Never too late? Quadruplets at the age of 65 years

Background We discuss the challenges of multiple pregnancy at very advanced reproductive age. Case presentation We present the case of a quadruplet pregnancy at the maternal age of 65 following in-vitro fertilization (IVF) with donor eggs and sperm, involving cross-border reproductive care. All children born were at 25 weeks’ gestation and survived; however, poor neurodevelopmental outcome remains a major concern in one child. Conclusions The use of reproductive technology to achieve a multiple pregnancy at such an advanced post-menopausal age generated a debate on ethical, psychosocial and medical questions. We share this debate and highlight the need to reconsider international guidelines for women of advanced reproductive age.

Never too late? - Quadruplets at the age of 65 years

Background We discuss the challenges of multiple pregnancy at very advanced reproductive age. Case Presentation We present the case of a quadruplet pregnancy at the maternal age of 65 following in-vitro fertilization (IVF) with donor eggs and sperm, involving cross-border reproductive care. All children born were at 25 weeks gestation and survived; however, poor neurodevelopmental outcome remains a major concern in one child. Conclusions The use of reproductive technology to achieve a multiple pregnancy at such an advanced post-menopausal age generated a debate on ethical, psychosocial and medical questions. We share this debate and highlight the need to reconsider international guidelines for women of advanced reproductive age.

ARTIFICIAL OOCYTE ACTIVATION IMPROVES THE LABORATORY AND CLINICAL OUTCOME IN VITRIFIED DONOR OOCYTE GROUP

Introduction: Oocyte donation is proved effective. Vitrification of donor eggs allows creation of donor egg banking. Simultaneously, for good clinical outcome it is recommended to thaw 10-15 oocytes at once. In the current study, we demonstrate the benefit of using artificial oocyte activation in order to reduce the number of thawed donor eggs for IVF program without any affect on laboratory and clinical outcome. Aim of study: To improve the good quality blastocyst formation rate using artificial activation with vitrified donor eggs. Is it possible to increase the clinical pregnancy rate (CPR) and live birth rate (LBR) thawing only 6-8 donor eggs? Materials and Methods: The retrospective cohort studyincluded 40 fresh (Group A) and 12 vitrified (Group B) donor egg programs. ICSI was conducted to all oocytes. In Group B, we also used artificial oocyte activation with calcium ionophore. Student T test was used to infer statistical significance. P value < 0.05 was considered significant. Results: The fertilization and good quality blastocyst formation rate is not different between the groups. The majority of usable blastocysts, 72% in Group A and 93% in Group B were formed on Day 5. The CPR is not statistically different between groups A and B and is 52.5% and 50% respectively. The IR is not statistically significant and is 39% in Group A and 42% in Group B. The LBR is higher in Group A (50%) comparing to Group B (25%), but the difference is not statistically significant. Conclusions: Considering our data, we suggest that artificial oocyte activation is feasible for use with vitrified donor eggs. It might decrease the expenses of patients on thawing less number of donor oocytes without negative impact on the laboratory and clinical outcome.

Next-Generation Sequencing Revealed that High Proportion of Human Embryos Resulted from Donor Eggs Are Segmental Chromosome Abnormal

High proportion of human embryos produced by in vitro fertilization (IVF) are aneuploidy or have segmental chromosomal errors. Not only a whole chromosome aneuploidy, but also small errors in a chromosome, such as microdeletion can be detected by current next-generation sequencing (NGS) for preimplantation genetic testing (PGT). The prevalence of aneuploidy in donor egg IVF was significantly different between fertility clinics. In the present study, we examined whether different embryo biopsy procedures affect embryonic aneuploidies in donor egg IVF. We did not find significant differences in the samples with abnormal chromosomes between two biopsy methods. When we further analyzed the samples with abnormal chromosomes, we found that 64.0–80.7% of the abnormalities were whole chromosome aneuploidies while 19.3–36.0% were segmental chromosome abnormalities. High embryo implantation rates were obtained after transferring screened euploid blastocysts. These results indicate that blastocyst biopsy procedures may not significantly affect embryo’s chromosomal status, but PGT by high-resolution NGS revealed that high proportions of human embryos derived from donor eggs are not only aneuploidy, but also segmental chromosome abnormal, and screening of small chromosomal errors by NGS is beneficial to patients who use donated eggs for infertility treatment.

Endometrial scratch vs no intervention in egg donation cycles: the ENDOSCRATCH trial protocol

Background The effects of endometrial scratching (ES) on embryo implantation have been studied for many years. Several studies have shown better outcomes when performed on patients undergoing intrauterine insemination and in vitro fertilization (IVF) cycles, but many other reports have not been able to find these differences. As far as cycles with donor eggs are concerned, reported evidence is scarce. Our aim in this trial is to determine if ES is useful for those patients undergoing IVF cycles with donor eggs, in order to assure a greater homogeneity in embryo quality and endometrial preparation. Methods This single centre randomized controlled trial will include patients undergoing an egg donation cycle, meeting the inclusion criteria and who accept to participate in the study. Once informed consent is signed, patients will be randomly allocated to the study arm (group A) and then receive ES in the luteal phase of the cycle prior to embryo transfer, or the control arm (group B) without any intervention. All cycle data will be collected and analyzed to obtain the clinical pregnancy and the live birth rates in the two groups. Discussion Several studies have tried to determine the effectiveness of an ES in IVF cycles, but it is still unclear due to the heterogeneity of these reports. The aim of this study is to determine if there are differences in clinical pregnancy rate and live birth rate in egg donor cycles, when comparing an ES performed in the preceding luteal phase versus no intervention, given that embryo quality and endometrial preparation protocols will be comparable. Trial registration Ethical approval of version 2.0 of this trial was obtained on the 13th January 2017. It was retrospectively registered on the 5th April 2017 as the ENDOSCRATCH Trial (NCT03108157) in ClinicalTrials.gov.