3.5代試管並無法有效提高活產率  是商業促銷手法下ㄉ產物
如果你胚胎很多  你可以挑出最佳胚胎  但累積懷孕率凍胚植入你終究會懷孕
如果你胚胎不多  你也沒得挑 

J Assist Reprod Genet. 2019 Aug;36(8):1757-1758. doi: 10.1007/s10815-019-01514-w. Epub 2019 Jun 25.

Lack of evidence to support the superiority of TLI over conventional morphology to select among euploid embryos determined by PGT-A.

Guo Y1, Zhang H2, Guo S3.

Author information

1

Reproductive Center, Shenyang Women's and Children's Hospital, Shenyang, China.

2

Department of Hemotology Laboratory, Shengjing Hospital of China Medical University, Shenyang, China.

3

Reproductive Center, Shenyang Women's and Children's Hospital, Shenyang, China. shuaishuai1974@sina.com.

傳統觀念建議禁慾3-5天  本篇發現禁慾1h 反而提升囊胚染色體正常率

J Assist Reprod Genet. 2019 Aug;36(8):1591-1597. doi: 10.1007/s10815-019-01533-7. Epub 2019 Jul 19.

How 1 h of abstinence improves sperm quality and increases embryo euploidy rate after PGT-A: a study on 106 sibling biopsied blastocysts.

Scarselli F1, Cursio E2, Muzzì S2, Casciani V2, Ruberti A2, Gatti S2, Greco P2, Varricchio MT2, Minasi MG2, Greco E2.

Author information

1

Centre for Reproductive Medicine, European Hospital, Via Portuense 700, 00149, Rome, Italy. filomenascarselli@virgilio.it.

2

Centre for Reproductive Medicine, European Hospital, Via Portuense 700, 00149, Rome, Italy.

Abstract

PURPOSE:

The aim of our study was to evaluate the influence of different ejaculatory abstinence time frames (several days versus 1 h) on semen parameters, blastocysts ploidy rate, and clinical results in assisted reproduction cycles on sibling oocytes.

METHODS:

This is a prospective study including 22 preimplantation genetic testing for aneuploidy (PGT-A) cycles performed between November 2015 and December 2018. Male partners with oligoastenoteratozoospermia produced two semen samples on the day of oocyte retrieval: the first one after several days of abstinence and the second, 1 h after the first one. Oocytes from each patient were divided into two groups: those in group 1 were injected with spermatozoa from the first ejaculate (N = 121) and oocytes in group 2 with spermatozoa from the second one (N = 144). Outcomes of aniline blue test, fertilization, blastocyst formation, ploidy rates, and clinical results were compared between the two groups.

RESULTS:

Semen volume resulted lower in the second sperm retrieval. Sperm concentration, motility, and morphology were similar in the two groups. A total of 106 blasotcysts were biospied. Higher blastocyst euploidy rates resulted in group 2 (43.6%) than in group 1 (27.5%). A higher percentage of mature chromatine was observed in group 2.

CONCLUSION:

Using spermatozoa from samples with a shorter abstinence could be a simple method to select higher quality spermatozoa, reducing aneuploidy rate in blastocysts. Prospective randomized controlled trials should be performed to confirm the potential advantage of using semen samples with short abstinence period to improve the outcome of assisted reproduction cycles.

人工受孕植入1次  vs    人工受孕植入2次
---約增高2%懷孕率 (14--->16%)

J Assist Reprod Genet. 2019 Aug 13. doi: 10.1007/s10815-019-01561-3. [Epub ahead of print]

Double intrauterine insemination (IUI) of no benefit over single IUI among lesbian and single women seeking to conceive.

Monseur BC1, Franasiak JM2,3, Sun L4, Scott RT Jr2,3, Kaser DJ2,3.

Author information

1

Sidney Kimmel Medical College, Thomas Jefferson University, 833 Chestnut Street, Suite 301, Philadelphia, PA, 19107, USA. Brent.Monseur@jefferson.edu.

2

Sidney Kimmel Medical College, Thomas Jefferson University, 833 Chestnut Street, Suite 301, Philadelphia, PA, 19107, USA.

3

IVI-RMA New Jersey, Basking Ridge, NJ, USA.

