Vitro Fertilization Research Articles

Is expectant management feasible for select patients diagnosed with a heterotopic tubal pregnancy following in vitro fertilization/intracytoplasmic sperm injection?

BackgroundHeterotopic pregnancy (HP) is a rare type of pathological pregnancy, and the most common site of concomitant ectopic pregnancy (EP) is the fallopian tube. Some studies have shown that expectant treatment could be considered because some EPs tend to regress spontaneously. However, data on the expectant treatment of HP are lacking. This study aimed to examine the outcomes of eutopic pregnancies following expectant management of concomitant tubal EP after in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI).MethodsThis was a retrospective, observational matched cohort study. All patients who conceived with tubal HP (HTP) via IVF/ICSI and were treated expectantly between January 2010 and December 2021 were enrolled. Each HTP patient managed expectantly (A) was randomly matched with one control patient who conceived with a solely eutopic pregnancy (B) and one HTP patient who underwent surgical therapy (C) from our clinical database according to predefined criteria. The expectant group and the control groups were matched for maternal age (MA; ±1 year), gravidity (0; ≥1) and gestational age (GA) at presentation (± 2 days). The pregnancy outcomes of the study group and the control groups were compared.ResultsMore than three-quarters of the EPs in patients treated expectantly were inhomogeneous solid masses (n = 95, 76.6%), and an empty gestational sac was the second most common (n = 18, 14.5%). The rates of live birth (76.6%, 79.0%, 73.4%; P = 0.647 (A versus B); P = 0.557 (A versus C)) and early miscarriage (21.8%, 19.4%, 25.8%; P = 0.637 (A versus B); P = 0.456 (A versus C)) in the expectant group were similar to those in the eutopic group and those in the surgical group. There were no significant differences in of the preterm birth rate (7.3%, 7.3%, 7.3%; P = 1.000 (A versus B); P = 1.000 (A versus C)), perinatal mortality (1.0%, 1.0%, 1.1%; P = 1.000 (A versus B); P = 1.000 (A versus C)), GA at delivery (38.7 ± 2.1, 38.4 ± 2.4, 38.5 ± 2.3 weeks; P = 0.286 (A versus B); P = 0.425 (A versus C)) or birth weight (3294.8 ± 507.2, 3238.2 ± 646.1, 3194.5 ± 452.9 g; P = 0.498 (A versus B); P = 0.157 (A versus C)).ConclusionExpectant management was an option for select women with HTP. The prognoses of the concomitant eutopic pregnancies were comparable to those of the solely eutopic singleton pregnancies and the HTPs managed surgically. The application of this protocol in clinical practice significantly reduces the need for surgical or medical treatment of EP. Notably, close follow-up is required, and patients need to be vigilant and have immediate access to medical resources in case of an emergency.

An additive opinion to the committee opinion of ASRM and SART on the use of preimplantation genetic testing for aneuploidy (PGT-A).

After over 20years of progressively increasing clinical utilization of PGT-A (and its precursors), the American Society for Reproductive Medicine (ASRM) and its daughter society, the Society for Assisted Reproduction (SART), for the first time published a committee opinion clearly acknowledging that "the value of PGT-A as a routine screening test for patients undergoing in vitro fertilization (IVF) has not been demonstrated." This statement is timely and welcome but requires some additions and raises some new questions, among those why, if PGT-A in a general population does not improve IVF cycle outcomes, the routine clinical utilization of PGT-A should continue.

Uniparental disomy (UPD) exclusion in embryos following Preimplantation Genetic Testing for Structural Rearrangements (PGT-SR).

