Traditional IVF Research Articles

Assessing the Relationship Between Traditional In Vitro Fertilization and Birth Defects: A Systematic Review and Meta-Analysis

Background Previously published meta-analyses revealed that IVF combined with intracytoplasmic sperm injection (ICSI) had an increased risk of birth defects in children. ICSI is more invasive, expensive, and time-consuming than IVF, but both result in comparable live birth rates. Currently, despite traditional IVF being used less frequently nationally and internationally than combined IVF/ICSI, it is important to understand the relationship between traditional IVF and birth defects due to a paucity of literature. Objective This systematic review and meta-analysis focused on whether traditional IVF techniques increase the risk for “all” birth defects and “major” birth defects in singletons compared to naturally conceived children. Search Strategy PubMed and EMBASE databases adhered to PRISMA guidelines. Selection Criteria Study selection consisted of original publications in English reporting birth defects for IVF singletons vs. naturally conceived children. Data Collection and Analysis Nine selected items from STROBE criteria were employed to rate study quality. Random effect models were used to calculate pooled odds ratios. Results From 916 publications, fifteen studies met eligibility criteria. Eight studies were rated as high quality, while the remaining 7 were rated as medium. A higher rate of “all” birth defects (pooled OR= 1.44 (95% CI:1.15-1.80) as well as a higher risk for “major” birth defects (pooled OR= 1.64; 95% CI: 1.24-2.18) were observed among traditional IVF-conceived singletons compared to naturally conceived children. Conclusions This is the first systematic review and meta-analysis to date to provide the highest available evidence that IVF is associated with “all” and “major” birth defects among IVF singletons compared to naturally conceived infants. Future large prospective studies should employ standardized reporting and uniform protocols for identifying birth defects with consistent diagnostic criteria for both minor and major birth defects, and comparable durations of follow-up in order to obtain an accurate estimate of birth defects after IVF.

Positive Association of the Number of Oocyte Retrieved with the Maternal hCG Concentration in Early Pregnancy Achieved by Vitrified-Warmed Embryo Transfer after In Vitro Maturation

Background: Human chorionic gonadotropin (hCG) is synthesized by trophoblast cells and play a critical effect in early pregnancy. The serum hCG concentration is significantly higher in early gestation period achieved through in vitro maturation (IVM) than that by traditional IVF. Since IVM does not involve ovarian hyperstimulation, we wonder whether the number of oocyte retrieved affect the hCG concentration in early pregnancy achieved by IVM. Methods: The retrospective analysis involved 51 women who delivered singletons were analyzed. The number of oocyte retrieved and the maternal hCG concentration were collected and analyzed. Results: 51 women had delivered singletons through IVM. The mean number of oocytes retrieved was 16.78 ± 11.23, and the hCG concentration was 614.47 ± 445.50 IU/L and 10930.20 ± 7223.17 IU/L at day 14 and 21, respectively. After confounding factors adjusted, the concentration of serum hCG at day 14 and 21 associated significantly with the number of oocyte retrieved. The result of crude linear regression analysis exhibited a positive relationship between the number of oocyte retrieved and the hCG concentration in early gestation. Conclusions: Our results suggested that the number of oocyte retrieved associated positively with the serum hCG level in female with early pregnancies that underwent IVM.

P-501 Sharing motherhood: same-sex female couples’ reasons for choosing shared biological motherhood

