In Vitro Fertilization Center Research Articles

Evaluation of Humoral Immunological Profile in Infertile Women after IVF Failure in Baghdad City

Background: An (in Vitro) Fertilization (IVF), means fertilizing an ovum with a spermatozoon outside the body in a culture dish under controlled culture conditions. And It was taken a principle option to treat infertility, which is define as a disease of the reproductive system can be diagnosis by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse. The cause of infertility may be immunological or genetic. A progress was made an in vitro fertilization (IVF) techniques, However the majority of transferred embryos fail to implant. Morphology embryo scoring is the standard procedure for most IVF centers for choosing the best embryo, but remains limited since even the embryos classified as (top quality) may not implant. The initial investigation on the cause recurrent (in vitro) fertilization failure ignites the attention on the reproductive immunology. The production of antibodies is an immunomodulatory factor that causes failure of embryo implantation, and the most commonly studied antibodies in women with implantation failure after IVF procedure , include antiphospholipid (aPL), antisperm antibodies (ASA), and antinuclear antibodies (ANA).Objectives: The aim of this study is to determine the immunological aspects of patients after IVF failure, such as ; antiphospholipid antibodies (aPLs), antinuclear antibodies (ANAs), and anti-sperm antibodies (ASA).Patients, Materials and Method: This prospective study was undertaken on ninety infertile women undergoing in vitro fertilization (IVF) programe. Their age was from 20years to 49 years. Blood specimens were collected from all women, on the day of egg pick up, and screened for all studied parameters by ELISA, and were statistically analyzed.Results: In the present study clinical pregnancy rate was 27.8%. And the present study showed a highly significant difference (P<0.01) in aPL (IgM, IgG) between patients and control group.The data in the present study, demonstrated a highly significant difference (P<0.01) in Antinuclear antibodies (ANAs) between the studied groups. Also a highly significant difference (P<0.01) in Antisperm antibodies (ASAs) between the studied groups.Conclusions: In vitro fertilization (IVF) failure, precisely failed embryo implantation, associated with produced auto-antibodies (anti-phospholipid antibodies, anti-sperm antibodies, and anti-nuclear antibodies), in the sera of the female.

The Role of Inflammatory Hematological Markers in Predicting IVF Success.

Objective:To investigate the predictive role of inflammatory hematological markers on treatment success in in vitro fertilization (IVF) patients.Methods:In this study, we analyzed the data from the patients who admitted to our IVF center, and we recorded demographic characteristics, medical histories, laboratory biomarkers, cycle characteristics, and IVF outcomes from the patients’ files. We assessed the value of white blood cell (WBC) counts, neutrophil/lymphocyte ratio (NLR), monocyte/lymphocyte ratio (MLR), platelet/lymphocyte (PLR), mean platelet volume (MPV) and platelet distribution width (PDW) of the patients from their complete blood count. We compared these values in terms of predicting positive HCG test after embryo transfer (ET).Results:There were 132 patients, of which 63 (47.7%) were treated for male factor, 43 (32.6%) for unexplained infertility, 19 (14.4%) for diminished ovarian reserve, 5 (3.8%) for endometriosis and 2 (1.5%) for hypogonadotropic hypogonadism. After ovarian stimulation and oocyte retrieval, 115 patients underwent embryo transfer, and 28 patients had a positive HCG test (24.3%). The positive HCG group had a statistically lower PLR when compared to the HCG (-) group (p=0.02). In the ROC analysis, PLR was significant in predicting positive HCG (p=0.028). However, when we added other factors to the model, only age and MII oocyte count were successful in predicting pregnancy outcomes in a logistic regression analysis.Conclusion:According our results, inflammatory hematological markers were not effective in predicting IVF success.

