Immaculate Conceptions examines devotional writings, religious and literary texts, and visual art that feature the mystery of the immaculacy of the Virgin Mary in the culture of early modern Spain. ...The author's analysis is motivated by the complexity and multivalent capacity of the doctrine and its icon at a time when the debates around Mary's conception imbued all levels of religious and social life. She considers the many interests--political, doctrinal, artistic, and gender-driven--that intersect and compete in the exegesis and textual and visual representations of the Immaculate Conception. She argues that the Immaculate Conception of Mary proved to be a fertile conceptual and ideological field wherein the identities of the Spanish state, local communities, and individuals were negotiated, variously defined, and contested. The study's broader aim is to delineate a speculative category, the religious imagination, defined as a spiritual, intellectual, or artistic pursuit in which the individual is committed to sacred truth yet articulates this truth through contingent, partial, and contextually determined theological propositions. The representational status of the image and its relationship to theories of physical sight and spiritual vision are central to the author's formulation of this category.
The objective of this study was to evaluate the effect of a PGF2α-analogue (PGF) on ovulation and pregnancy rates after timed artificial insemination (TAI) in cattle. In Experiment 1 cows received an ...intravaginal progesterone-releasing device (CIDR) plus 2 mg im of estradiol benzoate (EB) on Day 0. The CIDR devices were removed on Day 8, and all cows received 150 μg im of d-cloprostenol (PGF2α-analogue), 300 IU of eCG and 1 mg of estradiol cypionate (ECP) im. On Day 9, cows were randomly assigned into two groups: 1) ECP Group (n = 17), that did not receive any further treatment; and 2) ECP-PG Group (n = 14) that were given 150 μg of d-cloprostenol (PGF) as adjuvant stimulus for ovulation. No difference between groups was detected in interval for ovulation (P = 0.5), and in the proportion of cows ovulating (P = 0.09). In Experiment 2, multiparous suckling crossbred Aberdeen Angus cows (n = 260), were treated into two groups, similarly as Experiment 1; ECP group (n = 122), and ECP-PG group (n = 138). All females were TAI on Day 10. The proportion of cows treated with ECP that became pregnant was 54.9% (67/122), and cows treated with ECP plus PGF was 55.1% (76/138; P = 0.9). In Experiment 3, 686 Nelore cows, 40 to 50 days postpartum, were treated as Experiment 1 (ECP group), however, on Day 8 cows were divided into 3 groups: ECP Group (n = 216); PGF-SC Group (n = 228), in which cows did not receive ECP and were given an additional subcutaneous injection of PGF on Day 8; and PGF–IM Group (n = 242), in which cows also did not receive ECP on Day 8 and were given an additional injection of PGF im on Day 9. On Day 10, estrus was evaluated at timed AI (TAI). There was no difference in the diameter of the dominant follicle at CIDR removal and at TAI, and pregnancy per AI among groups (P > 0.05). However, the proportion of cows that displayed estrus between CIDR removal and TAI was higher in ECP group than in PGF-SC and PGF-IM groups (P < 0.001). Cows that displayed estrus has higher P/AI than cows that did not (P = 0.008). In conclusion, these results suggested that intramuscular or subcutaneous injection of PGF2α could be successfully used to induce ovulation in cattle undergoing TAI, with similar pregnancy rates when compared with ECP. The subcutaneous injection of PGF on the same day of CIDR removal could be an interesting alternative due it reduces cattle management to obtain similar results.
•Intramuscular or subcutaneous injection of PGF2α could be successfully used to induce ovulation in cattle undergoing TAI;•Cows with estrus expression present higher LF at TAI and P/AI;•Subcutaneous injection of PGF on the same day of CIDR removal could be an interesting alternative due it reduces cattle management with similar results.