Abstract Study question Why do same-sex female couples choose to conceive using shared biological motherhood, where one mother uses her egg and the other gestates the pregnancy? Summary answer Couples consider factors within their family alongside pressures from wider society when choosing to conceive by shared biological motherhood. What is known already Shared biological motherhood (SBM), sometimes known as ‘reciprocal-IVF’, describes a treatment available to same-sex female couples where eggs are retrieved from one prospective mother, fertilised in-vitro with donor sperm, then carried by the other mother, meaning one partner has a gestational connection to their child, and the other has a genetic connection. SBM is growing in popularity across Europe, but it is only available in a few countries due to ongoing ethical debate. Existing research demonstrates the clinical efficacy of SBM (Bodri et al., 2017), but no research has studied the motivations and experiences of mothers who choose this treatment. Study design, size, duration In-depth, semi-structured interviews were carried out separately with genetic and gestational mothers in fifteen families created through shared biological motherhood (n = 30 parents). Children were aged between 0-3 years (M = 22 months). Data were collected between December 2019 and June 2021. Participants/materials, setting, methods Participants were recruited through the London Women’s Clinic. Of the 30 parents, 90% were working in professional or managerial occupations. Interviews addressed a range of topics including treatment choices, experiences of treatment, thoughts and feelings about pregnancy and biological relatedness (genetic and gestational), and the nature of each mother’s relationship with their infant, and with each other. Data were analysed using qualitative content analysis and reflexive thematic analysis methods (Braun & Clarke, 2006; 2019). Main results and the role of chance Preliminary analysis indicates that the reasons prospective parents choose SBM are complex as couples consider factors within their family alongside pressures from wider society. Within-family factors include the desire to have a child that shares biological connections with both parents and the opportunity to protect against rejection from the child in future. Outside the family, SBM offered both parents a social and legal legitimacy that was not guaranteed with traditional IVF. A significant minority of parents understood SBM to be ‘as close as they can get’ to heterosexual reproduction. Decisions regarding who will carry the pregnancy were mediated by parent age and the expected success rate of undergoing IVF. However, the desire to experience pregnancy and feel closeness forged through breastfeeding also shaped these decisions. Around half of families planned to, or already had, completed further round(s) of SBM with the biological roles reversed. Both genetic and gestational mothers identified contradictions in their own feelings regarding the importance of biological relationships in their family. Parents reported that the impact of their genetic or gestational link was limited in day-to-day family life, but they were still grateful that access to SBM meant they both had a biological connection to their child. Limitations, reasons for caution There is a risk of selection bias, with families who have had a more positive experience of SBM being more likely to participate in research, although the diversity observed in the narratives in the sample suggests otherwise. Wider implications of the findings The current findings support existing clinical literature showing that SBM can be a viable and meaningful route to parenthood for same-sex female couples. The complex reasons why reciprocal-IVF appeals to prospective parents should be considered by clinicians and policy makers in the debate surrounding the regulation and practice of SBM. Trial registration number N/A

Extracellular vesicles from seminal plasma improved development of in vitro-fertilized mouse embryos.

In vitro fertilization (IVF) has wide application in human infertility and animal breeding. It is also used for research on reproduction, fertility and development. However, IVF embryos are still inferior to their in vivo counterparts. Some substances in seminal plasma appear to have important roles in embryo development, and during the traditional IVF procedure, the seminal plasma is washed away. In this study, extracellular vesicles (EVs) were concentrated from seminal plasma by ultracentrifugation, visualized using transmission electron microscopy, and particle size distributions and concentrations were determined with a NanoSight particle analyzer. We found particles of various sizes in the seminal plasma, the majority having diameters ranging from 100 to 200 nm and concentrations of 6.07 × 1010 ± 2.91 × 109 particles/ml. Addition of seminal plasma EVs (SP-EVs) to the IVF medium with mouse oocytes and sperm significantly increased the rate of blastocyst formation and the inner cell mass (ICM)/trophectoderm (TE) cell ratio, and reduced the apoptosis of blastocysts. Our findings provide new insights into the role of seminal plasma EVs in mediating embryo development and it suggests that SP-EVs may be used to improve the developmental competence of IVF embryos, which has important significance for assisted reproduction in animals and humans.

Randomized allocation of oocytes to IVF or ICSI for IVF-naïve cases with unexplained infertility in an IVF-ICSI Split protocol favors ICSI to optimize live birth outcomes

