The Corelation Between Serum Estradiol (C23H32O3) Impact on Selected Biomarkers and Outcome of Fresh Embryo Transfer in Comparison with Freeze All Strategy in in vitro Fertilisation Patients

2020 ◽  
Vol 71 (7) ◽  
pp. 419-424
Author(s):  
Dragos Albu ◽  
Alice Albu ◽  
Romina Marina Sima ◽  
Mircea Octavian Poenaru ◽  
Adrian Neacsu ◽  
...  
Keyword(s):  
Embryo Transfer ◽  
In Vitro Fertilisation ◽  
Study Group ◽  
Cleavage Stage ◽  
Total Group ◽  
Cleavage Stage Embryo ◽  
Stage Embryo ◽  
Fresh Transfer ◽  
Frozen Transfer

In stimulated cycles the endometrium could be more advanced than the embryos, with a possible negative impact on their implantation capacity. Therefore, there is an ongoing debate regarding the best transfer strategy: freeze-all versus fresh embryos transfer. Our study aimed to analyse if the frozen only embryos-transfer strategy for in vitro fertilisation (IVF) has higher clinical pregnancy rate (CPR) than the traditionally fresh transfer. We performed a retrospective study in a private centre of reproductive medicine. We included only patients who performed fresh embryo transfers (n=245) and patients with all the embryos frozen and then transferred into a non-stimulated cycle (n=117). The reasons for delayed transfer were an increased risk of ovarian hyperstimulation syndrome or the increase of late follicular phase serum progesterone level. The mean age of the study group was 34.33�b4.28 years and mean AMH was 3.68�b3.56 ng/mL. Patients with fresh transfer were significantly older (p[0.0001) and obtained significantly lower number of oocytes at egg retrieval (p[0.0001) and lower zygotes number (p[0.0001) in comparison with patients with frozen transfer. After adjustment for confounders, CPR was significantly higher in patients with fresh transfer in comparison with those with frozen transfer in total group (OR 2.7, p=0.001) and in patients with cleavage stage embryo transfer (OR 6, p=0.008), but not in patients with blastocyst transfer. Similarly, the implantation rate was significantly higher in total group and in both subgroups (p[0.0001). Our study shows that the freeze all strategy should not be performed in all the patients, being inferior to fresh transfer in the total study group and cleavage stage embryo transfers. The decision to transfer frozen embryos should take into account the availability of blastocysts for transfer and the risk benefit profile.

P–146 Differential impact of three embryo culture media for IVF on in vitro development and perinatal outcome: a single-center RCT

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
M Murakami ◽  
K Tanaka ◽  
H Otsubo ◽  
S Mizumoto ◽  
Y Nagao ◽  
...  
Keyword(s):  
Embryo Transfer ◽  
Embryo Culture ◽  
Culture Medium ◽  
Culture Media ◽  
Blastocyst Stage ◽  
Cleavage Stage ◽  
Embryo Culture Medium ◽  
Cleavage Stage Embryo ◽  
Stage Embryo

