This document discusses the debate around whether embryo transfer should occur at the cleavage stage (day 3) or blastocyst stage (day 5-6).
It summarizes a study that found transferring embryos at the blastocyst stage resulted in a significantly higher ongoing pregnancy rate compared to cleavage stage in patients aged 35 or older, but no difference was seen in younger patients. The cumulative ongoing pregnancy rate was also higher but not significantly for blastocyst transfers.
The document also discusses some potential risks of blastocyst culture and transfer, including increased rates of preterm birth and large babies. Some studies found higher risks of congenital anomalies and epigenetic issues with blastocyst transfers as well.
Overall,
EMBRYO QUALITY ASSESSMENT, WHICH TO SELECT? Rahul Sen
Traditional embryo evaluation systems are simple, non-invasive, cost-effective & mainstay in majority of IVF laboratories. Embryo selection based on combinations of morphology scores at different stages of embryonic development with time may be more effective
Invited lecture by Dr Sujoy Dasgupta in the Scientific Session on "Embryo Transfer and Beyond " in the AICOG (All India Congress of Obstetrics and Gynaecology) at Kolkata, 2023
In-vitro fertilization (IVF) is a process by which oocytes are fertilized by sperm outside the women’s womb, in vitro. It still represents one of the most exciting modern scientific developments and continues to have a tremendous impact on
people's lives.
Here, we will discuss all about the embryo development inside the dish.
Also we discuss which embryo to choose for transferring into female's uterus.
It was while performing SUZI that a single spermatozoon accidentally penetrated into the oolemma and provided the hint that a direct sperm injection would be more efficient.
1st successful birth by ICSI took place on Jan 14, 1992.
EMBRYO QUALITY ASSESSMENT, WHICH TO SELECT? Rahul Sen
Traditional embryo evaluation systems are simple, non-invasive, cost-effective & mainstay in majority of IVF laboratories. Embryo selection based on combinations of morphology scores at different stages of embryonic development with time may be more effective
Invited lecture by Dr Sujoy Dasgupta in the Scientific Session on "Embryo Transfer and Beyond " in the AICOG (All India Congress of Obstetrics and Gynaecology) at Kolkata, 2023
In-vitro fertilization (IVF) is a process by which oocytes are fertilized by sperm outside the women’s womb, in vitro. It still represents one of the most exciting modern scientific developments and continues to have a tremendous impact on
people's lives.
Here, we will discuss all about the embryo development inside the dish.
Also we discuss which embryo to choose for transferring into female's uterus.
It was while performing SUZI that a single spermatozoon accidentally penetrated into the oolemma and provided the hint that a direct sperm injection would be more efficient.
1st successful birth by ICSI took place on Jan 14, 1992.
Extending the duration of embryo culture to the blastocyst stage for assisted reproduction offers sev- eral theoretical advantages over the transfer of cleavage-stage embryos. These include 1) a higher implantation rate, 2) the opportunity to select the most viable embryo(s) for transfer
Sperm DNA Fragmentation : Role in natural and assisted conception: Recent adv...Shivani Sachdev
Male factor infertility is responsible for >40% of couples presenting for ART. Conventional SA continues to be the only routine test to diagnose this condition. Current SA is based on 5th edition of the WHO manual (2010) . All normal values shifted to lower centile compared to previous edition. Less men now classified as infertile (Murray et al 2012). Sperm DNA damage - used to denote abnormal genetic material which in turn may lead to male sub fertility/ IVF failure / miscarriage.
DNA Fragmentation Index of Sperm - Expressed as DFI- or percentage of the number of cells with defects in protamination of DNA structure in the evaluated sperm cells
The integrity of paternal genome is of paramount importance in the initiation of viable pregnancy. The fragmented DNA is incompatible with normal embryonic development
Sperm chromatin anomalies are often present in men with abnormal semen analyses 8% of men with normal semen parameters have abnormal sperm DNA integrity
Zini A.Biologic variability of sperm DNA denaturation in infertile men. Urology 2001
We discuss the various tests used and recent concepts and techniques and what are the newer treatment options
The day 3 embryo versus day 5 embryo transfer is a debate that has always persisted and here we attempt to present relevant data to assist in making a decision #day3embryo #day5embryo #ivf #icsi #embryotransfer #bestembryo #ivfsuccess #pgt #pgd #preimplantationgenetictesting #embryo #day3versusday5embryo
Austin Journal of Invitro Fertilization is an international scholarly, peer review, Open Access journal, which aims to promote the Fertilization research all over the world.
Austin Journal of Invitro Fertilization is a comprehensive Open Access peer reviewed scientific journal that covers multidisciplinary fields. We provide limitless access towards accessing our literature hub with colossal range of articles. The journal accepts high quality varied article types such as Research, Review, Short Communications, Case Reports, Perspectives (Editorials) and Clinical Images.
Austin Journal of Invitro Fertilization supports the scientific modernization and enrichment in Invitro Fertilization research community by magnifying access to peer reviewed scientific literary works. Austin also brings universally peer reviewed member journals under one roof thereby promoting knowledge sharing, collaborative and promotion of multidisciplinary technology.