4

Foundation for Embryonic Competence, Basking Ridge, NJ, USA.

Abstract

PURPOSE:

To explore clinical benefit of performing two intrauterine inseminations (IUI) 24 h apart-a double IUI vs. a single IUI among lesbian and single women.

METHODS:

Retrospective cohort study using electronic medical record review during a 17-year period (11/1999-3/2017). A total of 11,396 patients at a single academic-affiliated private practice were included in this study. All cycles with a single or double IUI were included. A sub-analysis of first cycles only (n = 10,413) was also performed. Canceled IVF cycles converted to IUI were excluded. T tests and Wilcoxon rank-sum tests were used for continuous data, and chi-square for categorical data. Multivariable logistic regression controlled for patient age, day 3 follicle-stimulating hormone (D3 FSH), body mass index (BMI), peak estradiol (E2), and post-wash total motile sperm counts to model the association between IUI number and ongoing pregnancy rate (OPR) according to sperm source (autologous vs. donor). Generalized estimating equations and mixed effect models accounted for multiple cycles from the same woman. Adjusted odds ratio (AOR) with 95% CI was determined. Sub-analyses of sexual orientation and partner status were performed to compare heterosexual couples with proven infertility to women with lesbian and single women.

RESULTS:

During the study period, 22,452 cycles met inclusion criteria (single IUI 1283 vs. double IUI 21,169). Mean patient age and BMI were similar between groups. For couples using autologous sperm, OPR was significantly higher with double IUI (12.0% vs. 14.1%; p = 0.0380). A similar increase was observed for donor sperm OPR among heterosexual couples (14.4% vs. 16.2%), though this did not reach statistical significance (p = 0.395). A sub-analysis restricted to donor sperm demonstrates a clinical benefit of second IUI in heterosexual couples, 8.5% vs. 17.6% OPR (AOR 2.94; CI 1.00-10.99; p = 0.0496). When lesbian and single patients were evaluated, there was no difference (17.2% vs. 15.2%; AOR 0.99; CI 0.59-1.70; p = 0.0958).

CONCLUSIONS:

Double IUI is associated with a significantly higher OPR for heterosexual couples using an autologous or donor sperm source. The benefit of a second IUI is less clear in patients with undocumented fertility status using donor sperm, such as single and lesbian women.

Day5形成囊胚: 染色體正常率約67%
Day6形成囊胚: 染色體正常率約52%
Day7形成囊胚: 染色體正常率約43%

Hum Reprod. 2019 Aug 12. pii: dez138. doi: 10.1093/humrep/dez138. [Epub ahead of print]

Worth the wait? Day 7 blastocysts have lower euploidy rates but similar sustained implantation rates as Day 5 and Day 6 blastocysts.

Tiegs AW1,2, Sun L3, Patounakis G4, Scott RT1,2.

Author information

1

Instituto Valenciano de Infertilidad - Reproductive Medicine Associates (IVI-RMA), Basking Ridge, NJ, USA.

2

Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.

3

Foundation for Embryonic Competence (FEC), Basking Ridge, NJ, USA.

4

Reproductive Medicine Associates of Florida, Orlando, FL 32746, USA.

Abstract

STUDY QUESTION:

Does the reproductive potential of embryos change when blastocyst development takes longer than the traditionally accepted 5 days when accounting for aneuploidy and endometrial-embryo asynchrony?

SUMMARY ANSWER:

Aneuploidy increases with increasing duration of blastulation, but if blastocyst morphologic quality and endometrial-embryo asynchrony are controlled for, euploid Day 7 embryos have similar sustained implantation as compared to Days 5 and 6 euploid blastocysts.

WHAT IS KNOWN ALREADY:

The relative contributions of diminished embryo quality versus endometrial and embryo asynchrony to poor outcomes associated with embryos cultured past Day 6 are not clear. Asynchrony can be eliminated by embryo vitrification with transfer in a subsequent month after retrieval.

STUDY DESIGN, SIZE, DURATION:

Retrospective cohort study of patients from a single center attempting conception through ICSI and utilizing preimplantation genetic testing for aneuploidy screening (PGT-A) from January 2017 to September 2018. Cycles were excluded if they utilized surgical sperm or preimplantation genetic testing for monogenetic/single gene defects. ICSI cycle outcomes from 2586 patients were evaluated for ploidy status of embryos.