Determining the optimal insemination moment for individual cows is complex, particularly when considering the impact of pregnancy on milk production. The effect of pregnancy on the absolute milk ...yield has already been reported in several studies. Currently, there is limited quantitative knowledge about the association between days post conception (DPC) and lactation persistency, based on a lactation curve model, and, specifically, how persistency changes during pregnancy and relates to the days in milk at conception (DIMc). Understanding this association might provide valuable insights to determine the optimal insemination moment. This study, therefore, aimed to investigate the association between DPC and lactation persistency, with an additional focus on the influence of DIMc. Available milk production data from 2005 to 2022 were available for 23,908 cows from 87 herds located throughout the Netherlands and Belgium. Persistency was measured by a lactation curve characteristic decay, representing the time taken to halve milk production after peak yield. Decay was calculated for 8 DPC (0, 30, 60, 90, 120, 150, 180 and 210 d after DIMc) and served as the dependent variable. Independent variables included DPC, DIMc (< = 60, 61–90, 91–120, 121–150, 151–180, 181–210, > 210), parity group, DPC × parity group, DPC × DIMc and variables from 30 d before DIMc as covariates. The results showed an increase in decay, i.e., a decrease in persistency, during pregnancy for both parity groups, albeit in different ways. Specifically, from DPC 150 to DPC 210, multiparous cows showed a higher decline in persistency compared with primiparous cows. Furthermore, a later DIMc (cows conceiving later) was associated with higher persistency. Except for the early DIMc groups (DIMc < 90), DIMc does not impact the change in persistency by gestation. The findings from this study contribute to a better understanding of how DPC and DIMc during lactation influence lactation persistency, enabling more informed decision-making by farmers who wish to take persistency into account in their reproduction management.
The initial ovulatory response during synchronization programs is often low in dairy heifers, largely due to follicular dynamics and hormonal dynamics. Specifically, the progesterone concentration ...(P4) at the time of the first GnRH treatment in a breeding program can influence the LH response, often resulting in a suboptimal ovulatory response. The objective of this study was to determine the effect of the highest label dose 200 μg (100 μg vs. 200 μg) of GnRH (50 μg gonadorelin hydrochloride per mL; Factrel®; Zoetis Inc. Madison, NJ) at the first GnRH of a 6-d CoSynch plus P4 device program on ovulatory response and pregnancy per AI (P/AI) in first service in Holstein heifers. A total of 1308 Holstein heifers were randomly allocated at the beginning of a 6-d CIDR-Synch program, Day 0, to receive either i.m. treatment of 100 μg (2CC, n = 655) or 200 μg (4CC, n = 653) of GnRH. Also, at Day 0, heifers received an intravaginal insert with 1.38 g of P4 (Eazi-Breed CIDR® Cattle Insert; Zoetis Inc., Madison, NJ). On Day 6, the insert was removed, and i.m. treatment of 25 mg of PGF2α (12.5 mg dinoprost tromethamine/mL; Lutalyse® HighCon Injection Zoetis) was administered. On Day 7, a second i.m. treatment of 25 mg of PGF2α was given, followed on Day 9 by concurrent i.m. treatment of 100 μg of GnRH and timed AI (TAI). A subset of 396 heifers had their ovaries scanned to evaluate ovulatory response, and blood samples were collected to measure the serum concentration of P4 at Day 0 and Day 6 of the study. The P4 concentrations at Day 0 were categorized as Low (≤3ng/mL) or High (>3ng/mL). The ovulatory response was greater for heifers receiving 4CC than 2CC at Day 0 (54.7% vs. 42.8%). The ovulatory response was greater for Low P4 than High P4 at Day 0 (54.3% vs. 37.8%). However, there was not an interaction between treatment and P4 concentrations (Low P4 2CC = 48.6% vs. High P4 2CC = 30.0%; Low P4 4CC = 60.0% vs. High P4 4CC = 45.5%). The ROC curve analysis indicates that P4 concentrations at Day 0 treatment could predict the ovulatory response, although the area under the curve was only 0.6. As expected, heifers that ovulated had increased P/AI (No = 55.6% vs. Yes = 67.7%); however, there was no effect of treatment on P/AI (2CC = 63.3% vs. 4CC = 59.6%), nor interactions between treatment and ovulation and treatment and P4 (HIGH vs LOW) for pregnancy outcomes. In summary, P4 concentration and increasing the dose of GnRH at Day 0 positively impacted ovulatory response in Holstein heifers. However, there was no interaction between treatment and P4 on ovulation and no subsequent impact of GnRH dose on P/AI.