How to Reduce the Potential Harmful Effects of Light on Blastocyst Development during IVF

Purpose: Earlier findings revealed the damaging effect of visible light on zygotes and gametes. The aim of our study is to eliminate or significantly reduce the potentially harmful effects of light exposure during in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) and to investigate the effect of light protection on embryo development and implantation. Materials and Methods: To protect sperm cells, oocytes, and embryos from the potential harmful effects of light exposure during laboratory procedures, we created a dark environment for the cells and applied red filters on laboratory lamps and UV or infrared filters in the microscopes in order to eliminate white light exposure of the cells throughout all work stages. Results: The fertilization rate was significantly (p = 0.011) higher in light-protected ICSI cycles. Blastocyst development rates (blastocyst/embryo) were significantly (p < 0.001) higher in light-protected embryos than in those manipulated in conventional light conditions both in IVF (20.9% difference) and ICSI (38.6% difference). Numbers of clinical pregnancies/transfers of ICSI fertilized day 5 blastocysts were also significantly (p = 0.040) higher in light-protected conditions. Conclusions: These data show that light protection has a positive effect on fertilization rate and increases the blastocyst development as well as the number of clinical pregnancies/transfers. Implementation of this light protection method in IVF centers may improve the success rate while maintaining maximal embryo safety.

To study the impact of blood and mucus on embryo transfer catheter tip and IVF outcome

Background: To study the impact of blood and mucus on embryo transfer (ET) catheter tip and in vitro fertilisation (IVF) outcome. Aims: To compare the implantation rate and clinical pregnancy rate of blood and mucus on ET catheter tip. Study setting: Ajanta Hospital and IVF Centre, Lucknow, Uttar Pradesh. Study design: Prospective observational comparative study. Study period: August 2019 to March 2020. Material and methods: In this prospective observational comparative study, 60 patients undergoing IVF-ET were included in the study. Patients were observed for the presence of blood or mucus on the ET catheter tip. The tip of the ET inner catheter was examined under the microscope for the presence of blood or mucus. Statistical analysis: Statistical analysis was performed by the SPSS program of Windows, version 17.0 (SPSS, Chicago, Illinois). Continuous variables being presented as mean ± SD. Normally distributed continuous variables were compared by unpaired t test, whereas the Mann-Whitney U test used for not normally distributed variables. Categorical variables are analyzed by chi square test or Fisher test. P < 0.05 was taken as statistically significant.Results: By this study, it is observed that the implantation rate for mucus group was 66%, whereas for blood group is 20.6% (P value < 0.001). It is observed that the clinical pregnancy rate for mucus group was 66.7%, whereas for blood group was 29.2% (P value = 0.004). Conclusion: A successful ET needs to be smooth, easy to transfer, and have an atraumatic path through cervix and slow transfer of embryos in the endometrium for good implantation rate. This study showed that when blood was present on the ET catheter, there was decreased clinical pregnancy rate and implantation rate, whereas implantation rate (IR) and clinical pregnancy rate (CPR) were unaffected when mucus was present on catheter

Comparison of clinical efficacy of long- versus short-acting gonadotrophin-releasing hormone agonists for pituitary down regulation in In vitro fertilisation cycles.

Gonadotrophin-Releasing Hormone agonist (GnRHa) - long and short acting - is used for pituitary down regulation prior to ovarian stimulation in in vitro fertilisation (IVF) treatment. However, there are controversies in the literature as to their effectiveness, dose of gonadotrophin needed subsequently for ovarian stimulation and the clinical outcome. The objective of the study was to compare the efficacy of single-dose long-acting GnRHa - goserelin - and daily dose short-acting GnRHa - buserelin - for pituitary down regulation and their clinical outcome in IVF treatment. : This prospective comparative study was undertaken at the IVF centre in National Hospital Abuja, a public tertiary hospital in Nigeria. A total of 114 IVF patients were consecutively allocated into either long-acting GnRHa - goserelin - 3.6 mg single dose (Group A) or short-acting GnRHa - buserelin - 0.5 mg daily (Group B) both starting on day 21 of the cycle preceding the IVF treatment. The effects on pituitary down regulation and treatment outcomes were compared. Time taken (days) to achieve down regulation (22.6 ± 4.3 vs. 26.1 ± 8.0; P = 0.084) and the mean number of human menopausal gonadotrophin (HMG) doses used (57.7 ± 13.7 vs. 54.2 ± 16.7; P = 0.222) were similar in the two groups. Although the number of oocytes retrieved (9.9 ± 6.7 vs. 7.2 ± 5.0; P = 0.02) and fertilised (6.2 ± 4.4 vs. 4.6 ± 3.5; P = 0.04) were significantly higher in Group A, there was no statistically significant difference in the number of embryos (4.4 ± 2.6 vs. 4.0 ± 3.0; P = 0.850) and clinical pregnancy rate at 6 weeks (49.2% vs. 43.6%; odds ratio 1.249; confidence interval = 0.579-2.612; P = 0.578) in both the groups. While group B had a significantly higher number of hospital visits (P = 0.0001) as well as a higher number of injections (P = 0.0001), the mean cost of GnRHa and gonadotrophin used was significantly higher in Group A (P = 0.043). Single-dose long-acting GnRHa is as effective as daily dose short-acting GnRHa for pituitary desensitisation prior to controlled ovarian stimulation in IVF cycles.

