Higher Implantation Rates Research Articles

Evidence-Based Percutaneous Closure of the Left Atrial Appendage in Patients with Atrial Fibrillation

Atrial fibrillation is the most common cardiac arrhythmia, and its prevalence is increasing. Cardioembolic stroke, most of the times secondary to thrombus formation in the left atrial appendage, is its most feared and life threatening consequence. Oral anticoagulation with vitamin-K-antagonists is currently the most used prophylaxis for stroke in patients with atrial fibrillation; unfortunately, its benefits are limited by a narrow therapeutic window and an increased risk for bleeding, making it often undesired. Percutaneous occlusion of the left atrial appendage is a novel alternative strategy for cardioembolic stroke prophylaxis in patients with atrial fibrillation at a high risk of stroke but with contraindication for long-term oral anticoagulation therapy. At present, several devices have been developed specifically for percutaneous occlusion of the left atrial appendage. Current results show good feasibility and efficacy for these devices, with a high rate of successful implantation, although also associated with the inherent potential periprocedural complications. This work reviews the current state of the art of percutaneous left atrial appendage closure for stroke prophylaxis in patients with atrial fibrillation.

High pregnancy and implantation rates can be obtained with preincubation of oocytes before insemination in IVF and ICSI procedures

Purpose: Evaluate the effect of preincubation of oocytes prior to IVF or ICSI cycles with embryo transfer at blastocyst stage. Methods: Retrospective non randomized study based on secondary analysis of data. Setting: Laboratory of Assisted Reproduction at the Alcivar Hospital. Patients: One hundred-eighteen cycles of IVF and ICSI were analyzed in the present study. The evaluated groups were formed for those patients whose oocytes, after retrieval, were inseminated at 1-3 h (Group I) or 4-6 h (Group II). Results: There was no difference in fertilization rate (83.6% and 78.1%), Day 3 cleavage rate (95.1% and 97.1%), and blastocyst formation (31.1% and 39.1%) for groups I and II respectively. Clinical pregnancy rates (PR: 53.0% vs 22.9%) and implantation rates (IR: 38.1% vs 13.0%) were significantly higher in group II versus group I, respectively (P < 0.05). Conclusions: Preincubation of oocytes before insemination is a factor which raises the PR and IR after the blastocyst transfer.

Improvement in embryo quality and pregnancy rates by using autologous cumulus body during icsi cycles

To determine whether the addition of intact cumulus cell mass (ICM) to both embryo culture (EC) and embryo transfer (ET) improves embryo quality and pregnancy rates. A total of 133 infertile couples were included, of which 67 received ICM (study group) and 66 did not (control group). The ICM was obtained from a simple cutting of the cumulus corona oocyte complex (CCOC). A case control study design was used. The clinical characteristics of the two groups before the embryo culturing step were similar with respect to age, estradiol level on the day of hCG and endometrial thickness on the day of embryo transfer (p>0.05). On the other hand study group with ICM had higher number of high quality embryos (3.1±1.4 vs 2.4±1.1, p=0.03), higher implantation rate (53.7% vs 34.8%, p=0.02) and higher ultrasound confirmation of gestational sac and fetal heart beat as ongoing pregnancy rates (44.7% vs 27.2%, p=0.04) compared to the control group without ICM. Addition of ICM improves embryo quality and pregnancy rates. This is a cost-and time-effective simple procedure that shows great promise for the improvement of infertility treatment.

Twin live births following transfer using eight-cell cleavage stage embryos on Day 4 with developmental arrest