Extending the duration of embryo culture to the blastocyst stage for assisted reproduction offers sev- eral theoretical advantages over the transfer of cleavage-stage embryos. These include 1) a higher implantation rate, 2) the opportunity to select the most viable embryo(s) for transfer
Sperm DNA Fragmentation : Role in natural and assisted conception: Recent adv...Shivani Sachdev
Male factor infertility is responsible for >40% of couples presenting for ART. Conventional SA continues to be the only routine test to diagnose this condition. Current SA is based on 5th edition of the WHO manual (2010) . All normal values shifted to lower centile compared to previous edition. Less men now classified as infertile (Murray et al 2012). Sperm DNA damage - used to denote abnormal genetic material which in turn may lead to male sub fertility/ IVF failure / miscarriage.
DNA Fragmentation Index of Sperm - Expressed as DFI- or percentage of the number of cells with defects in protamination of DNA structure in the evaluated sperm cells
The integrity of paternal genome is of paramount importance in the initiation of viable pregnancy. The fragmented DNA is incompatible with normal embryonic development
Sperm chromatin anomalies are often present in men with abnormal semen analyses 8% of men with normal semen parameters have abnormal sperm DNA integrity
Zini A.Biologic variability of sperm DNA denaturation in infertile men. Urology 2001
We discuss the various tests used and recent concepts and techniques and what are the newer treatment options
The day 3 embryo versus day 5 embryo transfer is a debate that has always persisted and here we attempt to present relevant data to assist in making a decision #day3embryo #day5embryo #ivf #icsi #embryotransfer #bestembryo #ivfsuccess #pgt #pgd #preimplantationgenetictesting #embryo #day3versusday5embryo
Austin Journal of Invitro Fertilization is an international scholarly, peer review, Open Access journal, which aims to promote the Fertilization research all over the world.
Austin Journal of Invitro Fertilization is a comprehensive Open Access peer reviewed scientific journal that covers multidisciplinary fields. We provide limitless access towards accessing our literature hub with colossal range of articles. The journal accepts high quality varied article types such as Research, Review, Short Communications, Case Reports, Perspectives (Editorials) and Clinical Images.
Austin Journal of Invitro Fertilization supports the scientific modernization and enrichment in Invitro Fertilization research community by magnifying access to peer reviewed scientific literary works. Austin also brings universally peer reviewed member journals under one roof thereby promoting knowledge sharing, collaborative and promotion of multidisciplinary technology.
Multiple births—the delivery of twins, triplets, or more—is common with fertility treatments. During the use of assisted reproductive technology (ART)—such as in vitro fertilization (IVF)—multiple births primarily result from transfer of more than one embryo during the procedure
"Embryo Transfer Strategies: Cleavage vs. Blastocyst"
Brief overview of the significance of embryo transfer in assisted reproductive technologies (ART) and the focus on cleavage and blastocyst stages with their merits and demerits.
Cumulous cells co-culture and surrogacy - Marrakech May 2013Ioannis Giakoumakis
The use of human cumulous cells co-culture has proved advantageous in many ways which might prove crucial in achieving higher implantation rates in an SMP.
M. Benkhalifa, D. Daphnis, M. Solanou, M. Tsouroupaki and I. Giakoumakis
The comparison of dinoprostone and vagiprost for induction of lobar in post t...iosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
Characterization and the Kinetics of drying at the drying oven and with micro...Open Access Research Paper
The objective of this work is to contribute to valorization de Nephelium lappaceum by the characterization of kinetics of drying of seeds of Nephelium lappaceum. The seeds were dehydrated until a constant mass respectively in a drying oven and a microwawe oven. The temperatures and the powers of drying are respectively: 50, 60 and 70°C and 140, 280 and 420 W. The results show that the curves of drying of seeds of Nephelium lappaceum do not present a phase of constant kinetics. The coefficients of diffusion vary between 2.09.10-8 to 2.98. 10-8m-2/s in the interval of 50°C at 70°C and between 4.83×10-07 at 9.04×10-07 m-8/s for the powers going of 140 W with 420 W the relation between Arrhenius and a value of energy of activation of 16.49 kJ. mol-1 expressed the effect of the temperature on effective diffusivity.
Accuracy of cervico vaginal fetal fibronectin test in predicting risk of spon...Open Access Research Paper
Preterm delivery is the leading cause of neonatal mortality. One of the best predictors to assess the risk of preterm labour (PTB) is by measuring fetal fibronectin (fFN) in cervico vaginal secretion after 26 weeks of pregnancy. The aim is to evaluate the diagnostic accuracy of qualitative cervico vaginal fFN in symptomatic women and asymptomatic high risk women during antenatal care. Prospective study which was conducted in Basrah Maternity and Child Hospital. It included 106 pregnant women at gestational age more than 26 weeks who had uterine contraction with or without pervious risk factors for PTB. Cervico vaginal fluid sampling was undertaken from all women included in the study after the age of 26 weeks of gestation and qualitative fFN assessment was done with 50ng/ml is the cut off point for positivity. As regard qualitative fFN assessment for predicting of PTB sensitivity, specificity, PPV, NPV, were 71%, 87%, 40.50%, 94% respectively in symptomatic women. While in asymptomatic women with previous high risk had 26% sensitivity, 84% specificity, 32% PPV, and 87% NPV. Qualitative assessment of fFN in cervico vaginal fluid is good predictive marker in detecting of PTB.
