The document discusses preimplantation genetic testing for aneuploidy (PGT-A), which screens embryos for chromosomal abnormalities during in vitro fertilization (IVF) treatment. It notes that while PGT-A is purported to improve live birth rates and reduce miscarriage risks, two recent large randomized controlled trials found no significant benefits. A study analyzed in the document found PGT-A to be not cost-effective due to the high costs associated with preventing one miscarriage. Overall, the document concludes that the current evidence is insufficient to support the routine use of PGT-A in clinical practice.
Dr Sujoy Dasgupta moderated a panel in “Milan”, the conference of all of the Obstetric and Gynaecological Societies of West Bengal, held in Kolkata in February, 2022
Recent advances in pre-implantation genetic testing allow for more comprehensive chromosome screening. Microarray techniques like array comparative genomic hybridization and single nucleotide polymorphism microarrays can assess all chromosome pairs. Next generation sequencing provides single nucleotide level detection of aneuploidies and mutations. Non-invasive techniques collect cell-free DNA from culture media to determine genetic information. Time lapse imaging selects embryos based on developmental patterns correlated with implantation success. New methods like karyomapping use parental genotyping to identify embryos carrying normal chromosomes without customized test development. These techniques improve pre-implantation genetic testing capabilities.
PGD combines advances in Molecular genetics and in assisted reproductive technology and is conducted before the embryo is placed inside the womb of the woman.Pre implantation genetic diagnosis was introduced to prevent the inheritance of sex linked diseases
This document summarizes research comparing outcomes of fresh embryo transfers versus frozen embryo transfers (FET). It finds that FET results in better pregnancy and implantation rates than fresh transfers, likely due to ovarian stimulation negatively impacting endometrial receptivity in fresh cycles. Specifically, FET cycles have higher success rates for slower developing embryos and embryos transferred in cycles with premature progesterone elevation. FET outcomes in young patients can rival fresh donor egg cycles. Randomized trials show significantly higher pregnancy rates with FET compared to fresh transfer in normal responders.
EMBRYO QUALITY ASSESSMENT, WHICH TO SELECT? Rahul Sen
This document discusses various methods for assessing embryo quality and selecting the best embryo for transfer, including traditional morphology assessment, kinetic/time-lapse imaging assessment, pre-implantation genetic testing, and 'omics' techniques. It emphasizes that traditional morphology alone provides limited information and that incorporating multiple parameters like developmental timing, fragmentation levels, and ploidy status can improve embryo selection and lead to higher implantation and pregnancy rates.
The document discusses the Endometrial Receptivity Array (ERA) test, which analyzes the endometrial gene expression to determine the window of implantation (WOI). It provides the indications for ERA as recurrent implantation failure with good quality embryos. The timing of the endometrial biopsy is discussed for natural, modified natural, and hormone replacement therapy cycles. A receptive result means proceeding with embryo transfer in the same cycle/day as biopsy, while a non-receptive result may recommend validating a new personalized WOI with a second biopsy.
1) Embryo transfer is the final step in IVF where embryos are placed in the uterus. Careful technique is important for success.
2) Factors that can affect the success of embryo transfer include embryo selection, the timing of the transfer, cervical infections, endometrial thickness and pattern, and experience of the provider.
3) During the procedure, gentle technique, ultrasound guidance, and depositing embryos slightly below the uterine fundus can help maximize the chances of implantation and pregnancy. Meticulous attention to factors before, during, and after embryo transfer is crucial.
Dr Sujoy Dasgupta moderated a panel in “Milan”, the conference of all of the Obstetric and Gynaecological Societies of West Bengal, held in Kolkata in February, 2022
Recent advances in pre-implantation genetic testing allow for more comprehensive chromosome screening. Microarray techniques like array comparative genomic hybridization and single nucleotide polymorphism microarrays can assess all chromosome pairs. Next generation sequencing provides single nucleotide level detection of aneuploidies and mutations. Non-invasive techniques collect cell-free DNA from culture media to determine genetic information. Time lapse imaging selects embryos based on developmental patterns correlated with implantation success. New methods like karyomapping use parental genotyping to identify embryos carrying normal chromosomes without customized test development. These techniques improve pre-implantation genetic testing capabilities.