Assessment of Turkey IVF (In Vitro Fertilization) websites according to the American Society for Reproductive Medicine (ASRM)/Society for Assisted Reproductive Technology (SART) guidelines.

To evaluate websites of in-vitro fertilisation centres in terms of standardised ethical guidelines for advertising. The cross-sectional study was conducted in Turkey from February to April 2017. A total of 148 IVF centre websites were evaluated in terms of objective criteria in accordance with American Medical Association, American College of Obstetricians and Gynaecologists, American Society for Reproductive Medicine / Society for Assisted Reproductive. Technology guidelines for advertising. Websites were surveyed with attention paid to success rates, testimonials, sales promotions, price, psychological support offered as part of the service, regulating / certifying bodies, misleading language, and the ethical principles of autonomy, beneficence, non-maleficence and justice. Data was analysed using SPSS 23. Out of 193 centres, 148(76.7%) had active websites; 104(70.3%) private, 38(25.7%) in university hospitals and 6(4%) in state hospitals. Of them, 103(69.6%) centres used at least one example of misleading language when compared to the relevant guidelines. Among these centres, 82(79.6%) were private, 18(17.5%) university hospitals and 3(2.9%) were state hospitals. A massive majority of websites related to in-vitro fertilisation centres did not follow standardised guidelines for advertising.

Impact of Serum Human Chorionic Gonadotropin and Luteinizing Hormone Receptor Expression to Oocyte Maturation Rate: A Study of Controlled Ovarian Stimulation.

Background:Few studies have assessed the impact of serum human chorionic gonadotropin (hCG) levels before oocyte retrieval and luteinizing hormone receptor (LHR) mRNA expression.Aims:The objective was to assess the correlations between serum hCG levels at 12-h posttrigger granulosa cell LHR mRNA expression during the in vitro fertilization (IVF) cycle with oocyte maturation rate and to determine the cutoff level of serum hCG at 12-h posttrigger.Settings and Design:A cross-sectional was conducted for this study at the IVF center of Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia.Materials and Methods:Recombinant follicle-stimulating hormone was used on day 2 of the menstrual cycle with multiple doses of a gonadotropin-releasing hormone antagonist. Recombinant hCG was used to trigger ovulation. At 12-h posttrigger, hCG serum levels were measured using an enzyme-linked immunosorbent assay.Statistical Analysis:Pearson's correlation coefficient was used to evaluate the correlation between oocyte maturation rates, serum hCG levels, and LHR mRNA levels. Cutoff values were determined using a receiver operating characteristic (ROC) curve.Results:Serum hCG levels were positively correlated (r = 0.467;P < 0.01), and LHR mRNA expression was weakly correlated (r = 0.073; P = 0.701) with oocyte maturation. The cutoff of serum hCG for a high maturation rate was 77 mIU/mL, with an area under the ROC curve of 0.765 (95% confidence interval: 0.598–0.939) andP < 0.001.Conclusion:Oocyte maturation is correlated with serum hCG levels with 77 mIU/mL as the cutoff point for oocyte retrieval.