Strategies for improving success in Poor respondersKaberi Banerjee
Overcoming challenges associated with poor ovarian response is a critical aspect of in vitro fertilization (IVF) for individuals classified as poor responders. Various strategies can be employed to enhance the chances of success in this particular group of patients.
Firstly, individualized ovarian stimulation protocols play a crucial role. Tailoring medication dosages and adjusting the type of gonadotropins used based on the patient's age, ovarian reserve, and response to previous stimulation cycles is essential. Utilizing personalized approaches can optimize follicular development and improve egg yield.
Co-administration of adjuvant medications is another effective strategy. Growth hormone supplementation has shown promise in enhancing ovarian response and improving the quality of eggs in poor responders. Additionally, androgen pre-treatment has been explored as a means to improve ovarian function and response to stimulation.
Advancements in laboratory techniques, such as the use of time-lapse imaging systems, can aid in the selection of the most viable embryos for transfer. This ensures that the highest-quality embryos are chosen, increasing the chances of successful implantation.
Embryo transfer techniques also play a significant role in optimizing success for poor responders. Employing the assisted hatching technique or using preimplantation genetic testing (PGT) to screen embryos for chromosomal abnormalities can improve implantation rates.
In some cases, considering alternative approaches such as natural cycle IVF or minimal stimulation IVF may be beneficial for poor responders. These protocols aim to work with the patient's natural cycle or use lower doses of medications to reduce the risk of overstimulation and improve egg quality.
Furthermore, addressing lifestyle factors that may impact fertility, such as nutrition, stress management, and adequate sleep, is crucial for optimizing outcomes in poor responders.
In conclusion, a multifaceted approach is essential for improving success in poor responders undergoing IVF. By customizing ovarian stimulation protocols, incorporating adjuvant medications, leveraging advanced laboratory techniques, optimizing embryo transfer, and considering alternative protocols, fertility specialists can enhance the chances of a positive outcome for individuals facing the challenge of poor ovarian response.
Embryo Transfer- Tips and Tricks to improve successKaberi Banerjee
Improving embryo transfer technique is crucial in the field of assisted reproductive technology (ART) as it significantly influences the success of in vitro fertilization (IVF) procedures. A well-executed embryo transfer is vital for the optimal implantation of embryos, leading to a higher likelihood of a successful pregnancy. Here are several key strategies to enhance the embryo transfer technique:
Firstly, proper training and skill development for the fertility specialist or clinician performing the procedure are essential. Training programs that emphasize hands-on experience and guidance from experienced practitioners contribute to proficiency in embryo transfer. Continuous professional development ensures that practitioners stay updated on the latest advancements in the field.
Secondly, utilizing ultrasound guidance during embryo transfer enhances precision. Real-time visualization enables the clinician to accurately navigate the catheter through the cervix and deposit the embryos in the ideal location within the uterine cavity. This minimizes the risk of trauma and increases the chances of successful implantation.
Maintaining a relaxed and comfortable environment during the procedure is equally important. Studies suggest that minimizing stress and anxiety in both the patient and the clinician can positively impact the success of embryo transfer. This involves effective communication with the patient, addressing any concerns, and ensuring a supportive atmosphere in the clinic.
Optimizing the timing of embryo transfer concerning the woman's menstrual cycle is another critical factor. Synchronization between the embryo's developmental stage and the endometrial receptivity is vital. Personalized protocols and careful monitoring of hormonal levels contribute to better timing, enhancing the chances of successful implantation.
Lastly, considering individualized patient factors, such as uterine anatomy and the woman's overall health, is essential. Tailoring the embryo transfer technique to the specific needs of each patient increases the likelihood of a positive outcome.
In conclusion, continuous education, technological advancements, personalized approaches, and a patient-centered focus are key elements in improving the embryo transfer technique. Implementing these strategies can contribute to higher success rates in IVF procedures, bringing hope to individuals and couples seeking to build their families through assisted reproductive technologies.
The thin endometrium refers to the lining of the uterus, known as the endometrium, being insufficiently thick. This condition is typically characterized by a reduced thickness of the endometrial layer, which plays a crucial role in supporting the implantation and development of a fertilized egg during the menstrual cycle.
A thin endometrium is commonly associated with hormonal imbalances, such as low estrogen levels, which are vital for the growth and maintenance of the endometrial tissue. Inadequate blood flow to the uterus, chronic inflammation, or certain medical conditions can also contribute to this condition. Women with a thin endometrium may experience difficulties in achieving and maintaining pregnancy, as the thin lining may not provide an optimal environment for the embryo to implant and thrive.
Addressing the underlying causes of a thin endometrium often involves hormonal therapies to regulate estrogen levels, lifestyle modifications, and sometimes surgical interventions. Fertility treatments, such as in vitro fertilization (IVF), may be considered to overcome the challenges associated with a thin endometrium.