Most forms of assisted reproduction require maintenance ofeither or both of the male and female gametes and the resultingembryos in vitro. Developmental arrest is one of the mecha-nisms responsible for increased embryonic demise during thefirst week of in vitro development [1]. In most of the speciesstudied, researchers have observed embryos arrested atspecific stages of preimplantation development in vitro.Thedevelopmental blocks and retardation observed in animals alsooccur in human embryos between the 4- and 16-cell stages [2],which is the point in time at which embryonic products oftranscription and translation become functional [3] and reachthe morula stage [4]. Embryos are not blocked in development,however, if they have proceeded to the blastocyst stage.Research interest has increased in blastocyst developmentin vitro and the benefit of blastocyst transfer has been attrib-uted to facilitating a natural selection of good quality embryos[5,6]. Blastocyst transfer has been reported to generate highimplantation rates, whereas lowering the multiple gestationrates following in vitro fertilization (IVF) [5,6]. The effortrequired for blastocyst culture, compounded by concerns aboutthe occasional suboptimal performance of sequential media,has led many clinics to continue to perform Day 2 or 3 embryotransfer (ET).Recent advances in our understanding of the dynamicphysiology of early human embryos have resulted in thedevelopment of culture systems now capable of yieldingviable blastocysts with greater consistency. At the same time,extended cultures have enabled embryologists to observehuman embryo development in vitro. Approximately10e15% of IVF embryos get permanently arrested in mitosisat the two- to four-cell cleavage stage, showing no signs ofapoptosis [1]. In our previous report, we suggested thata combined evaluation of the Z-score and Day 3 embryomorphology is highly predictive of embryo viability after IVFor intracytoplasmic sperm injection [7]. From our data, all ofthe zygotes placed in extended culture had a Day 5 embryosurvival rate of 56.9 1.3%. These predictions are consistentwith empirical data in the literature. The assessment ofembryo survival was based on embryo morphology andcleavage speed. Embryos that had the same number of blas-tomeres at two sequential times (24 hours), together with thosezygotes that remained blocked at the pronuclear stage, wereconsidered to have developmental arrest. From our experience,a developmentally arrested embryo in vitro always progressesto apoptosis.Until the present, arrested embryos could not be designatedas “alive” and were not appropriate for transfer to the uterususing assisted reproductive techniques. We describe a uniquecase of twin live births following transfer using three goodmorphology but developmentally arrested (>24 hours)embryos. We have followed the healthy twins for 2 years as ofthis writing.A 35-year-old nulligravida presented with primary infer-tility for 9 years and polycystic ovarian disease. Her weightwas 72 kg and her height was 161 cm with a body massindex of 27.8 kg/m

Time lapse technology reveals that embryo kinetics are not affected by culture media