Luteal phase after conventional stimulation in the same ovarian cycle might improve the management of poor responder patients fulfilling the Bologna criteria: a case series

To assess the clinical contribution of luteal-phase stimulation (LPS) to follicular-phase stimulation (FPS) in a single ovarian cycle (DuoStim) for poor responder patients fulfilling the Bologna criteria. Observational study (years 2015-2017) including women satisfying ≥2 of the following characteristics: maternal age ≥40 years and/or ≤3 oocytes retrieved after previous conventional stimulation and/or reduced ovarian reserve (i.e., antral follicle count <7 follicles or antimüllerian hormone <1.1 ng/mL). The LPS was started regardless of the outcome of the FPS. Private invitro fertilization center. A total of 100 of 297 patients fulfilling the Bologna criteria chose to undergo DuoStim. The FPS and LPS with the same antagonist protocol and agonist trigger, intracytoplasmic sperm injection with ejaculated sperm, preimplantation genetic testing for aneuploidies, and vitrified-warmed euploid single blastocyst transfer. The contribution of LPS to the cumulative live birth rate (CLBR) per intention-to-treat (ITT). Patients (100) underwent FPS (maternal age, 42.1 ± 1.4 y; previous invitro fertilization cycles with ≤3 collected oocytes, 0.7 ± 0.9; antral follicle count, 3.8 ± 1.2 follicles; and antimüllerian hormone, 0.56 ± 0.3 ng/mL). Ninety-one patients completed DuoStim. All patients were included in the analysis. More oocytes were obtained after LPS with similar developmental and chromosomal competence as paired FPS-derived ones. The CLBR per ITT increased from 7% after FPS to 15% after DuoStim. Conversely, the CLBR per ITT among the 197 patients that chose a conventional controlled ovarian stimulation strategy was 8%, as only 17 patients who were not pregnant returned for a second stimulation after the first attempt (drop-out rate, 81%). The LPS-derived oocytes increased the CLBR per ITT in a single ovarian cycle in patients fulfilling the Bologna criteria. The DuoStim strategy is promising to manage this thorny population of patients, especially to avoid discontinuation after a first failed attempt.

Time of morulation and trophectoderm quality are predictors of a live birth after euploid blastocyst transfer: a multicenter study

To investigate whether the morphodynamic characterization of a euploid blastocyst's development allows a higher prediction of a live birth after single-embryo-transfer (SET). Observational cohort study conducted in two phases: training and validation. Private invitro fertilization centers. Euploid blastocysts: 511 and 319 first vitrified-warmed SETs from 868 and 546 patients undergoing preimplantation genetic testing for aneuploidies (PGT-A) in the training and validation phase, respectively. Data collected from time of polar body extrusion to time of starting blastulation, and trophectoderm and inner-cell-mass static morphology in all embryos cultured in a specific time-lapse incubator with a continuous medium. Logistic regressions conducted to outline the variables showing a statistically significant association with live birth. In the validation phase, these variables were tested in an independent data set. Live births per SET. The average live birth rate (LBR) in the training set was 40% (N = 207/511). Only time of morulation (tM) and trophectoderm quality were outlined as putative predictors of live birth at two IVF centers. In the validation set, the euploid blastocysts characterized by tM <80hours and high-quality trophectoderm resulted in a LBR of 55.2% (n = 37/67), while those with tM ≥ 80hours and a low-quality trophectoderm resulted in a LBR of 25.5% (N = 13/51). Time of morulation and trophectoderm quality are better predictors of a euploid blastocyst's reproductive competence. Our evidence was reproducible across different centers under specific culture conditions. These data support the crucial role of morulation for embryo development, a stage that involves massive morphologic, cellular, and molecular changes and deserves more investigation.

Impact of Metformin on IVF Outcomes in Overweight and Obese Women With Polycystic Ovary Syndrome: A Randomized Double-Blind Controlled Trial.