PGD combines advances in Molecular genetics and in assisted reproductive technology and is conducted before the embryo is placed inside the womb of the woman.Pre implantation genetic diagnosis was introduced to prevent the inheritance of sex linked diseases
This document summarizes research comparing outcomes of fresh embryo transfers versus frozen embryo transfers (FET). It finds that FET results in better pregnancy and implantation rates than fresh transfers, likely due to ovarian stimulation negatively impacting endometrial receptivity in fresh cycles. Specifically, FET cycles have higher success rates for slower developing embryos and embryos transferred in cycles with premature progesterone elevation. FET outcomes in young patients can rival fresh donor egg cycles. Randomized trials show significantly higher pregnancy rates with FET compared to fresh transfer in normal responders.
EMBRYO QUALITY ASSESSMENT, WHICH TO SELECT? Rahul Sen
This document discusses various methods for assessing embryo quality and selecting the best embryo for transfer, including traditional morphology assessment, kinetic/time-lapse imaging assessment, pre-implantation genetic testing, and 'omics' techniques. It emphasizes that traditional morphology alone provides limited information and that incorporating multiple parameters like developmental timing, fragmentation levels, and ploidy status can improve embryo selection and lead to higher implantation and pregnancy rates.
The document discusses the Endometrial Receptivity Array (ERA) test, which analyzes the endometrial gene expression to determine the window of implantation (WOI). It provides the indications for ERA as recurrent implantation failure with good quality embryos. The timing of the endometrial biopsy is discussed for natural, modified natural, and hormone replacement therapy cycles. A receptive result means proceeding with embryo transfer in the same cycle/day as biopsy, while a non-receptive result may recommend validating a new personalized WOI with a second biopsy.
1) Embryo transfer is the final step in IVF where embryos are placed in the uterus. Careful technique is important for success.
2) Factors that can affect the success of embryo transfer include embryo selection, the timing of the transfer, cervical infections, endometrial thickness and pattern, and experience of the provider.
3) During the procedure, gentle technique, ultrasound guidance, and depositing embryos slightly below the uterine fundus can help maximize the chances of implantation and pregnancy. Meticulous attention to factors before, during, and after embryo transfer is crucial.
This document discusses endometriosis and its impact on fertility and IVF outcomes. It provides information on diagnosing and treating endometriosis, including:
- Laparoscopy is the gold standard for diagnosing endometriosis. Surgical excision of endometriomas and deep endometriosis can improve pain and fertility outcomes.
- For subfertility, treatment depends on factors like disease severity, pain levels, and reproductive plans. IVF is an option if conservative treatments fail.
- Studies show endometriosis may reduce ovarian response and increase IVF cancellation rates. However, it does not significantly impact live birth, pregnancy, or miscarriage rates compared to other infertility factors
This document provides an overview of preimplantation genetic diagnosis (PGD). PGD is an in vitro fertilization procedure that tests embryos for genetic conditions before implantation. It was first reported in 1990 and combines advances in genetics and assisted reproduction. The document discusses the indications for PGD, including chromosomal disorders and monogenic diseases. It also describes the technical processes involved, such as blastomere biopsy and genetic analysis using fluorescence in situ hybridization, array comparative genomic hybridization, and polymerase chain reaction. Both the benefits and risks of PGD are outlined.
Novel treatments to trigger final follicular maturation and luteal phase supportSandro Esteves
This document summarizes novel strategies for triggering final follicular maturation and supporting the luteal phase in fertility treatments. It discusses evaluating the quality of trigger and luteal phase support methods based on indicators of safety, effectiveness, and patient-centeredness. Specific strategies used at Androfert clinic are presented, including individualizing triggers and support according to patient risk factors. Recombinant hCG is shown to have advantages over urinary hCG in terms of effectiveness, safety, and patient preferences. GnRH agonist triggering avoids risk of ovarian hyperstimulation syndrome but needs additional luteal phase support.
The document discusses endometrial receptivity and factors that affect implantation success during IVF. It notes that the main causes of IVF failure are poor embryo quality and inadequate endometrial receptivity. The window of implantation is a critical period of 4-5 days when the endometrium is optimally receptive. Ovarian hyperstimulation and advanced maternal age can negatively impact endometrial development and closure of the implantation window. Various biomarkers and imaging techniques are used to assess receptivity, including integrins, pinopodes, and endometrial thickness and vascularity on ultrasound. Optimizing receptivity is important to improve IVF outcomes.
1) PGD and PGS are genetic testing techniques used prior to embryo transfer in IVF treatment. PGD screens for known genetic disorders while PGS screens for chromosome abnormalities.
2) While PGD has clear benefits when used appropriately, the effectiveness of routine PGS is questionable as it may reduce pregnancy rates. Techniques like day 3 biopsy have limitations due to mosaicism.
