Embryo Transfer Quality Research Articles

Prevalence, risk factors and obstetric outcomes of zygotic splitting after single embryo transfer cycles

To describe the prevalence, main determining factors and obstetric outcomes of multiple pregnancy due to zygotic splitting after single embryo transfer (sET). We performed a retrospective observational study in 521 clinical pregnancies resulting from cleavage-stage or blastocyst single embryo transfer (sET) following IVF or ICSI cycles with autologous or donated eggs. Fresh and frozen-warmed sET from January 2015 to June 2017 were included, and analyzed for the occurrence of assisted hatching, embryo biopsy for PGT, or insemination type (IVF vs. ICSI). We also evaluated embryo grading, blastocyst expansion grade, and quality of embryo transfer. We retrospectively analysed all pregnancies achieved through single embryo transfers at our center. The population included IVF or ICSI cycles with autologous or donated eggs, and/or their subsequent frozen-thawed cycle. Monozygotic twinning was defined as 2 or more heart beats at 5-6 weeks ultrasound. We analyzed 521 clinical pregnancies resulting from 1708 single embryo transfers in cleavage-stage (N=674) or blastocyst stage (N=1034). The overall MZT rate 2.87% (15/521), accounting for 0.87 % of cleavage stage derived pregnancies (1/115) and 3.45% of blastocyst stage derived pregnancies (14/406, p=0.01). The incidence of MZT was higher with ICSI (14/368) compared to conventional IVF (1/153), although not statistically significant (P=0,08). In the blastocyst transfer group the incidence of MZT was not increased by Assisted Hatching (AH), Preimplantation Genetic Testing (PGT) nor was it affected by type of transfer, (either fresh or frozen) or quality/type of catheter used in the transfer. Fifteen patients with MZT had 10 term deliveries with no neonatal complications, four of which had vanishing embryos, (one of them triple with a double vanishing embryo). One case had placenta accreta and underwent cesarean hysterectomy. Four patients miscarried, 2 in the first trimester and two in the second trimester ( one due to cervical incompetence, and one voluntary interruption, due to a thoracopagus Siamese Twin pregnancy) Finally, one patient delivered at 30 weeks, with twin neonatal demise. Although MZT is a rare event associated with ART it cannot be disregarded due to its potentially serious obstetric consequences, especially in a sET blastocyst transfer program. Monozygotic twinning is increased in blastocyst transfers, and special care should be taken to properly inform prospective parents when blastocysts are transferred.

Assisted reproductive technology : experience with IVF/ICSI.

To analyze success rates of assisted reproduction techniques ART (IVF/ICSI) in couples experiencing subfertility, and factors which may help in predicting treatment outcome. A prospective cohort follow-up study. Study was conducted at Concept Fertility Centre, Karachi, between July 1, 2000 and December 31, 2002. A cohort of 310 couples undergoing 330 in-vitro fertilization (IVF) and intra cytoplasmic sperm injection (ICSI) cycles were followed for treatment outcomes. Predictor variables included age of women, cause of subfertility, drug regimen used for ovulation induction, day of embryo transfer, and ease of embryo transfer. While outcome variables included rates of fertilization, pregnancy, live birth, miscarriages, multiple pregnancies and ovarian hyperstimulation syndrome (OHSS). The overall pregnancy rate was 35.2 %, while takehome live-birth rate was 25.1%. Treatment cycles which were done for male factor only, had higher probability of success as compared to female factors or for unexplained infertility. Patients who underwent transvaginal ovum pick up and embryo transfer (TVOPU + ET) had an overall pregnancy rate of 29.4% as compared to those who underwent frozen embryo transfer (FET) cycles (22.6%). There was no statistically significant difference between pregnancy rates for ovulation induction with recumbent FSH (rFSH) and HMG (32.7% v 33.6%, p-value 0.87). Quality of embryo transfer was significantly better (33.7%, v 24.2%, p-value 0.042) in patients who conceived. Our results are comparable in terms of pregnancy rates, live birth rates and complication rates, to the results reported in international literature. We however, need more data from centres in Pakistan for future reference and research.

Correction: Decreased Sperm Motility Retarded ICSI Fertilization Rate in Severe Oligozoospermia but Good-Quality Embryo Transfer Had Achieved the Prospective Clinical Outcomes

[This corrects the article DOI: 10.1371/journal.pone.0163524.].

Decreased Sperm Motility Retarded ICSI Fertilization Rate in Severe Oligozoospermia but Good-Quality Embryo Transfer Had Achieved the Prospective Clinical Outcomes.