To evaluate the impact of metformin on in vitro fertilization (IVF) outcomes in overweight and obese women with polycystic ovary syndrome (PCOS). This was a randomized double-blind placebo-controlled study ( ClinicalTrials.gov : NCT02910817) carried out in a University IVF Center. The study included 102 overweight and obese women (body mass index [BMI] >24 kg/m2) with PCOS who underwent their first fresh autologous IVF-embryo transfer cycle and agreed to participate in the study. The study participants were randomized into 2 groups: metformin group received metformin (1000 mg per day) at the start of controlled ovarian stimulation (COH) until the day of the pregnancy check, and placebo group received placebo tablets in the same duration. The primary outcome measure was the total number of retrieved oocytes. Both groups were homogenous in baseline demographic characteristics. Metformin group versus the placebo group demonstrated decrease in the mean number of the retrieved oocytes (9.06 ± 4.23 vs 16.86 ± 8.3, P < .01) and similar live birth rate (LBR; 25.5% vs 17.6%, P = .34). The number of fertilized oocytes was lower in the metformin group (5.65 ± 2.66 vs 9 ± 4.55, P < .01). However, the fertilization rate was similar in both groups (62.3% vs 53.4%, P = .10). There was no difference in the implantation rate (15.7% vs 11.8%, P = .32), multiple pregnancy rate (13.4% vs 3.9%, P = .08), or miscarriage rate (23.5% vs 35.7%, P = .46). No cases of ovarian hyperstimulation syndrome (OHSS) were observed in both groups. Short-term administration of metformin to overweight or obese women with PCOS undergoing IVF decreased number of the retrieved oocytes but did not improve the LBR. Metformin use could decrease the number of retrieved oocytes in overweight and obese women with polycystic ovary syndrome undergoing IVF.

Minimal Stimulation Using Letrozole in Poor Responders

Background: Poor responders refer to women who undergo ovarian stimulation with suboptimal response and an optimal treatment for them has yet to be proven. Minimal stimulation which uses lower doses of gonadotropins than standard long protocols had been shown to yield fewer but higher quality embryos. Minimal stimulation had thus been proposed as an option for poor responders who do not benefit from longer and higher cost regimens. The aim of this retrospective study was to evaluate outcomes of poor responders who underwent minimal stimulation using letrozole and whether they are comparable to outcomes of conventional in vitro fertilization (IVF) in a tertiary center in Singapore. Methods: This was a retrospective study of 43 poor responders who underwent minimal stimulation protocol in KK Women Women’s and Children Women’s Hospital IVF center between March 2011 and March 2014. The protocol involved sequential administration of letrozole followed by low-dose gonadotropins and a gonadotropin-releasing hormone (GnRH) antagonist. Primary outcomes included clinical pregnancy rate and live birth rate per patient. A subgroup analysis was done for women undergoing minimal stimulation protocol and having failed conventional IVF protocol in which their outcomes were compared. Results: The average age at time of stimulation was 38.6 years old. Clinical pregnancies were achieved in nine women (20.9%), out of which eight (18.6%) were live births. In the subgroup analysis, cleavage rate obtained in the minimal stimulation protocol was significantly higher at 61.3% compared to the cleavage rate obtained in the conventional IVF cycle at 28.7%. There were no significant differences in the pregnancy and live birth rates of the two cycles. Conclusion: Minimal stimulation protocol using letrozole produces a reasonable live birth rate in poor responders and potentially higher quality oocytes than conventional IVF protocol. J Clin Gynecol Obstet. 2019;8(3):77-80 doi: https://doi.org/10.14740/jcgo557

Cytokines hold promise for human embryo culture in vitro: results of a randomized clinical trial