3) Extensive counseling is important given technical limitations and risks of erroneous results. Not all genetic issues can be detected and treatment has biological limits. Caution is needed against unnecessary "indication creep".
This document discusses various ovulation induction protocols including:
- Clomiphene citrate is commonly used as a first line treatment but some women are clomiphene resistant.
- Gonadotropins like hMG can cause multifollicular development and increase risks of complications like OHSS.
- A novel protocol uses a combination of hMG for several days followed by clomiphene to promote monofollicular development while reducing risks of complications. Initial studies found this protocol increased follicle recruitment over hMG alone without increasing LH levels or risks.
Empty follicle syndrome is a complication where mature follicles fail to yield oocytes during egg retrieval despite optimal stimulation and triggering. It can be genuine, with no clear cause, or false due to issues with the hCG trigger shot. Risk factors include advanced age, infertility duration, and low ovarian reserve. Treatment of false EFS involves re-administering hCG and repeating retrieval after 36 hours. Prognosis is generally good except for recurrent cases. Ongoing research aims to better understand the mechanisms and identify prevention strategies.
1) The document reviews the use of GnRH agonists versus HCG for triggering final oocyte maturation in IVF/ICSI cycles using a GnRH antagonist protocol.
2) In fresh autologous cycles, GnRH agonist triggering was found to have lower live birth, ongoing pregnancy rates and higher miscarriage rates compared to HCG, but lower OHSS incidence.
3) In donor-recipient cycles, there was no difference in ongoing pregnancy or miscarriage rates between GnRH agonist and HCG triggering, but GnRH agonists reduced OHSS incidence. Modified luteal phase support strategies have shown mixed results in improving outcomes after GnRH agonist triggering.
In vitro fertilization and embryo transfer "IVF"; Overview on the Story FRO...Ahmed Mowafy
The document discusses the history and development of in vitro fertilization (IVF). It mentions:
- Aldous Huxley predicted IVF techniques in his 1931 novel "Brave New World".
- The first reported pregnancies from IVF occurred in the late 1950s and early 1960s involving animals.
- The first reported human pregnancy from IVF was in 1973, though it resulted in miscarriage.
- The first successful human birth from IVF, Louise Brown, occurred in 1978 in the UK from the work of Steptoe and Edwards.
This presentation discusses controlled ovarian hyperstimulation (COH) for patients with polycystic ovary syndrome (PCOS) undergoing in vitro fertilization (IVF). COH is challenging for PCOS patients due to an initial poor response followed by an exaggerated response, putting them at high risk for ovarian hyperstimulation syndrome (OHSS). The presentation recommends individualizing COH protocols based on a patient's risk factors to optimize egg retrieval while avoiding OHSS complications. GnRH antagonist protocols are preferred over agonists as they allow for GnRH agonist triggering to prevent OHSS in high responders. Careful monitoring and strategies like coasting or cryopreservation can further reduce OHSS risks for PCOS patients undergoing CO
Number of oocytes and progesterone levels in IVF: Do they matter?Sandro Esteves
- The document summarizes research on factors that influence IVF success rates, including the number of oocytes retrieved and progesterone levels.
- It finds that retrieving around 15 oocytes optimizes live birth rates, and that recombinant FSH preparations yield more oocytes than other gonadotropins.
- While progesterone levels on the day of hCG administration correlate with the number of oocytes, there is no clear evidence that certain progesterone levels negatively impact pregnancy rates, especially with adequate embryos for freezing and future transfers.
- Considering cumulative live birth rates from multiple transfer cycles is important to properly assess IVF success rates and outcomes. Optimizing oocyte yield, embryo culture, vitrification techniques, and performing
Panel IUI by DR SHASHWAT JANI ( Optimizing Success in Intrauterine Inseminati...DR SHASHWAT JANI
This document discusses optimizing success with intrauterine insemination (IUI). It lists male and female factors that can indicate IUI, including issues like retrograde ejaculation or cervical hostility. Standard protocols for IUI are discussed, including using clomiphene, gonadotropins, or a combination. The timing of hCG administration and IUI is outlined. Techniques for sperm preparation and factors affecting IUI success rates are also summarized. Limitations of IUI are noted.
1. The document presents guidelines for embryo transfer (ET) based on a systematic review of the literature.
2. It provides recommendations for ET supported by evidence from randomized controlled trials (Grade A) including using transabdominal ultrasound guidance, soft catheters, and placing the embryo in the upper uterus.
