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Basak Balaban - One of the best experts on this subject based on the ideXlab platform.
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Impact of the presence of one or more multinucleated blastomeres on the developmental potential of the embryo to the Blastocyst Stage
Fertility and sterility, 2005Co-Authors: Kayhan Yakin, Basak Balaban, Bulent UrmanAbstract:A retrospective study of 5,982 embryos in 619 Blastocyst-Stage embryo transfer cycles revealed that detection of multinucleated blastomeres either on day 2 or 3 signifies a poor prognosis for Blastocyst formation and that no good-quality Blastocyst can be expected from an embryo with more than one multinucleated blastomere. Patients should be counseled regarding a poor prognosis when multiple embryos with multinucleated blastomeres are present.
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Transfer at the Blastocyst Stage of embryos derived from testicular round spermatid injection
Human reproduction (Oxford England), 2002Co-Authors: Bulent Urman, Cengiz Alatas, Senai Aksoy, Ramazan Mercan, Aycan Isiklar, Alp Nuhoglu, Alper Mumcu, Basak BalabanAbstract:BACKGROUND: Intracytoplasmic injection of testicular round spermatids has been suggested as a salvage treatment in couples when testicular sperm extraction does not yield any mature sperm. However, the success of the procedure is debatable, and controversy surrounds issues such as the presence and (if present) identification of spermatids in testicular tissue. Progression rate to the Blastocyst Stage of spermatid-derived embryos appears to be low. METHODS: In this study, we investigated the feasibility and outcome of Blastocyst Stage embryo transfer after round spermatid injection (ROSI). ROSI was undertaken in 58 couples who did not yield mature or elongated sperm to testicular sperm extraction. RESULTS: The incidence of Blastocyst formation from two pronuclear oocytes was 7.6%. A total of 16 Blastocysts were transferred in 12 patients (20.7%). None of the patients conceived. CONCLUSIONS: The results of this study indicate that the Blastocyst Stage is reached by only very few ROSI-derived embryos and these embryos do not implant.
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Blastocyst-Stage transfer of poor-quality cleavage-Stage embryos results in higher implantation rates.
Fertility and sterility, 2001Co-Authors: Basak Balaban, Bulent Urman, Cengiz Alatas, Senai Aksoy, Ramazan Mercan, Aycan IsiklarAbstract:Abstract Objective: To determine the feasibility and success of Blastocyst-Stage embryo transfers in patients having only fair and poor quality cleavage-Stage embryos on day 3. Design: Prospective case study with historic controls. Setting: Tertiary care private hospital IVF center. Patient(s): A total of 158 day 5 embryo transfer cycles in patients with grade 3 and grade 4 cleavage-Stage embryos. Control group consisted of 162 day 3 transfer cycles performed with embryos of similar quality. Intervention(s): In vitro culture of embryos up to the Blastocyst Stage. Main Outcome Measure(s): The percentage of cycles that culminated in the transfer of at least one Blastocyst and implantation and pregnancy rate related to the day of transfer. Result(s): In the day 3 transfer group, a mean of 5.2 embryos were replaced per patient. This was significantly more than the mean of 2.4 embryos that could be replaced on day 5 ( P P >.05). The implantation rate per embryo was significantly higher in the day 5 transfer group (15% vs. 5.9%). The multiple pregnancy and abortion rates were similar between the groups. Conclusion(s): Transfer of fair and poor quality embryos at the Blastocyst Stage is feasible and is associated with higher implantation rates as compared to transfer of similar quality embryos on day 3.
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Blastocyst quality affects the success of Blastocyst-Stage embryo transfer.