IntroductionSpermatozoa motility is the critical parameter to affect the treatment outcomes during assisted reproductive technologies (ART), but its reproductive capability remains a little informed in condition of severe male factor infertility. This retrospective cohort study aimed to evaluate the effects of reduced sperm motility on the embryological and clinical outcomes in intra-cytoplasmic sperm injection (ICSI) treatment of severe oligozoospermia.Patients and Methods966 cycles (812 couples) of severe oligozoospermia diagnosed by spermatozoa count ≤ 5 × 106/mL and motile spermatozoa ≤ 2 × 106/mL were divided into four groups in according to the number of motile spermatozoa in one ejaculate on the day of oocyte retrieval (Group B—E). The control (Group A) was 188 cycles of moderate oligozoospermia with spermatozoa count > 5 × 106/mL and motile spermatozoa > 2 × 106/mL. All female partners were younger than 35 years of age. Logistic regression analyzed embryological outcomes (the rates of fertilization, cleavage and good-quality embryo) and clinical outcomes (the rates of pregnancy, implantation, early miscarriage and live birth). Quality of embryo transfer (ET) was divided into three classes as continuous factor to test the effects of embryo quality on clinical outcomes.ResultsThe reduction in the number of motile sperm in four groups of severe oligozoospermia gave rise to comparable inability of the fertilization (p < 0.001) and a decreased rate of good-quality embryo at Day 3 (p < 0.001) by compared to the control. The cleavage rate of the derived zygotes was similar to the control. ET classes significantly affected the clinical outcomes (p < 0.001). Class I ET gave rise to similar rates of clinical outcomes between five groups, but Class II and Class III ET retarded the rates of pregnancy, implantation and live birth and this particularly occurred in Group C, D and E. The rate of early miscarriage was not comparably different between groups. Overall rates in all groups were 41.26% clinical pregnancy, 25.74% implantation and 36.32% live birth, which gave live birth to 252 girls and 252 boys.ConclusionsThe reduction of motile spermatozoa in severe oligozoospermia decreased the rates of fertilization and good-quality embryo. Obtaining and transfer of good-quality embryos was the good prognostic to achieve prospective clinical outcomes regardless of the severity of oligozoospermia.

The uselfulness of ultrasound in predicting pregnancy rate in an oocyte donation program

One of the limiting steps in ART success, is the relatively low embryo implantation rate. Among important factors in the implantation process, embryo quality and endometrial adequacy are key factors. Many ART programs have correlated endometrial morphology and width, and the uterine perfusion as measured by transvaginal ultrasound and color Doppler (TV-US) with pregnancy. In previos studies differents ultrasound parameters of endometrial receptivity in patients with ovarian stimulation were evaluated with good correlation between them. Which ones are the better predictors of optimal endometrial receptivity in a oocyte donor cycle ? The aim of this study was to evaluate four good sonographic parameters as a useful predictor of endometrial receptivity in terms of pregnancy rate in an oocyte donation program. Prospective , controlled, study. We evaluated sonographic parameters of uterine receptivity, measured on the day when Progesterone supplementation should begin. 78 consecutive patients whose stimulation endometrial cycle resulted in embryo transfer from fresh oocyte donor cycle, were included in this study. Four ultrasonographic parameters of good prognosis were considered as follow: Endometrial thickness ≥ 7mm, trilaminar endometrial pattern, uterine artery Pulsatility index (PI) ≤ 3 and presence of subendometrial vessels ≥ 4 Two groups were formed accordingly to the number of parameters founded (PF) Group I: 62 patients with ≥ 3 PF Group II: 16 patients with <3 PF Epidemiological data, age, number and quality of embryo transfer, Pregnancy rate and clinical pregnancy rate were evaluated between groups. Student and Fisher Test were used. Epidemiological data between groups were comparable. Patients age was in Gr I 42.6±5.4, in Gr II 43.7±6.8 (pNS). The number of embryo transfered was 3,2 ± 0,7 in Group I and 3,1 ± 0,9 in Group II (pNS). Pregnancy rate 71% (44 / 62) in gr I and 12,5% (2/16) in gr II (p 0.0001). Clinic pregnancy rate 61,3% (38 / 62) in GrI and 12,5 % (2/16) in Gr II ( p<0.0001) This data shows sensibility 75.8%, specificity 43.75%, positive predictive value 70.9% and negative predictive value 87.5%. When three or more parameters of good prognosis were present , a higher pregnancy rate was obtained. The sum of good prognostic sonographic criteria offers a useful tool for predicting success in oocyte donation cycles.