To evaluate the effects of cytokine enrichment of culture medium on embryological and clinical outcomes after intracytoplasmic sperm injection (ICSI). A randomized clinical trial. Invitro fertilization centers. This trial included 443 ICSI cycles randomized into two groups. This study evaluated the influence of integration of granulocyte-macrophage colony-stimulating factor, heparin-binding epidermal growth factor-like growth factor, and leukemia inhibitory factor into culture media on human embryo development after ICSI. Ongoing pregnancy rate per a randomized participant. Cytokine enrichment of culture medium showed improvement in ongoing pregnancy rate compared with no cytokines (106/224 [47%] vs. 78/219 [36%]; absolute rate difference [ARD] = 12; 95% confidence interval [CI], 2.5-21). This integration of cytokines also showed better rates of live birth (101/224 [45%] vs. 71/219 [33%]; ARD = 13; 95% CI, 4-21) and cumulative live birth (132/224 [60%] vs. 97/219 [44%]; ARD = 12; 95% CI, 4-20) and lower rate of pregnancy loss (27/124 [22%] vs. 37/103 [36%]; ARD = -14; 95% CI, -26 to -2) than conventional medium. Embryos developed in the cytokine-supplemented medium showed better blastocyst formation, quality, cryopreservation, and use than control medium. Integration of cytokines into human embryo culture media showed improvement in embryological and clinical outcomes after ICSI. However, the long-term effect of cytokine enrichment of a medium is still unclear and warrants further studies with longitudinal follow-up. NCT02420886 at ClinicalTrials.gov.

Non-invasive prenatal testing has altered positive predictive value following transfer of a euploid blastocyst

The positive predictive value (PPV) of non-invasive prenatal testing (NIPT) has been reported to range from 91.3-97.2% in the general population (1,2). However, PPV is dependent upon the prevalence of the disease in the population being tested. Patients who undergo in vitro fertilization (IVF) with preimplantation genetic testing for aneuploidy (PGT-A) and transfer a euploid embryo are presumably a lower risk population when compared to the general population. The objective of this study is to explore the PPV for NIPT following transfer of a euploid blastocyst. Retrospective cohort study. All patients at a single IVF center between 2014 and 2018 who pursued pre-implantation genetic testing for aneuploidy (PGT-A) and underwent transfer of a euploid blastocyst between 2014 and 2018 were contacted to request completion of a medical record release form authorizing release of antenatal records. Records were reviewed, and patients who had documentation of an abnormal NIPT were included in this study. Results of any subsequent prenatal or postnatal diagnostic testing were used to classify each positive NIPT as a “true positive” or a “false positive”. The PPV of NIPT was calculated. A total of 1,202 patients eligible for inclusion were contacted for completion of the medical record release form. Five patients with abnormal NIPT following transfer of a euploid blastocyst were identified. Four of these patients (80%) had subsequent definitive prenatal diagnostic testing which revealed a euploid karyotype concordant with their PGT-A results. One patient, who had a PGT-A result indicating 46,XX but a NIPT positive for Turner syndrome, underwent amniocentesis which confirmed Turner mosaicism (45,X karyotype in 80% of cells). Therefore, the PPV of NIPT in this patient cohort was 20%. The PPV of NIPT for patients undergoing transfer of a euploid blastocyst is lower than that for the general population. PGT-A may be more likely to yield inaccurate results in the presence of embryonic mosaicism, as illustrated by the true positive NIPT case in this study cohort. PGT-A is an imperfect screening tool and follow-up antenatal screening is advisable; however, clinicians and patients should recognize that patients undergoing transfer of a euploid blastocyst are at a relatively lower risk for fetal aneuploidy when compared to the general population and, as a result, the PPV of NIPT is altered in this setting.

Elective oocyte freezing for nonmedical reasons: a 6-year report on utilization and in vitro fertilization results from a Swedish center.

Elective oocyte freezing started in Sweden in 2011, a few years after oocyte vitrification was introduced internationally as an effective method for cryopreservation of oocytes. The objective of this study is to describe the age of the women who choose to undergo this procedure, the subsequent utilization of cryopreserved oocytes and the results of autologous in vitro fertilization (IVF). We conducted a descriptive follow-up study of a subset of women at a private IVF center. All women (n=254) who electively vitrified oocytes at Nordic IVF Göteborg between 1 August 2011 and 31 August 2017 were included. Ages at oocyte vitrification and warming, number of vitrified oocytes and results of IVF are presented. A total of 254 women underwent elective oocyte freezing and 38 (15%) of these returned to use their cryopreserved oocytes for autologous IVF before November 2018. In the total cohort, the mean number of vitrified oocytes per woman, undergoing one or more oocyte retrievals, was 7.6 (range 1-37). Their mean age at first vitrification was 36.9years (range 23-43years). The mean ages for the subset of women that subsequently used their oocytes for IVF were 38.7 and 42.7years at vitrification and oocyte warming, respectively. Forty-nine oocyte warming cycles resulting in 42 fresh and 16 frozen embryo transfers, have been performed. Cumulative live birth rate/ongoing pregnancy rates are 63%, 26% and 0% in women of ages 36-37, 38-39 and ≥40years of age at vitrification, respectively. Five babies have been born and there are 5 ongoing pregnancies. Elective oocyte freezing has been offered in Sweden for >7years. The utilization rate has so far been low. Pregnancy results after oocyte warming and IVF are encouraging when oocytes are cryopreserved at an age below 40years.