PARTICIPANTS/MATERIALS, SETTING, METHODS:

Only patients undergoing single, euploid frozen embryo transfer were included when analyzing cycle outcomes by day of blastocyst expansion of the transferred embryo (n = 2130). Ploidy rates by the day upon which an embryo was considered to be usable (denoted, 'usable blastulation day') were determined so as to assess the contribution of aneuploidy to slow embryo development. Outcomes of euploid frozen single embryo transfers (SET) of Day 7 embryos were evaluated to assess the reproductive potential associated with embryos that were slowly developing for reasons other than aneuploidy. Analyses were adjusted by maternal age and blastocyst morphology.

MAIN RESULTS AND THE ROLE OF CHANCE:

Overall, 67.7% (n = 3508) of usable Day 5 blastocysts were euploid, 52.1% (n = 5560) of usable Day 6 blastocysts were euploid and 43.1% (n = 229) of usable Day 7 embryos were euploid (Day 5 versus Day 6: odds ratio (OR) 0.7 (95% CI, 0.64-0.76), P < 0.001; Day 5 versus Day 7: OR 0.56 (95% CI, 0.46-0.69), P < 0.001; Day 6 versus Day 7: OR 0.81 (95% CI, 0.67-0.99), P = 0.036). Stratified by Society for Assisted Reproductive Technology maternal age groups, a reduction in the prevalence of euploidy by increasing time to embryo blastulation was still seen. The sustained implantation rate (SIR) was similar after euploid SET of Days 5 and 6 embryos (overall, 68.9% (95% CI, 66.0-71.6) and 66.8% (95% CI, 63.8-69.7), respectively; P = 0.81). SIR after euploid Day 7 SET appeared slightly lower than that of Days 5 and 6 embryos (52.6% (95% CI, 35.8-69.0); (Day 5 versus Day 7: OR, 0.67 (95% CI, 0.32-1.41), P = 0.29; Day 6 versus Day 7: OR 0.58 (95% CI, 0.28-1.2), P = 0.14)) but did not achieve statistical significance.

精蟲冷凍 0.5-5 vs 6-10 vs 11-15 years
活產率:  81.63%, 79.11% and 73.91%,
流產率:  12.26%, 11.38% and 17.39%
精蟲冷凍超過5年可能對於精蟲品質也輕微不良影響

Fertil Steril. 2019 Jul 29. pii: S0015-0282(19)30505-9. doi: 10.1016/j.fertnstert.2019.06.008. [Epub ahead of print]

Long-term cryostorage of semen in a human sperm bank does not affect clinical outcomes.

Huang C1, Lei L2, Wu HL1, Gan RX1, Yuan XB2, Fan LQ3, Zhu WB4.

Author information

1

Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, Hunan, People's Republic of China.

2

Institute of Reproductive and Stem Cell Engineering, Basic Medicine College, Central South University, Hunan, People's Republic of China.

3

Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, Hunan, People's Republic of China; Institute of Reproductive and Stem Cell Engineering, Basic Medicine College, Central South University, Hunan, People's Republic of China.

4

Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, Hunan, People's Republic of China; Institute of Reproductive and Stem Cell Engineering, Basic Medicine College, Central South University, Hunan, People's Republic of China. Electronic address: zhuwenbing0971@sina.com.

Abstract

OBJECTIVE:

To evaluate the affect of the duration of donor sperm storage on pregnancy success among women undergoing assisted reproduction.

DESIGN:

Retrospective cross-sectional study.

SETTING:

Sperm bank.

PATIENT(S):

A total of 119,558 specimens retrieved using a clinical information database of young adult men who were qualified sperm donors at the Hunan Province Human Sperm Bank of China from 2001 to 2016.

INTERVENTION(S):

Analysis of semen samples and clinical outcomes after semen use.

MAIN OUTCOME MEASURE(S):

Clinical information included semen parameters before and after freezing, clinical pregnancy, abortion and live birth rates after semen use.