Cycle regimens for frozen‐thawed embryo transfer Ghobara, Tarek; Gelbaya, Tarek A; Ayeleke, Reuben Olugbenga ...
Cochrane database of systematic reviews,
07/2017, Letnik:
2017, Številka:
7
Journal Article
Recenzirano
Odprti dostop
Background
Among subfertile couples undergoing assisted reproductive technology (ART), pregnancy rates following frozen‐thawed embryo transfer (FET) treatment cycles have historically been found to ...be lower than following embryo transfer undertaken two to five days following oocyte retrieval. Nevertheless, FET increases the cumulative pregnancy rate, reduces cost, is relatively simple to undertake and can be accomplished in a shorter time period than repeated in vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI) cycles with fresh embryo transfer. FET is performed using different cycle regimens: spontaneous ovulatory (natural) cycles; cycles in which the endometrium is artificially prepared by oestrogen and progesterone hormones, commonly known as hormone therapy (HT) FET cycles; and cycles in which ovulation is induced by drugs (ovulation induction FET cycles). HT can be used with or without a gonadotrophin releasing hormone agonist (GnRHa). This is an update of a Cochrane review; the first version was published in 2008.
Objectives
To compare the effectiveness and safety of natural cycle FET, HT cycle FET and ovulation induction cycle FET, and compare subtypes of these regimens.
Search methods
On 13 December 2016 we searched databases including Cochrane Gynaecology and Fertility's Specialised Register, CENTRAL, MEDLINE, Embase, PsycINFO and CINAHL. Other search sources were trials registers and reference lists of included studies.
Selection criteria
We included randomized controlled trials (RCTs) comparing the various cycle regimens and different methods used to prepare the endometrium during FET.
Data collection and analysis
We used standard methodological procedures recommended by Cochrane. Our primary outcomes were live birth rates and miscarriage.
Main results
We included 18 RCTs comparing different cycle regimens for FET in 3815 women. The quality of the evidence was low or very low. The main limitations were failure to report important clinical outcomes, poor reporting of study methods and imprecision due to low event rates. We found no data specific to non‐ovulatory women.
1. Natural cycle FET comparisons
Natural cycle FET versus HT FET
No study reported live birth rates, miscarriage or ongoing pregnancy.
There was no evidence of a difference in multiple pregnancy rates between women in natural cycles and those in HT FET cycle (odds ratio (OR) 2.48, 95% confidence interval (CI) 0.09 to 68.14, 1 RCT, n = 21, very low‐quality evidence).
Natural cycle FET versus HT plus GnRHa suppression
There was no evidence of a difference in rates of live birth (OR 0.77, 95% CI 0.39 to 1.53, 1 RCT, n = 159, low‐quality evidence) or multiple pregnancy (OR 0.58, 95% CI 0.13 to 2.50, 1 RCT, n = 159, low‐quality evidence) between women who had natural cycle FET and those who had HT FET cycles with GnRHa suppression. No study reported miscarriage or ongoing pregnancy.
Natural cycle FET versus modified natural cycle FET (human chorionic gonadotrophin (HCG) trigger)
There was no evidence of a difference in rates of live birth (OR 0.55, 95% CI 0.16 to 1.93, 1 RCT, n = 60, very low‐quality evidence) or miscarriage (OR 0.20, 95% CI 0.01 to 4.13, 1 RCT, n = 168, very low‐quality evidence) between women in natural cycles and women in natural cycles with HCG trigger. However, very low‐quality evidence suggested that women in natural cycles (without HCG trigger) may have higher ongoing pregnancy rates (OR 2.44, 95% CI 1.03 to 5.76, 1 RCT, n = 168). There were no data on multiple pregnancy.