3. Techniques not recommended due to insufficient evidence include analgesics, massage, and acupuncture. The guidelines aim to standardize the ET process based on available evidence.
The document outlines the key considerations for setting up an ART lab, including location, equipment, consumables, procedures, and quality control. The lab must be in a safe, pathogen-free environment with stable temperature and air quality. Critical equipment includes incubators, laminar flow hoods, micromanipulators, medical refrigerators, and liquid nitrogen tanks. Consumables must be established brands and not expired. Procedures must be documented and strictly followed. Quality control such as temperature monitoring is crucial.
Sperm DNA Fragmentation in Male InfertilitySandro Esteves
This document summarizes a presentation on sperm DNA fragmentation (SDF) and male infertility. It discusses how SDF provides different information than routine semen analysis and is a better prognostic indicator. Elevated SDF is associated with infertility, poor assisted reproductive technology outcomes, and miscarriage. Several methods can assess SDF but differ in their ability to directly or indirectly measure damage. Lifestyle changes like reducing stress and smoking, treating underlying conditions, and using oral antioxidants can help lower SDF. Varicocele repair is also effective at reducing SDF levels in men with the condition.
This document discusses intracytoplasmic morphologically selected sperm injection (IMSI), a technique that uses higher magnification than conventional ICSI to select sperm for fertilization. It provides background on sperm morphology and vacuoles, and their relationship to fertility outcomes. Studies comparing IMSI to ICSI are summarized, finding improved outcomes with IMSI, especially in cases of poor semen quality or previous ICSI failure. Guidelines for when IMSI may be beneficial over conventional ICSI are presented.
Dr. Sujoy Dasgupta presented information on blastocyst versus cleavage stage embryo transfer. Key points include:
- Blastocyst transfer results in higher implantation and clinical pregnancy rates per embryo transferred compared to cleavage stage. However, it also results in more cycle cancellations and fewer embryos available for freezing.
- Blastocyst biopsy is preferable for PGT due to analysis of more cells and lower mosaicism compared to cleavage stage biopsy.
- While blastocyst transfer improves outcomes in good prognosis patients, it may also be associated with risks like preterm birth, monozygotic twinning, and perinatal outcomes that require more research. Selection of embryos likely to reach blastocyst stage could help reduce
Fertility preservation options are important for cancer patients of reproductive age undergoing treatment. For women, established options include embryo freezing for married patients and oocyte freezing for single patients, both of which require delaying cancer treatment. Ovarian tissue freezing can be done at any age or relationship status and does not delay treatment, but reimplantation success is currently low. For pre-pubertal patients, ovarian tissue or testicular tissue freezing are the only available options. Future methods may allow in vitro gamete maturation or stem cell derived gametes. Multidisciplinary care and individualized counseling are key to help patients preserve their fertility whenever possible before cancer treatment.
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
Ovarian Stimulation in IUI- Overview Sr. Jyoti BhaskarLifecare Centre
The document discusses ovarian stimulation protocols for intrauterine insemination (IUI) in subfertile women. It provides information on the rationale for controlled ovarian hyperstimulation (COH) in IUI, including increasing the number of eggs and overcoming subtle defects. The aim of COH is to recruit multiple follicles, control ovulation timing, prevent premature LH surges, time insemination, and increase pregnancy rates. Optimal stimulation results in 2-3 follicles ≥18-19mm in size and a thick, trilaminar endometrium. Gonadotropins are more effective than anti-estrogens like clomiphene citrate for IUI, and low
This study evaluated the use of blastocyst biopsy and array comparative genomic hybridization (aCGH) for preimplantation genetic diagnosis in 12 patients with chromosomal translocations. The diagnostic efficiency was 90.2% and euploidy rate was 32.7%. Ten cycles of thawed embryo transfer resulted in three live births and three ongoing pregnancies, for an ongoing pregnancy rate of 60% per transfer cycle. Prenatal diagnoses confirmed the PGD/aCGH results. The strategy demonstrates promising outcomes and may provide a more effective approach than traditional methods like fluorescence in situ hybridization. Larger studies are still needed to verify the results.
This document discusses preimplantation genetic screening (PGS) with fresh embryo transfer. It provides information on various PGS techniques including array comparative genomic hybridization (aCGH) and next generation sequencing (NGS). Key points discussed include the benefits of blastocyst biopsy over earlier stages and of comprehensive chromosome analysis over earlier PGS methods. Data is presented on euploidy rates, implantation rates, and the elimination of the maternal age effect with current PGS techniques. Both fresh and frozen embryo transfer are considered.