ObjectiveTime-lapse technology allows us to use embryo kinetics as potential markers for selection. Previous studies associate some of these markers with a higher implantation. Our objective is to evaluate the effect of culture media on embryo kinetics and to validate these markers for the different media utilized.DesignProspective double blinded cohort study.Materials and Methods723 oocytes were randomly divided at retrieval. Half of the oocytes from each donor were treated with media 1 (Global, USA) (n = 369), the other half with media 2 (Sage, USA) (n = 354). After injection, oocytes were placed inside the Embryoscope (Unisense-Fertilitech, Aahrus-Denmark), an incubator with programmable time-lapse image acquisition. Variables studied included: timing to 2 (T2), 3 (T3), and 4 cells (T4). We also studied variables associated with higher implantation rates such as: timing to 5 cell (T5), length of second cycle (CC2 = t3-t2) and synchrony from 2 to 4 cell embryos (S2 = t4-t3). Optimal ranges proposed for these variables were: 48.8-56.6 hours, < 12 hours and < 0.75 hours respectively.ResultsTabled 1T5S2CC2Out of range48.8-56.6 hOut of range< 0.75 hOut of range< 12 hMedia 1N15092129134126143%62.0%38.0%49.0%51.0%46.8%53.2%Media 2N14396133136131143%59.8%40.2%49.4%50.6%47.8%52.2%P valueNSNSNS Open table in a new tab ConclusionCulture media does not affect embryo kinetics. To the best of our knowledge, this is the first study evaluating culture media based on a continuous dynamic evaluation. The percentage of embryos within optimal ranges is not different. Therefore these markers can be used for embryo selection regardless of the media utilized. ObjectiveTime-lapse technology allows us to use embryo kinetics as potential markers for selection. Previous studies associate some of these markers with a higher implantation. Our objective is to evaluate the effect of culture media on embryo kinetics and to validate these markers for the different media utilized. Time-lapse technology allows us to use embryo kinetics as potential markers for selection. Previous studies associate some of these markers with a higher implantation. Our objective is to evaluate the effect of culture media on embryo kinetics and to validate these markers for the different media utilized. DesignProspective double blinded cohort study. Prospective double blinded cohort study. Materials and Methods723 oocytes were randomly divided at retrieval. Half of the oocytes from each donor were treated with media 1 (Global, USA) (n = 369), the other half with media 2 (Sage, USA) (n = 354). After injection, oocytes were placed inside the Embryoscope (Unisense-Fertilitech, Aahrus-Denmark), an incubator with programmable time-lapse image acquisition. Variables studied included: timing to 2 (T2), 3 (T3), and 4 cells (T4). We also studied variables associated with higher implantation rates such as: timing to 5 cell (T5), length of second cycle (CC2 = t3-t2) and synchrony from 2 to 4 cell embryos (S2 = t4-t3). Optimal ranges proposed for these variables were: 48.8-56.6 hours, < 12 hours and < 0.75 hours respectively. 723 oocytes were randomly divided at retrieval. Half of the oocytes from each donor were treated with media 1 (Global, USA) (n = 369), the other half with media 2 (Sage, USA) (n = 354). After injection, oocytes were placed inside the Embryoscope (Unisense-Fertilitech, Aahrus-Denmark), an incubator with programmable time-lapse image acquisition. Variables studied included: timing to 2 (T2), 3 (T3), and 4 cells (T4). We also studied variables associated with higher implantation rates such as: timing to 5 cell (T5), length of second cycle (CC2 = t3-t2) and synchrony from 2 to 4 cell embryos (S2 = t4-t3). Optimal ranges proposed for these variables were: 48.8-56.6 hours, < 12 hours and < 0.75 hours respectively. ResultsTabled 1T5S2CC2Out of range48.8-56.6 hOut of range< 0.75 hOut of range< 12 hMedia 1N15092129134126143%62.0%38.0%49.0%51.0%46.8%53.2%Media 2N14396133136131143%59.8%40.2%49.4%50.6%47.8%52.2%P valueNSNSNS Open table in a new tab ConclusionCulture media does not affect embryo kinetics. To the best of our knowledge, this is the first study evaluating culture media based on a continuous dynamic evaluation. The percentage of embryos within optimal ranges is not different. Therefore these markers can be used for embryo selection regardless of the media utilized. Culture media does not affect embryo kinetics. To the best of our knowledge, this is the first study evaluating culture media based on a continuous dynamic evaluation. The percentage of embryos within optimal ranges is not different. Therefore these markers can be used for embryo selection regardless of the media utilized.

Comprehensive chromosome screening (CCS) of previously cryopreserved embryos results in excellent ongoing pregnancy rates

Comprehensive chromosome screening (CCS) of previously cryopreserved embryos results in excellent ongoing pregnancy rates

High implantation rates following single embryo transfer provide similar pregnancy rates to multiple embryo transfer using vitrified donor oocytes

High implantation rates following single embryo transfer provide similar pregnancy rates to multiple embryo transfer using vitrified donor oocytes

The role of embryonic stage at biopsy and uterine receptivity at transfer in the clinical outcome of preimplantation genetic screening