2. Modified natural cycle FET comparisons
Modified natural cycle FET (HCG trigger) versus HT FET
There was no evidence of a difference in rates of live birth (OR 1.34, 95% CI 0.88 to 2.05, 1 RCT, n = 959, low‐quality evidence) or ongoing pregnancy (OR 1.21, 95% CI 0.80 to 1.83, 1 RCT, n = 959, low‐quality evidence) between women in modified natural cycles and those who received HT. There were no data on miscarriage or multiple pregnancy.
Modified natural cycle FET (HCG trigger) versus HT plus GnRHa suppression
There was no evidence of a difference between the two groups in rates of live birth (OR 1.11, 95% CI 0.66 to 1.87, 1 RCT, n = 236, low‐quality evidence) or miscarriage (OR 0.74, 95% CI 0.25 to 2.19, 1 RCT, n = 236, low‐quality evidence) rates. There were no data on ongoing pregnancy or multiple pregnancy.
3. HT FET comparisons
HT FET versus HT plus GnRHa suppression
HT alone was associated with a lower live birth rate than HT with GnRHa suppression (OR 0.10, 95% CI 0.04 to 0.30, 1 RCT, n = 75, low‐quality evidence). There was no evidence of a difference between the groups in either miscarriage (OR 0.64, 95% CI 0.37 to 1.12, 6 RCTs, n = 991, I2 = 0%, low‐quality evidence) or ongoing pregnancy (OR 1.72, 95% CI 0.61 to 4.85, 1 RCT, n = 106, very low‐quality evidence).
There were no data on multiple pregnancy.
4. Comparison of subtypes of ovulation induction FET
Human menopausal gonadotrophin(HMG) versus clomiphene plus HMG
HMG alone was associated with a higher live birth rate than clomiphene combined with HMG (OR 2.49, 95% CI 1.07 to 5.80, 1 RCT, n = 209, very low‐quality evidence). There was no evidence of a difference between the groups in either miscarriage (OR 1.33, 95% CI 0.35 to 5.09,1 RCT, n = 209, very low‐quality evidence) or multiple pregnancy (OR 1.41, 95% CI 0.31 to 6.48, 1 RCT, n = 209, very low‐quality evidence).
There were no data on ongoing pregnancy.
Authors' conclusions
This review did not find sufficient evidence to support the use of one cycle regimen in preference to another in preparation for FET in subfertile women with regular ovulatory cycles. The most common modalities for FET are natural cycle with or without HCG trigger or endometrial preparation with HT, with or without GnRHa suppression. We identified only four direct comparisons of these two modalities and there was insufficient evidence to support the use of either one in preference to the other.
Background
In vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI) treatments conventionally consist of a fresh embryo transfer, possibly followed by one or more cryopreserved embryo ...transfers in subsequent cycles. An alternative option is to freeze all suitable embryos and transfer cryopreserved embryos in subsequent cycles only, which is known as the 'freeze all' strategy. This is the first update of the Cochrane Review on this comparison.
Objectives
To evaluate the effectiveness and safety of the freeze all strategy compared to the conventional IVF/ICSI strategy in women undergoing assisted reproductive technology.
Search methods
We searched the Cochrane Gynaecology and Fertility Group Trials Register, CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, and two registers of ongoing trials from inception until 23 September 2020 for relevant studies, checked references of publications found, and contacted study authors to obtain additional data.
Selection criteria
Two review authors (TZ and MZ) independently selected studies for inclusion, assessed risk of bias, and extracted study data. We included randomised controlled trials comparing a 'freeze all' strategy with a conventional IVF/ICSI strategy including a fresh embryo transfer in women undergoing IVF or ICSI treatment.
Data collection and analysis
The primary outcomes were cumulative live birth rate and ovarian hyperstimulation syndrome (OHSS). Secondary outcomes included effectiveness outcomes (including ongoing pregnancy rate and clinical pregnancy rate), time to pregnancy and obstetric, perinatal and neonatal outcomes.