This document discusses endometriosis and its impact on fertility and IVF outcomes. It provides information on diagnosing and treating endometriosis, including:
- Laparoscopy is the gold standard for diagnosing endometriosis. Surgical excision of endometriomas and deep endometriosis can improve pain and fertility outcomes.
- For subfertility, treatment depends on factors like disease severity, pain levels, and reproductive plans. IVF is an option if conservative treatments fail.
- Studies show endometriosis may reduce ovarian response and increase IVF cancellation rates. However, it does not significantly impact live birth, pregnancy, or miscarriage rates compared to other infertility factors
This document provides an overview of preimplantation genetic diagnosis (PGD). PGD is an in vitro fertilization procedure that tests embryos for genetic conditions before implantation. It was first reported in 1990 and combines advances in genetics and assisted reproduction. The document discusses the indications for PGD, including chromosomal disorders and monogenic diseases. It also describes the technical processes involved, such as blastomere biopsy and genetic analysis using fluorescence in situ hybridization, array comparative genomic hybridization, and polymerase chain reaction. Both the benefits and risks of PGD are outlined.
Novel treatments to trigger final follicular maturation and luteal phase supportSandro Esteves
This document summarizes novel strategies for triggering final follicular maturation and supporting the luteal phase in fertility treatments. It discusses evaluating the quality of trigger and luteal phase support methods based on indicators of safety, effectiveness, and patient-centeredness. Specific strategies used at Androfert clinic are presented, including individualizing triggers and support according to patient risk factors. Recombinant hCG is shown to have advantages over urinary hCG in terms of effectiveness, safety, and patient preferences. GnRH agonist triggering avoids risk of ovarian hyperstimulation syndrome but needs additional luteal phase support.
The document discusses endometrial receptivity and factors that affect implantation success during IVF. It notes that the main causes of IVF failure are poor embryo quality and inadequate endometrial receptivity. The window of implantation is a critical period of 4-5 days when the endometrium is optimally receptive. Ovarian hyperstimulation and advanced maternal age can negatively impact endometrial development and closure of the implantation window. Various biomarkers and imaging techniques are used to assess receptivity, including integrins, pinopodes, and endometrial thickness and vascularity on ultrasound. Optimizing receptivity is important to improve IVF outcomes.
1) PGD and PGS are genetic testing techniques used prior to embryo transfer in IVF treatment. PGD screens for known genetic disorders while PGS screens for chromosome abnormalities.
2) While PGD has clear benefits when used appropriately, the effectiveness of routine PGS is questionable as it may reduce pregnancy rates. Techniques like day 3 biopsy have limitations due to mosaicism.
3) Extensive counseling is important given technical limitations and risks of erroneous results. Not all genetic issues can be detected and treatment has biological limits. Caution is needed against unnecessary "indication creep".
This document discusses various ovulation induction protocols including:
- Clomiphene citrate is commonly used as a first line treatment but some women are clomiphene resistant.
- Gonadotropins like hMG can cause multifollicular development and increase risks of complications like OHSS.
- A novel protocol uses a combination of hMG for several days followed by clomiphene to promote monofollicular development while reducing risks of complications. Initial studies found this protocol increased follicle recruitment over hMG alone without increasing LH levels or risks.
Empty follicle syndrome is a complication where mature follicles fail to yield oocytes during egg retrieval despite optimal stimulation and triggering. It can be genuine, with no clear cause, or false due to issues with the hCG trigger shot. Risk factors include advanced age, infertility duration, and low ovarian reserve. Treatment of false EFS involves re-administering hCG and repeating retrieval after 36 hours. Prognosis is generally good except for recurrent cases. Ongoing research aims to better understand the mechanisms and identify prevention strategies.
1) The document reviews the use of GnRH agonists versus HCG for triggering final oocyte maturation in IVF/ICSI cycles using a GnRH antagonist protocol.
2) In fresh autologous cycles, GnRH agonist triggering was found to have lower live birth, ongoing pregnancy rates and higher miscarriage rates compared to HCG, but lower OHSS incidence.
3) In donor-recipient cycles, there was no difference in ongoing pregnancy or miscarriage rates between GnRH agonist and HCG triggering, but GnRH agonists reduced OHSS incidence. Modified luteal phase support strategies have shown mixed results in improving outcomes after GnRH agonist triggering.
In vitro fertilization and embryo transfer "IVF"; Overview on the Story FRO...Ahmed Mowafy
The document discusses the history and development of in vitro fertilization (IVF). It mentions:
- Aldous Huxley predicted IVF techniques in his 1931 novel "Brave New World".
