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Empirical In Vitro Fertilization for Recurrent Pregnancy Loss: Is It a Valid Concept?
Published in Howard J.A. Carp, Recurrent Pregnancy Loss, 2020
Michal Kirshenbaum, Raoul Orvieto
Embryo quality has a significant role in the success of an ART cycle. ART includes methods to improve gametes and embryo quality, such as sperm selection, PGT-A, and morphologic examination. Although maximizing embryonal quality might improve the pregnancy outcome in couples with RPL, further adequately powered studies are needed to assess the results.
Analysis of fertilization
Published in David K. Gardner, Ariel Weissman, Colin M. Howles, Zeev Shoham, Textbook of Assisted Reproductive Techniques, 2017
However, the study did not evaluate the position of the pronuclei relative to the presumed polar axis. This arrange- ment has been reported to relate to embryo quality (31, 32). Edwards and Beard (33) suggested that the oocyte may establish this polarity by either ooplasmic or pronuclear rotation towards the second polar body. Such a resetting of a new axis after fertilization is governed by cytoplasmic contraction waves organized by the sperm centrosome (33). Embryos unable to achieve optimal pronuclear orien- tation, possibly due to shorter cytoplasmic waves (4), may exhibit poor morphology (e.g., uneven cleavage or frag- mentation) (31).
Empirical treatments to improve receptivity: Why not?
Published in Carlos Simón, Linda C. Giudice, The Endometrial Factor, 2017
The widespread adoption of unproven empirical treatments that aim to improve endometrial receptivity after in vitro fertilization (IVF) treatment says much about the challenges that clinicians face as they seek to help patients struggling to conceive. Developments in ovarian stimulation protocols and laboratory techniques have improved IVF outcomes, and the great majority of women will now, after undergoing treatment, have embryos available for transfer into the uterus. Since the development of IVF, clinical research in the field of infertility has focused primarily on improving embryo quality, as the embryo has been considered to be the prime determinant of successful implantation. Although embryo quality is an important factor in successful implantation, the quality and function of the endometrium are increasingly being recognized as the key factors determining further improvement in outcomes. However, for clinicians, there has been a frustrating lack of validated clinical investigational tools for interrogating endometrial receptivity in a clinical setting. As a result, most current therapeutic interventions aimed at modulating receptivity are largely empirical, based on a degree of plausible biological rationale, but with little clinical evidence to support their use. The pressures to “do something” to “improve implantation,” which include assertive patient demand and the competitive commercial context in which IVF is increasingly practiced, continue to rise, and empirical treatments have come in to fill the gap between scientific rationale and clinical need.
Impact of having surplus blastocysts cryopreserved on the ongoing pregnancy rate following a fresh transfer
Published in Gynecological Endocrinology, 2023
Rui Wu, Zhuo Chen, Wenfang Xu, Chao Yang, Hua Zhou, Wenjie Xu, Guanyou Huang, Shuyun Zhao
Selecting good embryos for transfer is extremely important for successful IVF/ICSI cycles. In IVF lab, embryo quality is evaluated by considering morphological parameters. Over the past decades, many studies have been conducted to predict clinical outcomes according to embryo morphology. For blastocysts, it has been reported that the morphology of the inner cell mass (ICM) and trophectoderm can be used to predict the live birth rate following single blastocyst transfer [5–7]. Moreover, post-warmed ICM grade is considered to represent a good predictive indicator for selecting the best blastocysts for single blastocyst transfer [8]. The dynamics of embryo culture are also associated with embryo quality and clinical pregnancy rate (CPR) in ART; this led to the development of time-lapse imaging, a new system for embryo culture and evaluation. Several studies have reported that selecting embryos for transfer by time-lapse can improve the rate of implantation [9–11].
The effect of endometrial thickness and pattern on the success of frozen embryo transfer cycles and gestational age accuracy
Published in Gynecological Endocrinology, 2021
Einat Shalom-Paz, Nitzan Atia, Yuval Atzmon, Mordechai Hallak, Alon Shrim
This retrospective cohort study was conducted in a single referral reproductive center. Records of all patients treated with FET from January 2012 to August 2018 were evaluated. After the fresh cycle of ovum pick up, embryos were cultured till day 3 or blastocyst stage and were either transferred or frozen for future use. Only top-quality embryos were vitrified and used in the next FET, if no pregnancy was achieved in the fresh cycle. Embryo quality was evaluated according to number of cells, symmetry, granularity, type, percentage of fragmentation, presence of multinucleate blastomers, and degree of compaction, as previously described [16]. A top-quality embryo included the following parameters: 4–5 cells on days 2 or 3; >6 equal-sized blastomeres and ≤20% fragmentation; no multinucleate cells and KID score and Alfa ESHRE score of 5.3 or 5.2 or 4.3 or 4.2, respectively.
Microfluidic sperm selection yields higher sperm quality compared to conventional method in ICSI program: A pilot study
Published in Systems Biology in Reproductive Medicine, 2021
Fatemeh Anbari, Mohammad Ali khalili, Abdul Munaf Sultan Ahamed, Esmat Mangoli, Ali Nabi, Fatemeh Dehghanpour, Mojdeh Sabour
The potential application of microfluidics has still not been fully realized for clinical outcomes (Samuel et al. 2018). Therefore we analyzed the fertilization, embryo quality, implantation, and clinical pregnancy outcomes. The embryo quality is overall affected by multiple factors, including the possible effects by spermatozoa processing and selection methodologies. Few studies have investigated new devices for sperm selection using embryo quality. Gianaroli et al. suggested that sperm selected with an inverted microscope produced higher embryo quality and ongoing pregnancy rates compared with classical ICSI (Gianaroli et al. 2010). We changed the sperm processing method and demonstrated a significant difference in sperm parameters in the MSS study group compared to the DSU processing group. The total number of high-quality embryos after ICSI treatment, implantation rate, and clinical pregnancy were higher in the MSS technique group compared to DSU group.