In assisted reproduction treatments (ART), applying the ICSI method for fertilization of oocytes rather than traditional IVF method, is regarded as controversial for two reasons, namely utility and safety. Our study examines an IVF-ICSI Split model for couples with unexplained infertility, where male factor is meticulously excluded and ART is conducted by a strict algorithm, a commitment to blastocyst culture, along with single embryo transfers and a high commitment to cryopreservation. From 242 treatment cycles, 3346 oocytes recovered (13.8 per OPU) were randomly allocated to IVF or ICSI and the fertilization rates standardized to the number of 2PNS arising from each group applying the metaphase II oocyte number identified for the ICSI group, as the denominator for both groups. The fertilization rates were significantly higher overall for ICSI (83.2% vs 65.4%; p<0.0001), being most pronounced for women under 40 years. The resultant embryos had equivalent implantation rates in both fresh ET and frozen (FET) cycles with no significant differences in pregnancy rates, miscarriage rates or live birth outcomes indicating equivalent embryo quality. However, there were significantly higher numbers of ICSI-generated embryos cryopreserved and subsequent FET procedures showed higher live birth rates (21 births vs 6 births; p<0.005) and potential livebirths (214 births vs 104 births; p<0.0001). No congenital fetal abnormalities were detected in any of the 199 babies delivered during the study period to December 2020, neither IVF-generated nor ICSI-generated. Whilst the data strongly favors ICSI, there were 2 women (from 26 with fertilization in one arm only) who demonstrated fertilization only in the IVF arm of the study. We conclude that the IVF-ICSI Split model should be undertaken on all IVF-naïve women with unexplained infertility to determine the appropriate fertilization mode, albeit ICSI will be safely preferred for >90% of cases.

Infertility and Intracytoplasmic Sperm Injection (ICSI)

Infertility is generally defined as a Time to pregnancy (TTP) of longer than 12 months among couples who engage in unprotected intercourse in the fertile days of the menstrual cycle, any specific threshold is arbitrary. The prevalence of infertility differs greatly from one country to another, being 15% globally, >30% in some developing countries, and 17-28% in industrialized countries. The term ‘implantation failure’ can be used to describe both patients who have never shown quantifiable signs of implantation such as increased levels of hCG, and those who have increased hCG production without later ultrasound evidence of a gestational sac. Intracytoplasmic sperm injection (ICSI) is a form of assisted reproductive technology in which a single sperm is injected into the cytoplasm of an egg in order to fertilize it. Complete fertilization failure following ICSI is an uncommon occurrence (1–3 percent), although it does occur even when spermatozoa appear to be normal. Furthermore, in some individuals, low to moderate fertilization (30 percent) has been reported in repeated ICSI cycles. Fertilization failure with ICSI is not the same as it is with traditional IVF technique. 60–90 percent of oocytes which showed a fertilization failure in traditional IVF are devoid of sperm nuclei, assuming that sperm ejection or penetration failure is the most common reason for the failure in fertilization process.

Positive Association of the Number of Oocyte Retrievals With the Maternal hCG Concentration in Early Pregnancy After <i>in vitro</i> Maturation

In vitro maturation (IVM), which is widely used for infertile women, offers many benefits, and it does not involve ovarian hyperstimulation. In addition, the serum human chorionic gonadotropin (hCG) level is significantly higher in women with early pregnancies achieved by IVM than in those with pregnancies achieved by traditional IVF. In the present study, we explored the association between the number of oocyte retrievals and the maternal hCG concentration on days 14 and 21 after IVM. Data from 51 women who delivered singletons were analyzed. The mean number of oocytes retrieved was 16.78 ± 11.23, and the hCG concentration was 614.47 ± 445.50 IU/L on day 14 and 10930.20 ± 7223.17 IU/L on day 21. After adjusting for confounding factors, the concentration of maternal serum hCG on days 14 and 21 associated significantly with the number of oocyte retrievals. Crude linear regression analysis showed a positive relationship between the number of oocytes retrieved and the hCG concentration. Our results showed that the number of oocytes retrieved associated positively with the serum hCG concentration in women with early pregnancies that underwent IVM. Our results partially explain the transient changes in the early maternal serum hCG concentration after IVM.

Using a Dielectrophoretic Microfluidic Biochip Enhanced Fertilization of Mouse Embryo in Vitro.