In conclusion, a thin endometrium can pose challenges to fertility and reproductive health, requiring a comprehensive approach to address the underlying factors and improve the chances of successful conception.
Preimplantation Genetic Testing - Dr Kaberi BanerjeeKaberi Banerjee
Preimplantation Genetic Testing for Aneuploidy (PGT-A), formerly known as preimplantation genetic screening (PGS), is a technique used during in vitro fertilization (IVF) to screen embryos for chromosomal abnormalities before implantation. Like any medical procedure, PGT-A has both advantages and disadvantages.
Pros of PGT-A:
Reduced Risk of Aneuploidy: PGT-A helps identify embryos with chromosomal abnormalities, such as aneuploidy, which can reduce the risk of implantation failure, miscarriage, and certain genetic disorders.
Improved IVF Success Rates: By selecting embryos with the correct number of chromosomes, PGT-A can enhance the chances of a successful implantation and a healthy pregnancy, leading to improved overall IVF success rates.
Reduced Miscarriage Rates: Identifying and transferring embryos with the correct chromosomal makeup may decrease the likelihood of spontaneous miscarriages, particularly in older women who are at a higher risk of producing embryos with chromosomal abnormalities.
Family Planning for Genetic Disorders: PGT-A allows couples at risk of transmitting specific genetic disorders to screen embryos for these conditions, enabling them to make informed decisions about which embryos to implant.
Cons of PGT-A:
No Guarantee of Pregnancy: PGT-A does not guarantee a successful pregnancy. Other factors, such as uterine receptivity, can still impact the success of embryo implantation.
False Positives and Negatives: PGT-A is not foolproof, and false positives and negatives can occur. In some cases, embryos identified as abnormal may be viable, leading to the potential discarding of healthy embryos, or vice versa.
Invasive Nature: The procedure involves removing a small number of cells from the developing embryo, which some argue could potentially harm the embryo, although the impact is generally considered minimal.
Financial Cost: PGT-A adds an additional cost to the already expensive IVF process. The financial burden may be a significant consideration for some couples, especially if insurance does not cover the expense.
Limited Scope: PGT-A primarily screens for numerical chromosomal abnormalities and may not detect all genetic disorders or structural chromosomal abnormalities. Additional testing, such as preimplantation genetic testing for monogenic disorders (PGT-M) or preimplantation genetic testing for chromosomal structural rearrangements (PGT-SR), may be necessary for a more comprehensive assessment.
In summary, while PGT-A offers potential benefits in terms of reducing the risk of aneuploidy and improving IVF success rates, it is essential for couples to weigh these advantages against the potential drawbacks and consider their individual circumstances, including the financial and emotional aspects of the procedure.
Endometrial Receptivity Array- Dr Kaberi BanerjeeKaberi Banerjee
The endometrial receptivity array (ERA) is a diagnostic tool used in assisted reproductive technology (ART) to assess the receptivity of the endometrium, or the lining of the uterus, during the implantation window. While ERA has shown promise in improving the chances of successful embryo implantation, it also comes with its own set of advantages and disadvantages.
Pros of Endometrial Receptivity Array (ERA):
Personalized Timing: ERA helps determine the optimal window of endometrial receptivity for a specific woman. This personalized approach aims to synchronize the embryo transfer with the most favorable conditions for implantation, potentially improving the chances of successful pregnancy.
Reduced Pregnancy Loss: By accurately identifying the receptive window, ERA may contribute to reducing the risk of implantation failure and early pregnancy loss, especially in cases where previous IVF cycles were unsuccessful.
Improved Treatment Precision: ERA provides a more precise understanding of the individual's endometrial cycle, allowing fertility specialists to tailor the timing of embryo transfer to maximize the likelihood of success. This personalized approach may be particularly beneficial for women with irregular menstrual cycles.
Enhanced Cost-Efficiency: While the initial cost of an ERA test is an additional expense in the IVF process, the potential for increased success rates and reduced need for repeated embryo transfers may lead to cost savings in the long run.
Cons of Endometrial Receptivity Array (ERA):
Limited Evidence: Some critics argue that there is limited conclusive evidence supporting the routine use of ERA in all IVF cycles. The effectiveness of ERA is still a topic of ongoing research, and its widespread adoption may require more comprehensive validation.
Additional Cost: The ERA test adds an extra cost to the already expensive IVF process. Some couples may find it financially burdensome, especially if insurance coverage does not include this diagnostic procedure.
Invasive Nature: The endometrial biopsy required for the ERA test is an invasive procedure that may cause discomfort and pose a slight risk of infection or bleeding. However, the risks are generally minimal.
Time Consumption: The time required for the ERA test may extend the overall duration of the IVF process, which can be a concern for couples seeking a more expedited fertility treatment.
In conclusion, while the endometrial receptivity array offers potential benefits in improving IVF success rates through personalized timing, its adoption should be carefully considered based on individual circumstances, including financial considerations and the need for further research on its long-term efficacy.