To determine whether the improved clinical outcomes observed by various groups following day-5 biopsy (and vitrification) is due to the nature of the biopsy procedure or improved uterine receptivity in a hormone replacement cycle. Retrospective study including preimplantation genetic screening (PGS) performed in a single clinic. All PGS cycles were performed using 9 or 12 fluorescent in situ hybridization (FISH) probes. Patients were divided into five groups as detailed in Table 1 below. Results are summarized in Table 1. There were significant differences in implantation rate, defined as the number of gestational sacs per embryo transferred, in Groups 1 to 3 vs. the control Groups 4 and 5 (P<0.001). A higher implantation rate was noted in Groups 2 and 3 vs. control Group 4, and in control Group 5 vs. control Group 4, but these differences were not statistically significant.Table 1Summary of Results.Day of Biopsy/Transfer Cycle# of CyclesAvg. Age (Yrs)% Normal Embryos# Embryos Transferred# Gestational Sacs% Implantation/TransferGroup 1Day 3 - Fresh ET12539.622.0%1062826.4% aGroup 2Day 3 - Thaw ET2353920.0%1846736.4% aGroup 3Day 5 - Thaw ET9039.534.0%611931.1% aGroup 4No Bx - Fresh Day 5 ET5039.5-2293515.3% bGroup 5No Bx - Thaw Day 5 ET51139.5-74413718.4% ba vs. b P<0.001 (Chi-square test) Open table in a new tab a vs. b P<0.001 (Chi-square test) The results show that the day of biopsy does not have an effect on clinical outcome of PGS by FISH if embryos are cryopreserved and transferred in a natural or hormone-replacement thaw cycle. They further suggest that improved uterine receptivity in a thaw cycle is an advantage for PGS cycles. It would be interesting to see whether the same trends are observed following array-based PGS, which allows comprehensive analysis of chromosome integrity in embryos. A randomized clinical trial is needed to further substantiate these observations.

Increased incidence of monozygotic twins following blastocyst stage transfer

Blastocyst transfer increases implantation rates and supports eSET but may increase imprinting disorders and monozygotic twins (MZT). We investigated MZT rates following BT or cleavage stage (CT) embryo transfer for all fresh IVF cycles performed between 2007-10. Retrospective data review MZT were identified by routine ultrasound at 6-8 weeks as 2 fetal hearts/sac or fetal hearts > no. transferred embryos. MZT rate = MZT events/total clinical pregnancies. Comparisons used t-tests with significance set at p <0.05. Of 4696 ETs, 710 (15.1%) were BT and 3986 (84.9%) were CT. Women in the BT group were younger (35 ± 4, [23-48 yrs] vs 36 ± 4, [22-47]) with more oocytes retrieved (15.4 ± 6, [3-41] vs 9.0 ± 5, [1-43]) compared with the CT group. The mean number of embryos transferred (1.9) was the same in both groups. BT resulted in higher implantation rates (41.6% vs 22.8%), clinical pregnancy rate/ET (53.2% vs 34.2%) and multiple pregnancy rates (42.1% vs 28.0%) compared with CT. Overall MZT rate (1.78 % - 31/1741) differed with ET stage. The 4.5% (17/378) MZT rate after BT was 4 times higher than the 1.03% (14/1363) observed in CT cycles and 10 times that for natural conceptions (0.4%). There was no difference in the MZT rate between ICSI (17/957 = 1.78%) and IVF (14/763 = 1.83%) clinical pregnancies. No difference in overall MZT rate was observed between two different culture media used during the study period (1.94 % (5/258) - Vitrolife and 1.75 % (26/1483) - Sage media). MZT rates following successful embryo biopsy, assisted hatching (AH) and frozen-thawed embryo transfer (FET) cycles were 4.26% (2/47), 2.22% (1/45) and 0% (0/131) respectively. We observed increased MZT following ART which is significantly higher if using blastocyst transfer. We plan to continue monitoring MZT rates and further investigate culture media and specific ART procedures (e.g. biopsy). Patients need to be advised appropriately since MZT carry additional risks beyond those of DZT.

Perinatal outcome of children born after vitrification of blastocysts (5434 Cycles: 11 years experiences)