Uniparental disomy (UPD) is a genetic condition which both copies of a chromosome are inherited from a single parent, potentially leading to imprinting disorders. This study aimed to assess the integration of Short Tandem Repeat (STR) analysis into Preimplantation Genetic Testing for Structural Rearrangements (PGT-SR) to assess UPD risk and its impact on selecting euploid embryos for embryo transfer in couples with chromosomal translocations involving imprinted chromosomes. This study evaluated three couples carrying balanced chromosomal translocations: 45,XX,der(13;14)(q10;q10), 46,XX,t(10;11)(q22;q13), and 45,XY,der(14;15)(q10;q10). STR analysis was performed on trophectoderm (TE) biopsies after Whole Genome Amplification (WGA) after PGT-SR analysis using parental blood samples to assess UPD risk in euploid embryos. Haplotyping was conducted with five to six STR markers specific to each rearranged chromosome to detect UPD in euploid embryos. Of the four embryos analyzed across the three families, two couples had euploid embryos that tested negative for UPD. These embryos were successfully transferred, resulting in the birth of two healthy children. In the third family, the euploid embryo also tested negative for UPD but failed to implant after transfer, resulting in no pregnancy. Despite its rarity, UPD involving imprinted chromosomes poses significant clinical risks, as seen in disorders such as Prader-Willi syndrome and Angelman syndrome. This study highlights the importance of integrating UPD screening into PGT-SR protocols, to detect both heterodisomic and isodisomic UPD events minimizing the risk of severe genetic disorders. Integrating STR-based UPD screening within PGT-SR workflows is a reliable and cost-effective strategy that enhances embryo selection and mitigates the risk of imprinting disorders. This approach improves reproductive outcomes for families with chromosomal rearrangements, offering a practical advancement in assisted reproduction.

Advancements and Challenges in Preimplantation Genetic Testing for Aneuploidies: In the Pathway to Non-Invasive Techniques

The evolution of preimplantation genetic testing for aneuploidy (PGT-A) techniques has been crucial in assisted reproductive technologies (ARTs), improving embryo selection and increasing success rates in in vitro fertilization (IVF) treatments. Techniques ranging from fluorescence in situ hybridization (FISH) to next-generation sequencing (NGS) have relied on cellular material extraction through biopsies of blastomeres at the cleavage stage on day three or from trophectoderm (TE) cells of the blastocyst. However, this has raised concerns about its potential impact on embryo development. As a result, there has been growing interest in developing non-invasive techniques for detecting aneuploidies, such as the analysis of blastocoel fluid (BF), spent culture medium (SCM), and artificial intelligence (AI) models. Non-invasive methods represent a promising advancement in PGT-A, offering the ability to detect aneuploidies without compromising embryo viability. This article reviews the evolution and principles of PGT-A, analyzing both traditional techniques and emerging non-invasive approaches, while highlighting the advantages and challenges associated with these methodologies. Furthermore, it explores the transformative potential of these innovations, which could optimize genetic screening and significantly improve clinical outcomes in the field of assisted reproduction.

Value of PGT-A when only one or two blastocysts are obtained: propensity-score matching and cost-effectiveness study.

