Day5-6囊胚破卵與否與胚胎植入後活產率無明顯差異(55% vs 50%)

Hum Reprod. 2016 Sep 12. [Epub ahead of print]

Hatching status before embryo transfer is not correlated with implantation rate in chromosomally screened blastocysts.

Rodriguez-Purata J1, Gingold J2, Lee J2, Whitehouse M2, Slifkin R2, Briton-Jones C2, Copperman A3, Sandler B3.

Author information

Abstract

STUDY QUESTION:

Do the reproductive outcomes from the transfer of fully hatched (FH) blastocysts differ from those of not fully hatched (NFH) blastocysts?

SUMMARY ANSWER:

Biochemical pregnancy rate (BPR), implantation rate (IR), live birth rate (LBR) and early pregnancy loss (EPL) rate are similar in FH and NFH single euploid blastocyst embryo transfers.

WHAT IS KNOWN ALREADY:

The use of extended culture and PGS often leads to transfer of an embryo that is well developed and frequently FH from the zona pellucida. Without the protection of the zona, an FH embryo could be vulnerable to trauma during the transfer procedure. To date, no other study has evaluated the reproductive competence of an FH blastocyst transfer.

STUDY DESIGN, SIZE, DURATION:

The retrospective study included 808 patients who underwent 808 cycles performed between September 2013 and July 2015 at a private academic IVF center. Of these, 436 cycles entailed transfer of a NFH blastocyst (n = 123 fresh transfer, n = 313 frozen/thawed embryo transfer (FET)) and 372 cycles entailed transfer of an FH blastocyst (n = 132 fresh, 240 FET). Fresh and FET cycles and associated clinical outcomes were considered separately. LBR was defined as the delivery of a live infant after 24 weeks of gestation.

PARTICIPANTS/MATERIALS, SETTING, METHOD:

Trophectoderm biopsies were performed on Day 5 (d5) or 6 (d6) for embryos meeting morphology eligibility criteria (set at ≥3BC). Morphologic grading was determined using a modified Gardner-Schoolcraft scale prior to transfer. A single euploid embryo was selected for transfer per cycle on either the morning of d6, for fresh transfers or 5 days after progesterone supplementation for patients with transfer in an FET cycle. Embryos were classified as NFH (expansion Grade 3, 4 or 5) or FH (expansion Grade 6) cohorts. The main outcome measure was IR.

MAIN RESULTS AND THE ROLE OF CHANCE:

In the fresh transfer group, IR was similar between NFH and FH cycles (53.7% versus 55.3%, P = 0.99, odds ratio (OR) 0.9; 95% confidence interval (CI) 0.6-1.5). Secondary outcomes were also statistically similar between groups: BPR (65.9% versus 66.7%, OR 1.0; 95% CI: 0.6-1.6), LBR (43.1% versus 47.7%, P = 0.45, OR 1.2; 95% CI: 0.7-1.9) and EPL rate (22.8% versus 18.2%, OR 1.3; 95% CI: 0.7-2.4). After adjusting for age, BMI, endometrial thickness at the LH surge and oocytes retrieved in a logistic regression (LR) model, the hatching status remained not associated with IR (P > 0.05). In the FET cycles, IR was similar between NFH and FH cycles (62.6% versus 61.7%, OR 1.0; 95% CI: 0.7-1.5). Secondary outcomes were similar between groups: BPR (74.1% versus 72.9%, respectively, OR 1.1; 95% CI: 0.7-1.6), LBR (55.0% versus 50.0%, OR 0.8; 95% CI: 0.6-1.1) and EPL rate (18.9% versus 22.9%, respectively, OR 0.8; 95% CI: 0.5-1.2). After adjusting for age, BMI, endometrial thickness at the LH surge and oocytes retrieved in an LR model, the hatching status was not shown to be associated with implantation (P > 0.05).

使用即時監控胚胎time lapse篩選胚胎 vs 傳統胚胎型態篩選胚胎
二者懷孕率無明顯差異(34.3% vs 34.6%)

time lapse無法明顯提高胚胎篩選著床率

Hum Reprod. 2016 Sep 12. [Epub ahead of print]

Embryo selection using time-lapse analysis (Early Embryo Viability Assessment) in conjunction with standard morphology: a prospective two-center pilot study.

Kieslinger DC1, De Gheselle S2, Lambalk CB3, De Sutter P2, Kostelijk EH3, Twisk JW4, van Rijswijk J3, Van den Abbeel E2, Vergouw CG3.

