Specificity of 2D TVS and 3D USG. A total of 160 patients were accessed and finally 90 were included in the study. There was no significant difference in baseline demographic characteristics, type of infertility, duration of infertility, hormonal profile & mean antral follicle count and size. The Sn, Sp, PPV for 2D TVS & 3D USG was found to be 66.6%, 90%, 75% & 90.9%, 95% and 90.9% respectively. There was no difference in CPR and miscarriage rate in patients who conceived in each group. The results of the study are in line with the previous studies. Larger scale RCTs need to be conducted to ascertain the exact role of prior hysteroscopy in pregnancy outcome in infertile patients with no uterine anomalies.

Outcomes in poor responders treated with in vitro fertilization/intracytoplasmic sperm injection according to bologna criteria

Purpose of the study was to evaluate the effectiveness of various approaches of artificial reproductive technologies (ART) in advanced maternal age patients with poor ovarian response (POR). Materials and methods . This is retrospective cohort study of 455 patients with POR who have undergone an IVF and embryo transfer program at from June 2016 to June 2018. Researchers evaluated pregnancy rate (PR) per embryo transferand live birth rate (LBR) per embryo transferas in vitro fertilization (IVF) outcomes. The patients fulfilled Bologna criteria were divided into 5 groups: long protocol, ant-gonadotropin-releasing hormone protocol, freeze embryos transfer without preimplantation genetic diagnostic (PGS), freeze embryos transfer with PGS, natural cycle. Results. There was no statistically significant difference in the age, Anti-Mullerian hormone level and duration of infertility between the groups. Despite different protocols of ovarian stimulation, there was no statistically significant difference in pregnancy rate in fresh cycles. At the same time, cancellation of transfer was significantly higher observed in natural cycles (p <0.001). PR and LBR were statistically significant higher in freeze embryo transfer group 29% and 12.1% vs 13.3% and 5,5% respectively (p<0.001 and p = 0.040). During the transfer of the embryo unexamined by PGS and after PGS the pregnancy rate did not differ (29.4% vs 28.2%, p <0.05), but LBR was statistically significant higher after euploid embryo transfer (8.2% without PGS vs 20.5% after PGS, p = 0.028). Conclusion. The most effective approach in patients with a poor ovarian response was cycle segmentation, cryopreservation of embryos, PGS and transfer of an euploid embryo. This category of patients requires a personalized approach to the treatment of infertility. The choice of protocol in ART program must be carried out with the full voluntary and informed consent of the patient, depending on their desires and capabilities, including financial.

Cryopreservation induces higher oxidative stress levels in Bos indicus embryos compared with Bos taurus

Freezing and thawing of Bos indicus embryos affect their quality for embryo transfer. The objective of this study was to compare the levels of reactive oxygen species between Bos indicus and Bos taurus embryos produced in vivo, before and after conventional freezing, as well as to analyze damage caused by apoptosis and lipid peroxidation. Bos indicus has higher levels of reactive oxygen species than Bos taurus embryos, both fresh (14.32 ± 1.41 auf vs 8.07 ± 1.15 auf (arbitrary units of fluorescence), P < 0.05) and after freezing (20.91 ± 1.21 auf vs 14.39 ± 0.58 auf, P < 0.05). The number of apoptotic nuclei is also significantly higher in Bos indicus embryos than Bos taurus (8.28 ± 0.80 vs 1 ± 0.57, P < 0.05) but highlighting a notable increase after the freeze-thaw process in both subspecies (Bos indicus from 8.28 ± 0.80 to 10.71 ± 0.42, P < 0.05; Bos taurus from 1 ± 0.57 to 5.5 ± 1.15, P < 0.05). Finally, although lipid peroxidation is lower in Bos indicus embryos before freezing in comparison with Bos taurus (2.46 ± 0.14 vs 4.20 ± 0.51), the effect after the freeze-thaw process showed an increase of 4.34 in Bos indicus than Bos taurus embryos (51.45 ± 5.52 auf vs 11.85 ± 2.88 auf, P < 0.05). In conclusion, in comparison with Bos taurus, Bos indicus embryos undergo greater oxidative stress causing increases in the cryopreservation process, promoting major cell damage and lowering embryonic viability.

Serum Progesterone Levels on the Day of Frozen Embryo Transfer (FET) and Pregnancy Outcomes

Serum Progesterone Levels on the Day of Frozen Embryo Transfer (FET) and Pregnancy Outcomes

Ovulation induction in infertile women with endometriotic ovarian cysts: current evidence and potential pitfalls.