OBJECTIVE: Vitrification has been recognized as a useful method for cryopreservation of human blastocysts (BLs). However, a major drawback is the use of a relatively high concentration of cryoprotectants, and the higher incidence of MZT(monozygotic twinning). Therefore, we analyzed perinatal incidence after 13 weeks of gestation including the rate of MZT in infants born after vitrified BL. DESIGN: Retrospective analysis. MATERIALS ANDMETHODS: Perinatal outcome were summarized for all patients who had vitrified BL transfer cycles between 2000 and 2010. Vitrification involved the exposure DMSO and EG during the cooling step, and 0.25/0.5 M sucrose solution for warming. The blastocoelic cavity was collapsed with laser pulse, prior to vitrification. After warming, zona hatching was carried out. MZT was defined that the number of FHB was more than that of embryos transferred. RESULTS: A total of 8960 vitrified BLs from 5434 cycles were warmed and 8432 survived (94.1%). In 5347 transfers, 2568 resulted in pregnancy (48.0%). A total of 7532 vitrified BLs were transferred and 2882 were implanted (38.3%). A total of 1751 children(899boys & 852girls) were born in 1533 deliveries. Forty one clinical pregnancies were confirmed as MZT(2.7%). Thirty three cases had either congenital birth defects or perinatal complications (1.9%), including six chromosomal abnormalities (two 18, four 21 trisomy), six multiple anomalies, one stillbirth due to hydropus, four stillbirths of unknown causes, one anencephaly, one spina bifida, nine congential heart malformations, one esophageal and one biliary duct obstruction, one Cornelia De Lange, and one Treacher Collins syndrome. CONCLUSION: The perinatal results of 1517 deliveries of 1735 babies, the incidence rate of MZT (2.7%) and rate of congenital defect and neonatal complication (1.9%) that were both similar to fresh BL transfer as we reported previously (2.3% & 2.0%), confirm the safety of vitrified BL program. Also, the high implantation rate encourages us to establish single BL transfer.

Live birth outcome with trophectoderm biopsy, blastocyst vitrification, and single-nucleotide polymorphism microarray–based comprehensive chromosome screening in infertile patients

The combination of trophectoderm biopsy, blastocyst vitrification, and single-nucleotide polymorphism microarray-based technology for comprehensive chromosome screening results in high implantation and live birth rates that could contribute to the practical application of single embryo transfer for infertility patients.

A review of the promises and pitfalls of oocyte and embryo metabolomics

Embryo viability assessment is one of the most important and challenging tasks in IVF. Evaluation of embryo quality is critical when selecting the best embryo(s) to transfer or cryopreserve. Until recently, the only instrument used for embryo evaluation was the inverted light microscope, which provided information based on morphological characteristics. Developmental and morphological information gained from microscopic assessment have been positively associated with IVF outcomes, including pregnancy and implantation rates. However, based on general statistics, it is clear that IVF currently still results in relatively low pregnancy rates, while simultaneously being associated with relatively high multiple implantation rates. Only with novel embryo assessment and selection procedures would it be possible to improve these outcomes. Accordingly, it has been proposed that it is possible to test the culture environment of a developing embryo to gain valuable information regarding its viability. Different approaches have been used. These include the measurement of oxygen consumption by the embryo and testing of the soluble HLA-G in the environment, as it was proposed that secretion of HLA-G is associated with higher implantation rates. Amino acid turnover, which appears to be correlated to blastocyst development, can be measured as an indication of embryo viability. Other approaches, such as time-lapse video observation or cumulus cell gene expression analysis, may be used in the future to gain a broader understanding of embryo viability. Proteomics and metabolomics are also useful tools for assessment of embryo developmental potential. Results from recent studies on predicting embryo viability by analyzing the metabolome of different stage embryos are promising, as increases in pregnancy and implantation rates were obtained using the metabolomic profile for embryo selection. Several novel approaches are currently being developed to aid in viability assessment. These need to be evaluated in prospective clinical trials, while considering their practicality in the clinical laboratory.

Improvement in pregnancy rate by removal of cervical discharge prior to embryo transfer in ICSI cycles: A randomised clinical trial

The present study aimed to evaluate the effect of removing cervical discharge prior to embryo transfer (ET) on pregnancy rates. Five hundred and thirty women who were candidates for fresh ET in intracytoplasmic sperm injection (ICSI) cycles were randomly allocated to intervention or control groups. In the intervention group, the cervical canal was cleansed using sterile cotton swabs prior to ET. The control group had routine ET. Multiple logistic regression analysis was used to estimate the adjusted effect of removing the cervical discharge on pregnancy rates. There was a significant difference in pregnancy rates between the two groups. The clinical pregnancy rate was 104/265 (39.2%) in the intervention group compared with 60/265 (22.6%) in the control group (P<0.001). The intervention group also had a higher implantation rate (20.5%) compared with the control group (12.2%; P<0.001). Additionally, the live birth rate in the intervention group (33.6%) was significantly higher than in the control group (17.4%; P<0.001). The logistic regression analysis indicated that the odds ratio of pregnancy in the intervention group was 2.297 (95% CI, 1.552-3.399) compared with the control group. Removal of cervical discharge prior to ET may have a significant effect on the rate of implantation, pregnancy and live birth.

