賀本院月子中心成立
2017年2月27日
2 cell 胚胎胚葉細胞呈現多核現象活產率明顯下降
(MNB2/2cell vs MNB1/2cell vs Without-MNB2cell ----->18 vs 22 vs 29%)
To determine the prognostic impact of the nuclear status at the two-cell stage on intracytoplasmic sperm injection (ICSI) outcomes.
Retrospective study.
Hospital.
Only ICSI cycles with time-lapse monitoring of transferred embryos with known implantation/delivery data from November 2012 to December 2014 were included. A total of 2,449 embryos were assessed for multinucleation rates at the two- and four-cell stage, and 608 transferred embryos were studied for ICSI outcomes.
None.
Implantation rate (IR) and live birth rate (LBR) according to the number of multinucleated blastomeres at the two-cell stage: none (Without-MNB2cell), one (MNB1/2cell), and two (MNB2/2cell); morphokinetics of MNB2cell embryos.
Embryos with MNB1/2cell led to lower IR (27.7%) and LBR (22.7%) than embryos Without-MNB2cell (33.4% and 29.8%, respectively). The MNB2/2cell embryos led to significantly lower IR (18.3%) and LBR (13.4%) than embryos Without-MNB2cell. This difference remained significant in multivariate analysis for implantation (odds ratio 0.57; 95% confidence interval 0.34-0.94) and birth (odds ratio 0.46; 95% confidence interval 0.26-0.80), independently of the other significant parameters (women's age, time of two-cell formation, and multinucleation at the four-cell stage). Among implanted MNB2cell, if cleavage into four cells occurred later than 37 hours after insemination, embryos were significantly more likely to lead to birth.
The presence of multinucleation at the two-cell stage and more specifically in both blastomeres had a significant negative impact on birth potential. Thus, embryo multinucleation at the two-cell stage should be used as an additional noninvasive criterion for embryo selection.
(MNB2/2cell vs MNB1/2cell vs Without-MNB2cell ----->18 vs 22 vs 29%)
Fertil Steril. 2017 Jan;107(1):97-103.e4. doi: 10.1016/j.fertnstert.2016.09.022. Epub 2016 Oct 26.
Embryo multinucleation at the two-cell stage is an independent predictor of intracytoplasmic sperm injection outcomes.
Abstract
OBJECTIVE:
DESIGN:
SETTING:
PATIENT(S):
INTERVENTION(S):
MAIN OUTCOME MEASURE(S):
RESULT(S):
CONCLUSION(S):
2017年2月24日
冷凍卵子施行ICSI後形成囊胚之染色體正常率與新鮮卵子無差異(42% vs 40%)
冷凍卵子施行ICSI後形成囊胚之著床率與新鮮卵子無差異(56% vs 60%)
In a preimplantation genetic diagnosis for aneuploidy (PGD-A) program, the more embryos available for biopsy, consequently increases the chances of obtaining euploid embryos to transfer. The aim was to increase the number of viable euploid blastocysts in patients undergoing PGD-A using fresh oocytes together with previously accumulated vitrified oocytes.
Sixty-nine patients with normal ovarian reserve underwent PGD-A for repeated implantation failure or recurrent pregnancy loss indication. After several cycles of ovarian stimulation, 591 accumulated vitrified oocytes and 463 fresh oocytes were micro-injected with the same partner's semen sample. PGD-A was completed on 134 blastocysts from vitrified/warmed oocytes and 130 blastocysts from fresh oocytes.
A mean of 9.6% euploid blastocyst per micro-injected vitrified/warmed oocytes and 11.4% euploid blastocyst per micro-injected fresh oocyte were obtained (p > 0.05). The euploidy and aneuploidy rates were comparable in blastocysts obtained from micro-injected vitrified/warmed oocytes and fresh oocytes (42.5 versus 40.8% and 57.5 versus 59.2%, p > 0.05). Implantation rates of euploid blastocysts were comparable between the two sources of oocytes (56.0% from vitrified/warmed oocytes versus 60.9% from fresh oocytes, p > 0.05).