Endometriosis is a chronic benign gynecological disease with symptoms that can severely impact quality of life and well-being. Women affected by endometriotic ovarian cyst could have associated infertility problems. Infertility affects 30% to 50% of women with endometriosis. Women with endometriosis are at risk of decreased ovarian reserve, due to the disease pathophysiologic mechanisms. Generally, infertility management include surgical procedure (usually with minimally invasive approach) and ovulation induction with intrauterine insemination or in vitro fertilization. Fertility preservation technologies also include oocyte or embryo freezing and ovarian tissue cryopreservation. Approach to patients with endometriotic cysts still remains controversial, and a multidisciplinary approach is a key factor to achieve the best outcome with appropriate patient counselling. Such management by a multidisciplinary team is a key factor in achieving the successful outcome.

Kualitas, Kemampuan Implantasi dan Viabilitas in-vivo Embrio Mencit (Mus muculus) Galur Swiss Webster Setelah Pembekuan Dengan Metode Vitrifikasi

Reproductive technologies including in vitro fertilization (IVF), embryo manipulation, gamete and embryo freezing, thawing and embryo transfer were rapidly developed. Vitrification is an embryo freezing technique that is the most developed. In this experiment, we vitrified mouse embryos and then examined the embryos i.e: (i) the quality of the embryos after thawing, (ii) the implantation rate of the embryos and (iii) viability of the embryos in vivo. Morulae and blastocycsts were collected from female mice that were pregnant a day 3,5. The embryos were equilibraten in mPBS +10% etilene glycol. Vitrification was carried out by using VABEDS medium, containing 6-10 embryos that were dropped into a tip of a straw, then frozen in liquid nitrogen for 24 hours. Thawing was carried out by flushing the embryos using mPBS suplemented with 0.5, 0.25, 0.1 and 0 M sucrose. After being incubated in M2 medium at 37oC for 1-2 hours, the recovery embryos were then transferred into the uteri of day 2.5 of pseudopregnat females. The females were then sacrificed at day 16 of gestation and the total implantaion, total life and death fetuses, as well as resorpted embryos, were taken as data. The results showed that vitrification significantly (p&lt;0,05) reduced the quality of the embryos, as well as their implantation rate and the viability of the fetuses, which may be caused by the unoptimal combination of the cryoprotectant in the vitrification medium, temperature and exposure time during vitrification.

On Ice: The impact of vitrification on the use of eggs in fertility treatment.

The possibility to freeze sperm and embryos has long been available to men and women facing infertility as a result of an illness or medical treatment. However, the ability to successfully cryopreserve human eggs is comparatively recent. The introduction and increasing use of egg vitrification from the mid-2000s onwards, alongside the use of intracytoplasmic sperm injection, has seen improved ongoing clinical pregnancy rates compared with slow freezing methods. Despite concerns, the technology has been widely embraced by the scientific community and in recent years has been applied in a greater variety of contexts. In this short perspective paper, we consider two specific applications for the vitrification of human eggs in routine assisted reproduction practice: social egg freezing and the use of frozen eggs in egg donation. We suggest that vitrification is transforming the reproductive landscape in novel and complex ways and that we must be alert to the challenges, complexities and ethics of such developments, especially for those who may be excluded or marginalised by these techniques.

Robotic Assisted Laparoscopic Resection of Anterior Adenomyoma

Video Objective This video demonstrates a unique technique of anterior adenomyoma resection and repair of the defect laparoscopically. Setting Our patient is a 40 yo G 3P0020 with secondary infertility and had multiple failed euploid frozen embryo transfers. She was diagnosed to have an anterior adenomyoma and decision was taken to excise the adenomyoma to optimize the fertility outcome. Interventions We performed a robotic assisted laparoscopic anterior adenomyomectomy where we excised the adenomyoma leaving approximately 1 cm of myometrium to the endometrium and serosa and then close d the defect by the overlap flap technique. Conclusion We describe an unique technique for optimal adenomyoma resection and then the effective way to close the uterine defect. This technique is easily adaptable and reproducible. This repair technique achieves good myometrial thickness after closure that reduces the chance of uterine rupture and the addition of extra suture layer decreases the chance of hematoma formation.

EP18.23: Uterine artery Doppler study in pregnancies obtained by IVF/ICSI with fresh or frozen embryo transfers

EP18.23: Uterine artery Doppler study in pregnancies obtained by IVF/ICSI with fresh or frozen embryo transfers