Author information

Abstract

STUDY QUESTION:

Does prospective embryo selection using the results from the Eava Test (Early Embryo Viability Assessment) in combination with standard morphology increase the pregnancy rate of IVF and ICSI patients compared to embryo selection based on morphology only?

SUMMARY ANSWER:

Embryo selection using the Eeva Test plus standard morphology on Day 3 results in comparable pregnancy rates as conventional morphological embryo selection.

WHAT IS KNOWN ALREADY:

Time-lapse monitoring of embryo development may represent a superior way to culture and select embryos in vitro. The Eeva Test records the development of each embryo with a cell-tracking system and predicts the likelihood (High, Medium or Low) that an embryo will form a blastocyst based on an automated analysis of early cell division timings.

STUDY DESIGN, SIZE, DURATION:

This trial was designed as a prospective, observational, two-center pilot study with a propensity matched control group. The analysis involved 280 of 302 enrolled patients who were included in the Eeva Test group in 2013 and 560 control patients who were treated in the years 2011-2013. The majority of transfers (98%) were single embryo transfers.

PARTICIPANTS/MATERIALS, SETTING, METHODS:

Two academic hospitals (VUmc Amsterdam and UZ Gent) enrolled patients <41 years old, with <3 previous attempts and ≥5 normally fertilized eggs. Propensity matching was used to identify a propensity matched control group from a cohort of 1777 patients based on age, cycle number, oocyte number and number of fertilized oocytes.

MAIN RESULTS AND THE ROLE OF CHANCE:

There was no difference in patient baseline characteristics between the two groups. The ongoing pregnancy rate (OPR) of patients enrolled in the Eeva Test group (34.3%; 96/280) did not differ significantly from the OPR in the propensity matched control group (34.6%, 194/560; P = 0.92). However, significantly less top quality embryos (eight-cell embryos with ≤25% fragmentation) were transferred in the Eeva Test group compared to the propensity matched control group (70.4% vs. 82.3%; P < 0.001). The transfer of Eeva High and Medium embryos resulted in a significantly higher OPR of 36.8% (89/242) compared to 18.4% (7/38) for Eeva Low embryos (P = 0.02).

基礎LH<15之病患不適合使用單獨GnRHa破卵
應輔助施打低劑量HCG 破卵

Fertil Steril. 2016 Aug 1. pii: S0015-0282(16)62481-0. doi: 10.1016/j.fertnstert.2016.07.1068. [Epub ahead of print]

Dual trigger for final oocyte maturation improves the oocyte retrieval rate of suboptimal responders to gonadotropin-releasing hormone agonist.

Lu X1, Hong Q1, Sun L1, Chen Q1, Fu Y1, Ai A1, Lyu Q1, Kuang Y2.

Author information

Abstract

OBJECTIVE:

To identify the risk factors for suboptimal response to GnRH agonist (GnRH-a) trigger and evaluate the effect of hCG on the outcome of patients with suboptimal response to GnRH-a.

DESIGN:

A retrospective data analysis.

SETTING:

A tertiary-care academic medical center.

PATIENT(S):

A total of 8,092 women undergoing 8,970 IVF/intracytoplasmic sperm injection (ICSI) treatment cycles.

INTERVENTION(S):

All women underwent hMG + medroxyprogesterone acetate (MPA)/P treatment cycles during IVF/ICSI, which were triggered using a GnRH-a alone or in combination with hCG (1,000, 2,000, or 5,000 IU). Viable embryos were cryopreserved for later transfer.

MAIN OUTCOME MEASURE(S):

The rates of oocyte retrieval, mature oocytes, fertilization, and the number of oocytes retrieved, mature oocytes, and embryos frozen.

RESULT(S):

In total, 2.71% (243/8,970) of patients exhibited a suboptimal response to GnRH-a. The suboptimal responders (LH ≤15 mIU/mL) had a significantly lower oocyte retrieval rate (48.16% vs. 68.26%), fewer mature oocytes (4.10 vs. 8.29), and fewer frozen embryos (2.32 vs. 3.54) than the appropriate responders. Basal LH levels served as the single most valuable marker for differentiating suboptimal responders with the areas under the receiver operating curve of 0.805. Administering dual trigger (GnRH-a and hCG 1,000, 2,000, 5,000 IU) significantly increased oocyte retrieval rates (60.04% vs. 48.16%; 68.13% vs. 48.16%; and 65.76% vs. 48.16%, respectively) in patients with a suboptimal response.