Influencia de la calidad embrionaria y seminal en el síndrome del embrión evanescente

Background The vanishing embryo phenomenon is defined as the spontaneous loss of one or more embryos in a multiple pregnancy without its interruption. The aim of this study was to determine the rate of vanishing embryo syndrome in women with multiple pregnancies conceived by Intracytoplasmic Sperm Injection (ICSI), to analyse the evolution of these pregnancies, and to find a relationship with possible causes, such as embryo and seminal quality. Material and methods A retrospective analysis was performed of 145 multiple pregnancies conceived by ICSI, from January 2004 to December 2008. They were divided in two groups (112 without vanishing syndrome and 33 with any embryo suffering from vanishing syndrome). We then carried out a case-control study in order to compare the neonatal results of single pregnancies with vanishing embryo syndrome. We carried out transvaginal ultrasound monitoring until 12 weeks of gestation. The data were obtained from the centre data base. Results Vanishing embryo syndrome was observed in 22.7% of our patients, with 17.5% of cases being observed in twin pregnancies, and 50% in triple pregnancies. The vanishing embryo rate in multiple pregnancies was significantly lower in the group with two gestational sacs than in the group with three or more gestational sacs ( P < .001). The rate of good quality embryos was significantly higher in the group without vanishing embryos ( P < .001). No differences were observed in terms of age and seminal quality among study groups. Perinatal outcomes of live births were similar in both groups. Conclusion Vanishing embryos rate seems to increase in pregnancies with over two gestational sacs. We observed a relationship between this syndrome and embryo transfer quality.

Embryo transfer quality and provider-specific pregnancy rates in IVF-ET

Objective: Mounting evidence suggests that embryo transfer (et) technique is a significant variable affecting treatment success in ivf-et. using a transfer grading system developed at our institution, physician-specific scoring of embryo transfer procedures was performed to determine if this approach is meaningful and consistent enough to serve as a quality control method for et procedures in ivf-et. Design: Prospective study. Materials and methods: Over a period of 10 consecutive months, all embryo transfers performed by our four physicians were graded at time of the procedure by the attending embryologists using an 8-category scoring system. zero to four points were given for the presence or absence of mucus and blood in or/and around the catheter tip, the type of catheter used, the degree of ultrasound visualisation of the transfer catheter during the transfer, the presence or absence of uterine cramping, the number of times embryos are retained, the number of reloads necessary, as well as the length of the procedure. the transfer grade was based on the total points scored, with grade 1 indicating the best possible technique (0 points scored) and grade 5 the worst (>10 points scored). Pregnancy rates/et, mean embryo quality score, mean number of embryos transferred/et, distribution of day 3 vs day 5/6 et’s, and name of attending embryologists were recorded for the individual physicians (a,b,c,d). fisher’s exact test and anova were used for statistical analysis where appropriate. Results: A total of 291 et’s were performed during the observation period. There was no difference in the mean embryo grade per et, mean number of embryos transferred, d3 vs d5/d6, fresh vs frozen transfers and the distribution of embryologists among physicians. mean embryo transfer grades by physician were 1.4 (a), 1.7 (b), 1.9 (c), 2.0 (d), (p values a: d ∗∗∗<0.001, a: c ∗< 0.05, a: b/b: c /b: d/c: d n.s.). individual pregnancy rates were 62.3% (a), 45.7% (b), 44.4% (c), 47.8% (d) (p values a: d < 0.05, a: c/a: b/c: d/b: d/b: c n.s.). a statistically significant difference in individual mean et grades and mean pregnancy rates/et is limited to the physicians with the lowest and the highest et-score, but these preliminary results demonstrate a trend towards a higher pregnancy rate if the individual physician’s et-score is lower. Conclusion: Further study is needed to analyse the individual components generating a physician’s average et-score. Although preliminary and weakened by small study populations, these data provide encouragement towards continuing efforts to monitor, and ultimately adjust, embryo transfer techniques in an attempt to improve outcome in ivf-et without risking multiple pregnancies.

The effect of embryo transfer on pregnancy rate in an IVF program

Objective: Many factors play a role in the successful outcome of an Assisted Reproductive Technology (ART) cycle. Major factors implicated in ART success are patient age, stimulation protocols, embryo culture environment, and embryo transfer quality. The objective of this study was to determine the relationship between the embryo transfer grading system developed in our laboratory to subsequent clinical pregnancy rate within our patient population.