RESULT(S):

The sperm's frozen-thaw survival rate decreased from 85.72% to 73.98% after 15 years of cryopreservation (P<.01). The clinical pregnancy rate of women undergoing artificial insemination with donor sperm was 23.09%, 22.36% and 22.32%, the clinical abortion rate was 10.06%, 10.02% and 12.00% and the live birth rate was 82.17%, 80.21% and 80.00% in the groups with 0.5-5, 6-10 and 11-15 storage years, respectively. The clinical pregnancy rate of women undergoing in vitro fertilization was 64.29%, 64.94% and 53.48%, the clinical abortion rate was 12.26%, 11.38% and 17.39% and the live birth rate was 81.63%, 79.11% and 73.91%, in the groups with 0.5-5, 6-10 and 11-15 years, respectively.

CONCLUSION(S):

The long-term cryostorage of semen in a human sperm bank does not affect clinical outcomes. However, cryopreservation longer than 5 years negatively influenced the quality of frozen-thawed donor sperm samples.

凍胚 vs 鮮胚---植入後懷孕生產胎兒體重無明顯差異

Fertil Steril. 2019 Jul 29. pii: S0015-0282(19)30477-7. doi: 10.1016/j.fertnstert.2019.05.020. [Epub ahead of print]

Fresh versus frozen embryo transfer has no effect on childhood weight.

Ainsworth AJ1, Wyatt MA2, Shenoy CC3, Hathcock M4, Coddington CC3.

Author information

1

Division of Reproductive Endocrinology and Infertility, Mayo Clinic, Rochester, Minnesota. Electronic address: ainsworth.alessandra@mayo.edu.

2

Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota.

3

Division of Reproductive Endocrinology and Infertility, Mayo Clinic, Rochester, Minnesota.

4

Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota.

Abstract

OBJECTIVE:

To evaluate the effect of frozen, compared with fresh, embryo transfer on neonatal and pediatric weight and weight gain trajectory.

DESIGN:

Retrospective cohort study.

SETTING:

Academic medical center.

PATIENT(S):

Women who underwent fresh or frozen embryo transfer at the Mayo Clinic from 2010 to 2014. All included embryo transfers resulted in a singleton live birth. Children were followed from birth to at least 18 months. When possible, growth was evaluated to 5 years of age.

INTERVENTIONS(S):

Fresh versus frozen embryo transfer.

MAIN OUTCOME MEASURE(S):

Propensity score methodology was used to balance the two groups by maternal characteristics and gestational age before evaluating outcomes. Each infant and childhood growth measurement was compared between the two groups.

RESULT(S):

Of the 136 women, 87 underwent a fresh embryo transfer and 49 underwent a frozen embryo transfer. Birth length and head circumference were significantly different in infants delivered after fresh versus frozen embryo transfer. There was a statistically significant difference in birth weight between infants born after fresh versus frozen embryo transfer. However, this difference did not persist when adjusted for gestational age, sex, and maternal factors. Childhood growth measurements including age- and sex-specific weight, and body mass index percentiles were not significantly different between groups.

CONCLUSION(S):

This study confirmed an association of frozen embryo transfer and increased birth weight, but the association did not persist when controlling for confounding maternal factors. We found no effect of fresh versus frozen embryo transfer on neonatal weight and childhood weight gain trajectory.

1PN胚胎於Day 2,3 植入後著床率比2PN低
若能形成囊胚   植入後著床率與2PN類似
顯示部分1PN具有染色體自有修復之功能

Fertil Steril. 2019 Jul 1. pii: S0015-0282(19)30424-8. doi: 10.1016/j.fertnstert.2019.04.045. [Epub ahead of print]

Obstetrical and neonatal outcomes after transfer of cleavage-stage and blastocyst-stage embryos derived from monopronuclear zygotes: a retrospective cohort study.

Si J1, Zhu X1, Lyu Q1, Kuang Y2.

Author information

1

Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China.

2

Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China. Electronic address: kuangyanp@126.com.

Abstract

OBJECTIVE:

To evaluate the outcomes of embryo transfer with the use of monopronuclear (1PN) zygotes, and the risks of congenital malformations and postpartum developmental disorders.

DESIGN:

Retrospective cohort study.

SETTING:

Tertiary-care academic medical center.

PATIENT(S):

This study included patients who underwent single embryo transfer of 1PN frozen-thawed cleavage- or blastocyst-stage embryos. Seventy-six singletons were assessed for congenital malformations and defects in psychomotor development.