Abstract Study question This report provides updated data from an RCT determining which embryo culture medium yields optimal IVF outcomes. Summary answer Embryo culture systems used for IVF differentially affected preimplantation development and resultant obstetric and perinatal outcomes, including birthweights of live-born singletons. What is known already Currently, multiple embryo culture medium systems are in use for IVF, raising questions regarding which is optimal. However, the ability of a medium to yield preimplantation embryos is not necessarily indicative of embryo viability. For example, supplementation of medium with serum was commonly used to increase animal blastocyst yields, but this impaired embryonic, fetal, and offspring health. In humans, medium composition and culture duration can influence IVF efficacy and offspring phenotype. Given the importance of culture systems in determining clinical outcomes, existing data regarding differential culture system impacts are insufficient and additional well-designed studies are required. Study design, size, duration Between February 2016 and August 2017, 795 couples undergoing their first autologous clinical IVF cycle and freeze-all strategy were recruited. Participants were randomized via computer-generated tables into three groups. Following standard oocyte retrieval and IVF/ICSI procedures, embryos were cultured using three different culture media, G1 Plus/G2 Plus (G1/G2; Vitrolife), Global Total (GT; LifeGlobal), or Sequential Cleav/Sequential Blast (SC/SB; Origio). Thirty-eight patients exhibiting no 2PN oocytes following insemination or those undergoing fresh embryo transfers were excluded. Participants/materials, setting, methods For patients yielding a single good-quality cleavage-stage (day–2 or day–3) embryo, that cleavage-stage embryo was vitrified. For patients yielding two or more good-quality cleavage-stage embryos, two or less good-quality cleavage-stage embryos were vitrified. The culture period of the remaining embryos was extended, and all good-quality blastocyst-stage (day–5 or day–6) embryos were vitrified. This report presents data for vitrified embryo transfer performed until the end of December 2020. Main results and the role of chance The mean per-cycle vitrified embryo yield (± SD) was comparable between groups for cleavage-stage embryos, but significantly different for blastocyst-stage embryos (G1/G2: 1.69 ± 2.2, GT: 2.53 ± 3.01, SC/SB: 2.04 ± 2.42; P = 0.001). Following vitrified cleavage- or blastocyst-stage embryo transfers, biochemical pregnancy rates were significantly different between groups (G1/G2: 55.6%, GT: 59.1%, SC/SB: 46.2%; P = 0.011). Furthermore, a between-group trend towards different live birth rates was observed (G1/G2: 41.7%, GT: 42.1%, SC/SB: 33.1%; P = 0.063). Of 382 live births, data for first-borns (n = 323; 295 singletons and 14 twin-pairs) are reported here. Perinatal data did not differ significantly between groups for both cleavage- and blastocyst-stage embryo transfers, including gestational age- and gender-adjusted singleton birthweight (z-score). Following multiple linear regression (including selected covariates), adjusted mean singleton birthweights were significantly lower in the G1/G2 and GT groups than in the SC/SB group (by 131 g; P = 0.011 and 110 g; P = 0.032, respectively) and tended to be lower for cleavage-stage embryo transfers than for blastocyst-stage embryo transfers (by 102 g; P = 0.053). Limitations, reasons for caution A larger cohort size and longer-term follow-up are required to verify and further elucidate the impact of embryo culture methods on child health. Such studies will raise awareness regarding the sensitivity of in vitro-cultured human embryos to their environment, ultimately resulting in practices that decrease IVF risks to offspring. Wider implications of the findings: Pregnancy outcome of the medium yielding fewer blastocysts was comparable or superior to that of other media, highlighting the importance of differentiating between the ability to support preimplantation development versus the ability to yield viable embryos. Embryo culture medium had a greater impact than embryo transfer stage on live birthweight. Trial registration number UMIN000020910

scholarly journals Perinatal outcomes in singleton live births after fresh blastocyst-stage embryo transfer: a retrospective analysis of 67 147 IVF/ICSI cycles

2019 ◽  
Vol 34 (9) ◽  
pp. 1716-1725 ◽  
Author(s):  
Nicola Marconi ◽  
Edwin Amalraj Raja ◽  
Siladitya Bhattacharya ◽  
Abha Maheshwari
Keyword(s):  
Birth Weight ◽  
Embryo Transfer ◽  
Group Analysis ◽  
Perinatal Outcomes ◽  
Blastocyst Stage ◽  
Blastocyst Transfer ◽  
High Birth Weight ◽  
Cleavage Stage ◽  
Cleavage Stage Embryo ◽  
Stage Embryo