Oocyte vitrification and warming do not generate aneuploidy in blastocysts. The number of viable euploid embryos for transfer can be increased by using accumulated vitrified oocytes together with fresh oocytes in ICSI.
冷凍卵子施行ICSI後形成囊胚之著床率與新鮮卵子無差異(56% vs 60%)
J Assist Reprod Genet. 2017 Jan 9. doi: 10.1007/s10815-016-0868-0. [Epub ahead of print]
The accumulation of vitrified oocytes is a strategy to increase the number of euploid available blastocysts for transfer after preimplantation genetic testing.
Chamayou S1, Sicali M2, Alecci C2, Ragolia C2, Liprino A2, Nibali D2, Storaci G2, Cardea A2, Guglielmino A2.
Abstract
PURPOSE:
METHODS:
RESULTS:
CONCLUSIONS:
新觀念: day 1-3使用5%O2培養環境，day3-5使用2%O2培養環境可能可達到更高囊胚率
Fellows in Reproductive Endocrinology and Infertility training are expected to complete 18 months of clinical, basic, or epidemiological research. The goal of this research is not only to provide the basis for the thesis section of the oral board exam but also to spark interest in reproductive medicine research and to provide the next generation of physician-scientists with a foundational experience in research design and implementation. Incoming fellows often have varying degrees of training in research methodology and, likewise, different career goals. Ideally, selection of a thesis topic and mentor should be geared toward defining an "answerable" question and building a practical skill set for future investigation. This contribution to the JARG Young Investigator's Forum revisits the steps of the scientific method through the lens of one recently graduated fellow and his project aimed to test the hypothesis that "sequential oxygen exposure (5% from days 1 to 3, then 2% from days 3 to 5) improves blastocyst yield and quality compared to continuous exposure to 5% oxygen among human preimplantation embryos."
J Assist Reprod Genet. 2017 Feb 4. doi: 10.1007/s10815-017-0887-5. [Epub ahead of print]
On developing a thesis for Reproductive Endocrinology and Infertility fellowship: a case study of ultra-low (2%) oxygen tension for extended culture of human embryos.
Abstract
研究指出day3以後胚胎培養環境使用低氧達2%，可能更符合生理狀況
There has been much debate regarding the optimal oxygen tension in clinical embryo culture. The majority of the literature to date has compared 5% oxygen to atmospheric levels (20-21%). While the majority of modern IVF labs have accepted the superiority of 5% oxygen tension, a new debate has emerged regarding whether a further reduction after day 3 of development represents the most physiologic system. This new avenue of research is based on the premise that oxygen tension is in fact lower in the uterus than in the oviduct and that the embryo crosses the uterotubal junction sometime on day 3. While data are currently limited, recent experience with ultra-low oxygen (2%) after day 3 of development suggests that the optimal oxygen tension in embryo culture may depend on the stage of development. This review article will consider the current state of the literature and discuss ongoing efforts at studying ultra-low oxygen tension in extended culture.
J Assist Reprod Genet. 2017 Feb 8. doi: 10.1007/s10815-017-0880-z. [Epub ahead of print]
Oxygen tension in embryo culture: does a shift to 2% O2 in extended culture represent the most physiologic system?
Abstract
2017年2月22日
較胖IVF病患(BMI>30), 使用GnRH antagonist懷孕率較高(compared to GnRHagonist)
Are cumulative live birth rates (CLBRs) similar in GnRH-antagonist and GnRH-agonist protocols for the first ART cycle including all subsequent frozen-thaw cycles from the same oocyte retrieval?
The chances of at least one live birth following utilization of all fresh and frozen embryos after the first ART cycle are similar in GnRH-antagonist and GnRH-agonist protocols.