Single embryo transfer (SET) is a reproductive technique employed during in vitro fertilization (IVF) that involves transferring only one embryo into the uterus. This approach has both advantages and disadvantages, influencing the decision-making process for couples and fertility specialists.
Pros of Single Embryo Transfer (SET):
Reduced Multiple Births: One of the primary benefits of SET is the significant reduction in the occurrence of multiple pregnancies, such as twins or triplets. Multiple pregnancies are associated with higher risks for both the mother and the babies, including preterm birth and low birth weight.
Enhanced Pregnancy Success Rates: Focusing on transferring a single embryo allows for better control and optimization of the conditions for implantation. This can result in higher success rates per transfer, increasing the likelihood of a healthy pregnancy.
Lower Risk of Complications: Single embryo transfers minimize the risk of complications associated with multiple pregnancies, such as gestational diabetes, preeclampsia, and cesarean section. This can lead to better maternal and neonatal outcomes.
Cost Savings: Although the initial cost of IVF is not necessarily reduced with SET, the long-term costs associated with caring for multiple preterm infants and potential complications are significantly lower.
Cons of Single Embryo Transfer (SET):
Lower Pregnancy Rates per Cycle: While SET can result in higher success rates per transfer, the overall pregnancy rates per IVF cycle may be lower compared to transferring multiple embryos. This can be a concern for couples with limited resources or time.
Potential Need for Multiple IVF Cycles: Achieving pregnancy with SET may require multiple IVF cycles, extending the time and financial investment for couples trying to conceive.
Emotional Stress: The uncertainty of success with each cycle can contribute to emotional stress for couples undergoing fertility treatments, particularly if they experience multiple unsuccessful attempts.
Age-Related Factors: For older women with diminished ovarian reserve, transferring a single embryo may further reduce the chances of success. In such cases, the decision to transfer multiple embryos may be considered based on individual circumstances.
In conclusion, the choice between single and multiple embryo transfer in IVF involves weighing the potential benefits of a healthy, singleton pregnancy against the desire for higher success rates and faster conception, considering the unique circumstances of each couple.
Chronic endometritis and its effect on FertilityKaberi Banerjee
Chronic endometritis, inflammation of the endometrial lining, may hinder fertility by disrupting the implantation process. Early diagnosis and treatment are crucial for optimizing reproductive outcomes and addressing infertility challenges.
"Transforming Reproductive Medicine with AI"
Brief overview of the impact of AI on various fields, leading into its applications in reproductive medicine.
A failed IVF cycle can be because of poor egg quality, sperm quality or uterine lining. It is assumed that all the stimulation egg pick up, laboratory procedures and embryo transfers have been done meticulously in previous attempts. We offer certain modifications in an IVF cycles for optimizing outcome in couples suffering from failed IVF attempts-
Optimized stimulation protocol: The short antagonist protocol offers the best results in terms of selection of the best oocytes (eggs) in most cases.
Selection of Sperm: In many cases, Intra Cytoplasmic Sperm Injection (ICSI) is offered as it has been suggested that it may improve fertilization rates and hence, overall pregnancy outcome. Our embryologist takes special care to select the best sperms for doing ICSI.
Hysteroscopy: The hysteroscope aids us in picking up uterine abnormalities which are sometimes missed at routine ultrasound e.g., small polyps. It is also useful in washing and cleaning the uterus which sometimes may help in improving the outcomes. Endometrial scratching is also done at the same setting to improve the uterine receptivity.
Intravenous Immunoglobulin (IYIg): IVIg seems to directly affect NK cell level and activity, by reducing their absolute numbers and increasing the expression of inhibitory receptors CD94 which potentially can improve pregnancy outcome.
Vitamins and Antioxidants: DHEA, L Arginine, Zinc, selenium etc. are given to women and men as indicated to improve the egg and sperm quality.
Atosiban: This is a uterine relaxant which is given during the embryo transfer. It helps in relaxing the uterus and therefore, improving the endometrial receptivity.
Laser Hatching: Laser hatching of the embryos is performed on the day of embryo transfer to ensure that the shell of the embryo hatches easily. This allows the embryo to implant better. This is mainly suitable for embryos with thick shell, advanced age group and frozen embryos.
ERA: ERA presumably detects the phase of the endometrium in which the embryo best implant. However, there is controversy regarding the actual benefit of this in improving the live birth rate.
PGS: PGS is a way of detecting abnormal embryos thus may help in improving the pregnancy rates. However, each case must be individualized.
Day of Transfer: Not all women will be benefitted by Blastocyst (Day 5 ) transfer as many seem to believe by studying the internet. The day of transfer should be individualized for each patient.
Meticulous Transfer Technique: Embryo transfer is the final and one of the most crucial step of IVF. All embryo transfers at AFGC are performed by Dr Kaberi Banerjee who has taken special training in embryo transfer from UK.
Preimplantation Genetic Diagnosis (PGD)/Screening (PGS) With IVFKaberi Banerjee
Pre-implantation genetic Screening (PGS) or Pre-implantation genetic diagnosis (PGD) plays an important role in increasing the chances of pregnancy for infertile couples.
