雙重切片+雙重玻璃化冷凍 or 單次切片+雙重玻璃化冷凍解凍

vs.  單次切片+ 單次玻璃化冷凍解凍

----均導致活產率/持續懷孕率和臨床懷孕率下降。

Meta-Analysis

 

. 2024 Dec 1;39(12):2674-2684.

 doi: 10.1093/humrep/deae235.

Impacts of double biopsy and double vitrification on the clinical outcomes following euploid blastocyst transfer: a systematic review and meta-analysis

Study question: Compared to the 'single biopsy + single vitrification' approach, do 'double biopsy + double vitrification' or 'single biopsy + double vitrification' arrangements compromise subsequent clinical outcomes following euploidy blastocyst transfer?

Summary answer: Both 'double biopsy + double vitrification' and 'single biopsy + double vitrification' led to reduced live birth/ongoing pregnancy rates and clinical pregnancy rates.

What is known already?: It is not uncommon to receive inconclusive results following blastocyst biopsy and preimplantation genetic testing for aneuploidy (PGT-A). Often these blastocysts are warmed for re-test after a second biopsy, experiencing 'double biopsy + double vitrification'. Furthermore, to achieve better workflow, IVF laboratories may choose to routinely vitrify all blastocysts and schedule biopsy at a preferred timing, involving 'single biopsy + double vitrification'. However, in the current literature, there is a lack of systematic evaluation of both arrangements regarding their potential clinical risks in reference to the most common 'single biopsy + single vitrification' approach.

Study design, size, duration: A systematic review and meta-analysis were performed, with the protocol registered in PROSPERO (CRD42023469143). A search in PUBMED, EMBASE, and the Cochrane Library for relevant studies was carried out on 30 August 2023, using the keywords 'biopsy' and 'vitrification' and associated variations respectively. Only studies involving frozen transfers of PGT-A tested euploid blastocysts were included, with those involving PGT-M or PGT-SR excluded.

Participants/materials, setting, methods: Study groups included blastocysts having undergone 'double biopsy + double vitrification' or 'single biopsy + double vitrification', with a 'single biopsy + single vitrification' group used as control. The primary outcome was clinical pregnancy, while secondary outcomes included live birth/ongoing pregnancy, miscarriage, and post-warming survival rates. Random effects meta-analysis was performed with risk ratios (RR) and 95% CIs were used to present outcome comparisons.

Main results and the role of chance: A total of 607 records were identified through the initial search and nine studies (six full articles and three abstracts) were eventually included. Compared to 'single biopsy + single vitrification', 'double biopsy + double vitrification' was associated with reduced clinical pregnancy rates (six studies, n = 18 754; RR = 0.80, 95% CI = 0.71-0.89; I2 = 0%) and live birth/ongoing pregnancy rates (seven studies, n = 20 964; RR = 0.72, 95% CI = 0.63-0.82; I2 = 0%). However, no significant changes were seen in miscarriage rates (seven studies, n = 22 332; RR = 1.40, 95% CI = 0.92-2.11; I2 = 53%) and post-warming survival rates (three studies, n = 13 562; RR = 1.00, 95% CI = 0.99-1.01; I2 = 0%) following 'double biopsy + double vitrification'. Furthermore, 'single biopsy + double vitrification' was also linked with decreased clinical pregnancy rates (six studies, n = 13 284; RR = 0.84, 95% CI = 0.76-0.92; I2 = 39%) and live birth/ongoing pregnancy rates (seven studies, n = 16 800; RR = 0.79, 95% CI = 0.69-0.91; I2 = 70%), and increased miscarriage rates (five studies, n = 15 781; RR = 1.48, 95% CI = 1.31-1.67; I2 = 0%), but post-warming survival rates were not affected (three studies, n = 12 452; RR = 0.99, 95% CI = 0.97-1.01; I2 = 71%) by 'single biopsy + double vitrification'.

男性年齡& BMI與胚胎形態動力學 (PN~blastocyst時間點)

男性年齡與胚胎形態動力學早期階段（tPNa、tPNf、t2、t3、t4、t6）有顯著相關。

 male age was significantly associated with earlier embryo morphokinetics timings (tPNa, tPNf, t2, t3, t4, t6)

 tPNa time of pronuclei appearance, tPNf time of pronuclei fading

https://pmc.ncbi.nlm.nih.gov/articles/PMC12602791/

Impact of male factors on morphokinetic parameters: a prospective analysis using time-lapse monitored embryos

Introduction  Time-lapse technology enables recording embryo morphokinetic parameters, which are associated with embryonic competence and assisted reproductive technology (ART) outcomes. While female factors such as age and BMI are known to influence these parameters, the role of male factors remains understudied.

Aim  This study aimed to evaluate the influence of male factors on preimplantation embryo morphokinetics.

Methods  In this prospective observational study, 1,210 embryos from infertile couples undergoing Intracytoplasmic sperm injection (ICSI) or intracytoplasmic morphologically-selected sperm injection (IMSI) were monitored using time-lapse imaging. Male data, including age, BMI, sperm concentration, and sperm DNA fragmentation (SDF) were collected. Multiple regression analysis assessed the association between paternal factors and morphokinetic parameters, adjusting for female confounders.

Results   After adjustment, male age and BMI were found to significantly influence embryo developmental stages (from time to pronuclei appearance to t4 and t6 for age, from time to pronuclei appearance to t2 and t8 for BMI). The impact of sperm concentration was less consistent, and no significant relationship was observed with SDF.