Droplet microfluidics has appealed to many interests for its capability to epitomize cells in a microscale environment and it is also a forceful technique for high-throughput single-cell epitomization. A dielectrophoretic microfluidic system imitates the oviduct of mammals with a microchannel to achieve fertilization in vitro (IVF) of an imprinting control-region (ICR) mouse. We applied a microfluidic chip and a positive dielectrophoretic (p-DEP) force to capture and to screen the sperm for the purpose of manipulating the oocyte. The p-DEP responses of the oocyte and sperm were exhibited under applied bias conditions (waveform AC 10 Vpp, 1 MHz) for trapping 1 min. The insemination concentration of sperm nearby the oocyte was increased to enhance the probability of natural fertilization through the p-DEP force trapping. A simulation tool (CFDRC-ACE+) was used to simulate and to analyze the distribution of the electric field. The DEP microfluidic devices were fabricated using poly (dimethylsiloxane) (PDMS) and ITO (indium tin oxide)-glass with electrodes. We discuss the requirement of sperm in a DEP microfluidic chip at varied concentrations to enhance the future rate of fertilization in vitro for an oligozoospermia patient. The result indicates that the rate of fertility in our device is 17.2 ± 7.5% (n = 30) at about 3000 sperms, compatible with traditional droplet-based IVF, which is 14.2 ± 7.5% (n = 28).

The Future of Cryopreservation in Assisted Reproductive Technologies.

Societal changes and the increasing desire and opportunity to preserve fertility have increased the demand for effective assisted reproductive technologies (ART) and have increased the range of scenarios in which ART is now used. In recent years, the “freeze-all” strategy of cryopreserving all oocytes or good quality embryos produced in an IVF cycle to transfer later—at a time that is more appropriate for reasons of medical need, efficacy, or desirability—has emerged as an accepted and valuable alternative to fresh embryo transfer. Indeed, improvements in cryopreservation techniques (vitrification) and the development of more efficient ovarian stimulation protocols have facilitated a dramatic increase in the practice of elective frozen embryo transfer (eFET). Alongside these advances, debate continues about whether eFET should be a standard treatment option available to the whole IVF population or if it is important to identify patient subgroups who are most likely to benefit from such an approach. Achieving successful outcomes in ART, whether by fresh or frozen embryo transfer, is influenced by a wide range of factors. As well as the efficiency of IVF and embryo transfer protocols and techniques, factors affecting implantation include maternal aging, sperm quality, the vaginal and endometrial microbiome, and peri-implantation levels of serum progesterone. The safety of eFET, both during ART cycles and on longer-term obstetric and neonatal outcomes, is also an important consideration. In this review, we explore the benefits and risks of freeze-all strategies in different scenarios. We review available evidence on the outcomes achieved with elective cryopreservation strategies and practices and how these compare with more traditional IVF cycles with fresh embryo transfers, both in the general IVF population and in subgroups of special interest. In addition, we consider how to optimize and individualize “freeze-all” procedures to achieve successful reproductive outcomes.

Are children born from singleton pregnancies conceived by ICSI at increased risk for congenital malformations when compared to children conceived naturally? A systematic review and meta-analysis.

Since 1992, the development of intra-cytoplasmic sperm injection (ICSI) has allowed infertile couples and couples affected by severe male factor infertility in particular, many of which with a history of failed traditional IVF, to become parents. This has generated considerable controversy over the safety of the procedure for the offspring. This systematic review seeks to determine whether evidence indicates that the use of ICSI increases the risk of congenital malformation in children born from singleton pregnancies versus naturally conceived children. Twenty-one of the 104 publications listed in the literature search were included in the analysis. Observational studies reported mostly an increased risk for congenital malformation; the risk of congenital malformations is 7.1% in ICSI and 4.0% in the general population (OR 1.99 (95% CI [1.87 - 2.11]). However, attributing higher risk solely to ICSI might seem far-fetched, as in vitro and simulation procedures, patient diseases, and ICSI indication may also be associated with higher risk of malformation.

Neonatal outcomes in pregnancies resulting from oocyte donation: a cohort study in Sweden.