Preimplantation genetic diagnosis (PGD) is a procedure used to diagnose embryos for known genetic disorders that both the patients and partners.
Read more: https://www.advancefertility.in/preimplantation-genetic-diagnosis-pgd-pgs-with-ivf/
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
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2 Case Reports of Gastric Ultrasound
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
3. < 4 E M B RYO S
C L E AVAG E B E T T E R
C L E AVAG E B E T T E R
I N YO U N G E R
B L A S TO C Y S T N OT
S I G N I F I CA N T LY
B E T T E R
ASSISTED REPRODUCTION TECHNOLOGIES
Ongoing and cumulative pregnancy rate after cleavage-stage
versus blastocyst-stage embryo transfer using vitrification
for cryopreservation: Impact of age on the results
S. Fernández-Shaw & R. Cercas & C. Braña & C. Villas & I. Pons
Received: 8 August 2014 /Accepted: 4 November 2014 /Published online: 18 November 2014
# Springer Science+Business Media New York 2014
Abstract
Purpose To determine if blastocyst transfer increases the on-
going and cumulative pregnancy rates, compared with day 3
embryo transfer, in women of all ages when at least 4 zygotes
are obtained.
Methods Prospective study including patients undergoing a
first IVF/ICSI treatment and assigned to cleavage stage (n=
46) or blastocyst (n=58) embryo transfer. Supernumerary em-
bryos were vitrified and patients failing to achieve an ongoing
pregnancy after fresh embryo transfer would go through cryo-
preserved cycles. The main outcome measure was the ongoing
pregnancy rate after the fresh IVF/ICSI transfer and the cumu-
lative ongoing pregnancy rate. Results were also analyzed
according to age (under 35 and 35 or older).
Results A majority of patients (96.6 %) had a blastocyst
transfer when at least 4 zygotes were obtained. The ongoing
pregnancy rate was significantly higher in the day-5 group
compared with the day-3 group (43.1 % vs. 24 %, p=0.041).
The cumulative ongoing pregnancy rate was higher (but not
significantly) with blastocyst than with cleavage stage embry-
os (56.8 % vs. 43.4 %, p=0.174). When analysed by age,
Keywords Blastocyst .Ongoingpregnancyrate .Cumulative
pregnancy rate . Age . Vitrification
Introduction
The rationale for blastocyst culture is to improve both uterine
and embryonic synchronicity and enable self selection of
viable embryos thus resulting in higher implantation rate [1].
The meta-analysis by Papanikolaou et al., in 2008 [2],
analysing eight randomized controlled trials (RCTs) conclud-
ed that the clinical pregnancy rate and live birth rate after fresh
IVF were significantly higher after blastocyst-stage embryo
transfer as compared to cleavage-stage embryo transfer when
equal number of embryos were transferred in the two groups
compared. Subsequently 12 RCTs summarized in the
Cochrane review [1] demonstrated that live birth rates can
be optimized by performing fresh blastocyst transfer com-
pared to cleavage stage embryo transfers, but no differences
were observed in the analysis of 23 RCTs in either clinical
J Assist Reprod Genet (2015) 32:177–184
DOI 10.1007/s10815-014-0387-9
pregnancy rate after the fresh IVF/ICSI transfer and the cumu-
lative ongoing pregnancy rate. Results were also analyzed
according to age (under 35 and 35 or older).
Results A majority of patients (96.6 %) had a blastocyst
transfer when at least 4 zygotes were obtained. The ongoing
pregnancy rate was significantly higher in the day-5 group
compared with the day-3 group (43.1 % vs. 24 %, p=0.041).
The cumulative ongoing pregnancy rate was higher (but not
significantly) with blastocyst than with cleavage stage embry-
os (56.8 % vs. 43.4 %, p=0.174). When analysed by age,
patients 35 or older showed significantly higher ongoing
pregnancy rate (48.4 % vs. 19.3 %, p=0.016) and cumulative
ongoing pregnancy rate (58 % vs. 25.8 %, p=0.01) in the day-
5 group compared to the day-3 group, while no such differ-
ences were observed in women under 35.
Conclusions Blastocyst transfer can be suggested whenever
there are at least 4 zygotes. While there are no differences in
women under 35, the benefit of this option over cleavage stage
transfer could be significant in women 35 or older.
ana
ed
IVF
tran
equ
com
Co
be
par
we
pre
tria
gro
The
cre
sig
rate
per
pre
stu
cle
age
Capsule The transfer of blastocysts significantly improve the clinical and
ongoing pregnancy rate as well as thecumulative pregnancy rate in
women 35 years or older.
5. ASSISTED REPRODUCTION TECHNOLOGIES
No advantage of fresh blastocyst versus cleavage stage embryo transfer
in women under the age of 39: a randomized controlled study
Paolo Emanuele Levi-Setti1,2
& Federico Cirillo1
& Antonella Smeraldi1
&
Emanuela Morenghi3
& Giulia E. G. Mulazzani4
& Elena Albani1
Received: 17 August 2017 /Accepted: 14 November 2017 /Published online: 22 November 2017
# Springer Science+Business Media, LLC, part of Springer Nature 2017
Abstract
Purpose Is there a difference in implantation and pregnancy rates between embryos transferred electively at cleavage or blasto-
cyst stage in infertile women ≤ 38 years with at least four zygotes on day 1 post retrieval?