Fertility and sterility, 2000Co-Authors: Basak Balaban, Bulent Urman, Aycan Sertac, Cengiz Alatas, Senai Aksoy, Ramazan MercanAbstract:Abstract Objective: To determine the relationship between Blastocyst quality and the results of embryo transfer at the Blastocyst Stage. Design: Retrospective case analysis. Setting: Tertiary care private hospital IVF center. Patient(s): A total of 350 Blastocyst-Stage embryo transfer cycles. Intervention(s): In vitro culture to the Blastocyst Stage was undertaken in 350 ICSI cycles where four or more cleavage-Stage embryos were available on day 3. Main Outcome Measure(s): Relationship between Blastocyst quality and implantation and clinical and multiple pregnancy rates. Result(s): Transfer of at least one grade 1 or grade 2 Blastocyst or one hatching Blastocyst was associated with very high implantation and pregnancy rates. However, transfer of grade 3 Blastocysts yielded very low implantation and pregnancy rates. Conclusion(s): There appears to be a strong correlation between Blastocyst quality and success of Blastocyst transfer.
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Progression to the Blastocyst Stage of embryos derived from testicular round spermatids
Human reproduction (Oxford England), 2000Co-Authors: Basak Balaban, Bulent Urman, Cengiz Alatas, Senai Aksoy, Ramazan Mercan, Aycan Isiklar, Alp NuhogluAbstract:Progression to the Blastocyst Stage of embryos derived from testicular round spermatids in men with non-obstructive azoospermia was studied. A total of 56 men were studied in whom partial spermatogenesis failure had occurred where only very few spermatozoa (fewer than the number of oocytes retrieved) were extracted from multiple testicular biopsy specimens. Oocytes remaining after intracytoplasmic injection of testicular spermatozoa (group 1) were injected with round spermatids (ROSI, group 2). Only embryos derived from group 1 were transferred. Remaining embryos were observed under culture for 8 days and their progression to the Blastocyst Stage was recorded. Of the 546 oocytes injected with testicular spermatozoa, 404 (73.9%) showed evidence of 2-pronuclear (2PN) fertilization. Injection of testicular round spermatids resulted in 2PN fertilization rate of 50% (P < 0.05). Using a four-point grading system, 53% of the good quality embryos (grade 1 or 2) in group 1 reached the Blastocyst Stage compared with 25% in group 2 (P < 0.05). The rate of progression to the Blastocyst Stage of grade 3 and grade 4 embryos was 46 and 8.5% in the two groups respectively (P < 0.05). Using a different three-point grading system for the Blastocysts, 75.3% of the Blastocysts in group 1 were either grade 1 or grade 2 and 24.7% were grade 3. However, in group 2 all Blastocysts were grade 3. All embryos observed in group 1 reached the Blastocyst Stage by day 5 or 6 compared with 25% of the embryos reaching the Blastocyst Stage by this time in group 2. While 31.2% of the Blastocysts in group 1 showed evidence of spontaneous hatching in vitro, none of the Blastocysts in group 2 hatched. In conclusion, progression to the Blastocyst Stage occurred at a much lower and slower rate in embryos derived from testicular round spermatids. Furthermore, all Blastocysts resulting from ROSI were of poor quality and none showed spontaneous hatching. These results may explain the dismal outcome associated with ROSI.
Bulent Urman - One of the best experts on this subject based on the ideXlab platform.
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Impact of the presence of one or more multinucleated blastomeres on the developmental potential of the embryo to the Blastocyst Stage
Fertility and sterility, 2005Co-Authors: Kayhan Yakin, Basak Balaban, Bulent UrmanAbstract:A retrospective study of 5,982 embryos in 619 Blastocyst-Stage embryo transfer cycles revealed that detection of multinucleated blastomeres either on day 2 or 3 signifies a poor prognosis for Blastocyst formation and that no good-quality Blastocyst can be expected from an embryo with more than one multinucleated blastomere. Patients should be counseled regarding a poor prognosis when multiple embryos with multinucleated blastomeres are present.