Conclusions   These findings highlight the role of male factors, particularly age and BMI, in influencing embryo morphokinetics, even after accounting for female confounders. This underscores the potential for clinical interventions targeting paternal health to optimize ART outcomes. Additionally, the study reinforces the importance of considering both parental contributions in ART success, particularly the increasingly recognized influence of male age.

 GRHantagonist vs. progestin 誘導排卵COH

---GnRH antagonist可以取得較多卵子

Gonadotropin-releasing hormone antagonist protocol is associated with higher oocyte yield in young women at high risk for low oocyte retrieval: a retrospective study using three statistical methods

To study whether the gonadotropin-releasing hormone (GnRH) antagonist protocol is associated with improved oocyte retrieval outcomes compared with the progestin-primed ovarian stimulation (PPOS) protocol in young women at high predicted risk for low oocyte yield.

A total of 2,068 women aged ≤35 years undergoing their first in vitro fertilization and intracytoplasmic sperm injection treatment cycles between January 2023 and April 2025, identified as high risk for low oocyte retrieval (predicted score ≥0.41) using a validated nomogram incorporating factors such as age, antimüllerian hormone levels, antral follicle count, basal follicle-stimulating hormone levels, and follicle-stimulating hormone:luteinizing hormone ratio.

Exposure

Ovarian stimulation with either a GnRH antagonist protocol or a PPOS protocol, with protocol selection on the basis of clinical judgment and patient characteristics.

Main Outcome Measures

Incidence of low oocyte retrieval (<10 oocytes) and the number of oocytes retrieved.

Results

Among 2,068 young women at high predicted risk for low oocyte yield, the GnRH antagonist protocol resulted in significantly better ovarian stimulation outcomes compared with the PPOS protocol. After propensity score matching, the antagonist group had a higher mean number of oocytes retrieved (8.3 vs. 5.3; Bayes factor in favor of the alternative hypothesis [BF10] >1028) and a higher oocyte retrieval rate (88.2% vs. 81.2%; BF10 >103). The incidence of low oocyte retrieval (<10 oocytes) was significantly lower in the antagonist group (65.2% vs. 86.0%; BF10 >1019). No significant differences were observed in embryo quality or fertilization rates. Risk-based stratified analysis showed that the GnRH antagonist protocol significantly reduced the incidence of low oocyte retrieval in low-risk to midrisk groups (median odds ratio, 0.30–0.57, BF10 up to 647.8), whereas in the highest-risk subgroup, PPOS showed a potential advantage.

Conclusion

The GnRH antagonist protocol is superior to PPOS in maximizing oocyte retrieval among young women at high predicted risk for low oocyte retrieval, highlighting the value of individualized risk-based stimulation strategies to improve clinical outcomes.

• 常規 IVF 的 SCM 進行 niPGT 的方法與 ICSI 具有可比的性能
• 可擴大 niPGT 的應用範圍。

• 161個常規IVF胚胎和122個ICSI胚胎的niPGT表現無顯著差異（P > 0.05），
• IVF和ICSI方法的倍性一致率分別為75%和74.6%。
• niPGT胚胎的整倍體預測機率為 82.8%
• 性染色體嵌合體的預測機率為 77.8%，
• 低水平嵌合體的預測機率為 62.5%，
• 多條異常染色體的預測機率為 50.0%，
• 多條異常染色體的預測機率為 50.0

Observational Study

 

. 2022 Sep 4;20(1):396.

 doi: 10.1186/s12967-022-03596-0.

Non-invasive preimplantation genetic testing for conventional IVF blastocysts

Background: Previous studies suggested that non-invasive preimplantation genetic testing (niPGT) for intracytoplasmic sperm injection (ICSI) blastocysts can be used to identify chromosomal ploidy and chromosomal abnormalities. Here, we report the feasibility and performance of niPGT for conventional in vitro fertilization (IVF) blastocysts.

Methods: This was a prospective observational study. In the preclinical stage, whole genome amplification and NGS were performed using the sperm spent culture medium (SCM). Then, trophectoderm (TE) biopsies and corresponding SCM derived from 27 conventional IVF monopronuclear embryos were collected. In the clinical stage, samples from 25 conventional IVF cycles and 37 ICSI cycles from April 2020-August 2021 were collected for performance evaluation.

Results: Preclinically, we confirmed failed sperm DNA amplification under the current amplification system. Subsequent niPGT from the 27 monopronuclear blastocysts showed 69.2% concordance with PGT results of corresponding TE biopsies. In the clinical stage, no paternal contamination was observed in any of the 161 SCM samples from conventional IVF. While maternal contamination was observed in 29.8% (48/161) SCM samples, only 2.5% (4/161) samples had a contamination ratio ≥ 50%. Compared with that of TE biopsy, the performances of NiPGT from 161 conventional IVF embryos and 122 ICSI embryos were not significantly different (P > 0.05), with ploidy concordance rates of 75% and 74.6% for IVF and ICSI methods, respectively. Finally, evaluation of the euploid probability of embryos with different types of niPGT results showed prediction probabilities of 82.8%, 77.8%, 62.5%, 50.0%, 40.9% and 18.4% for euploidy, sex-chromosome mosaics only, low-level mosaics, multiple abnormal chromosomes, high-level mosaics and aneuploidy, respectively.

Conclusions: Our research results preliminarily confirm that the niPGT approach using SCM from conventional IVF has comparable performance with ICSI and might broadening the application scope of niPGT.