CONCLUSION(S):

Basal LH level was useful predictor of the suboptimal response to GnRH-a trigger. Administrating dual trigger including 1,000 IU hCG for final oocyte maturation could improve the oocytes retrieval rate of GnRH-a suboptimal responder.

第七天才形成之Day7囊胚活產率(per transfer)僅剩10% (Day5 活產率47%, Day6 活產率46%)
37歲以上囊胚植入活產率明顯下降

Fertil Steril. 2016 Aug;106(2):354-362.e2. doi: 10.1016/j.fertnstert.2016.04.022. Epub 2016 May 10.

Factors associated with birth outcomes from cryopreserved blastocysts: experience from 4,597 autologous transfers of 7,597 cryopreserved blastocysts.

Richter KS1, Ginsburg DK2, Shipley SK3, Lim J3, Tucker MJ3, Graham JR3, Levy MJ3.

Author information

Abstract

OBJECTIVE:

To evaluate factors associated with cryopreserved blastocyst transfer birth outcomes, including age, expansion time, cryopreservation protocol, cryodamage, and number of embryos transferred.

DESIGN:

Retrospective cohort study.

SETTING:

Private infertility practice.

PATIENT(S):

Cryopreserved blastocyst transfer patients from January 2003 to April 2012.

INTERVENTION(S):

None.

MAIN OUTCOME MEASURE(S):

Birth per transfer and children per embryo.

RESULT(S):

Overall live birth per transfer was 32%, with 17% twin births and 0.3% triplets. Live birth per transfer was significantly higher for vitrification compared with slow-freeze (day 5 cryopreservation: 47% vs. 35%; day 6 cryopreservation: 46% vs. 24%), as was live born children per transferred embryo (39% vs. 29% for day 5; 36% vs. 18% for day 6). Birth rates declined only slightly with increasing age at cryopreservation through 37 years, followed by an increasingly rapid decline in success with increasing age thereafter. Live birth rates declined rapidly (49%-18% for vitrification and 37%-10% for slow-freeze) as the percentage of intact cells after cryopreservation decreased from 95%-100% to 70%-79%, with almost no births when the percentage of intact cells was <70%. Increasing numbers of embryos per transfer were associated with significant increase in live birth per transfer but significant decrease in children per transferred embryo. Birth rates were much lower for blastocysts with delayed expansion on day 7 (10% per transfer).

CONCLUSION(S):

Birth outcomes from cryopreserved blastocyst transfer are influenced by age, timing of expansion, cryopreservation protocol, visible cryodamage, and the number of embryos transferred. Vitrification substantially improves outcomes versus slow freezing.

E2過高(>5000)對於懷孕初期後之胎盤功能有不良影響

Fertil Steril. 2016 Aug;106(2):363-370.e3. doi: 10.1016/j.fertnstert.2016.04.023. Epub 2016 May 10.

Are intracytoplasmic sperm injection and high serum estradiol compounding risk factors for adverse obstetric outcomes in assisted reproductive technology?

Royster GD 4th1, Krishnamoorthy K2, Csokmay JM3, Yauger BJ3, Chason RJ3, DeCherney AH4, Wolff EF4, Hill MJ3.

Author information

Abstract

OBJECTIVE:

To evaluate whether intracytoplasmic sperm injection (ICSI) use and E2 on the final day of assisted reproductive technology (ART) stimulation are associated with adverse obstetric complications related to placentation.

DESIGN:

Retrospective cohort study.

SETTING:

Large private ART practice.

PATIENT(S):

A total of 383 women who underwent ART resulting in a singleton live birth.

INTERVENTION(S):

None.

MAIN OUTCOME MEASURE(S):

Adverse placental outcomes composed of placenta accreta, placental abruption, placenta previa, intrauterine growth restriction, preeclampsia, gestational hypertension, and small for gestational age infants.

RESULT(S):

Patients with adverse placental outcomes had higher peak serum E2 levels and were three times more likely to have used ICSI. Adverse placental outcomes were associated with increasing E2 (odds ratio 1.36, 95% confidence interval 1.13-1.65) and ICSI (odds ratio 3.86, 95% confidence interval 1.61-9.27). Adverse outcomes increased when E2 was >3,000 pg/mL and continued to increase in a linear fashion until E2 was >5,000 pg/mL. The association of ICSI with adverse outcomes was independent of male factor infertility. Interaction testing suggested the adverse effect of E2 was primarily seen in ICSI cycles, but not in conventional IVF cycles. Estradiol >5,000 pg/mL was associated with adverse placental events in 36% of all ART cycles and 52% of ICSI cycles.