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Transfer at the Blastocyst Stage of embryos derived from testicular round spermatid injection
Human reproduction (Oxford England), 2002Co-Authors: Bulent Urman, Cengiz Alatas, Senai Aksoy, Ramazan Mercan, Aycan Isiklar, Alp Nuhoglu, Alper Mumcu, Basak BalabanAbstract:BACKGROUND: Intracytoplasmic injection of testicular round spermatids has been suggested as a salvage treatment in couples when testicular sperm extraction does not yield any mature sperm. However, the success of the procedure is debatable, and controversy surrounds issues such as the presence and (if present) identification of spermatids in testicular tissue. Progression rate to the Blastocyst Stage of spermatid-derived embryos appears to be low. METHODS: In this study, we investigated the feasibility and outcome of Blastocyst Stage embryo transfer after round spermatid injection (ROSI). ROSI was undertaken in 58 couples who did not yield mature or elongated sperm to testicular sperm extraction. RESULTS: The incidence of Blastocyst formation from two pronuclear oocytes was 7.6%. A total of 16 Blastocysts were transferred in 12 patients (20.7%). None of the patients conceived. CONCLUSIONS: The results of this study indicate that the Blastocyst Stage is reached by only very few ROSI-derived embryos and these embryos do not implant.
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Blastocyst-Stage transfer of poor-quality cleavage-Stage embryos results in higher implantation rates.
Fertility and sterility, 2001Co-Authors: Basak Balaban, Bulent Urman, Cengiz Alatas, Senai Aksoy, Ramazan Mercan, Aycan IsiklarAbstract:Abstract Objective: To determine the feasibility and success of Blastocyst-Stage embryo transfers in patients having only fair and poor quality cleavage-Stage embryos on day 3. Design: Prospective case study with historic controls. Setting: Tertiary care private hospital IVF center. Patient(s): A total of 158 day 5 embryo transfer cycles in patients with grade 3 and grade 4 cleavage-Stage embryos. Control group consisted of 162 day 3 transfer cycles performed with embryos of similar quality. Intervention(s): In vitro culture of embryos up to the Blastocyst Stage. Main Outcome Measure(s): The percentage of cycles that culminated in the transfer of at least one Blastocyst and implantation and pregnancy rate related to the day of transfer. Result(s): In the day 3 transfer group, a mean of 5.2 embryos were replaced per patient. This was significantly more than the mean of 2.4 embryos that could be replaced on day 5 ( P P >.05). The implantation rate per embryo was significantly higher in the day 5 transfer group (15% vs. 5.9%). The multiple pregnancy and abortion rates were similar between the groups. Conclusion(s): Transfer of fair and poor quality embryos at the Blastocyst Stage is feasible and is associated with higher implantation rates as compared to transfer of similar quality embryos on day 3.
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Blastocyst quality affects the success of Blastocyst-Stage embryo transfer.
Fertility and sterility, 2000Co-Authors: Basak Balaban, Bulent Urman, Aycan Sertac, Cengiz Alatas, Senai Aksoy, Ramazan MercanAbstract:Abstract Objective: To determine the relationship between Blastocyst quality and the results of embryo transfer at the Blastocyst Stage. Design: Retrospective case analysis. Setting: Tertiary care private hospital IVF center. Patient(s): A total of 350 Blastocyst-Stage embryo transfer cycles. Intervention(s): In vitro culture to the Blastocyst Stage was undertaken in 350 ICSI cycles where four or more cleavage-Stage embryos were available on day 3. Main Outcome Measure(s): Relationship between Blastocyst quality and implantation and clinical and multiple pregnancy rates. Result(s): Transfer of at least one grade 1 or grade 2 Blastocyst or one hatching Blastocyst was associated with very high implantation and pregnancy rates. However, transfer of grade 3 Blastocysts yielded very low implantation and pregnancy rates. Conclusion(s): There appears to be a strong correlation between Blastocyst quality and success of Blastocyst transfer.