To compare the effectiveness and cost of in-vitro fertilization (IVF) with or without preimplantation genetic testing for aneuploidy (PGT-A) when only one or two blastocysts are obtained. A dataset was gathered from 1829 patients including 368 non-PGT-A and 1461 PGT-A cycles with one or two blastocysts obtained, between April 2013 and July 2022. Patients were matched 1:1 by propensity-score matching for maternal age, number of metaphase-II oocytes inseminated and number of blastocysts obtained, achieving a database of 242 patients per group. The non-PGT-A and PGT-A groups were compared for differences in live birth rate (LBR) per embryo transfer (ET), cumulative LBR per patient, miscarriage rate (MR) per clinical pregnancy, number of days between oocyte retrieval and conclusion of the IVF cycle (primary outcome), mean expenses incurred at the clinic and incremental cost-effectiveness ratio (ICER). More than twice as many ETs were conducted in the non-PGT-A group compared with the PGT-A group, yet the cumulative LBR per patient was similar between groups (23.6% (95% CI, 18.5-29.5%) vs 27.3% (95% CI, 21.9-33.4%)). This outcome was achieved with a higher LBR per ET (16.2% (95% CI, 12.6-20.5%) vs 41.5% (95% CI, 33.9-49.4%)) and lower MR per clinical pregnancy (30.1% (95% CI, 21.8-42.6%) vs 13.9% (95% CI, 7.5-24.0%)) in the PGT-A group. The MR per patient was also lower in the PGT-A group (9.5% (95% CI, 6.2-14.1%) vs 4.5% (95% CI, 2.4-8.2%)). The mean duration between oocyte retrieval and IVF cycle conclusion was 131 (95% CI, 113-150) days in the non-PGT-A group vs 74 (95% CI, 61-87) days in the PGT-A group (P < 0.001; power = 99.8%). The ICER of PGT-A for the months saved between oocyte retrieval and conclusion of the IVF cycle was €499 overall, ranging between €170 and €2065 according to the number of blastocysts obtained and/or maternal age. The ICER of PGT-A for prevented miscarriages was €18 968, decreasing to €3525 when calculated among patients aged ≥ 35 years with two blastocysts obtained. When conducted in expert IVF clinics for patients indicated for the procedure, PGT-A is clinically valuable even when only one or two blastocysts are obtained. PGT-A reduces the number of ETs and miscarriages while the cumulative LBR per patient remains unaffected, and allows these outcomes to be achieved in a shorter timeframe. The ICER of PGT-A vs non PGT-A decreased as maternal age increased. © 2024 International Society of Ultrasound in Obstetrics and Gynecology.

Efficacy of Surgically Extracted Sperm in Assisted Reproductive Technology

Objectives The objective of this study is to evaluate and compare the efficacy of various sperm extraction techniques used in Assisted Reproductive Technology (ART), focusing on sperm retrieval rates, fertilization rates, and clinical outcomes in patients undergoing fertility treatments. Material and Methods This retrospective observational study was conducted at RISAA IVF, Green Park, New Delhi, from January 2023 to January 2024. The study included male participants diagnosed with azoospermia, who underwent ART procedures such as in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI). Sperm extraction techniques evaluated include percutaneous epididymal sperm aspiration (PESA), testicular sperm aspiration (TESA), and microdissection testicular sperm extraction (micro-TESE). Data were collected from electronic medical records, laboratory reports, and patient charts, focusing on demographic data, sperm retrieval rates, and clinical outcomes. Statistical analysis was performed using SPSS software, with significance set at P &lt; 0.05. Results Surgical sperm retrieval was performed on 11 azoospermic patients. Viable sperm was successfully retrieved using PESA in 18.1% of the patients, while TESA and micro-TESE yielded successful retrievals in 63.6% and 18.1% of the cases, respectively. The overall pregnancy rate achieved through these procedures was 63.6%. No significant difference in pregnancy rates was observed between the different sperm retrieval techniques (P &gt; 0.05). Conclusion The study highlights that PESA, TESA, and micro-TESE are effective sperm extraction techniques for azoospermic patients undergoing ART. The success in sperm retrieval and subsequent pregnancy outcomes underscores the importance of selecting the appropriate method based on individual patient conditions. These findings contribute to the evidence base for optimizing fertility treatments in patients with severe male factor infertility.

Surrogate motherhood regulation in South Africa: Medical and ethico-legal issues in need of reform

Chapter 19 of the Children’s Act No. 32 of 2005 regulates the practice of surrogate motherhood in South Africa and provides legal certainty regarding the rights of the children born as a result of surrogacy, including the rights of the different parties involved. Despite the clarity regarding the legal consequences of human reproduction by artificial fertilisation of women acting as surrogate mothers, some legal gaps and inconsistencies regarding certain medical and ethico-legal issues remain. The purpose of this article is to critically examine selected provisions whose implementation is hampered by a lack of detail or clarity, compromising compliance by the different parties to the surrogate motherhood agreement. The article concludes with recommendations on how some of these issues may be addressed to provide for legal certainty and transparency.