Reproductive outcomes of ART treatment are traditionally reported as pregnancies per cycle or per embryo transfer. However, the primary concern is the overall chance of a live birth. After the first ART cycle with fresh embryo transfer, we found live birth rates (LBRs) of 22.8% and 23.8% (P = 0.70) for the GnRH-antagonist and GnRH-agonist protocols, respectively. But with CLBRs including both fresh and frozen embryos from the first oocyte retrieval, chances of at least one live birth increases. There are no previous randomized controlled trials (RCTs) comparing CLBRs in GnRH-antagonist versus GnRH-agonist protocols. Previous studies on CLBR are either retrospective cohort studies including multiple fresh cycles or RCTs comparing single embryo transfer (SET) with double embryo transfer (DET).
CLBR was a secondary outcome in a Phase IV, dual-center, open-label, RCT including 1050 women allocated to a short GnRH-antagonist or a long GnRH-agonist protocol in a 1:1 ratio over a 5-year period using a web-based concealed randomization code. The minimum follow-up time from the first IVF cycle was 2 years. The aim was to compare CLBR between the two groups following utilization of all fresh and frozen embryos from the first ART cycle.
All women referred for their first ART cycle at two public fertility clinics, <40 years of age were approached. A total of 1050 subjects were allocated to treatment and 1023 women started standardized ART protocols with recombinant human follitropin-β (rFSH) stimulation. Day-2 SET was planned and additional embryos were frozen and used in subsequent frozen-thawed cycles. All pregnancies generated from oocyte retrieval during the first IVF cycle including fresh and frozen-thaw cycles were registered. Ongoing pregnancy was determined by ultrasonography at gestational week 7-9 and live birth was irrespective of the duration of gestation. CLBR was defined as at least one live birth per allocated woman after fresh and frozen cycles. Subjects were censored out after the first live birth. Cox proportional hazard model was used to evaluate the relative prognostic significance of female age, BMI, the number of retrieved oocytes and the diagnosis of infertility in relation to the CLBR.
Baseline characteristics were similar and equal proportions of patients continued with frozen-thaw (frozen embryo transfer, FET) cycles after their fresh ART cycle in the GnRH-antagonist and GnRH-agonist arms. When combining all fresh and frozen-thaw embryo transfers from first oocyte retrieval with a minimum of 2-year follow-up, the CLBR was 34.1% (182/534) in the GnRH-antagonist group versus 31.2% (161/516) in the GnRH-agonist group (odds ratio (OR):1.14; 95% CI: 0.88-1.48, P = 0.32). Mean time to the first live birth was 11.0 months in the GnRH-antagonist group compared to 11.5 months in the GnRH-agonist group (P < 0.01). The total number of deliveries from all FET cycles where embryos were thawed were higher in the antagonist group 64/330 (19.4%) compared to the agonist group 43/355 (12.1%) ((OR): 1.74; 95% CI: 1.14-2.66, P = 0.01). The evaluation of prognostic factors showed that more retrieved oocytes were associated with a significantly higher CLBR in both treatment groups. For the subgroup of obese women (BMI >30 kg/m2), the CLBR was significantly higher in the GnRH-antagonist group (P = 0.02).
Hum Reprod. 2017 Jan 26. doi: 10.1093/humrep/dew358. [Epub ahead of print]
Cumulative live birth rates after one ART cycle including all subsequent frozen-thaw cycles in 1050 women: secondary outcome of an RCT comparing GnRH-antagonist and GnRH-agonist protocols.
Abstract
STUDY QUESTION:
SUMMARY ANSWER:
WHAT IS KNOWN ALREADY:
STUDY DESIGN, SIZE, DURATION:
PARTICIPANTS/MATERIALS, SETTING, METHODS:
MAIN RESULTS AND THE ROLE OF CHANCE:
2017年2月21日
每天一顆優潔通utrogestan可用於取代GnRHa預防LH surge排卵
(缺點: 排卵針劑量會提高500iu)
To compare the clinical characteristics in a Utrogestan and hMG protocol with the use of different doses of Utrogestan in normally ovulating women undergoing in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) treatments.
Prospective controlled study.
Tertiary-care academic medical center.
A total of 150 infertile patients undergoing IVF/ICSI treatments.
