OBJECTIVE: To evaluate, using time-lapse monitoring, the temporal influence of culture in 5% O₂ or 20% O₂ on human embryonic development. DESIGN: Retrospective cohort study. SETTING: University-based ...fertility clinic. PATIENT(S): In vitro fertilized embryos from women aged <38 years with no endometriosis and ≥8 oocytes retrieved. INTERVENTION(S): Culture in 20% O₂ exclusively (group 1), 20% and 5% O₂ combined (group 2), or 5% O₂ exclusively (group 3). MAIN OUTCOME MEASURE(S): Developmental rates and timing of developmental stages. RESULT(S): The timing of the third cleavage cycle was delayed for embryos cultured in 20% O₂ (group 1) compared with embryos cultured in 5% O₂ (groups 2 and 3). No difference was observed in timing of the early and full blastocyst stages. More embryos in groups 2 and 3 reached the 8-cell, early blastocyst, and full blastocyst stages than in group 1. We found that embryos in group 3 (5% O₂) reached the 8-cell stage faster than embryos in group 2 (5% + 20% O₂), but none of the other parameters (i.e., other time points, cumulative development, and embryo score) differed between the two groups. CONCLUSION(S): Culture in 20% O₂ reduces developmental rates and delays completion of the third cell cycle. The delayed development after culture in atmospheric oxygen was seen in the precompaction embryo only and therefore appears to be stage specific. CLINICAL TRIAL REGISTRATION NUMBER: NCT01139268.
Within the past few years the morphological evaluation of in vitro fertilized embryos has been extended to include continuous surveillance, enabled by the introduction of time-lapse incubators ...developed specifically for IVF treatment. As a result time-lapse monitoring has been implemented in many clinics worldwide. The proposed benefits compared with culture in a standard incubator and fixed time-point evaluation are uninterrupted culture, a flexible workflow in the laboratory, and improved embryo selection. The latter is based on the reasonable assumption that more frequent observations will provide substantially more information on the relationship between development, timing, and embryo viability. Several retrospective studies have confirmed a relationship between time-lapse parameters and embryo viability evaluated by developmental competence, aneuploidy, and clinical pregnancy. Furthermore a much anticipated randomized study has shown improved pregnancy rates (PRs) after culture in a time-lapse incubator combined with selection using a hierarchical time-lapse selection model. At present this is the only randomized study on possible benefits of time lapse in human embryology. Strict evidence may still seem too weak to introduce time lapse in routine clinical setting. This aim of this review is therefore to perform a balanced discussion of the evidence for time-lapse monitoring.
Objective To evaluate the evidence on the efficacy of psychosocial interventions for improving pregnancy rates and reducing distress for couples in treatment with assisted reproductive technology ...(ART). Design Systematic review and meta-analysis. Data sources PsycINFO, PubMed, EMBASE, CINAHL, Web of Science and The Cochrane Library between 1978 and April 2014. Study selection Studies were considered eligible if they evaluated the effect of any psychosocial intervention on clinical pregnancy and/or distress in infertile participants, used a quantitative approach and were published in English. Data extraction Study characteristics and results were extracted and the methodological quality was assessed. Effect sizes (ES; Hedges g) were pooled using a random effects model. Heterogeneity was assessed using the Q statistic and I2, and publication bias was evaluated using Egger’s method. Possible moderators and mediators were explored with meta-analyses of variances (ANOVAs) and meta-regression. Results We identified 39 eligible studies (total N=2746 men and women) assessing the effects of psychological treatment on pregnancy rates and/or adverse psychological outcomes, including depressive symptoms, anxiety, infertility stress and marital function. Statistically significant and robust overall effects of psychosocial intervention were found for both clinical pregnancy (risk ratio=2.01; CI 1.48 to 2.73; p<0.001) and combined psychological outcomes (Hedges g=0.59; CI 0.38 to 0.80; p=0.001). The pooled ES for psychological outcomes were generally larger for women (g: 0.51 to 0.73) than men (0.13 to 0.34), but the difference only reached statistical significance for depressive symptoms (p=0.004). Meta-regression indicated that larger reductions in anxiety were associated with greater improvement in pregnancy rates (Slope 0.19; p=0.004). No clear-cut differences were found between effects of cognitive–behavioural therapy (CBT; g=0.84), mind–body interventions (0.61) and other intervention types (0.50). Conclusions The present meta-analysis suggests that psychosocial interventions for couples in treatment for infertility, in particular CBT, could be efficacious, both in reducing psychological distress and in improving clinical pregnancy rates.
As elective transfer of a single embryo (eSET) becomes increasingly accepted, the need to improve implantation rates becomes crucial. Selecting the most competent embryo therefore constitutes a major ...challenge in assisted reproductive technology. Embryo morphology and developmental stage at given time points are closely correlated with developmental competence and assessment of morphological parameters at discrete inspection points thus remains the preferred way of evaluating embryonic potential. Lately, more attention has been given to the assessment of dynamic embryo development as a tool for evaluating embryonic potential. The introduction of time-lapse equipment approved for use on human embryos offers novel clinical opportunities for continuous monitoring of embryos, enabling flexible evaluation of known morphological parameters and potentially introducing new dynamic markers of viability. Due to lack of larger, randomized clinical studies it remains to be elucidated whether embryo selection using dynamic parameters improves clinical outcome and which parameters are of significance. Before such randomized controlled studies are organized, the most promising parameters to evaluate must be identified. This mini-review summarizes the current knowledge about dynamic markers of viability and discusses the potential clinical role of time-lapse analysis in embryo assessment and selection.
To study whether women conceiving after preimplantation genetic diagnosis (PGD) and their children have greater risks of adverse pregnancy and birth outcomes compared with children conceived ...spontaneously or after IVF with or without intracytoplasmic sperm injection (ICSI).