Impact of caesarean scar defects on the success of assisted human reproduction: the NICHE-ART prospective French cohort study protocol

BackgroundThe global increase in caesarean sections (CS), currently at 21.1% of all deliveries, has led to a rise in uterine scar defects, or ‘niches’, at the hysterotomy site. These niches,...

Oxidative stress and antioxidant in pregnancy women conceived by In Vitro fertilization and Intrauterine Insemination

In vitro fertilisation (IVF) is a popular kind of assisted reproduction. Many infertile couples' only hope of becoming babies, this method is among the most popular treatments for infertility. One alternative for treating infertility is intrauterine insemination (IUI), which is simple, safe, inexpensive, and does not involve any intrusive procedures. Oocyte senility and other reproductive issues in females may be caused by oxidative stress (OS), which is the result of high amounts of reactive oxygen species (ROS). Antioxidants have long been used to treat subfertility because they can balance out the elevated levels of ROS that induce OS. Serum levels of superoxide dismutase, catalase, glutathione, reactive oxygen species, and malondialdehyde were measured in relation to age, body mass index (BMI), and the various forms of assisted reproductive technology used by pregnant women in this research. Enzyme-linked immune sorbent assay (ELISA) based on for the detection of SOD,CAT, ROS levels in the serum of pregnant women in the first trimester of pregnancy, while GSH measured by using amino acid analyzer. Results demonstrated a statistically significant drop in serum SOD, CAT, and GSH levels in the IVF, IUI, and SP groups compared to the NP group throughout pregnancy. Even if reactive oxygen species (ROS) and malondialdehyde (MDA) levels rise dramatically. The age and body mass index groups, as well as the three pregnancy groups (IVF, IUI, and SP), did not vary significantly from one another. There is significant decreases in serum GSH, CAT, and SOD during pregnancy corresponding significant increases in serum of ROS and MDA because pregnant women were more capable to oxidative damage than the non-pregnant as show by the decreased antioxidants. There is no significant effect among the groups of pregnant (IVF, IUI, and SP), perhaps because they are similar in age and BMI.

Mosaic embryos: Navigating technical uncertainties in assessing embryo potential.

Since the 1990s, preimplantation tests within in vitro fertilization have promised to enhance the selection of embryos for uterine implantation. However, alongside ethical controversies, these diagnostic techniques often identify a high rate of mosaic embryos-those containing a mix of cells deemed normal and abnormal-creating one of the largest technical challenges related to the testing. These cases raise dilemmas for professionals in assisted reproduction and, more intensely, create challenges for individuals whose embryos are identified as mosaic. This article examines the experiences of a woman who decides to implant a mosaic embryo, focusing on her strategies for managing technical uncertainties and evaluating the embryo's potential. It highlights the essential role that online forums play in this process and examines how users utilize these platforms to gain insights and navigate the complex decisions involved with new biomedical technologies.

Artificial Intelligence in IVF Laboratories: Elevating Outcomes Through Precision and Efficiency

Incorporating artificial intelligence (AI) into in vitro fertilization (IVF) laboratories signifies a significant advancement in reproductive medicine. AI technologies, such as neural networks, deep learning, and machine learning, promise to enhance quality control (QC) and quality assurance (QA) through increased accuracy, consistency, and operational efficiency. This comprehensive review examines the effects of AI on IVF laboratories, focusing on its role in automating processes such as embryo and sperm selection, optimizing clinical outcomes, and reducing human error. AI’s data analysis and pattern recognition capabilities offer valuable predictive insights, enhancing personalized treatment plans and increasing success rates in fertility treatments. However, integrating AI also brings ethical, regulatory, and societal challenges, including concerns about data security, algorithmic bias, and the human–machine interface in clinical decision-making. Through an in-depth examination of current case studies, advancements, and future directions, this manuscript highlights how AI can revolutionize IVF by standardizing processes, improving patient outcomes, and advancing the precision of reproductive medicine. It underscores the necessity of ongoing research and ethical oversight to ensure fair and transparent applications in this sensitive field, assuring the responsible use of AI in reproductive medicine.