INTERVENTION(S):

Monopronuclear frozen-thawed cleavage-stage or blastocyst embryos were compared with 2PN frozen-thawed cleavage-stage and blastocyst frozen embryos, in frozen-thawed embryo transfer (FET) cycles. Neonates from 2PN FET constituted the control group.

MAIN OUTCOME MEASURE(S):

Implantation rate (IR), clinical pregnancy rate (PR), miscarriage rate, live birth rate, congenital malformations, and motor and language development status were compared.

RESULT(S):

The cohort comprised 186, 676, 133, and 502 patients consenting to FET with, respectively, 1PN cleavage-stage, 2PN cleavage-stage, 1PN blastocystocyst, and 2PN blastocystocyst embryos. The IR, PR, and live birth rate were lower in 1PN than with 2PN cleavage-stage FET, but similar between 1PN and 2PN blastocystocysts. Miscarriage rates did not differ significantly between 1PN and 2PN cleavage-stage or blastocystocyst FET. Risk of congenital malformations and defects in psychomotor development did not differ significantly within 2 years postpartum with the use of 1PN or 2PN FET.

CONCLUSION(S):

The present results suggest that the value of 1PN blastocyst FET is similar to that of 2PN blastocyst FET, without an increased risk of miscarriage rate, congenital malformations, or defects of psychomotor development.

流產胚胎組織SNP基因分析發現葡萄胎佔3%

Fertil Steril. 2019 Aug 5. pii: S0015-0282(19)30548-5. doi: 10.1016/j.fertnstert.2019.06.015. [Epub ahead of print]

Single-nucleotide polymorphism microarray detects molar pregnancies in 3% of miscarriages.

Maisenbacher MK1, Merrion K1, Kutteh WH2.

Author information

1

Natera, San Carlos, California.

2

Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Memphis, Tennessee; Fertility Associates of Memphis, Memphis, Tennessee. Electronic address: wkutteh@fertilitymemphis.com.

Abstract

OBJECTIVE:

To determine the frequency of molar pregnancy in miscarriage cases based on single-nucleotide polymorphism (SNP) microarray testing on products of conception (POC) tissue and to estimate the sensitivity of ultrasound and histopathologic evaluation for cases identified to be at risk for gestational trophoblastic disease.

DESIGN:

Retrospective cohort analysis.

SETTING:

Reference laboratory.

PATIENT(S):

POC specimens from 26,101 consecutive miscarriages.

INTERVENTION(S):

POC samples were sent to a single laboratory for analysis. Maternal age, gestational age, egg donor use, indication for testing, and additional clinical information were obtained from the requisition form and a survey sent to ordering providers.

MAIN OUTCOME MEASURE(S):

Rates of full paternal uniparental disomy (UPD), indicative of complete molar pregnancy, and triploidy of paternal origin, indicative of partial molar pregnancy, in POC samples.

RESULT(S):

Paternal triploidy was detected in 638 cases (2.8%) and full paternal UPD in 72 cases (0.3%). Of the cases with complete clinical information (224/710; 31.5%), histopathology and/or ultrasound did not detect 71% of partial molar pregnancies and 30% of complete molar pregnancies.

CONCLUSION(S):

Molar pregnancy, detected in 3.1% of all miscarriages in this study with the use of 24-chromosome SNP microarray testing, occurred significantly more frequently than previously estimated with the use of ultrasound and/or histopathology.

paraffin oil vs mineral oil 應用於IVF胚胎培養, 胚胎品質& 懷孕率並無明顯差異

Syst Biol Reprod Med. 2019 Feb;65(1):81-86. doi: 10.1080/19396368.2018.1492645. Epub 2018 Jul 9.

Comparison between paraffin and mineral oil covering on early human embryo culture: a prospective randomized study.

Labied S1, Jouan C1, Wenders F1, Ravet S1, Gaspard O1, Thonon F1, Gridelet V1, Henry L1,2, Perrier d'Hauterive S1,2, Nisolle M1,2.

Author information

1

a Center for Assisted Medical Procreation University of Liège, CHR Citadelle , Liège , Belgium.