Methods A randomized clinical trial was conducted in a single tertiary care hospital with a sample size of 194 patients in each
arm for a total population of 388 women. Patients less than 39 years of age with more than three fertilized oocytes and less than
four previous assisted reproductive technology (ART) attempts were inclusion criteria.
Results The two groups were similar for age, years of infertility, indication to treatment, basal antimüllerian hormone and FSH,
number of previous ART cycles, primary or secondary infertility, type of induction protocol, days of stimulation, total gonad-
otrophin dose, and estradiol (E2) and progesterone (P) levels at trigger. No statistically significant differences were found in terms
of number of retrieved oocytes, inseminated oocytes, fertilization rate, canceled transfers (7.73% in blastocyst and 3.61% in
cleavage stage group), and cycles with frozen embryos and/or oocytes. Although a higher number of fertilized oocytes were in the
blastocyst stage group (6.18 ± 1.46 vs 5.89 ± 1.54, p = 0.052), a statistically greater number of embryos/randomized cycle were
Journal of Assisted Reproduction and Genetics (2018) 35:457–465
https://doi.org/10.1007/s10815-017-1092-2
6. • Low quality evidence that Blastocyst
transfer may be associated with
higher live birth rates than Cleavage
stage.
• No evidence of a difference between
the groups in Cumulative Pregnancy
rates
• Further RCTs are needed
Cochrane
Library
Cochrane Database of Systematic Reviews
Cleavage stage versus blastocyst stage embryo transfer in assisted
reproductive technology (Review)
Glujovsky D, Farquhar C, Quinteiro Retamar AM, Alvarez Sedo CR, Blake D
7. • Burden of additional transfer of
Cleavage Stage Embryos
• Cost of more embryos to freeze in
Cleavage Stage
• Burden of additional oocyte pick up if
no embryo formed or to freeze in
Blastocyst Transfer
• Cost of extended culture and
vitrification of Blastocyst
Cleavage-stage or blastocyst
transfer: what are the benefits
and harms?
Demi!
an Glujovsky, M.D., M.Sc.a
and Cynthia Farquhar, M.D., M.P.H.b
a
Department of Reproductive Medicine, Center of Studies of Genetics and Reproduction (CEGYR), Buenos Aire
and b
Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, The University
Auckland, New Zealand
ET is a critical step in an assisted reproduction cycle. Over the past decade there has been an increasing trend
cleavage-stage to blastocyst transfer. There has also been a trend to single ET and reporting the success of an
as a cumulative live-birth rate after using both fresh and frozen embryos. There is low evidence that fresh b
ciated with improved live-birth rates compared with fresh cleavage-stage embryos. However, in the few stud
pregnancy rates after fresh and frozen transfers, no significant difference was found. Cleavage-stage transfe
numbers of embryos available for freezing, and blastocyst transfer is associated with increased number of
transfer. Further well-designed studies are warranted to evaluate the outcomes for blastocyst transfer inclu
rate after fresh and frozen transfers, time to live birth, costs of the different transfer strategies, and perinatal
natal morbidity. (Fertil Steril! 2016;106:244–50. "2016 by American Society for Reproductive Medicine.)
Key Words: Embryo transfer, cleavage, blastocyst
Discuss: You can discuss this article with its authors and with other ASRM members at https://www.f
10584-cleavage-stage-or-blastocyst-transfer-what-are-the-benefits-and-harms
A
s many as one in six couples
will experience difficulty
conceiving and may seek assis-
ted reproduction to achieve a preg-
nancy. One of the most important
steps during an assisted reproduction
cycle is the transfer of the embryo
from the laboratory to the uterus. Tradi-
tionally, cleavage-stage embryos were
transferred on day 3, but over the past
decade there has been a move to trans-
ferring blastocysts on day 5 or 6. Trans-
fer at this stage is considered to be a
In Australia they have risen from less
than 30% of cycles in the 2004–7 to
over 60% of assisted reproductive tech-
nology (ART) cycles in 2013 (1, 2).
Similar increases have been reported in
the United States and the United
Kingdom, with approximately more
than one third of ART cycles in 2012
being blastocyst transfers (3, 4).
At the same time that blastocyst
transfer was increasingly used, there
were a number of other developments
occurring in the fertility laboratory.
move to p
screening of e
blastocyst dev
these new dev
of these shou
focus of this
whether blast
effective than
Direct co
two stages o
appear to supp
transfers in c
who undergo
Fertil Steril 2016
8. Extended embryo culture to the
blastocyst stage has the potential to
compromise obstetric and perinatal
outcomes as increased rate of
placenta praevia and preterm
delivery in fresh cycles.