CONCLUSION(S):

ICSI and elevated E2 on the day of hCG trigger were associated with adverse obstetric outcomes related to placentation. The finding of a potential interaction of E2 and ICSI with adverse placental events is novel and warrants further investigation.

黃體素P4過高(>2), 胚胎植入後著床率不高
以GnRHantagonist 破卵P4過高之機率高於以HCG破卵(5.5% vs. 3.1%) 

Fertil Steril. 2016 Sep 1;106(3):584-589.e1. doi: 10.1016/j.fertnstert.2016.04.024. Epub 2016 May 10.

Is the effect of premature elevated progesterone augmented by human chorionic gonadotropin versus gonadotropin-releasing hormone agonist trigger?

Connell MT1, Patounakis G1, Healy MW1, DeCherney AH2, Devine K3, Widra E3, Levy MJ3, Hill MJ4.

Author information

Abstract

OBJECTIVE:

To compare the effect of P on live birth rate between hCG and GnRH agonist (GnRH-a) trigger cycles.

DESIGN:

Retrospective cohort study.

SETTING:

Large private assisted reproductive technology (ART) practice.

PATIENT(S):

A total of 3,326 fresh autologous ART cycles.

INTERVENTION(S):

None.

MAIN OUTCOME MEASURE(S):

Live birth.

RESULT(S):

A total of 647 GnRH-a trigger cycles were compared with 2,679 hCG trigger cycles. Live birth was negatively associated with P in both the hCG trigger (odds ratio [OR] 0.62, 95% confidence interval [CI] 0.52-0.76) and the agonist trigger cohorts (OR 0.56, 95% CI 0.45-0.69). Interaction testing evaluating P and trigger medication was not significant, indicating that P had a similar negative effect on live birth rates in both cohorts. Progesterone ≥2 ng/mL occurred more commonly in GnRH-a trigger cycles compared with hCG trigger cycles (5.5% vs. 3.1%) and was negatively associated with live birth in both the hCG trigger (OR 0.28, 95% CI 0.11-0.73) and agonist trigger cohorts (OR 0.35, 95% CI 0.14-0.90). When P ≥2 ng/mL, the live birth rates were poor and similar in the hCG and GnRH-a cohorts (5.9% vs. 14.2%), indicating that P ≥2 ng/mL had a similar negative effect on live birth in both cohorts.

CONCLUSION(S):

Elevated serum P on the day of hCG was negatively associated with live birth rates in both hCG and GnRH-a trigger cycles.

Published by Elsevier Inc.

女性精蟲(22X)帶負電荷較男性精蟲(22Y)高
女性精蟲帶負電荷約-20 mV,
男性精蟲帶負電荷約-16 mV,

Int J Fertil Steril. 2016 Jul-Sep;10(2):253-60. Epub 2016 Jun 1.

Zeta Sperm Selection Improves Pregnancy Rate and Alters Sex Ratio in Male Factor Infertility Patients: A Double-Blind, Randomized Clinical Trial.

Nasr Esfahani MH1, Deemeh MR2, Tavalaee M3, Sekhavati MH4, Gourabi H5.

Author information

Abstract

BACKGROUND:

Selection of sperm for intra-cytoplasmic sperm injection (ICSI) is usually considered as the ultimate technique to alleviate male-factor infertility. In routine ICSI, selection is based on morphology and viability which does not necessarily preclude the chance injection of DNA-damaged or apoptotic sperm into the oocyte. Sperm with high negative surface electrical charge, named "Zeta potential", are mature and more likely to have intact chromatin. In addition, X-bearing spermatozoa carry more negative charge. Therefore, we aimed to compare the clinical outcomes of Zeta procedure with routine sperm selection in infertile men candidate for ICSI.

MATERIALS AND METHODS:

From a total of 203 ICSI cycles studied, 101 cycles were allocated to density gradient centrifugation (DGC)/Zeta group and the remaining 102 were included in the DGC group in this prospective study. Clinical outcomes were com- pared between the two groups. The ratios of Xand Y bearing sperm were assessed by fluorescence in situ hybridization (FISH) and quantitative polymerase chain reaction (qPCR) methods in 17 independent semen samples.