2

b Department of Obstetrics and Gynecology, CHR Citadelle , University of Liège , Liège , Belgium.

Abstract

The oil overlay in microdrop culture systems prevents medium evaporation, helps to maintain appropriate pH and osmotic conditions and protects from microbial contamination. In the present study, we prospectively compared covering by Ovoil™, a paraffin oil, and LiteOil®, a mineral oil, on the in vitro development of human embryos and their suitability for transfer/freezing at day 3 and live birth rate. One hundred and one patients undergoing in vitro fertilization (IVF) treatment by  intracytoplasmic sperm injection (ICSI) were enrolled in our study. After ICSI, 1237 oocytes were 1:1 randomly allocated into 2 groups according to the type of overlaying oil: Ovoil™ (616 oocytes) or LiteOil® (621 oocytes). Fertilization rate was assessed around 18 hours post-insemination (hpi) and embryos were checked for early cleavage at 25 hpi. Embryo morphology was recorded on days 2 and 3. A total of 437 (Ovoil™) and 438 day 3 embryos (LiteOil®) were analyzed. There were no differences between the two groups in terms of fertilization rate and occurrence of early cleavage. The proportion of top quality embryos (41.7% vs. 41.2%) and the final utilization rates (92.2% vs. 92.0%) were similar in Ovoil and LiteOil groups, respectively, at day 3. Live birth rate per transfer was essentially the same with Ovoil™ overlay (26.9%) when compared to LiteOil® (26.2%). Live birth rate in patients who simultaneously received  embryos from both overlay types was 17.2%. Despite the different characteristics of these two oils regarding hydrocarbon saturation, packing and temperature storage, Ovoil™ and LiteOil® can be used in parallel in the same IVF protocol. Abbreviations: ART: assisted reproductive technologies; hpi: hours post-insemination; hSA: human serum albumin; HTF: human tubal fluid; ICSI: intracytoplasmic sperm injection; IVF: in vitro fertilization; MII: metaphase II; MEA: mouse embryo assay; RT: room temperature.

施行輸卵管攝影中  使用油性輸卵管顯影劑比水溶性輸卵管顯影劑懷孕率更高 (39% vs 29%)

Hum Reprod Open. 2019 Jul 18;2019(3):hoz015. doi: 10.1093/hropen/hoz015. eCollection 2019.

Tubal flushing with oil- or water-based contrast medium: can we identify markers that indicate treatment benefit?

van Rijswijk J1, van Welie N1, Dreyer K1, Tajik P2, Lambalk CB1, Hompes P1, Mijatovic V1, Mol BWJ3, Zafarmand MH2,4.

Author information

1

Department of Reproductive Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.

2

Centre for Reproductive Medicine, Department of Obstetrics and Gynaecology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.

3

Department of Obstetrics and Gynaecology, Monash Medical Centre, Monash Health and Monash University, Melbourne, Australia.

4

Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.

Abstract

STUDY QUESTION:

Can we identify patient characteristics that distinguish which ovulatory infertile women undergoing hysterosalpingography (HSG) benefit more or less from flushing with oil-based contrast medium compared to water-based contrast medium?

SUMMARY ANSWER:

In ovulatory infertile women, HSG with oil-based contrast medium resulted in higher 6-month ongoing pregnancy and live birth rates as compared to HSG with water-based contrast medium and this treatment effect was independent of characteristics of the couple.

WHAT IS KNOWN ALREADY:

We recently showed that in infertile women undergoing HSG, flushing with oil-based contrast medium resulted in more ongoing pregnancies than flushing with water-based contrast medium.

STUDY DESIGN SIZE DURATION:

We used data from our randomized clinical trial (RCT) in which 1,119 ovulatory infertile women undergoing HSG during fertility work-up were randomized for use of oil-based (N = 557) or water-based (N = 562) contrast medium.

PARTICIPANTS/MATERIALS SETTING METHODS:

We built logistic regression models to predict ongoing pregnancy and live birth (secondary outcome) as a function of the specific contrast, the specific marker, and marker-by-contrast-interaction. Markers considered were female age, maternal ethnicity, female smoking, body mass index (BMI), duration of infertility, infertility being primary or secondary, sperm quality, and previous appendectomy.