BackgroundPregnancies resulting through oocyte donation have been associated with increased risk for adverse outcomes for the mother, such as gestational hypertensive disorders. However, little is known about possible neonatal complications of such pregnancies. The purpose of this study was to evaluate the neonatal health outcomes among singleton pregnancies in a population of relatively young and healthy oocyte recipients in Sweden, taking into account the medical indication leading to treatment.MethodsThis cohort study involved 76 women conceiving with donated oocytes, 149 age-matched nulliparous women conceiving spontaneously and 63 women conceiving after non-donor IVF. Participants were recruited during 2005–2008 and followed up until delivery. Data on neonatal outcomes were retrieved from the National Birth Medical Register and the medical records of oocyte recipients from seven Swedish University Hospitals with IVF clinics. Logistic regression analyses were performed to examine the association of mode of conception and neonatal outcomes, adjusted for maternal age and BMI, gestational age and delivery by cesarean section.ResultsInfants conceived through oocyte donation had higher odds for premature delivery [OR 2.36, 95 % CI (1.02–5.45)], for being small for gestational age [OR 4.23, 95 % CI (1.03–17.42)] and having Apgar score below 7 at 5 min [OR 10.57, 95 % CI (1.21–92.20)] compared to spontaneously conceived infants. Similar trends were observed when comparing infants conceived through oocyte donation to those conceived by traditional IVF. Furthermore, donor oocyte infants had a lower mean birthweight and length compared to autologous oocyte neonates (p = 0.013); however no differences were noted among infants born at term. Neonatal outcomes were more favorable among women with diminished ovarian reserve compared to those with other indications for oocyte donation.ConclusionsInfants conceived after oocyte donation in Sweden have higher odds of being born prematurely and having lower mean birthweight in comparison to non-donor infants.It seems that these unfavorable neonatal outcomes are present despite the age, weight and health restrictions applied to recipients before oocyte donation treatment in Sweden.

Can affordability and access to care be enhanced by minimal stimulation IVF (MS-IVF) and single embryo transfer (SET)?

To analyze cumulative live birth/ongoing pregnancy rates and potential cost savings associated with MS-IVF and single embryo transfer (SET) in good prognosis patients. A retrospective analysis comparing outcomes and costs of MS-IVF and traditional IVF in good prognosis patients. 137 good prognosis patients (defined as age <35, AMH>2.4, AFC>10, BMI <35, with diagnoses of PCOS, stage I-II endometriosis, tubal factor, and/or mild to moderate male factor) underwent MS-IVF or traditional IVF based on patient/physician preferences. FSH/low dose hcg/antagonist protocols were utilized. MS-IVF included 5 days of clomiphene 100mg prior to initiation of 150u FSH. Traditional IVF cycles had a mean starting FSH of 244u FSH. Cycle outcomes and cost analyses of the two groups included all fresh and frozen transfers. The two groups were comparable in age, basal FSH, BMI, and mean embryos transferred, with SET in all but one fresh transfer and all but one frozen transfer. The MS-IVF group was more likely to have a fresh transfer, contributing to cost reduction. 5 MS-IVF cycles were canceled due to low response; this was not statistically significant. There were significant differences in mean total gonadotropins, oocytes retrieved, blastocysts formed, and fresh transfers. SET was utilized to decrease multiple pregnancies while resulting in delivered, ongoing, and cumulative pregnancies higher than U.S. averages (SART 2014). Ongoing fresh, FET, and cumulative pregnancy rates achieved from one stimulation cycle were not statistically different between the two groups. Overall costs were 27% less in the MS-IVF group, while a 24% cost reduction was found on a per live birth/ongoing pregnancy basis. Greater affordability should result in enhanced access to IVF care by offering lower cost MS-IVF to good prognosis patients without sacrificing success. SET can dramatically reduce downstream costs associated with multiple gestation. We propose that MS-IVF combined with SET could be an appealing aspect of fertility benefits for employers and insurers who desire greater subscriber access to affordable IVF care.Tabled 1MS-IVF and Traditional IVF Outcome and Cost ComparisonMS-IVFTraditional IVFp ValueNumber of Stimulation Cycles8354Mean Total FSH Dose (IU's)12092168p<0.01Mean Total Oocytes15.724.1p<0.01Mean Blastocysts7.511.7p<0.01Fresh Transfers/Retrieval53/78 (68%)25/54 (45%)p<0.04Ongoing Pregnancies/Fresh transfer - N (%)33/53 (62%)17/25 (68%)NSOngoing Pregnancies/Frozen Transfer - N (%)28/45 (62%)29/44 (66%)NSOngoing Cumulative Pregnancies/Stimulation Cycle - N (%)61/83 (73%)46/54 (85%)NSMean Number of Transfers to Ongoing Pregnancy1.21.3NSMean Cycle Cost/Stimulation Cycle$14,088.80$19,345.54p<0.01Mean Cost/Live Birth or Ongoing Pregnancy$15,265.91$20,131.72p<0.01 Open table in a new tab