RESULTS:

In the present double-blind randomized clinical trial, a significant increase in top quality embryos and pregnancy rate were observed in DGC/Zeta group compared to DGC group. Moreover, sex ratio (XY/XX) at birth significantly was lower in the DGC/Zeta group compared to DGC group despite similar ratio of X/Y bearings sper- matozoa following Zeta selection.

CONCLUSION:

Zeta method not only improves the percentage of top embryo quality and pregnancy outcome but also alters the sex ratio compared to the conventional DGC method, despite no significant change in the ratio of Xand Ybearing sperm population 

未來生殖科技可能有能力將胚胎培養後之培養液化驗來偵測胚胎之DNA染色體狀況
以取代具侵犯性之傳統胚胎切片

Fertil Steril. 2016 Aug 23. pii: S0015-0282(16)62550-5. doi: 10.1016/j.fertnstert.2016.07.1112. [Epub ahead of print]

Proof of concept: preimplantation genetic screening without embryo biopsy through analysis of cell-free DNA in spent embryo culture media.

Shamonki MI1, Jin H2, Haimowitz Z3, Liu L2.

Author information

Abstract

OBJECTIVE:

To assess whether preimplantation genetic screening (PGS) is possible by testing for free embryonic DNA in spent IVF media from embryos undergoing trophectoderm biopsy.

DESIGN:

Prospective cohort analysis.

SETTING:

Academic fertility center.

PATIENT(S):

Seven patients undergoing IVF and 57 embryos undergoing trophectoderm biopsy for PGS.

INTERVENTION(S):

On day 3 of development, each embryo was placed in a separate media droplet. All biopsied embryos received a PGS result by array comparative genomic hybridization. Preimplantation genetic screening was performed on amplified DNA extracted from media and results were compared with PGS results for the corresponding biopsy.

MAIN OUTCOME MEASURE(S):

[1] Presence of DNA in spent IVF culture media. [2] Correlation between genetic screening result from spent media and corresponding biopsy.

RESULT(S):

Fifty-five samples had detectable DNA ranging from 2-642 ng/μL after a 2-hour amplification. Six samples with the highest DNA levels underwent PGS, rendering one result with a derivative log ratio SD (DLRSD) of <0.85 (a quality control metric of oligonucleotide array comparative genomic hybridization). The fluid sample and trophectoderm results were identical demonstrating (45XY, -13). Three samples were reamplified 1 hour later and tested showing improving DLRSD. One of the three samples with a DLRSD of 0.85 demonstrated (46XY), consistent with the biopsy. Overnight DNA amplification showed DNA in all samples.

CONCLUSION(S):

We demonstrate two novel findings: the presence of free embryonic DNA in spent media and a result that is consistent with trophectoderm biopsy. Improvements in DNA collection, amplification, and testing may allow for PGS without biopsy in the future.

ICSI後6h 90%卵子可見2nd PB
IVF 後10h 90%卵子可見2nd PB

ICSI後8h 75%卵子可見2PN原核
IVF 比ICSI PN形成速度慢4h

ICSI後20h卵子開始第一次分裂
IVF後24h卵子開始第一次分裂

ICSI後2PN形成非同步化佔18%
IVF後2PN形成非同步化佔46%

http://humrep.oxfordjournals.org/content/13/6/1606.long

Hum Reprod. 1998 Jun;13(6):1606-12.

Timing of oocyte activation, pronucleus formation and cleavage in humans after intracytoplasmic sperm injection (ICSI) with testicular spermatozoa and after ICSI or in-vitro fertilization on sibling oocytes with ejaculated spermatozoa.

Nagy ZP1, Janssenswillen C, Janssens R, De Vos A, Staessen C, Van de Velde H, Van Steirteghem AC.