Main results
We included 15 studies in the systematic review and eight studies with a total of 4712 women in the meta‐analysis. The overall evidence was of moderate to low quality. We graded all the outcomes and downgraded due to serious risk of bias, serious imprecision and serious unexplained heterogeneity. Risk of bias was associated with unclear blinding of investigators for preliminary outcomes of the study during the interim analysis, unit of analysis error, and absence of adequate study termination rules. There was an absence of high‐quality evidence according to GRADE assessments for our primary outcomes, which is reflected in the cautious language below.
There is probably little or no difference in cumulative live birth rate between the 'freeze all' strategy and the conventional IVF/ICSI strategy (odds ratio (OR) 1.08, 95% CI 0.95 to 1.22; I2 = 0%; 8 RCTs, 4712 women; moderate‐quality evidence). This suggests that for a cumulative live birth rate of 58% following the conventional strategy, the cumulative live birth rate following the 'freeze all' strategy would be between 57% and 63%.
Women might develop less OHSS after the 'freeze all' strategy compared to the conventional IVF/ICSI strategy (OR 0.26, 95% CI 0.17 to 0.39; I2 = 0%; 6 RCTs, 4478 women; low‐quality evidence). These data suggest that for an OHSS rate of 3% following the conventional strategy, the rate following the 'freeze all' strategy would be 1%.
There is probably little or no difference between the two strategies in the cumulative ongoing pregnancy rate (OR 0.95, 95% CI 0.75 to 1.19; I2 = 31%; 4 RCTs, 1245 women; moderate‐quality evidence).
We could not analyse time to pregnancy; by design, time to pregnancy is shorter in the conventional strategy than in the 'freeze all' strategy when the cumulative live birth rate is comparable, as embryo transfer is delayed in a 'freeze all' strategy. We are uncertain whether the two strategies differ in cumulative miscarriage rate because the evidence is very low quality (Peto OR 1.06, 95% CI 0.72 to 1.55; I2 = 55%; 2 RCTs, 986 women; very low‐quality evidence) and cumulative multiple‐pregnancy rate (Peto OR 0.88, 95% CI 0.61 to 1.25; I2 = 63%; 2 RCTs, 986 women; very low‐quality evidence). The risk of hypertensive disorders of pregnancy (Peto OR 2.15, 95% CI 1.42 to 3.25; I2 = 29%; 3 RCTs, 3940 women; low‐quality evidence), having a large‐for‐gestational‐age baby (Peto OR 1.96, 95% CI 1.51 to 2.55; I2 = 0%; 3 RCTs, 3940 women; low‐quality evidence) and a higher birth weight of the children born (mean difference (MD) 127 g, 95% CI 77.1 to 177.8; I2 = 0%; 5 RCTs, 1607 singletons; moderate‐quality evidence) may be increased following the 'freeze all' strategy. We are uncertain whether the two strategies differ in the risk of having a small‐for‐gestational‐age baby because the evidence is low quality (Peto OR 0.82, 95% CI 0.65 to 1.05; I2 = 64%; 3 RCTs, 3940 women; low‐quality evidence).
Authors' conclusions
We found moderate‐quality evidence showing that one strategy is probably not superior to the other in terms of cumulative live birth rate and ongoing pregnancy rate. The risk of OHSS may be decreased in the 'freeze all' strategy. Based on the results of the included studies, we could not analyse time to pregnancy. It is likely to be shorter using a conventional IVF/ICSI strategy with fresh embryo transfer in the case of similar cumulative live birth rate, as embryo transfer is delayed in a 'freeze all' strategy. The risk of maternal hypertensive disorders of pregnancy, of having a large‐for‐gestational‐age baby and a higher birth weight of the children born may be increased following the 'freeze all' strategy. We are uncertain if 'freeze all' strategy reduces the risk of miscarriage, multiple pregnancy rate or having a small‐for‐gestational‐age baby compared to conventional IVF/ICSI.