Worldwide live births following the transfer of chromosomally "Abnormal" embryos after PGT/A: results of a worldwide web-based survey.

Preimplantation genetic testing for aneuploidy (PGT-A) has become increasingly controversial since normal euploid births have been reported following transfer of embryos diagnosed as "abnormal." There is an increasing trend in transferring "abnormal" embryos; but it is still unknown how many IVF centers transfer "abnormal" embryos and with what efficiency. We performed a worldwide web-survey of IVF centers to elucidate PGT-A related practice patterns including transfer of human embryos found "abnormal" by PGT-A. Participating centers reflected in vitro fertilization (IVF) cycles in the USA, Canada, Europe, Asia, South America, and Africa. One hundred fifty-one IVF centers completed the survey; 125 (83%) reported utilization of PGT-A. Europe had the highest utilization (32.3%), followed by the USA and Canada combined at 29.1%. The leading indications for PGT-A were advanced maternal age (77%), followed by recurrent implantation failure (70%), unexplained pregnancy loss (65%), and sex determination (25%); 14% of respondents used PGT-A for all of their IVF cycles; 20% of IVF units reported transfers of chromosomally "abnormal" embryos, and 56% of these took place in the USA, followed by Asia in 20%. Remarkably, 106 (49.3%) cycles resulted in ongoing pregnancies (n = 50) or live births (n = 56). Miscarriages were rare (n = 20; 9.3%). The transfers of "abnormal" embryos by PGT-A offered robust pregnancy and live birth chances with low miscarriage rates. These data further strengthen the argument that PGT-A cannot reliably determine which embryos should or should not be transferred and leads to disposal of many normal embryos with excellent pregnancy potential.

Embryonic cell-free DNA versus trophectoderm biopsy for aneuploidy testing: concordance rate and clinical implications

To study whether embryonic cell-free DNA (cfDNA) in spent blastocyst media is representative of the chromosomal constitution of a blastocyst. Pilot prospective blinded study. Invitro fertilization center and genetics laboratory. A total of 115 trophectoderm (TE) biopsies and spent blastocyst media (SBM) from 46 patients with ages ranging from 32 to 46years, whose indications for preimplantation genetic testing of aneuploidy (PGT-A) were advanced maternal age, recurrent miscarriage, or recurrent implantation failure. Spent blastocyst media collection and TE biopsy. Concordance rates, sensitivity, and specificity between TE biopsies and SBM. Clinical outcomes in cases with euploid TE biopsies and euploid SBM compared with cases with euploid TE and aneuploid SBM. In general, the total concordance rate for ploidy and sex was 78.7%, and sensitivity and specificity were 94.5% and 71.7%, respectively. A significant increase for all parameters was observed for day 6/7 samples compared with day 5 samples, with day 6/7 samples showing total concordance for ploidy and sex of 84%, and sensitivity and specificity of 95.2% and 82.1%, respectively. Ongoing implantation rates in euploid TE/euploid SBM showed a threefold increase compared with euploid TE/aneuploid SBM (52.9% vs. 16.7%, respectively), without reaching significant differences. Interestingly, no miscarriages were observed when TE and SBM were euploidy concordant. These results offer a better understanding of the dynamics of cfDNA during embryo development and despite more basic research being needed, they are reassuring to consider in the future this noninvasive approach as an alternative to TE biopsy for PGT-A.