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Progression to the Blastocyst Stage of embryos derived from testicular round spermatids
Human reproduction (Oxford England), 2000Co-Authors: Basak Balaban, Bulent Urman, Cengiz Alatas, Senai Aksoy, Ramazan Mercan, Aycan Isiklar, Alp NuhogluAbstract:Progression to the Blastocyst Stage of embryos derived from testicular round spermatids in men with non-obstructive azoospermia was studied. A total of 56 men were studied in whom partial spermatogenesis failure had occurred where only very few spermatozoa (fewer than the number of oocytes retrieved) were extracted from multiple testicular biopsy specimens. Oocytes remaining after intracytoplasmic injection of testicular spermatozoa (group 1) were injected with round spermatids (ROSI, group 2). Only embryos derived from group 1 were transferred. Remaining embryos were observed under culture for 8 days and their progression to the Blastocyst Stage was recorded. Of the 546 oocytes injected with testicular spermatozoa, 404 (73.9%) showed evidence of 2-pronuclear (2PN) fertilization. Injection of testicular round spermatids resulted in 2PN fertilization rate of 50% (P < 0.05). Using a four-point grading system, 53% of the good quality embryos (grade 1 or 2) in group 1 reached the Blastocyst Stage compared with 25% in group 2 (P < 0.05). The rate of progression to the Blastocyst Stage of grade 3 and grade 4 embryos was 46 and 8.5% in the two groups respectively (P < 0.05). Using a different three-point grading system for the Blastocysts, 75.3% of the Blastocysts in group 1 were either grade 1 or grade 2 and 24.7% were grade 3. However, in group 2 all Blastocysts were grade 3. All embryos observed in group 1 reached the Blastocyst Stage by day 5 or 6 compared with 25% of the embryos reaching the Blastocyst Stage by this time in group 2. While 31.2% of the Blastocysts in group 1 showed evidence of spontaneous hatching in vitro, none of the Blastocysts in group 2 hatched. In conclusion, progression to the Blastocyst Stage occurred at a much lower and slower rate in embryos derived from testicular round spermatids. Furthermore, all Blastocysts resulting from ROSI were of poor quality and none showed spontaneous hatching. These results may explain the dismal outcome associated with ROSI.
Ramazan Mercan - One of the best experts on this subject based on the ideXlab platform.
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Transfer at the Blastocyst Stage of embryos derived from testicular round spermatid injection
Human reproduction (Oxford England), 2002Co-Authors: Bulent Urman, Cengiz Alatas, Senai Aksoy, Ramazan Mercan, Aycan Isiklar, Alp Nuhoglu, Alper Mumcu, Basak BalabanAbstract:BACKGROUND: Intracytoplasmic injection of testicular round spermatids has been suggested as a salvage treatment in couples when testicular sperm extraction does not yield any mature sperm. However, the success of the procedure is debatable, and controversy surrounds issues such as the presence and (if present) identification of spermatids in testicular tissue. Progression rate to the Blastocyst Stage of spermatid-derived embryos appears to be low. METHODS: In this study, we investigated the feasibility and outcome of Blastocyst Stage embryo transfer after round spermatid injection (ROSI). ROSI was undertaken in 58 couples who did not yield mature or elongated sperm to testicular sperm extraction. RESULTS: The incidence of Blastocyst formation from two pronuclear oocytes was 7.6%. A total of 16 Blastocysts were transferred in 12 patients (20.7%). None of the patients conceived. CONCLUSIONS: The results of this study indicate that the Blastocyst Stage is reached by only very few ROSI-derived embryos and these embryos do not implant.
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Blastocyst-Stage transfer of poor-quality cleavage-Stage embryos results in higher implantation rates.
Fertility and sterility, 2001Co-Authors: Basak Balaban, Bulent Urman, Cengiz Alatas, Senai Aksoy, Ramazan Mercan, Aycan IsiklarAbstract:Abstract Objective: To determine the feasibility and success of Blastocyst-Stage embryo transfers in patients having only fair and poor quality cleavage-Stage embryos on day 3. Design: Prospective case study with historic controls. Setting: Tertiary care private hospital IVF center. Patient(s): A total of 158 day 5 embryo transfer cycles in patients with grade 3 and grade 4 cleavage-Stage embryos. Control group consisted of 162 day 3 transfer cycles performed with embryos of similar quality. Intervention(s): In vitro culture of embryos up to the Blastocyst Stage. Main Outcome Measure(s): The percentage of cycles that culminated in the transfer of at least one Blastocyst and implantation and pregnancy rate related to the day of transfer. Result(s): In the day 3 transfer group, a mean of 5.2 embryos were replaced per patient. This was significantly more than the mean of 2.4 embryos that could be replaced on day 5 ( P P >.05). The implantation rate per embryo was significantly higher in the day 5 transfer group (15% vs. 5.9%). The multiple pregnancy and abortion rates were similar between the groups. Conclusion(s): Transfer of fair and poor quality embryos at the Blastocyst Stage is feasible and is associated with higher implantation rates as compared to transfer of similar quality embryos on day 3.