Utrogestan and hMG were administered simultaneously beginning on cycle day 3. The dose of Utrogestan was 100 mg/d in the study group and 200 mg/d in the control group. When the dominant follicles reached mature, 0.1 mg GnRH agonist was used for trigger. Viable embryos were cryopreserved in both protocols for later transfer.
The primary outcome measure was the incidence of premature LH surge. Secondary outcomes included the embryo results and clinical pregnancy outcomes.
Consistent LH suppression was achieved during controlled ovarian hyperstimulation with Utrogestan at 100 mg, and the number of patients with profound LH suppression (LH <1.2 IU/L) in the low-dose group was significantly less than that in the high-dose group. The number of oocytes retrieved in the low-dose group was similar to that in the high-dose group (9.87 ± 5.77 vs. 10.25 ± 5.43). No significant differences were observed in the number of mature oocytes, viable embryos, clinical pregnancy rate, or implantation rate.
Utrogestan at 100 mg is as effective as Utrogestan at 200 mg in reducing premature LH surge during controlled ovarian hyperstimulation.
(缺點: 排卵針劑量會提高500iu)
Fertil Steril. 2017 Feb;107(2):379-386.e4. doi: 10.1016/j.fertnstert.2016.10.030. Epub 2016 Nov 16.
Use of Utrogestan during controlled ovarian hyperstimulation in normally ovulating women undergoing in vitro fertilization or intracytoplasmic sperm injection treatments in combination with a "freeze all" strategy: a randomized controlled dose-finding study of 100 mg versus 200 mg.
Abstract
OBJECTIVE:
DESIGN:
SETTING:
PATIENT(S):
INTERVENTION(S):
MAIN OUTCOME MEASURE(S):
RESULT(S):
CONCLUSION(S):
time lapse胚胎即時監測對於胚胎染色體評估之準確性仍不理想
不同誘導排卵針對胚胎生長型態速度仍有個別影響
To study whether time-lapse morphokinetic (TLM) assessment predicts ploidy status when patient- and ovarian stimulation-related factors are taken into account.
Retrospective cohort study.
Private IVF clinic.
In total, 103 consecutive patients (415 blastocysts) were included. All embryos were individually cultured in a time-lapse incubator from intracytoplasmic sperm injection up to trophectoderm biopsy. Following trophectoderm biopsy on day 5 or 6, blastocysts were vitrified and 23 TLM parameters were analyzed.
Correlations between patient- and ovarian stimulation-related factors and TLM parameters were tested in a multilevel mixed-effects linear regression model and assessed by means of intraclass correlation coefficient (ICC).
Predictive ability of TLM parameters for euploidy.
The majority of TLM parameters had ICCs of 16%-47%. None of the patient- or ovarian stimulation-related factor had any systematic effect on any TLM parameter; however, body mass, total FSH dose, duration of infertility, number of previous cycles, antral follicle count, ovarian stimulation protocol, and E2 on the trigger day had a significant impact on some TLM parameters. With the use of multilevel mixed-effects logistic regression analysis, of the ten TLM parameters that were initially noted to be significantly different among euploid and aneuploid blastocysts in the univariate analysis, only five remained significant. However, the areas under the receiver operating characteristic curves at regression analysis were low, ranging from 0.55 to 0.63.
Five TLM parameters, all related to timing of blastocyst development, have limited ability to predict euploidy when patient- and ovarian stimulation-related factors are taken into account.
不同誘導排卵針對胚胎生長型態速度仍有個別影響
Fertil Steril. 2017 Feb;107(2):413-421.e4. doi: 10.1016/j.fertnstert.2016.11.005. Epub 2016 Dec 6.
Time-lapse morphokinetic assessment has low to moderate ability to predict euploidy when patient- and ovarian stimulation-related factors are taken into account with the use of clustered data analysis.