Historical cohort study.
Not applicable.
All deliveries following PGD treatment for single gene and sex-linked disorders or structural chromosomal aberrations (n = 126 deliveries/149 children), IVF/ICSI treatment (n = 30,418 deliveries/36,115 children), and spontaneous conception (n = 896,448 deliveries/909,624 children).
None.
Adverse obstetric and neonatal outcomes, such as pre-eclampsia, preterm primary rupture of membranes, placenta previa, abruption of placenta, preterm birth, low birth weight, malformations, and neonatal admission.
Compared with spontaneously conceived pregnancies, PGD pregnancies were at significantly increased risk of placenta previa (adjusted odds ratio ORa 9.1; 95% confidence interval 95% CI 3.4, 24.9), cesarean section (ORa 2.0; 95% CI 1.3, 2.9), preterm birth (ORa 1.6; 95% CI 1.0, 2.7), shorter gestation (mean difference -3.4 days; 95% CI -5.7, -1.1 days), and longer neonatal admission (mean difference 21 days; 95% CI 15, 28 days). The risks were comparable to that of pregnancies following IVF/ICSI. In subanalyses, adverse outcomes were only present in children conceived by PGD owing to parental monogenetic disorder and comparable to those of children born to parents with monogenic disorders conceiving without PGD, except for a higher risk of placenta previa.
In this cohort study, the risk of adverse obstetric and neonatal outcomes was mainly related to the underlying parental condition rather than the PGD procedure.
OBJECTIVE: To describe hatching of human embryos and investigate differences in hatching between IVF and intracytoplasmic sperm injection (ICSI)–fertilized embryos with the use of time-lapse ...monitoring. DESIGN: Clinical observational study. SETTING: University-based fertility clinic. PATIENT(S): From February 2011 to July 2012, 161 women consented to embryo culture in a time-lapse incubator until day 6 after oocyte retrieval. The mechanism of hatching was recorded and related to method of fertilization (ICSI or IVF) and clinical pregnancy outcome. INTERVENTION(S): IVF or ICSI. MAIN OUTCOME MEASURE(S): Hatching pattern. RESULT(S): A total of 430 IVF fertilized embryos from 62 patients and 594 ICSI-fertilized embryos from 99 patients were included. We observed spontanous hatching in 165 IVF embryos and 215 ICSI embryos. Two distinct mechanisms of hatching were observed. Type 1 was characterized by penetration of the zona pellucida (ZP) by small trophectoderm projections, whereas type 2 was preceded by a regular rupture of the ZP followed by extrusion of the blastocyst. Type of hatching was significantly different between IVF and ICSI embryos, with type 2 observed more often in IVF embryos than in ICSI embryos. Furthermore, IVF embryos escaped the ZP more readily than ICSI embryos. Regardless of the type of hatching, implantation rates were similar. CONCLUSION(S): We describe two distinct mechanisms of in vitro hatching related to fertilization method and suggest that hatching pattern is associated with fertilization method. The hatching pattern has, however, no influence on future implantation. CLINICAL TRIAL REGISTRATION NUMBER: NCT01139268.
Anti Mullerian hormone (AMH) has previously been measured using a manual method, but a fully automated assay from Roche Diagnostics was recently introduced. The aim of this study was to compare the ...results from the AMH gen II ELISA and Elecsys Cobas AMH methods in a clinical setting to evaluate whether the assays achieve the goals of analytical performance. A prospective observational study with 23 women seeking laparoscopic sterilization was conducted. Blood samples were collected preoperatively as well as 1 week and 1, 3 and 6 months postoperatively; they were evaluated with the AMH gen II ELISA and Elecsys Cobas AMH methods. The assays were validated according to the optimal performance of biochemical assays: CV Analytical < 0.25* CV Within Biological Variation.
We found a good correlation between the two methods; there was a bias of approximately 32 %. The total within-person biological variability ranged from approximately 21 to 32 %. The analytical variability of the AMH gen II ELISA and Elecsys Cobas methods ranged from 5.5 to 10.3 % and 2.8 to 3.3 %, respectively. Applying the goals for optimal assay performance, the Elecsys Cobas method achieved optimal performance throughout the measuring range, whereas the AMH Gen II only achieved optimal performance in the high end of the measuring range. Furthermore, the Elecsys Cobas assay had a low limit of quantitation of 0.5 pmol/l compared to 3.0 pmol/l for the AMH gen II ELISA.
In the clinical setting, the Elecsys Cobas AMH assay performs well according to the optimal standard for biochemical assays.
To study the motivation and attitudes toward donor anonymity, economic compensation, and insemination of lesbian and single women among Danish sperm donors in 2012 compared with the two preceding ...decades.
Anonymous survey.
Danish sperm bank.
Sperm donors active in 2012 (n = 97), 2002 (n = 62), and 1992 (n = 41).
All donors who donated sperm in the study period were asked to participate. The results were compared with those of previous surveys from the same sperm bank.
Motivation and attitudes toward donor anonymity, economic compensation, and insemination of lesbian and single women.
In 2012, the most frequently stated factor was altruism, motivating 90% of the sperm donors, which was not significantly different from the previous surveys. If economic compensations were removed, only 14% would continue to donate. The proportion of anonymous donors who would stop their donations if anonymity was abolished was 51%, 56%, and 67% in 1992, 2002, and 2012, respectively. A significantly increasing proportion of donors felt positive about donation to lesbian couples.
The motivation for sperm donation is multifaceted and primarily based on economic compensation and altruism. Most Danish donors would stop their donations if economic compensation or anonymity were abolished.
PDF