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Blastocyst quality affects the success of Blastocyst-Stage embryo transfer.
Fertility and sterility, 2000Co-Authors: Basak Balaban, Bulent Urman, Aycan Sertac, Cengiz Alatas, Senai Aksoy, Ramazan MercanAbstract:Abstract Objective: To determine the relationship between Blastocyst quality and the results of embryo transfer at the Blastocyst Stage. Design: Retrospective case analysis. Setting: Tertiary care private hospital IVF center. Patient(s): A total of 350 Blastocyst-Stage embryo transfer cycles. Intervention(s): In vitro culture to the Blastocyst Stage was undertaken in 350 ICSI cycles where four or more cleavage-Stage embryos were available on day 3. Main Outcome Measure(s): Relationship between Blastocyst quality and implantation and clinical and multiple pregnancy rates. Result(s): Transfer of at least one grade 1 or grade 2 Blastocyst or one hatching Blastocyst was associated with very high implantation and pregnancy rates. However, transfer of grade 3 Blastocysts yielded very low implantation and pregnancy rates. Conclusion(s): There appears to be a strong correlation between Blastocyst quality and success of Blastocyst transfer.
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Progression to the Blastocyst Stage of embryos derived from testicular round spermatids
Human reproduction (Oxford England), 2000Co-Authors: Basak Balaban, Bulent Urman, Cengiz Alatas, Senai Aksoy, Ramazan Mercan, Aycan Isiklar, Alp NuhogluAbstract:Progression to the Blastocyst Stage of embryos derived from testicular round spermatids in men with non-obstructive azoospermia was studied. A total of 56 men were studied in whom partial spermatogenesis failure had occurred where only very few spermatozoa (fewer than the number of oocytes retrieved) were extracted from multiple testicular biopsy specimens. Oocytes remaining after intracytoplasmic injection of testicular spermatozoa (group 1) were injected with round spermatids (ROSI, group 2). Only embryos derived from group 1 were transferred. Remaining embryos were observed under culture for 8 days and their progression to the Blastocyst Stage was recorded. Of the 546 oocytes injected with testicular spermatozoa, 404 (73.9%) showed evidence of 2-pronuclear (2PN) fertilization. Injection of testicular round spermatids resulted in 2PN fertilization rate of 50% (P < 0.05). Using a four-point grading system, 53% of the good quality embryos (grade 1 or 2) in group 1 reached the Blastocyst Stage compared with 25% in group 2 (P < 0.05). The rate of progression to the Blastocyst Stage of grade 3 and grade 4 embryos was 46 and 8.5% in the two groups respectively (P < 0.05). Using a different three-point grading system for the Blastocysts, 75.3% of the Blastocysts in group 1 were either grade 1 or grade 2 and 24.7% were grade 3. However, in group 2 all Blastocysts were grade 3. All embryos observed in group 1 reached the Blastocyst Stage by day 5 or 6 compared with 25% of the embryos reaching the Blastocyst Stage by this time in group 2. While 31.2% of the Blastocysts in group 1 showed evidence of spontaneous hatching in vitro, none of the Blastocysts in group 2 hatched. In conclusion, progression to the Blastocyst Stage occurred at a much lower and slower rate in embryos derived from testicular round spermatids. Furthermore, all Blastocysts resulting from ROSI were of poor quality and none showed spontaneous hatching. These results may explain the dismal outcome associated with ROSI.
Siladitya Bhattacharya - One of the best experts on this subject based on the ideXlab platform.