Developmental outcomes of very preterm infants conceived through in vitro fertilization

To compare in-hospital and neurodevelopmental (ND) outcomes between very preterm infants conceived spontaneously and those conceived utilizing in vitro fertilization (IVF). A 10-year retrospective study of a large regional, mixed urban and rural population was conducted. IVF conceived infants born <32 0/7 weeks gestational age (GA) were matched 1:2 to control patients who did not undergo any documented assisted reproductive technology (ART) based on GA, birth weight and gender. In-hospital and ND data were analyzed. There were 35,712 live births, including 755 (2.1%) IVF-conceived births (519 [68.7%] full term, 236 [31.3%] preterm, 33 born <32 0/7 weeks GA [14.0%] - including 27 cared for in the HSHS St. John's Hospital NICU with long-term ND data). When compared to 54 controls, these 27 very preterm IVF-conceived infants were more likely to be born to older women (OR 1.21 [1.07-1.35], p = 0.001), but other demographic data (i.e., including primigravida status, length of hospital stay, use of antenatal corticosteroids, mode of delivery, rural residency, etc.) were similar. Compared to other very preterm neonates, IVF conceived very preterm infants were less likely to receive surfactant therapy (9 [33%] vs. 34 [63%], p = 0.104). Other in-hospital outcomes were similar. Data for ND outcomes through 24 months (non-matched data due to loss to follow-up) were also similar between cohorts. Infants born very preterm after IVF conception have similar in-hospital and ND outcomes when compared to other very preterm infants. This is reassuring information that can be shared with individuals considering IVF conception.

The 'golden fleece of embryology' eludes us once again: a recent RCT using artificial intelligence reveals again that blastocyst morphology remains the standard to beat.

Grading of blastocyst morphology is used routinely for embryo selection with good outcomes. A lot of effort has been placed in IVF to search for the prize of selecting the most viable embryo to transfer ('the golden fleece of embryology'). To improve on morphology alone, artificial intelligence (AI) has also become a tool of interest, with many retrospective studies being published with impressive prediction capabilities. Subsequently, AI has again raised expectations that this 'golden fleece of embryology' was once again within reach. A recent RCT however was not able to demonstrate non-inferiority using a deep learning algorithm 'iDAScore version 1' for clinical pregnancy rate when compared to standard morphology. Good blastocyst morphology has again proven itself as a high bar in predicting live birth. We should however not give up on the development of further approaches which may allow us to identify extra features of viable embryos that are not captured by morphology.

The impact of age and number of oocytes retrieved on the cumulative live birth rate in women with poor ovarian response: A 15-year study

BackgroundApproximately 15 % of women undergoing assisted reproductive treatment (ART) fall in the category of poor ovarian reserve defined as the retrieval of three or fewer oocytes following conventional ovarian stimulation with a daily gonadotrophin dose of 150–450 international units, according to the Bologna criteria. Low number of oocytes collected is, therefore, likely to translate to low chance of successful ART treatment. ObjectivesThe objective of the study was to assess if age and number of oocytes retrieved influence the cumulative live birth rate (LBR) in women with poor ovarian response (POR) to controlled ovarian hyperstimulation. Study designWe have used anonymised, prospectively collected data spanning July 2004 until June 2019 on consecutive in vitro fertilisation (IVF) and intra-cytoplasmic sperm injection (ICSI) cycles performed at a tertiary fertility treatment unit. Women who underwent conventional ovarian stimulation with a starting daily gonadotrophin dose of 150–450 IU in their first or second IVF cycle where 1–3 oocytes were retrieved were included in the study, with women where four oocytes were retrieved formed a comparative control group. Only one cycle per patient was included. ResultsA total of 2,516 fresh IVF or ICSI cycles were analyzed. The overall clinical pregnancy and LBR in the cohort of included women were 16.4 % and 12.6 % respectively. The cumulative LBR per patient included was 13.1 %. When adjusting for age, treatment type, FSH at baseline, and daily gonadotrophin dose, a significant increase in cumulative LBR was observed for two (OR 2.63, 95 % CI 1.43–4.81), three (OR 3.74, 95 % CI 2.09–6.68) and four (OR 5.3, 95 %CI- 3.01–9.35) oocytes collected, compared to one oocyte only. A significantly lower chance of successful outcome was noted in women 43–45 years old versus younger age groups, irrespective of number of oocytes collected. ConclusionsIn this large cohort of women with POR, both age and number of oocytes retrieved are independent factors influencing the cumulative LBR after IVF treatment. Irrespective of age, retrieval of one additional oocyte is associated with an increase in the cumulative LBR per oocyte retrieval.