MAIN RESULTS AND THE ROLE OF CHANCE:

The 6-month ongoing pregnancy rates in the overall population were 39.7% after use of oil-based contrast versus 29.1% after use of water-based contrast medium [relative risk (RR), 1.37; 95% confidence interval (CI), 1.16-1.61; P < 0.001]. Among the studied baseline characteristics, BMI (P = 0.002) and semen volume (P = 0.02) were statistically significant prognosticators. The treatment effect of oil-based contrast was stronger in women with a BMI ≤30 kg/m2 [RR, 1.54; 95% CI, 1.23-1.92; P = 0.002], and in women whose partner had a semen volume >3 ml [RR, 1.77; 95% CI, 1.28-2.46; P = 0.02]. Also, in women who smoked, the treatment effect of flushing with oil was stronger, but this interaction did not reach statistical significance (P = 0.066). We found no positive effect of oil-based contrast in obese women. We found similar but weaker associations for live birth, which was probably due to lower number of events resulting in less power.

胚胎生長速度很關鍵  速度太慢ㄉ胚胎著床率不佳

正常地5天就該形成囊胚  到第7天才形成  染色體多半有問題

Hum Reprod. 2019 Aug 9. pii: dez129. doi: 10.1093/humrep/dez129. [Epub ahead of print]

What is the reproductive potential of day 7 euploid embryos?

Hernandez-Nieto C1, Lee JA1, Slifkin R1, Sandler B1,2, Copperman AB1,2, Flisser E1,2.

Author information

1

Reproductive Medicine Associates of New York, New York, NY, USA.

2

Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA.

Abstract

STUDY QUESTION:

What is the rate of euploidy and the reproductive potential of embryos biopsied after 6 days of development?

SUMMARY ANSWER:

Embryos biopsied after 6 days of development have higher rates of aneuploidy; however, day 7 euploid embryos selected at transfer can achieve acceptable pregnancy rates and live birth (LB) outcomes.

WHAT IS KNOWN ALREADY:

Recent publications have shown promising treatment results after euploid day 7 embryo transfers (ETs), albeit these studies were limited by small sample sizes. Whereas the current clinical standard has been to discard embryos that do not reach expansion by day 6 of development, the lack of robust data surrounding the clinical utility of day 7 embryos warrants further evaluation.

STUDY DESIGN, SIZE, DURATION:

Retrospective cohort analysis in a single, academic in vitro fertilization (IVF) center from January 2012 to March 2018. A total of 25 775 embryos underwent trophectoderm (TE) biopsy and preimplantation genetic testing for aneuploidy (PGT-A). Additionally, the clinical IVF outcomes of 3824 single, euploid frozen embryo transfer (FET) cycles were evaluated.

PARTICIPANTS/MATERIALS, SETTING, METHODS:

Cohorts were segregated by day of TE biopsy following oocyte retrieval (day 5, day 6 or day 7). PGT-A was performed to identify embryonic ploidy rates. Secondly, IVF and LB outcomes after single, euploid FET were evaluated for each cohort.

MAIN RESULTS AND THE ROLE OF CHANCE:

A total of day 5 (n = 12 535), day 6 (n = 11 939) and day 7 (n = 1298) embryos were included in the study analysis. The rate of embryo euploidy was significantly lower in day 7 blastocysts compared to day 5 or day 6 cohorts (day 7 = 40.5%; day 5 = 54.7%; day 6 = 52.9%; (P < 0.0001)). After adjusting for age, anti-Müllerian hormone, BMI, embryo quality and number of embryos biopsied, there was a significant association between aneuploidy and embryos biopsied on day 7 when compared to day 5 biopsied embryos (OR = 1.34, CI 95% 1.09-1.45, P = 0.001) and day 6 biopsied embryos (OR = 1.26, CI95% 1.07-1.16, P < 0.001).A sub-analysis of subsequent 3824 single, euploid FET cycles (day 5: n = 2321 cycles; day 6: n = 1381 cycles; and day 7: n = 116 cycles) showed significant differences among cohorts in implantation, clinical pregnancy, LB and clinical loss rates. There was a significant decrease in the odds of implantation, clinical pregnancy and LB, but no association with clinical loss or multiple pregnancy rates in patients who utilized day 7-biopsied embryos during treatment.