Author information

Abstract

In the first study, we evaluated 101 oocytes [2, 4, 6, 8, 16, 18 and 20 h after intracytoplasmic sperm injection (ICSI)] that had been microinjected with testicular spermatozoa. Of the 70 normally fertilized oocytes (69%) 30 (43%) had two pronuclei by 6 h after ICSI. Fifty-one (73%) by 8 h, 69 (99%) by 16 h and four of them by 20 h cleaved to the 2-cell stage. In the second study, 95 cumulus-corona-oocyte complexes (CCOC) were divided into two groups. Forty-seven CCOC were inseminated by conventional in-vitro fertilization (IVF) and 40 metaphase-II oocytes by ICSI. Oocytes were evaluated at 2, 4, 6 (only after ICSI), 8, 10, 12, 18, 20, 22, 24, 26, 28 and 30 h after both ICSI and IVF. After IVF, 35 oocytes were fertilized normally (75%), four of which (11%) had two pronuclei by 8 h, 11 (31%) by 10 h, 27 (77%) by 12 h and 35 (100%) by 14 h. The first cleavages had occurred by 24 h after insemination (four oocytes, 11%). After ICSI, 34 oocytes were fertilized normally (79%), 13 of which (38%) had two pronuclei by 6 h, 27 (79%) by 8 h and 32 (94%) by 10 h. Three oocytes cleaved by 20 h after microinjection (9%) and 19 by 24 h (56%). Pronuclei developed asynchronously in six oocytes after ICSI (18%) as opposed to 16 oocytes after IVF (46%). The results of this study suggest that the timing of pronuclear formation is no different when a testicular spermatozoon is microinjected into the oocytes from when an ejaculated spermatozoon is injected. Secondly, pronuclear development and first cleavage generally take place 4 h sooner after ICSI than after IVF. On the other hand, a higher proportion of oocytes develop two pronuclei asynchronously after IVF than after ICSI.

第五天達到成熟囊胚，冷凍解凍後植入活產率約50%
第六天才達到成熟囊胚，冷凍解凍後植入活產率約30%

囊胚空腔程度&速度(day 5達到50%以上)是評估囊胚著床活產率最重要指標(compared to TE, ICM)

異常多核胚葉之胚胎仍有1/4會發育至囊胚
time lapse EmbryoScope chamber無法明顯提高懷孕率

Fertil Steril. 2016 Aug 23. pii: S0015-0282(16)62525-6. doi: 10.1016/j.fertnstert.2016.07.1095. [Epub ahead of print]

Delayed blastulation, multinucleation, and expansion grade are independently associated with live-birth rates in frozen blastocyst transfer cycles.

Desai N1, Ploskonka S2, Goodman L2, Attaran M2, Goldberg JM2, Austin C2, Falcone T2.

Author information

Abstract

OBJECTIVE:

To identify blastocyst features independently predictive of successful pregnancy and live births with vitrified-warmed blastocysts.

DESIGN:

Retrospective study.

SETTING:

Academic hospital.

PATIENT(S):

Women undergoing a cycle with transfer of blastocysts vitrified using the Rapid-i closed carrier (n = 358).

INTERVENTION(S):

None.

MAIN OUTCOME MEASURE(S):

Clinical pregnancy and live-birth rates analyzed using logistic regression analysis.

RESULT(S):

A total of 669 vitrified-warmed blastocysts were assessed. The survival rate was 95%. A mean of 1.7 ± 0.5 embryos were transferred. The clinical pregnancy, live-birth, and implantation rates were 55%, 46%, and 43%, respectively. The odds of clinical pregnancy (odds ratio [OR] 3.08; 95% confidence interval [CI], 1.88-5.12) and live birth (OR 2.93; 95% CI, 1.79-4.85) were three times higher with day-5 blastocysts versus slower-growing day-6 vitrified blastocysts, irrespective of patient age at cryopreservation. Blastocysts from multinucleated embryos were half as likely to result in a live birth (OR 0.46; 95% CI, 0.22-0.91). A fourfold increase in live birth was observed if an expanded blastocyst was available for transfer. The inner cell mass-trophectoderm score correlated to positive outcomes in the univariate analysis. The implantation rate was statistically significantly higher for day-5 versus day-6 vitrified blastocysts (50% vs. 29%, respectively).

CONCLUSION(S):

The blastocyst expansion grade after warming was predictive of successful outcomes independent of the inner cell mass or trophectoderm score. Delayed blastulation and multinucleation were independently associated with lower live-birth rates in frozen cycles. Implantation potential of the frozen blastocysts available should be included in the decision-making process regarding embryo number for transfer.

IVM後成熟卵子施行ICSI受精前後，卵子大小明顯大於一般非IVM卵子
IVM卵子受精後1-2天後胚胎大小與一般胚胎無異

Fertil Steril. 2016 Aug 23. pii: S0015-0282(16)62683-3. doi: 10.1016/j.fertnstert.2016.08.014. [Epub ahead of print]

Structural and morphologic differences in human oocytes after in vitro maturation compared with standard in vitro fertilization.