The quality pioneer Dr. Joseph M. Juran first proposed the idea of quality by design. According to him, pharmaceutical quality by design is an organised approach to product development that starts ...with predetermined goals and places an emphasis on product, process understanding, control based on reliable science and quality risk management. The quality of a product or process can typically be affected by a number of input elements. Design of experiments has been employed widely recently to understand the impacts of multidimensional and interactions of input parameters on the output responses of analytical procedures and pharmaceutical goods. Depending on the design of experiments objectives, screening, characterization, or optimization of the process and formulation, a variety of designs, such as factorial or mixture, can be used. The most popular designs used in the stage of screening or factor selection are the 2-Level Factorial and Plackett-Burman designs, both of which have two levels for each factor (k), both economical and effective, and in optimization widely used designs in this step are full factorial at three levels, central composite, Box-Behnken design. The analysis of variance, regression significance, and lack of fit of the regression model were some of the key topics covered in the discussion of the main components of multiple regression model adjustment. Design of experiments is thus the primary element of the formulation and analytical quality by design. The details about design of experiments used for the analysis of pharmaceutical formulation using HPLC.
Background
In in vitro fertilisation (IVF) with or without intracytoplasmic sperm injection (ICSI), selection of the most competent embryo(s) for transfer is based on morphological criteria. However, ...many women do not achieve a pregnancy even after 'good quality' embryo transfer. One of the presumed causes is that such morphologically normal embryos have an abnormal number of chromosomes (aneuploidies). Preimplantation genetic testing for aneuploidies (PGT‐A), formerly known as preimplantation genetic screening (PGS), was therefore developed as an alternative method to select embryos for transfer in IVF. In PGT‐A, the polar body or one or a few cells of the embryo are obtained by biopsy and tested. Only polar bodies and embryos that show a normal number of chromosomes are transferred.
The first generation of PGT‐A, using cleavage‐stage biopsy and fluorescence in situ hybridisation (FISH) for the genetic analysis, was demonstrated to be ineffective in improving live birth rates. Since then, new PGT‐A methodologies have been developed that perform the biopsy procedure at other stages of development and use different methods for genetic analysis.
Whether or not PGT‐A improves IVF outcomes and is beneficial to patients has remained controversial.
Objectives
To evaluate the effectiveness and safety of PGT‐A in women undergoing an IVF treatment.
Search methods
We searched the Cochrane Gynaecology and Fertility (CGF) Group Trials Register, CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, and two trials registers in September 2019 and checked the references of appropriate papers.
Selection criteria
All randomised controlled trials (RCTs) reporting data on clinical outcomes in participants undergoing IVF with PGT‐A versus IVF without PGT‐A were eligible for inclusion.
Data collection and analysis
Two review authors independently selected studies for inclusion, assessed risk of bias, and extracted study data. The primary outcome was the cumulative live birth rate (cLBR). Secondary outcomes were live birth rate (LBR) after the first embryo transfer, miscarriage rate, ongoing pregnancy rate, clinical pregnancy rate, multiple pregnancy rate, proportion of women reaching an embryo transfer, and mean number of embryos per transfer.
Main results
We included 13 trials involving 2794 women. The quality of the evidence ranged from low to moderate. The main limitations were imprecision, inconsistency, and risk of publication bias.
IVF with PGT‐A versus IVF without PGT‐A with the use of genome‐wide analyses
Polar body biopsy
One trial used polar body biopsy with array comparative genomic hybridisation (aCGH). It is uncertain whether the addition of PGT‐A by polar body biopsy increases the cLBR compared to IVF without PGT‐A (odds ratio (OR) 1.05, 95% confidence interval (CI) 0.66 to 1.66, 1 RCT, N = 396, low‐quality evidence). The evidence suggests that for the observed cLBR of 24% in the control group, the chance of live birth following the results of one IVF cycle with PGT‐A is between 17% and 34%. It is uncertain whether the LBR after the first embryo transfer improves with PGT‐A by polar body biopsy (OR 1.10, 95% CI 0.68 to 1.79, 1 RCT, N = 396, low‐quality evidence). PGT‐A with polar body biopsy may reduce miscarriage rate (OR 0.45, 95% CI 0.23 to 0.88, 1 RCT, N = 396, low‐quality evidence). No data on ongoing pregnancy rate were available. The effect of PGT‐A by polar body biopsy on improving clinical pregnancy rate is uncertain (OR 0.77, 95% CI 0.50 to 1.16, 1 RCT, N = 396, low‐quality evidence).