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should we be promoting embryo transfer at Blastocyst Stage
Reproductive Biomedicine Online, 2016Co-Authors: Abha Maheshwari, Mark Hamilton, Siladitya BhattacharyaAbstract:Improved laboratory standards and better culture media have made extended culture to Blastocyst Stage a reality to identify embryos with maximum implantation potential. The strategy of extended culture has become more popular across the world at a time when regulatory bodies have emphasized the need to increase the uptake of elective single embryo transfer, minimize complications associated with multiple births and aim for a healthy singleton live-birth as the preferred outcome in IVF. New data on perinatal outcomes suggest that pregnancies after embryo transfer at Blastocyst Stage are associated with a higher risk of preterm delivery, large for gestational age babies, monozygotic twins and altered sex ratio compared with those following embryo transfers at cleavage Stage. In addition, concerns have been raised of increased congenital anomalies and epigenetic modifications with embryo transfer at Blastocyst Stage. Twenty-four years on from the first embryo transfer at Blastocyst Stage, we examine the reasons for extended embryo culture, evaluate the risks and benefits of this strategy and suggest the need to reconsider this policy in the interests of fetal safety.
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obstetric and perinatal outcomes in singleton pregnancies resulting from the transfer of Blastocyst Stage versus cleavage Stage embryos generated through in vitro fertilization treatment a systematic review and meta analysis
Fertility and Sterility, 2013Co-Authors: Abha Maheshwari, Theodoros Kalampokas, Jill E Davidson, Siladitya BhattacharyaAbstract:Objective To perform a systematic review and meta-analysis of obstetric and perinatal complications in singleton pregnancies after the transfer of Blastocyst-Stage and cleavage-Stage embryos generated through IVF. Design Systematic review. Setting University hospital. Patient(s) Singleton pregnancies resulting from ET at the Blastocyst Stage versus those at the cleavage Stage. Intervention(s) Medline, EMBASE, Cochrane Central Register of Clinical Trials DARE, and CINAHL (1980–2013) were searched. Two independent reviewers extracted data and assessed the methodological quality of the relevant studies using CASP scoring. Risk ratios and risk differences were calculated in Rev Man 5.1. Main Outcome Measure(s) Very preterm birth, preterm birth, small for gestational age, low birth weight, very low birth weight, congenital anomalies, perinatal mortality, preeclampsia, and placenta previa. Result(s) In vitro fertilization pregnancies occurring as a result of ET at the Blastocyst Stage were associated with a higher relative risk (RR; 95% confidence interval [CI]) of preterm (RR 1.27; 95% CI 1.22–1.31) and very preterm delivery (RR 1.22; 95% CI 1.10–1.35) in comparison with those resulting from the transfer of cleavage-Stage embryos. The risk of growth restriction was lower in babies conceived through Blastocyst transfer (RR 0.82; 95% CI 0.77–0.88). Conclusion(s) Data from observational studies show that ET at the Blastocyst Stage is associated with a higher risk of very preterm delivery. However, we were not able to adjust for confounders. Perinatal outcome data from existing randomized trials are needed to determine the safety of ET at the Blastocyst Stage compared with the cleavage Stage.
Michel Camus - One of the best experts on this subject based on the ideXlab platform.