Oocytes Quality Assessment—The Current Insight: A Systematic Review

An overall in vitro fertilization (IVF) outcome is dynamic. Good oocyte quality is important for achieving a better IVF pregnancy. Various methods have been used for OQ assessment (OQA). However, due to inconclusive evidence, one method’s superiority has not been proposed over others. Thus, OQA should be consolidated based on the current evidence for this matter. Our study aims to summarize the current OQA used and compare their recommended methods. Our results revealed that the optimal OQA for cost-effectiveness and clinical implementation is still via morphological assessment. The current method most opted for is total oocyte scoring. Although other methods—follicular fluid evaluation, mitochondria spindle assessment, or live zona imaging—can be applied with better precision, due to cost, additional tools, and expertise, and they should cater to research purposes and selected centers. Our results added value as a current strategy for optimizing OQA in IVF practice, aiming at cost-effectiveness and reproducibility for better clinical implementation.

Effect of basal luteinizing hormone/follicle-stimulating hormone ratio on clinical outcome of In Vitro fertilization in patients with polycystic ovarian syndrome: a retrospective cohort study.

The basal luteinizing hormone (LH) and the prior LH to follicle-stimulating hormone (FSH) ratio (LH/FSH) in polycystic ovarian syndrome (PCOS) are generally higher than those in non-PCOS patients and the general population. The potential negative effects of elevated LH on human reproductive function are highly controversial, as are the effects of down-regulation of LH on reproductive function. The purpose of this study was to evaluate the effect of the basal LH/FSH ratio on the live birth rate of PCOS patients undergoing in vitro fertilization (IVF) cycles. A retrospective analysis was conducted on 698 patients with polycystic ovary syndrome undergoing IVF treatments with a mild stimulation protocol (n = 95) and a gonadotropin-releasing hormone (GnRH) agonist protocol (n = 603). The basal LH/FSH ratio of 2 was used as the cut-off value for further subgroup analysis. The demographic properties, controlled ovarian hyperstimulation (COH) processes, and clinical pregnancy outcomes were compared between groups under each ovulation stimulation protocol. The live birth rate for patients with a LH/FSH ratio ≥ 2 group (56.38%, n = 149) was not statistically different from that of the ones with a ratio < 2 (53.74%, n = 454) in the GnRH agonist protocol (P = 0.576). Correspondingly, the live birth rate for the LH/FSH ratio ≥ 2 group (43.48%, n = 23) also showed no statistical difference from the ratio < 2 group (48.61%, n = 72) in the mild stimulation protocol (P = 0.668). Additionally, LH/FSH ratios had no significant effect on the live birth rate after adjusting for confounders both in the GnRH agonist protocol (adjusted OR: 1.111; 95% CI [0.467-2.642], P = 0.812) and in the mild stimulation protocol (adjusted OR: 4.057; 95% CI [0.431-38.195], P = 0.221). Furthermore, there was no significant difference in the live birth rate between different ovulation stimulation protocols in PCOS patients with the LH/FSH ratio ≥ 2. The live birth rate in IVF outcomes was not affected by an elevated basal LH/FSH ratio in patients with polycystic ovary syndrome. The choice of the GnRH agonist protocol or mild stimulation protocol for ovulation stimulation does not affect the final clinical outcomes either for PCOS patients with a basal LH/FSH ratio ≥ 2.