Abstract
OBJECTIVE:
DESIGN:
SETTING:
PATIENT(S):
INTERVENTION(S):
MAIN OUTCOME MEASURE(S):
RESULT(S):
CONCLUSION(S):
鼠胚研究顯示，4-8cell階段是最適合冷凍胚胎之時期
Vitrification has been shown as one of the most effective methods of cryopreservation for mammalian embryos. However, there is no consensus which stage of embryonic development is the most appropriate for vitrification with subsequent maximal development after thawing. This study was carried out to explore and compare the effect(s) of vitrification on mouse 2-cell, 4-cell, 8-cell, morula and blastocyst stage embryos and subsequent blast formation and hatching after thawing.
In this experimental study, 2-cell embryos were obtained from the oviducts of super ovulated female NMRI mice. Some embryos were randomly selected and vitrified through a two-step media protocol and cryotop. Other embryos were cultured to assess their development. During the ensuing days, some of these cultured embryos were vitrified at 4-cell, 8-cell, morula and blastocyst stages. After 10 to 14 days, the embryos were thawed to assess their survival and also cultured to determine the rate of blastocyst formation and hatching. The results were analyzed using one-way ANOVA and Tukey's post-hoc tests.
There was no significant difference in the survival rates of vitrified embryos at 2-cell, 4-cell, 8-cell, morula and blastocyst stages after thawing (P>0.05). The blastocyst formation rate of vitrified 8-cell embryos was significantly higher than that of 2-cell embryos (P<0.05). The hatching rate of vitrified 4-cell, 8-cell and blastocysts were significantly higher than that of 2-cell embryos (P<0.05).
Vitrification is suitable for cryopreservation of all stages of mouse embryonic development. However, the best tolerance for vitrification was observed at 4and 8-cell stages of development. Accordingly, the development of vitrified embryos to blastocysts, following thawing, was most efficacious for 4 and 8-cell embryos. Compared to mouse 2-cell embryos, embryos vitrified as blastocysts had the highest rate of hatching.
Int J Fertil Steril. 2017 Jan-Mar;10(4):357-362. Epub 2016 Nov 1.
Which Stage of Mouse Embryos Is More Appropriate for Vitrification?
Abstract
BACKGROUND:
MATERIALS AND METHODS:
RESULTS:
CONCLUSION:
Table 1
Mouse embryonic development after early cleavage-stage embryo vitrification-warming
| Stage of vitrification | Embryos (n) | Survival rate (%) ± SD | Blastocysts formation (%) ± SD | Hatched(%) ± SD |
|---|---|---|---|---|
| Vitrified 2-cell | 157 | 82.1%±16.8 | 56.5%±23.4 | 21.2%±14.7 |
| Vitrified 4-cell | 145 | 83.2%±11 | 79.8%±13.6 | 49.1%±25.5* |
| Vitrified 8-cell | 166 | 85.8%±22.4 | 84%±21.2* | 50.6%±25.7* |
| Vitrified morula | 180 | 77%±17.8 | 75.8%±21 | 30%±16.3 |
| Vitrified blastocyst | 140 | 60.5%±22.3 | - | 59.8%±25.7* |
睪丸癌病人接受放射治療或化療後，須等1-2年精蟲染色體才可恢復正常，屆時才可接受IVF試管治療
To study sperm aneuploidy in a population of testicular cancer (TC) patients treated with the use of either bleomycin-etoposide-cisplatin (BEP) chemotherapy or radiotherapy.
Multicenter prospective longitudinal study of TC patients analyzed before treatment and after 3, 6, 12, and 24 months (T3-T24).
Fifty-four TC patients and a control group of 10 fertile sperm donors.
University hospital laboratories.
Routine semen analyses; sperm aneuploidy and diploidy.
Comparison of sperm characteristics and sperm chromosome abnormalities during TC patient follow-up.
Semen characteristics recovered pretreatment values 12 months after radiotherapy and 24 months after more than two BEP cycles. A significant increase in sperm disomy YY and XX was observed in the TC group before treatment compared with the control group. After more than two BEP cycles, the mean sperm aneuploidy rate increased significantly at T12 and reached the pretreatment value at T24. After radiotherapy, the mean sperm aneuploidy returned to the pretreatment value at T12. At T24, nearly 40% of TC patients did not recover their pretreatment sperm aneuploidy rate.