Walls ML1, Hart R2, Keelan JA3, Ryan JP2.

Author information

Abstract

OBJECTIVES:

To study whether the size and texture of oocytes/zygotes differ between in vitro maturation (IVM) and traditional IVF and to determine whether these affect the rate of fertilization and blastocyst development.

DESIGN:

Prospective case-control study.

SETTING:

Fertility clinic.

PATIENT(S):

The study involved 83 participants/cycles of IVF with intracytoplasmic sperm injection (ICSI) or IVM treatment.

INTERVENTION(S):

Participants were allocated to the following groups: patients with and without polycystic ovary syndrome (PCOS) undergoing ICSI (PCOS-ICSI and Control-ICSI), and patients with PCOS undergoing IVM (PCOS-IVM). All oocytes were cultured in an Embryoscope incubator.

MAIN OUTCOME MEASURE(S):

Oocyte/zygote sizes were recorded and texture parameters of the ooplasm were analyzed using ImageJ and maZda software. Measurements were recorded at five developmental stages: sperm injection, second polar body extrusion, the first pronuclei appearance, pronuclei disappearance, and immediately before cytokinesis.

RESULT(S):

Normally fertilized PCOS-IVM oocytes were significantly larger at the sperm injection and second polar body extrusion stages, compared with both the PCOS-ICSI and Control-ICSI groups. The PCOS-IVM oocytes were significantly larger at the pronuclei disappearance stage compared with the Control-ICSI group. Oocyte texture parameters were significantly different from both other treatment groups in the early developmental stages, although these were predominantly seen when compared with the Control-ICSI group. There were no significant differences in size or texture by the final stage of immediately before cytokinesis between any of the treatment groups.

CONCLUSION(S):

This study suggests that oocyte size and texture differ in the early stages of the first cell cycle.

Copyright © 2016. Published by Elsevier Inc.

ICM 細胞內質體佔囊胚之半徑比例(ICM/blastocyst diameter ratio)決定懷孕著床率
成功著床之平均比率約0.49,    未成功著床之平均比率約0.34
ICM/blastocyst diameter ratio比率>0.46懷孕率明顯高於<0.46

Fertil Steril. 2016 Aug 24. pii: S0015-0282(16)62678-X. doi: 10.1016/j.fertnstert.2016.08.009. [Epub ahead of print]

The ratio between inner cell mass diameter and blastocyst diameter is correlated with successful pregnancy outcomes of single blastocyst transfers.

Almagor M1, Harir Y2, Fieldust S2, Or Y2, Shoham Z2.

Author information

Abstract

OBJECTIVE:

To evaluate the ability to predict pregnancy outcomes of single-blastocyst transfers by measuring the ratio of inner cell mass (ICM) diameter to blastocyst diameter using time-lapse images.

DESIGN:

Retrospective cohort study.

SETTING:

University-affiliated medical center.

PATIENT(S):

One hundred twenty-seven women undergoing a total of 129 blastocyst transfers with intracytoplasmic sperm injection.

INTERVENTION(S):

Embryo monitoring by time-lapse microscopy.

MAIN OUTCOME MEASURE(S):

The ratio of ICM diameter to blastocyst diameter in single-blastocyst transfers and clinical pregnancy rates.

RESULT(S):

In phase I of the study, 63 women underwent 65 single blastocyst transfers that resulted in 25 pregnancies (40% of the women). The successfully implanted blastocysts had an average ICM/blastocyst diameter ratio of 0.487 ± 0.086, whereas the average ICM/blastocyst ratio of nonimplanted blastocysts was significantly lower (0.337 ± 0.086). The live-birth rate was 29% (18/63). In phase II, 64 single-blastocyst transfers were performed in 64 women. The ICM/blastocyst diameter ratio was measured, and blastocysts with the highest ratios were chosen for transfer. Forty-three women (67%) with an average ICM/blastocyst diameter ratio of 0.46 achieved pregnancy, and 36 of the 43 pregnancies (84%) resulted in the delivery of a healthy baby. In the 21 women (33%) who failed to achieve pregnancy, the average ICM/blastocyst ratio was 0.45. The resultant positive predictive value was 74%, and the negative predictive value was 70%.

CONCLUSION(S):

The ICM-to-blastocyst diameter ratio is a predictor of implantation and live birth in single-blastocyst transfers, offering a simple, noninterfering method to select blastocysts with high developmental capacity.