Human Reproduction, Vol.35, No.4, pp. 805–815, 2020
Advance Access Publication on April 15, 2020 doi:10.1093/humrep/deaa032
ORIGINAL ARTICLE Fertility control
Obstetric and perinatal risks in 4601
singletons and 884 twins conceived
after fresh blastocyst transfers: a
Nordic study from the CoNARTaS
group
A.L. Spangmose1,*, E. Ginström Ernstad2
, S. Malchau2
, J. Forman3
,
A. Tiitinen4
, M. Gissler5
, S. Opdahl6
, L.B. Romundstad6,7
, C. Bergh2
,
U.B. Wennerholm2
, A.A. Henningsen1
, and A. Pinborg1
1
Fertility Clinic, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark 2
Department of Obstetrics and Gynecology,
Institute of Clinical Science, Sahlgrenska Academy, Gothenburg University, Sahlgrenska University Hospital, Gothenburg, Sweden 3
Section of
Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark 4
Department of Obstetrics and Gynecology,
Helsinki University Hospital and University of Helsinki, Helsinki, Finland 5
Information Services Department, Finnish Institute for Health and
Welfare (THL), Helsinki, Finland and Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
6
Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology,
Trondheim, Norway 7
Spiren Fertility Clinic, Trondheim, Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
*Correspondence address. Fertility Clinic, Department of Obstetrics and Gynaecology, Copenhagen University Hospital, Rigshospitalet,
Denmark. Tel: +45 30 59 38 15; E-mail: anne.laerke.spangmose.pedersen@regionh.dk
Submitted on October 21, 2019; resubmitted on December 13, 2019; editorial decision on February 9, 2020
STUDY QUESTION: Are obstetric and perinatal outcomes in pregnancies after fresh blastocyst transfer (BT) comparable with those born
after fresh cleavage stage transfer (CT) and spontaneous conception (SC)?
SUMMARY ANSWER Fresh BT is associated with a higher risk of placental and perinatal complications.
Downloaded
from
https://academic.oup.com/humrep/article/35/4/805/5820
9. • Good for good prognosis
• Not always for recurrant
implantation failure and those
with fewer embryos
• Pregnancy rate/started cycle may
be low
• CancelledTransfers Increase
• Can we predict blastulation rate?
• Excellent Laboratory and Skill set
• Excellent Cryopreservation Unit
• May have fewer/no embryos to
transfer
Blastocyst culture and transfer in
clinically assisted reproduction:
a committee opinion
Practice Committee of the American Society for Reproductive Medicine and Practice Committee of the
Society for Assisted Reproductive Technology
American Society for Reproductive Medicine, Birmingham, Alabama
The purposes of this Practice Committee Opinion, which replaces the 2013 ASRM Practice Committee Opinion of the same name (Fertil
Steril 2013; 99:667–72), are to review the literature regarding the clinical application of blastocyst transfer and identify the potential risks
and laboratory issues related to the use of this technology. This document does not apply to patients undergoing blastocyst culture and
transfer for preimplantation genetic testing. (Fertil Steril! 2018;110:1246–52. "2018 by American Society for Reproductive Medicine.)
Earn online CME credit related to this document at www.asrm.org/elearn
Discuss: You can discuss this article with its authors and other readers at https://www.fertstertdialog.com/users/16110-fertility-
and-sterility/posts/38842-26977
INTRODUCTION
Extending the duration of embryo cul-
ture to the blastocyst stage for assisted
reproduction offers several theoretical
advantages over the transfer of
ports blastocyst development equiva-
lently to that of sequential media
(14–16).
Commercially available media pro-
vide the means for any in vitro fertiliza-
these reasons, blastocyst transfer
should translate into higher implanta-
tion and, more importantly, live-birth
rates.
The results of a randomized trial in
Fertil Steril,2018
10. STUDY PROTOCOL Open Access
Non-inferiority of cleavage-stage versus
blastocyst-stage embryo transfer in poor
prognosis IVF patients (PRECiSE trial): study
protocol for a randomized controlled trial
Werner M. Neuhausser1,2,3,4,5*
, Denis A. Vaughan1,2,3
, Denny Sakkas3
, Michele R. Hacker1,2
, Tom Toth1,2,3
and
Alan Penzias1,2,3
Abstract
Background: With improvements in in vitro culture techniques there has been a steady shift in practice to transfer
embryos at the blastocyst stage (post fertilization day (p.f.d.) 5–7), when embryos reach the endometrial cavity
during natural conception. For patients with > 5 zygotes on day 1 of embryo development, fresh blastocyst embryo
transfer (ET) increases live birth rates when compared to cleavage stage (p.f.d. 3) transfer. In poorer prognosis
patients (≤ 5 zygotes) cleavage stage ET is commonly performed to reduce the risk of cycle cancellation if no
embryo survives to the blastocyst stage. However, there is a dearth of randomized controlled trial (RCT) data
demonstrating improved live birth rates per cycle for cleavage vs blastocyst stage ET in this subgroup of patients.
The hypothesis of the PRECiSE (PooR Embryo Yield Cleavage Stage Versus blaStocyst Embryo Transfer) trial is that
blastocyst ET is not inferior to cleavage stage ET with regard to live birth rates per retrieval in poorer prognosis
Neuhausser et al. Reproductive Health (2020) 17:16
https://doi.org/10.1186/s12978-020-0870-y