Abstract STUDY QUESTION Are perinatal outcomes different between singleton live births conceived from fresh blastocyst transfer and those following the transfer of fresh cleavage-stage embryos? SUMMARY ANSWER Fresh blastocyst transfer does not increase risks of preterm birth (PTB), low/high birth weight or congenital anomaly and does not alter the sex ratio at birth or prejudice the chance of having a healthy baby. WHAT IS KNOWN ALREADY Extended embryo culture is currently considered the best option for embryo selection, but concerns have been raised about increased risks of preterm delivery and large-for-gestational-age (LGA) babies. STUDY DESIGN, SIZE, DURATION We conducted a retrospective cohort study based on data from the Human Fertilisation and Embryology Authority (HFEA) anonymised and cycle-based dataset in the UK between 1999 and 2011. PARTICIPANTS/MATERIALS, SETTING, METHODS Baseline characteristics were compared between in vitro fertilisation (IVF)/intracytoplasmic sperm injection (ICSI) blastocyst-stage and cleavage-stage embryo transfer cycles using the χ2 test for categorical/dichotomised covariates and the Mann–Whitney test for continuous covariates. Statistical significance was set at <0.005. Poisson regression and multinomial logistic regression were used to establish relationships between perinatal outcomes and blastocyst-stage embryo transfer or cleavage-stage embryo transfer. Risk ratios (RRs), adjusted risk ratios (aRRs) and their 99.5% confidence intervals (CIs) were calculated as a measure of strength of associations. Results were adjusted for clinically relevant covariates. A sub-group analysis included women undergoing their first IVF/ICSI treatment. The level of significance was set at <0.05, and 95% CIs were calculated in the sub-group analysis. MAIN RESULTS AND THE ROLE OF CHANCE Of a total of 67 147 IVF/ICSI cycles, 11 152 involved blastocyst-stage embryo(s) and 55 995 involved cleavage-stage embryo(s). The two groups were comparable with regards to the risk of PTB (aRR, 1.00; 99.5% CI, 0.79–1.25), very-preterm birth (VPTB) (aRR, 1.00; 99.5% CI, 0.63–1.54), very-low birth weight (VLBW) (aRR, 0.84; 99.5% CI, 0.53–1.34), low birth weight (LBW) (aRR, 0.92; 99.5% CI, 0.73–1.16), high birth weight (HBW) (aRR, 0.94; 99.5% CI, 0.75–1.18) and very-high birth weight (VHBW) (aRR, 1.05; 99.5% CI, 0.66–1.65). The risk of congenital anomaly was 16% higher in the blastocyst-stage group than in the cleavage-stage group, but this was not statistically significant (aRR, 1.16; 99.5% CI, 0.90–1.49). The chance of having a healthy baby (born at term, with a normal birth weight and no congenital anomalies) was not altered by extended culture (aRR, 1.00; 99.5% CI, 0.93–1.07). Extended culture was associated with a marginal increase in the chance having a male baby in the main cycle-based analysis (aRR, 1.04; 99.5% CI, 1.01–1.09) but not in the sub-group analysis of women undergoing their first cycle of treatment (aRR, 1.04; 95% CI, 1.00–1.08). In the sub-group analysis, the risk of congenital anomalies was significantly higher after blastocyst-stage embryo transfer (aRR, 1.42; 95% CI, 1.12–1.81). LIMITATIONS, REASONS FOR CAUTION This study is limited by the use of observational data and inability to adjust for key confounders, such as maternal smoking status and body mass index (BMI), which were not recorded in the HFEA dataset. As the main analysis was cycle-based and we were unable to link cycles within women undergoing more than one IVF/ICSI cycle, we undertook a sub-group analysis on women undergoing their first treatment cycle. WIDER IMPLICATIONS OF THE FINDINGS Our findings should reassure women undergoing blastocyst-stage embryo transfer. For the first time, we have shown that babies born after blastocyst transfer have a similar chance of being healthy as those born after cleavage-stage embryos transfer. STUDY FUNDING/COMPETING INTEREST(S) The research activity of Dr Nicola Marconi was funded by the scholarship ‘A. Griffini-J. Miglierina’, Fondazione Comunitaria del Varesotto, Provincia di Varese, Italy. The authors do not have any competing interests to disclose. TRIAL REGISTRATION NUMBER N/A

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