Blastocyst stage biopsy
One trial used blastocyst stage biopsy with next‐generation sequencing. It is uncertain whether IVF with the addition of PGT‐A by blastocyst stage biopsy increases cLBR compared to IVF without PGT‐A, since no data were available. It is uncertain if LBR after the first embryo transfer improves with PGT‐A with blastocyst stage biopsy (OR 0.93, 95% CI 0.69 to 1.27, 1 RCT, N = 661, low‐quality evidence). It is uncertain whether PGT‐A with blastocyst stage biopsy reduces miscarriage rate (OR 0.89, 95% CI 0.52 to 1.54, 1 RCT, N = 661, low‐quality evidence). No data on ongoing pregnancy rate or clinical pregnancy rate were available.
IVF with PGT‐A versus IVF without PGT‐A with the use of FISH for the genetic analysis
Eleven trials were included in this comparison. It is uncertain whether IVF with addition of PGT‐A increases cLBR (OR 0.59, 95% CI 0.35 to 1.01, 1 RCT, N = 408, low‐quality evidence). The evidence suggests that for the observed average cLBR of 29% in the control group, the chance of live birth following the results of one IVF cycle with PGT‐A is between 12% and 29%. PGT‐A performed with FISH probably reduces live births after the first transfer compared to the control group (OR 0.62, 95% CI 0.43 to 0.91, 10 RCTs, N = 1680, I² = 54%, moderate‐quality evidence). The evidence suggests that for the observed average LBR per first transfer of 31% in the control group, the chance of live birth after the first embryo transfer with PGT‐A is between 16% and 29%. There is probably little or no difference in miscarriage rate between PGT‐A and the control group (OR 1.03, 95%, CI 0.75 to 1.41; 10 RCTs, N = 1680, I² = 16%; moderate‐quality evidence). The addition of PGT‐A may reduce ongoing pregnancy rate (OR 0.68, 95% CI 0.51 to 0.90, 5 RCTs, N = 1121, I² = 60%, low‐quality evidence) and probably reduces clinical pregnancies (OR 0.60, 95% CI 0.45 to 0.81, 5 RCTs, N = 1131; I² = 0%, moderate‐quality evidence).
Authors' conclusions
There is insufficient good‐quality evidence of a difference in cumulative live birth rate, live birth rate after the first embryo transfer, or miscarriage rate between IVF with and IVF without PGT‐A as currently performed. No data were available on ongoing pregnancy rates. The effect of PGT‐A on clinical pregnancy rate is uncertain.
Women need to be aware that it is uncertain whether PGT‐A with the use of genome‐wide analyses is an effective addition to IVF, especially in view of the invasiveness and costs involved in PGT‐A. PGT‐A using FISH for the genetic analysis is probably harmful.
The currently available evidence is insufficient to support PGT‐A in routine clinical practice.
The words we use to describe emotions vary in terms of prototypicality; that is, some of these words may be more representative of the semantic category of emotion than others (e.g., anger refers ...more clearly to an emotion than boredom). Based on a multicomponential conception of emotions, the aim of the present study was to examine the contribution of several variables to emotion prototypicality. Some of those variables are related to the distinct components of emotions: evaluation, action, body expression, internal body sensations (interoception), and feelings. Other variables are related to the concreteness/abstractness distinction: sensory experience, social interaction, thought, and morality. We collected ratings for these variables for a large set of words (1,286) which varied in emotion prototypicality. A regression analysis revealed that the variables that most contributed to emotion prototypicality were feelings and interoception. Furthermore, a factor analysis identified two underlying factors: socioemotional polarity and emotional experience. The scores of each word in both factors were used to create a two-dimensional space and a density plot which provides relevant information about the organization of emotion concepts in memory.
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