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cumulative live birth rates after fresh and vitrified cleavage Stage versus Blastocyst Stage embryo transfer in the first treatment cycle
Human Reproduction, 2016Co-Authors: Anick De Vos, Michel Camus, Lisbet Van Landuyt, Herman Tournaye, Hilde Van De Velde, Samuel Santosribeiro, Greta VerheyenAbstract:STUDY QUESTION Do cumulative live birth rates differ between single cleavage-Stage Day 3 transfer and single Blastocyst-Stage Day 5 transfer? SUMMARY ANSWER Cumulative live birth rates after Day 3 and 5 transfers were similar in young patients when the vitrified embryo transfers were also taken into account. WHAT IS KNOWN ALREADY Previous evidence has shown that the probability of live birth following IVF with a fresh embryo transfer is significantly higher after Blastocyst-Stage Day 5 transfer. However, because the introduction of vitrification has enhanced the survival of cryopreserved embryos and improved pregnancy rates, the optimal outcome measure for this comparison should now be cumulative live birth rates, as these include the eventual contribution of vitrified-warmed embryos. STUDY DESIGN, SIZE, DURATION Our retrospective study included first IVF/ICSI cycles performed between January 2010 and December 2013 at a tertiary care centre. PARTICIPANTS/MATERIALS, SETTING, METHODS All patients were scheduled for fresh single embryo transfer, either on Day 3 (n = 377) or on Day 5 (n = 623). Both IVF and ICSI cycles were included and the sperm used were either fresh or frozen partner ejaculates, or frozen donor ejaculates. The primary outcome was cumulative live birth (after 24 weeks) rate per started cycle, including the eventual contribution of vitrification until the birth of a first child. MAIN RESULTS AND THE ROLE OF CHANCE Live birth rates per started cycle were significantly lower after transferring the fresh single cleavage-Stage embryo, compared to a Blastocyst (31.3% and 37.8%, respectively, P = 0.041). Furthermore, the number of embryo transfers necessary until the first live birth was significantly lower for Blastocyst-Stage embryos (P < 0.001). However, the cumulative live birth rates were 52.6% for cleavage-Stage and 52.5% for Blastocyst-Stage transfers (P = 0.989). LIMITATIONS, REASONS FOR CAUTION The extrapolation of the results is limited by the retrospective nature of the study. Furthermore, the analysis was restricted to patients under 36 years of age undergoing their first treatment cycle. WIDER IMPLICATIONS OF THE FINDINGS These results deserve further clinical consideration in terms of time and cost efficiency. A subsequent analysis of the neonatal outcomes is necessary to confirm the safety of treatment cycles using extended culture. STUDY FUNDING/COMPETING INTERESTS No external funding was received and there are no conflicts of interest to declare.
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Cumulative live birth rates after fresh and vitrified cleavage-Stage versus Blastocyst-Stage embryo transfer in the first treatment cycle
Human reproduction (Oxford England), 2016Co-Authors: Anick De Vos, Michel Camus, Lisbet Van Landuyt, Samuel Santos-ribeiro, Herman Tournaye, Hilde Van De Velde, Greta VerheyenAbstract:STUDY QUESTION Do cumulative live birth rates differ between single cleavage-Stage Day 3 transfer and single Blastocyst-Stage Day 5 transfer? SUMMARY ANSWER Cumulative live birth rates after Day 3 and 5 transfers were similar in young patients when the vitrified embryo transfers were also taken into account. WHAT IS KNOWN ALREADY Previous evidence has shown that the probability of live birth following IVF with a fresh embryo transfer is significantly higher after Blastocyst-Stage Day 5 transfer. However, because the introduction of vitrification has enhanced the survival of cryopreserved embryos and improved pregnancy rates, the optimal outcome measure for this comparison should now be cumulative live birth rates, as these include the eventual contribution of vitrified-warmed embryos. STUDY DESIGN, SIZE, DURATION Our retrospective study included first IVF/ICSI cycles performed between January 2010 and December 2013 at a tertiary care centre. PARTICIPANTS/MATERIALS, SETTING, METHODS All patients were scheduled for fresh single embryo transfer, either on Day 3 (n = 377) or on Day 5 (n = 623). Both IVF and ICSI cycles were included and the sperm used were either fresh or frozen partner ejaculates, or frozen donor ejaculates. The primary outcome was cumulative live birth (after 24 weeks) rate per started cycle, including the eventual contribution of vitrification until the birth of a first child. MAIN RESULTS AND THE ROLE OF CHANCE Live birth rates per started cycle were significantly lower after transferring the fresh single cleavage-Stage embryo, compared to a Blastocyst (31.3% and 37.8%, respectively, P = 0.041). Furthermore, the number of embryo transfers necessary until the first live birth was significantly lower for Blastocyst-Stage embryos (P