Different ART outcomes at increasing peak estradiol levels with long and antagonist protocols: retrospective insights from ten years experience

To evaluate the impact of high estradiol (E2) levels on assisted reproductive technologies outcomes in high responders (≥12 oocytes retrieved) according to the controlled ovarian stimulation protocol (COS) used. Clinical retrospective evaluation of total, clinical pregnancy and implantation rates in ART cycles performed in high responders according to the COS protocol used (long or antagonist) at Pathophysiology Unit of Human Reproduction and Sperm Bank of Pordenone from June 2000 to December 2010. In high responders total, clinical and implantation rates were significantly higher in long if compared with antagonist protocol with peak estradiol level ≤3,000 pg/ml; on the contrary there was a significantly higher implantation rate with antagonist than long protocol with peak estradiol >3,000 pg/ml. However in this subgroup of patients total and clinical pregnancy rates showed only a trend favouring antagonist possibly due to a statistical β error. In high responders long protocol seems to work better than antagonist when peak E2 is lower than 3,000 pg/ml but the opposite may be true for cycles with higher E2 levels.

Mid-follicular LH supplementation in women aged 35–39 years undergoing ICSI cycles: a randomized controlled study

This single-centre, randomized, parallel group, comparative study aimed to identify potential benefits of mid-follicular recombinant human LH (r-HLH) supplementation in women aged 35-39 years undergoing ovarian stimulation for intracytoplasmic sperm injection (ICSI). The main endpoint was the number of metaphase II oocytes retrieved. After pituitary suppression with a gonadotrophin-releasing hormone agonist, ovarian stimulation was initiated with recombinant human FSH (r-HFSH; 300-450 IU/day). On stimulation day 6, patients were randomized to receive r-HFSH alone or r-HFSH + r-HLH (r-HLH 150 IU/day) for the remainder of the stimulation period. Final follicular maturation was triggered with 250 μg of recombinant human chorionic gonadotrophin. After assessing oocyte nuclear maturity, oocyte were fertilized by ICSI and afterwards embryo quality was analyzed. Of the 131 women enrolled, 68 were allocated to r-HFSH alone and 63 to r-HFSH + r-HLH. No significant differences were observed in markers of either oocyte or embryo quality or quantity. However, higher rates of implantation and live birth per started cycle were observed with r-HLH supplementation than with r-HFSH alone. Although additional large studies are required to further investigate these findings, r-HLH supplementation for women aged 35-39 years undergoing ICSI is recommended as it may have a beneficial action on implantation.

Letters to Editor A of bilateral tubal ectopic pregnancy following day 5 embryo transfer

Letters to Editor A of bilateral tubal ectopic pregnancy following day 5 embryo transfer

In vitro and in vivo viability of human blastocysts collapsed by laser pulse or osmotic shock prior to vitrification

This study was designed to investigate whether artificial shrinkage, induced by a laser pulse or hyperosmotic sucrose solutions, improves in vitro survival and/or implantation of vitrified-warmed human expanded blastocysts. Before Cryotop vitrification, the blastocoelic cavity was collapsed either by a laser pulse or sucrose solutions. Non-treated blastocysts were used as control. Post-warm blastocyst survival and implantation after transfer were examined. Implantation rate outcome was retrospectively analyzed by morphological grading and developmental kinetics of post-warm blastocysts. Survival rates in the three groups were high. Implantation rates in the laser-pulse group (59.7%) were comparable with those in the sucrose group (49.3%), and were significantly higher than those in the control group (34.2%). The proportion of blastocysts showing fast development tended to be higher when the blastocysts underwent artificial shrinkage treatment before vitrification. There was no clear correlation between morphology of post-warm blastocysts and implantation rate. Artificial shrinkage treatment before vitrification is associated with an increased probability of fast-developing embryos, resulting in higher implantation rates.