The Success Rate of Cryopreservation and Thawing of Embryos at Day 3 and Day 5 Following Intracytoplasmic Sperm Injection (ICSI)

Cryopreservation, the technique of freezing and thawing embryos, is essential in in vitro fertilization (IVF) treatments to ensure the long-term preservation of embryos for future use. This innovative study evaluates the effectiveness of these procedures conducted at a private hospital in Tangerang, Indonesia, over a period of seven years (2016-2023), involving 18,000 couples. The design research was conducted retrospectively. The study examined embryos that underwent cryopreservation and subsequent thawing, with data collected on the rates of cell division observed on Day 3 and the rates of blastocyst formation on Day 5 after thawing. The study investigated the rates of cellular division on Day 3 and the development of blastocysts on Day 5 following the thawing process. The findings demonstrated a remarkable cleavage rate of 95.24% and a blastocyst rate of 97.22%. The remarkable results underscore the efficacy of the advanced freezing and thawing techniques employed. This discovery is highly significant since there is an urgent requirement to improve the success rates of in vitro fertilization (IVF) for couples facing infertility. It offers a fresh sense of hope and increased opportunities for establishing successful pregnancies with the improvement of cryopreservation techniques.

Insulin-transferrin-selenium supplementation improves porcine embryo production in vitro.

In vitro production of porcine embryos is a complicated process that includes in vitro maturation (IVM), in vitro fertilization (IVF) and in vitro culture (IVC). Insufficient cytoplasmic maturation, slow zona reaction and improper embryo culture conditions will compromise the efficiency of porcine embryo production in vitro. Previous studies have shown that insulin-transferrin-selenium (ITS) in IVM or IVC medium could improve porcine oocyte maturation, decrease polyspermy fertilization and promote subsequent embryonic development in vitro. However, the effect of ITS both in IVM and IVC media on porcine embryo production in vitro hasn't been elucidated. In this study, we found that 1.0% ITS supplementation in IVM/IVC media promoted the expansion of cumulus cells, raised mitochondrial membrane potential, increased ATP content and reduced ROS level in matured oocytes, improved blastocyst rate and the cell number of blastocyst, simultaneously. In conclusion, the IVM/IVC media supplemented with 1.0% ITS can improve the efficiency of porcine embryo production in vitro.

The composition of commercially available human embryo culture media.