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in vitro fertilization with single Blastocyst Stage versus single cleavage Stage embryos
Obstetrical & Gynecological Survey, 2006Co-Authors: E G Papanikolaou, Michel Camus, Efstratios M Kolibianakis, Lisbet Van Landuyt, Andre Van Steirteghem, Paul DevroeyAbstract:Single-embryo transfer has been proposed as a way of limiting multiple births after in vitro fertilization (IVF) in women less than 36 years of age. Extending embryo culture from the 3-day cleavage Stage to the 5-day Blastocyst Stage might make pregnancy likelier and, in addition, the morphologic criteria that guide embryo selection are less subjective at the later date. This study analyzed the outcome of IVF in 351 infertile women age 35 and younger; 176 were assigned to have transfer of a single cleavage-Stage embryo, whereas 175 received a single Blastocyst-Stage embryo. Multifol-licular ovarian stimulation was carried out using recombinant follicle-stimulating hormone and a gonadotropin-releasing hormone antagonist. Oocyte maturation was promoted by administering human chorionic gonadotropin, and the luteal phase was supported by vaginally administered progesterone. More than 90% of women in both treatment groups were having their first or second trial of IVF or intracytoplasmic sperm injection. The groups were similar demographically and in embryologic characteristics, but significantly more embryos in the cleavage-Stage group were cryopreserved. Approximately two thirds of each group had a top-quality embryo for transfer. Compared with cleavage-Stage cases, the Blastocyst-Stage group had a significantly higher rate of ongoing pregnancy (33% vs 22%). The relative risk (RR) was 1.54 with a 95% confidence interval (CI) of 1.08 to 2.18. Deliveries also were significantly more frequent in the Blastocyst-Stage group (32% vs 22%); the RR was 1.48 with a 95% CI of 1.04 to 2.11. A higher rate of first-trimester pregnancy loss in the cleavage-Stage group (34% vs 19%) may be partly responsible, although the difference was not statistically significant. Two of 94 deliveries (2%), both in the cleavage-Stage group, resulted in monozygotic twin births. These results affirm the effectiveness of single-embryo transfer in reducing the risk of multiple births. In younger women having their first or second trial of IVF, transfer of a single Blastocyst-Stage embryo is significantly likelier than use of a cleavage-Stage embryo to result in pregnancy and delivery.
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in vitro fertilization with single Blastocyst Stage versus single cleavage Stage embryos
The New England Journal of Medicine, 2006Co-Authors: E G Papanikolaou, Michel Camus, Efstratios M Kolibianakis, Lisbet Van Landuyt, Andre Van Steirteghem, Paul DevroeyAbstract:Background Single-embryo transfer has been recommended to reduce the incidence of multiple gestations when in vitro fertilization is performed in women under 36 years of age. We designed a prospective, randomized, controlled trial to determine whether there were any differences in the rates of pregnancy and delivery between women undergoing transfer of a single cleavage-Stage (day 3) embryo and those undergoing transfer of a single Blastocyst-Stage (day 5) embryo. Methods We studied 351 infertile women under 36 years of age who were randomly assigned to undergo transfer of either a single cleavage-Stage embryo (176 patients) or a single Blastocyst-Stage embryo (175 patients). Multifollicular ovarian stimulation was performed with a gonadotropin-releasing hormone antagonist and recombinant folliclestimulating hormone. Results The study was terminated early after a prespecified interim analysis (which included 50 percent of the planned number of patients) found a higher rate of pregnancy among women undergoing transfer of a single Blastocyst-Stage embryo (P = 0.02). The rate of delivery was also significantly higher in this group than in the group undergoing transfer of a single cleavage-Stage embryo (32.0 percent vs. 21.6 percent; relative risk, 1.48; 95 percent confidence interval, 1.04 to 2.11). Two multiple births occurred, both of monozygotic twins, both of which were in the group undergoing transfer of a single cleavage-Stage embryo. Conclusions These findings support the transfer of a single Blastocyst-Stage (day 5) embryo in infertile women under 36 years of age.