Genetic counseling of TC patients should include information on the potential elevated risk of aneuploid conceptus from sperm recovered after treatment and the necessity to postpone conception up to ≥12 months after radiotherapy and ≥24 months after more than two BEP chemotherapy cycles. However, few men receiving one or two BEP cycles and some dropouts are the main limitations of this study.
Fertil Steril. 2017 Jan 6. pii: S0015-0282(16)63015-7. doi: 10.1016/j.fertnstert.2016.11.015. [Epub ahead of print]
Sperm aneuploidy after testicular cancer treatment: data from a prospective multicenter study performed within the French Centre d'Étude et de Conservation des Oeufs et du Sperme network.
Rives N1, Walschaerts M2, Setif V3, Hennebicq S4, Saias J5, Brugnon F6, Auger J7, Berthaut I8, Szerman E9, Daudin M10, Bujan L10.
Abstract
OBJECTIVE:
DESIGN:
PATIENT(S):
SETTING:
INTERVENTION(S):
MAIN OUTCOME MEASURE(S):
RESULT(S):
CONCLUSION(S):
2017年2月13日
Anastrozole 屬芳香抑制酶(類似letrozole), 用於治療乳癌
亦可用於男性不孕症, 可提高男性賀爾蒙濃度及精蟲濃度
To determine whether the change in sperm parameters in subfertile hypoandrogenic men treated with anastrozole is correlated to the magnitude of increase in testosterone (T) to estrogen ratio in men responding to treatment.
Retrospective study.
Male fertility clinic.
The study group consisted of 86 subfertile hypoandrogenic men with low T/estradiol (E2) ratio (n = 78) or a prior aversive reaction to clomiphene citrate (n = 8).
All patients were treated with 1 mg anastrozole daily, administered orally.
Hormone analysis and semen analysis before and after treatment were performed. Hormone analysis included measurements of total T, E2, sex-hormone binding globulin, albumin, FSH, and LH, and bioavailable T was calculated. Total motile sperm count was calculated from the semen analysis.
In all, 95.3% of patients had an increased serum T and decreased serum E2 after treatment with anastrozole. Sperm concentration and total motile counts improved in 18 of 21 subfertile hypoandrogenic oligozoospermic men treated with anastrozole. In these men the magnitude of total motile count increase was significantly correlated with the change in the T/E2 ratio. No improvement was seen in semen parameters of men with azoospermia, cryptozoospermia, or normozoospermia at presentation.
Approximately 95% of men with hypoandrogenism responded with improved endocrine parameters, and a subset of oligozoospermic men (approximately 25% of all patients) displayed significantly improved sperm parameters. In that subset, increase in sperm parameters was correlated with the change in the T/E2 ratio, which argues for a physiologic effect of treatment.
亦可用於男性不孕症, 可提高男性賀爾蒙濃度及精蟲濃度
Fertil Steril. 2017 Jan 6. pii: S0015-0282(16)63021-2. doi: 10.1016/j.fertnstert.2016.11.021. [Epub ahead of print]
Outcomes of anastrozole in oligozoospermic hypoandrogenic subfertile men.
Abstract
OBJECTIVE:
DESIGN:
SETTING:
PATIENT(S):
INTERVENTION(S):
MAIN OUTCOME MEASURE(S):
RESULT(S):
CONCLUSION(S):
2017年2月7日
PCO病患不成熟卵子經IVM+ICSI形成之胚胎, 異常多細胞核率較高, 囊胚率較低
Does polycystic ovarian syndrome (PCOS) or in vitro maturation (IVM) treatment affect embryo development events and morphokinetic parameters after time-lapse incubation?
There was an increase in some abnormal phenotypic events in PCOS-IVM embryos as well as an increase in early arrest of PCOS-IVM and PCOS-ICSI embryos; however, IVM treatment or PCOS status did not alter morphokinetic development of embryos suitable for transfer of vitrification.