Individual demands of human embryos on IVF culture medium: influence on blastocyst development and pregnancy outcome

The elucidation of the metabolic requirements of human embryos in vivo or in vitro remains, despite being intensively investigated, a work in progress. The adoption of extended embryo culture to the blastocyst stage during the last decade has entailed new challenges. With the increased attention to culture media formulations, more evidence on the sensitivity of embryos to their early environmental conditions is accumulating which might affect phenotype and developmental potential. A retrospective study was conducted that comprised 286 IVF cycles to evaluate the effect of two different culture media on blastocyst development and pregnancy outcome. Embryos were either cultured in a one step or a sequential medium. Higher fertilization rates and augmented blastocyst rates as well as higher implantation rates were observed when embryos were cultured in one step medium (P<0.05). Interestingly, the transfer of two embryos where one embryo was cultured in either medium resulted in a significantly higher rate of twin pregnancies. Although multiple pregnancies should be avoided in assisted reproduction treatment to reduce risks for offspring and mother, this higher frequency of twin pregnancies resulting from the transfer of embryos derived from different culture media suggests that each embryo makes individual demands on its early environment.

Preimplantation genetic screening on patients with meiotic disorders

OBJECTIVE: Meiotic disorders increase the percentage of sperm carrying chromosome abnormalities that can rise the rate of abnormal embryos. The major difficulty in diagnosing meiotic disorders is that they can only be directly diagnosed trough the study of meiosis in testicular biopsies. The two aims of this study have been: 1)To compare the aneuploidy rate in embryos of males with meiotic disturbances with a control group; 2) To analyze the outcomes obtained after the Preimplantation Genetic Screening (PGS) cycles. DESIGN: Prospective cohort study. MATERIALS AND METHODS: The study included 32 patients whose evaluation of meiotic stages, chiasmata count and meiotic characterization resulted abnormal. The analysis was performed in classic meiotic preparations of processed unilateral testicular biopsy. A single blastomere from 185 embryos coming from 42 treatment cycles was evaluated, being abnormal meiosis the only indication for PGS. Biopsy was performed on day 3 embryos and FISH was assessed for chromosomes 13,15,16,18,21,22, X and Y. A control group of 31 fertile couples performing 33 cycles with 200 embryos evaluated was used for statistical comparisons. This group underwent PGS for sex-linked diseases. Fisher's exact tests with Yates correction were used for statistical analysis. RESULTS: When male had abnormal meiosis there was a higher percentage of aneuploid embryos than the control group (57.46 vs 34.0%, p<0.01) gonosome abnormalities (15.47% vs 7.53% p=0.02) and trisomies 13 (4.32% vs 0.05%, p=0.03). However trisomies 21, trisomies 18, haploidy, triploidy and tetraploidy rates were similar. Regarding PGS cycles, both groups obtained comparable clinical pregrancy rate, implantation rate and miscarriage rate (47.06% vs 40.00%; 42.62% vs 34.40%; 12.5% vs 16.7%) being women's mean age and number of embryos replaced similar. CONCLUSION: Meiotic abnormalities have a direct effect on the chromosomal constitution of embryos. PGS should be offered to these patients, because it provides high pregnancy and implantation rate.

Comprehensive chromosome screening significantly improves implantation rates following frozen blastocyst transfer

OBJECTIVE: Blastocyst comprehensive chromosome screening (CCS) of all 23 pairs of chromosomes has demonstrated promising clinical results including higher implantation rates per blastocyst transferred. The aim of this study was to evaluate the contribution of a frozen blastocyst transfer (FBT) incorporating a non-stimulated endometrium, against the transfer of euploid blastocysts, in relation to the observed high implantation rates.