Modified natural cycle IVF increases value and access to care over traditional IVF for good prognosis patients: a decision analytic model and cost effectiveness analysis

Modified natural cycle IVF increases value and access to care over traditional IVF for good prognosis patients: a decision analytic model and cost effectiveness analysis

Differential effects of short co-incubation of gametes and early removal of cumulus cells in patients with different fertilizing capabilities

The objective of this retrospective study was to evaluate the embryological and clinical outcomes of short co-incubation of gametes and early removal of cumulus cells (SCGERCC) in patients with good IVF capability and those with complete fertilization failure treated by rescue intracytoplasmic sperm injection (ICSI). The study included 257 couples with >60% fertilization rate (SCGERCC group) in the SCGERCC cycle, 72 couples with complete fertilization failure in the SCGERCC cycle given early rescue ICSI treatment (early rescue group), and 219 couples who underwent IVF cycles with overnight co-incubation of gametes with >60% fertilization rate (traditional IVF group). The results showed that the SCGERCC group had a higher multi-pronuclei rate (13.34%, P < 0.001) than the early rescue ICSI (5.15%) and traditional IVF (6.15%) groups. The good quality embryo rate was higher in the SCGERCC group, but implantation, clinical pregnancy and live-birth rates (37.21%, 36.92% and 38.20% for SCGERCC, early rescue and traditional IVF groups, respectively) were comparable in all three groups. The study indicated that SCGERCC followed by rescue ICSI helped couples with initial complete fertilization failure attain clinical outcomes comparable with the other two groups, but it significantly increased the multi-pronuclei rate in couples with good fertilizing capabilities.

In vitro fertilization with preimplantation genetic screening improves implantation and live birth in women age 40 through 43

In Vitro Fertilization is an effective treatment for infertility; however, it has relatively low success in women of advanced maternal age (>37) who have a high risk of producing aneuploid embryos, resulting in implantation failure, a higher rate of miscarriage or birth of a child with chromosome abnormalities. The purpose of this study was to compare the implantation, miscarriage and live birth rates with and without preimplantation genetic screening (PGS) of embryos from patients aged 40 through 43 years. This is a retrospective cohort study, comparing embryos screened for ploidy using trophectoderm biopsy and array comparative genomic hybridization to embryos that were not screened. We compared pregnancy outcomes for traditional fresh IVF cycles with day 5 embryo transfers, Frozen Embryo Transfer (FET) cycles without PGS and PGS-FET (FET of only euploid embryos) cycles of patients with maternal ages ranging from 40 to 43 years, undergoing oocyte retrievals during the period between 1/1/2011 and 12/31/2012. The implantation rate of euploid embryos transferred in FET cycles (50.9%) was significantly greater than for unscreened embryos transferred in either fresh (23.8%) or FET (25.4%) cycles. The incidence of live birth per transferred embryo for PGS-FET (45.5%) was significantly greater than for No PGS fresh (15.8%) or No PGS FET (19.0 %) cycles. The incidences of live birth per implanted sac for PGS FET cycles (89.3%), No PGS fresh cycles (66.7%) and No PGS FET cycles (75.0%) were not significantly different. The present data provides evidence of the benefits of PGS with regard to improved implantation and live birth rate per embryo transferred.

Prospective RCT of Autologous Endometrial Coculture Versus Traditional IVF – An Updated Analysis

A contributing factor to poor success rates in IVF may be the suboptimal culture conditions used during fertilization and early embryonic development. This may result in embryos with compromised growth rates and reduced viability. In order to more closely mimic the in vivo preimplantation environment, the culture of embryos on a layer of cells has been developed (coculture). In response to the FDA's 2002 recommendation that only human cell lines be used (due to the concern of xenologous viral transmission) various human cell lines have been studied, in particular autologous endometrial coculture (AECC).