IVM has been less successful than standard IVF in terms of clinical pregnancy, implantation and live birth rates. There is currently no information available about the development of IVM embryos according to time-lapse analysis.
This article represents a prospective case-control study. The study involved 93 participants who underwent 93 treatment cycles. Cycles were completed between January 2013 and July 2014.
Participants were recruited for the study at Fertility Specialists of WA and Fertility Specialists South, Perth, Western Australia. Of the PCOS diagnosed patients, 32 underwent IVM treatment (PCOS-IVM) and 23 had standard ICSI treatment (PCOS-ICSI). There were 38 patients without PCOS who underwent standard ICSI treatment comprising the control group (control-ICSI).
The PCOS-IVM group showed significantly more embryos with multinucleated two cells (P = 0.041), multinucleated four cells (P = 0.001) and uneven two cells (P = 0.033) compared with the control-ICSI group, but not the PCOS-ICSI group. There were no significant differences in the rates of any abnormal events between the PCOS-ICSI and control-ICSI groups. Embryo arrest between Days 2 and 3 was higher in the PCOS-IVM and PCOS-ICSI groups compared with the control-ICSI group (P < 0.001 and P = 0.001). Embryo arrest from Days 3 to 4 was higher in the PCOS-IVM group compared with both the PCOS-ICSI and control-ICSI groups (P < 0.001). There were no differences in embryo arrest rates across all three groups at the compaction or blastulation stages. Cumulative rates of embryo arrest, from the time to second polar body extrusion (tPB2) to the time to formation of a blastocyst (tB), result in a decreased proportion of useable PCOS-IVM blastocysts compared with the other two treatment groups; however, of the embryos remaining, there was no significant difference in morphokinetic development between the three groups.
Hum Reprod. 2015 Aug;30(8):1842-9. doi: 10.1093/humrep/dev125. Epub 2015 Jun 3.
In vitro maturation is associated with increased early embryo arrest without impairing morphokinetic development of useable embryos progressing to blastocysts.
Abstract
STUDY QUESTIONS:
SUMMARY ANSWER:
WHAT IS KNOWN ALREADY:
STUDY DESIGN, SIZE AND DURATION:
PARTICIPANTS/MATERIALS, SETTING AND METHODS:
MAIN RESULTS AND THE ROLE OF CHANCE:
經PGD確認染色體正常之囊胚全冷凍再解凍植入活產率較新鮮植入高(77 vs 59%)
To compare two commonly used protocols (fresh vs. vitrified) used to transfer euploid blastocysts after IVF with preimplantation genetic screening.
Randomized controlled trial.
Private assisted reproduction center.
A total of 179 patients undergoing IVF treatment using preimplantation genetic screening.
Patients were randomized at the time of hCG administration to either a freeze-all cycle or a fresh day 6 ET during the stimulated cycle.
Implantation rates (sac/embryo transferred), ongoing pregnancy rates (PRs) (beyond 8 weeks), and live birth rate per ET in the primary transfer cycle.
Implantation rate per embryo transferred showed an improvement in the frozen group compared with the fresh group, but not significantly (75% vs. 67%). The ongoing PR (80% vs. 61%) and live birth rates (77% vs. 59%) were significantly higher in the frozen group compared with the fresh group.
Either treatment protocol investigated in the present study can be a reasonable option for patients. Freezing all embryos allows for inclusion of all blastocysts in the cohort of embryos available for transfer, which also results in a higher proportion of patients reaching ET. These findings suggest a trend toward favoring the freeze-all option as a preferred transfer strategy when using known euploid embryos.
Fertil Steril. 2017 Jan 27. pii: S0015-0282(16)63094-7. doi: 10.1016/j.fertnstert.2016.12.022. [Epub ahead of print]
Optimal euploid embryo transfer strategy, fresh versus frozen, after preimplantation genetic screening with next generation sequencing: a randomized controlled trial.
Abstract
OBJECTIVE:
DESIGN:
SETTING:
PATIENT(S):
INTERVENTION(S):
MAIN OUTCOME MEASURE(S):
RESULT(S):
CONCLUSION(S):
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