What is the composition of currently available commercial human embryo culture media provided by seven suppliers, for each stage of human preimplantation embryo development? While common trends existed across brands, distinct differences in composition underlined the absence of a clear standard for human embryo culture medium formulation. The reluctance of manufacturers to fully disclose the composition of their human embryo culture media generates uncertainty regarding the culture conditions that are used for human preimplantation embryo culture. The critical role of the embryo culture environment is well-recognized, with proven effects on IVF success rates and child outcomes, such as birth weight. The lack of comprehensive composition details restricts research efforts crucial for enhancing our understanding of its impacts on these outcomes. The ongoing demand for greater transparency remains unmet, highlighting a significant barrier in embryo culture medium optimization. For this study, 47 different human embryo culture media and protein supplements were purchased between December 2019 and June 2020; they comprise complete media (n = 23), unsupplemented media (n = 14), and supplements (n = 10). Unsupplemented media were supplemented with each available supplement from the same brand (n = 33 combinations). All samples were directly frozen in liquid nitrogen and stored at -80°C until composition analysis. We determined the concentrations of 40 components in all samples collected (n = 80). Seven electrolytes (calcium, chloride, iron, magnesium, phosphate, potassium, sodium), glucose, immunoglobulins A, G, and M (IgA, IgG, IgM), uric acid, alanine aminotransferase (ALAT), aspartate aminotransferase (ASAT), and albumin, as well as the total protein concentration, were determined in each sample using a Cobas 8000 Analyser (Roche Diagnostics). Analysis of pyruvate, lactate, carnitine, and 21 amino acids was achieved with Ultra-High Performance Liquid Chromatography-Mass Spectrometry (UPLC-MS/MS). Our analysis showed that generally, the concentrations of components of ready-to-use human embryo culture media align with established assumptions about the changing needs of an embryo during early development. For instance, glucose concentrations displayed a high-low-high pattern in sequential media systems from all brands: 2.5-3 mM in most fertilization media, 0.5 mM or below in all cleavage stage media, and 2.5-3.3 mM in most blastocyst stage media. Continuous media generally resembled glucose concentrations of cleavage stage media. However, for other components, such as lactate, glycine, and potassium, we observed clear differences in medium composition across different brands. No two embryo culture media compositions were the same. Remarkably, even embryo culture media from brands that belong to the same parent company differed in composition. Additionally, the scientific backing for the specific concentrations used and the differences in the composition of sequential media is quite limited and often based on minimal in vivo studies of limited sample size or studies using animal models. N/A. We used a targeted approach and performed a selection of tests which limit the composition analysis to this set of analytes. Comprehensive disclosure and complete transparency concerning the composition of human embryo culture media, including the exact concentration of each component, are crucial for evidence-based improvements of culture media for human preimplantation embryos. This research was supported by ZonMw (https://www.zonmw.nl/en), Programme Translational Research 2 (project number 446002003). M.G. declares an unrestricted research grant from Ferring not related to the presented work, paid to the institution VU Medical Center. The remaining authors have no conflicts of interest to declare. N/A.

Analysis of risk factors for very early preterm and early preterm birth in twins following invitro fertilization and intracytoplasmic sperm injection-assisted pregnancy: Aretrospective study.

To investigate the risk factors influencing very early preterm and early preterm births in twin pregnancies after invitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). This retrospective study analyzed 2042 twin pregnancies that underwent embryo transfer via IVF/ICSI at the Reproductive Center of Sir Run Run Shaw Hospital between January 2019 and December 2022. Spontaneous very early, early preterm, and provider-initiated preterm births were examined separately. Based on gestational age, participants were categorized into three groups: very early preterm birth (<28 weeks), early preterm birth (≥28 to <34 weeks), and ongoing pregnancy (≥34 weeks). Univariate analysis was conducted to assess general conditions, among the three groups. Multiple logistic regression analysis was performed to identify independent risk factors for very early and early spontaneous preterm birth in twin pregnancies. A total of 2042 twin pregnancies were included in the study, with birth rates of 4.36% (89 of 2042) <28 weeks, 12.14% (248 of 2042) ≥28 to <34 weeks, and 83.50% (1705 of 2042) ≥34 weeks. The primary cause of provider-initiated preterm birth <28 weeks was placental factors, while hypertensive disorders of pregnancy (31.11%) were the predominant cause for preterm births ≥28 to <34 weeks. Multiple logistic regression analysis identified the independent risk factors for births <28 weeks (P < 0.05) as cervical cerclage, history of late miscarriage or premature birth, uterine adhesions, primary infertility of polycystic ovary syndrome (PCOS), monochorionic pregnancies, history of cervical surgery, uterine malformations, body mass index ≥25 kg/m2, and uterine longitudinal axis lengths <3.6 cm. Cervical cerclage, main factors of infertility (PCOS), adenomyosis, and uterine longitudinal axis lengths <3.6 cm were identified as independent risk factors for ≥28 to 34 weeks (P < 0.05). It is crucial to consider risk factors during IVF/ICSI treatment because of the high incidence of very early and early preterm twin pregnancies, which can be identified early and properly managed.