Optimizing the temperature of embryo culture in IVF: a randomized controlled trial

Significant animal data exist to indicate that the temperature in the mammalian reproductive tract is more than one degree cooler than core. Traditional IVF systems culture embryos at 37 C to mirror standard cell culture practice. No study to date has evaluated the relationship between different culture temperatures, embryo development, aneuploidy, and ultimately implantation and delivery rates. This study seeks to compare these outcomes following in vitro culture at 36 and 37 C.

IVF versus ICSI for the fertilization of in-vitro matured human oocytes

Traditional dogma suggests that intracytoplasmic sperm injection (ICSI) should be performed to ensure successful oocyte fertilization in an in-vitro maturation (IVM) cycle. This study postulated that there would be no difference in the fertilization rate when ICSI was compared with IVF. This hypothesis was tested in a randomized trial of IVF versus ICSI in IVM. A total of 150 immature oocytes were collected in eight cycles of IVM for patients diagnosed with polycystic ovarian syndrome (PCOS). Patients were primed with minimal FSH before transvaginal oocyte aspiration. Sibling oocytes were inseminated by 50% IVF and 50% ICSI. There was no significant difference in fertilization, useable or total blastocyst development between the two insemination technique groups. Clinical pregnancy results for combined fresh and cryopreserved transfers were identical between the two insemination techniques with a total of two fresh and five cryopreserved IVF-inseminated embryos resulting in three clinical pregnancies (42.9%) and five fresh and two cryopreserved ICSI-derived embryos resulting in three clinical pregnancies (42.9%). This research has shown IVF to be a legitimate fertilization technique for IVM oocytes in PCOS patients and provides a greater awareness of the use of a fertilization method previously not utilized with IVM.In-vitro maturation (IVM) is an alternative treatment method to traditional IVF. Due to the minimal use of stimulating hormones in this treatment, IVM has a lower risk of ovarian hyperstimulation syndrome, it can be used for fertility preservation in cancer patients and it is more cost conservative. Early research into the effects of IVM showed a hardening effect on the membrane surrounding the egg (the zona pellucida). It was initially believed that, to overcome this hardening in order to allow the egg to be fertilized, spermatozoa would need to be injected into the egg using intracytoplasmic sperm injection. Due to recent advances in hormonal stimulation protocols (FSH priming) and culture conditions, we postulated that, for patients suffering from polycystic ovarian syndrome (PCOS), fertilization, embryo development and clinical pregnancy would not be superior in the injected oocytes compared with those inseminated by IVF. We found that by using the two insemination techniques on sibling oocytes from eight PCOS patients, there was no significant difference in fertilization, useable or total blastocyst development (day 5 or 6 embryos) and that clinical pregnancy results were identical. This research provides a greater awareness of a fertilization technique which is not normally utilized for IVM treatment, providing a less invasive, more cost-effective approach for the patient.

When ONE is the not-so-loneliest number!

When ONE is the not-so-loneliest number!

Preimplantation genetic diagnosis for gender selection: You don’t always get what you want

Parenting children of opposite genders is a powerful motive for parents to seek “sex-selection” services. Medical beneficence and patient autonomy support making these services available. Our goals in this study included data to permit proper patient education, assess outcome, and evaluation of potential biases in this technology. IVF/PGD cases from August 2004 to December 2009 were studied (n = 122). FISH was used to analyze nuclear DNA of biopsied embryos. The variables analyzed were patient age, Day 3 Fluorescent In Situ Hybridization (FISH), the number of fertilized embryos, the number of embryos biopsied, Preimplantation Genetic Diagnosis (PGD) results, the number of embryos transferred, and the fate of remaining embryos. Female embryos were sought in 84 cycles, and male embryos desired in 38 cycles. Couples seeking female offspring had a reduced likelihood of a female-only transfer vs. those seeking males (p < 0.001). No transfer was performed in 32 cases for lack of normal embryos of desired gender. Clinical pregnancy rate per embryo transfer was 30.4%. PGD success rates for gender variety were lower than expected comparative to traditional IVF. In this report we present our clinical experience with IVF/PGD for gender selection. We attempt to analyze which patients seek this specialized treatment and to provide direct clinical and laboratory outcome data from our completed cycles.