The Assessment of Short IVF Protocols: Clinical Status and Success Rates Among Women Treated in IVF Center in Prince Rashid Hospital, Jordan

The main objective of conventional ovarian stimulation protocols regarding in vitro fertilization (IVF) is to obtain highest oocyte yields.

The main will of the patients of a private Italian IVF clinic for their aneuploid/affected blastocysts would be donation to research: a currently forbidden choice.

Surplus cryopreserved affected/aneuploid blastocysts may be obtained after in vitro fertilization (IVF) treatments with preimplantation genetic testing (PGT). These embryos are considered not suitable for transfer and may be discarded. Currently, in Italy, an embryo disposition decision (EDD) is not allowed and the frozen/vitrified blastocysts (even if affected/aneuploid) should be kept cryopreserved indefinitely. In this peculiar clinical, social, and legislative scenario, we aimed at assessing the attitudes of the patients towards the fate of these embryos, in case the local regulation would be changed and allow an EDD regarding the surplus affected/aneuploid embryos obtained after PGT. A questionnaire with multiple answers was submitted to 832 patients who obtained affected/aneuploid embryos during a PGT cycle at our private IVF center. They were asked to choose between three putative options with related reasons: everlasting cryopreservation (only option currently available); discard or donate them to research. Overall, 149 patients (18%; 85 women and 64 men) answered the questionnaire. Among them, 84% (n = 126) would choose to donate their affected/aneuploid blastocysts to research, 9% (n = 13) would discard them and only 7% (n = 10) would keep them cryopreserved indefinitely. Donation of the affected/aneuploid blastocysts is the option chosen from most of the respondents (84%; 15% of the eligible patients). These patients are motivated from the altruistic will of incentivating the progress in IVF and/or stem cell research and supporting future couples to limit/solve their infertility/health issues.

Pregnancy Rates in In Vitro Fertilization Are Superior When Trophectoderm Biopsy Is Done Only on Hatching Embryos [40K

INTRODUCTION: In-vitro fertilization (IVF) with trophectoderm embryo biopsy and pre-implantation genetic screening (PGS) for aneuploidy, followed by elective single frozen embryo transfer (eSET) is becoming increasingly popular. However, embryos can be biopsied at various stages of blastocyst development. No studies to date have specifically investigated differences in pregnancy outcomes by timing of embryo biopsy. METHODS: Retrospective study of patients (n=363) at a single IVF center between January 1, 2013 and December 31, 2016 undergoing eSET with PGS. Embryo grading assessed at the time of biopsy and transfer. Pregnancy rates analyzed by embryo expansion, inner cell mass and trophectoderm grading. Statistical analyses performed by t-test, chi squared, Mann Whitney and Fischer exact tests. Interactions between embryo expansion, inner cell mass and trophectoderm grading were analyzed by 2-way ANOVA. IRB approval obtained. RESULTS: Implantation, clinical pregnancy and live birth rates improved significantly (P=.0001) and pregnancy loss decreased substantially (P<.001) with increased embryo expansion and if embryos were hatching at the time of embryo biopsy. For non-expanded or expanded embryos at biopsy, that later hatched at the time of eSET, pregnancy outcomes remained poor (live births 0% and 5.9%). Pregnancy rates from eSET with PGS where embryos were allowed to hatch, were far better than eSET of embryos without PGS. CONCLUSION: Embryos biopsied before they are hatching have extremely poor pregnancy outcomes regardless of how much they expand by the time of eSET. The embryo biopsy on a non-hatching embryo seems to significantly damage the embryo. IVF labs should wait until embryos hatch before performing trophectoderm biopsy.

High prevalence of vitamin D deficiency in Turkish women undergoing in vitro fertilization: A descriptive study

The authors’ aim in this study was to determine the vitamin D levels of Turkish women who were undergoing in vitro fertilization (IVF). The study design was a descriptive cohort study of a total of 208 infertile women at an IVF center in Turkey. Our findings showed that 4.3% of the women had a replete vitamin D level, 23.6% of the women had insufficient vitamin D levels, and 72.1% of women had deficient vitamin D levels. Our findings suggest that much more effective vitamin D support programs should be implemented for women who are seeking to become pregnant.