- The first reported pregnancies from IVF occurred in the late 1950s and early 1960s involving animals.
- The first reported human pregnancy from IVF was in 1973, though it resulted in miscarriage.
- The first successful human birth from IVF, Louise Brown, occurred in 1978 in the UK from the work of Steptoe and Edwards.
This presentation discusses controlled ovarian hyperstimulation (COH) for patients with polycystic ovary syndrome (PCOS) undergoing in vitro fertilization (IVF). COH is challenging for PCOS patients due to an initial poor response followed by an exaggerated response, putting them at high risk for ovarian hyperstimulation syndrome (OHSS). The presentation recommends individualizing COH protocols based on a patient's risk factors to optimize egg retrieval while avoiding OHSS complications. GnRH antagonist protocols are preferred over agonists as they allow for GnRH agonist triggering to prevent OHSS in high responders. Careful monitoring and strategies like coasting or cryopreservation can further reduce OHSS risks for PCOS patients undergoing CO
Number of oocytes and progesterone levels in IVF: Do they matter?Sandro Esteves
- The document summarizes research on factors that influence IVF success rates, including the number of oocytes retrieved and progesterone levels.
- It finds that retrieving around 15 oocytes optimizes live birth rates, and that recombinant FSH preparations yield more oocytes than other gonadotropins.
- While progesterone levels on the day of hCG administration correlate with the number of oocytes, there is no clear evidence that certain progesterone levels negatively impact pregnancy rates, especially with adequate embryos for freezing and future transfers.
- Considering cumulative live birth rates from multiple transfer cycles is important to properly assess IVF success rates and outcomes. Optimizing oocyte yield, embryo culture, vitrification techniques, and performing
Panel IUI by DR SHASHWAT JANI ( Optimizing Success in Intrauterine Inseminati...DR SHASHWAT JANI
This document discusses optimizing success with intrauterine insemination (IUI). It lists male and female factors that can indicate IUI, including issues like retrograde ejaculation or cervical hostility. Standard protocols for IUI are discussed, including using clomiphene, gonadotropins, or a combination. The timing of hCG administration and IUI is outlined. Techniques for sperm preparation and factors affecting IUI success rates are also summarized. Limitations of IUI are noted.
1. The document presents guidelines for embryo transfer (ET) based on a systematic review of the literature.
2. It provides recommendations for ET supported by evidence from randomized controlled trials (Grade A) including using transabdominal ultrasound guidance, soft catheters, and placing the embryo in the upper uterus.
3. Techniques not recommended due to insufficient evidence include analgesics, massage, and acupuncture. The guidelines aim to standardize the ET process based on available evidence.
The document outlines the key considerations for setting up an ART lab, including location, equipment, consumables, procedures, and quality control. The lab must be in a safe, pathogen-free environment with stable temperature and air quality. Critical equipment includes incubators, laminar flow hoods, micromanipulators, medical refrigerators, and liquid nitrogen tanks. Consumables must be established brands and not expired. Procedures must be documented and strictly followed. Quality control such as temperature monitoring is crucial.
Sperm DNA Fragmentation in Male InfertilitySandro Esteves
This document summarizes a presentation on sperm DNA fragmentation (SDF) and male infertility. It discusses how SDF provides different information than routine semen analysis and is a better prognostic indicator. Elevated SDF is associated with infertility, poor assisted reproductive technology outcomes, and miscarriage. Several methods can assess SDF but differ in their ability to directly or indirectly measure damage. Lifestyle changes like reducing stress and smoking, treating underlying conditions, and using oral antioxidants can help lower SDF. Varicocele repair is also effective at reducing SDF levels in men with the condition.
This document discusses intracytoplasmic morphologically selected sperm injection (IMSI), a technique that uses higher magnification than conventional ICSI to select sperm for fertilization. It provides background on sperm morphology and vacuoles, and their relationship to fertility outcomes. Studies comparing IMSI to ICSI are summarized, finding improved outcomes with IMSI, especially in cases of poor semen quality or previous ICSI failure. Guidelines for when IMSI may be beneficial over conventional ICSI are presented.
Dr. Sujoy Dasgupta presented information on blastocyst versus cleavage stage embryo transfer. Key points include:
- Blastocyst transfer results in higher implantation and clinical pregnancy rates per embryo transferred compared to cleavage stage. However, it also results in more cycle cancellations and fewer embryos available for freezing.
- Blastocyst biopsy is preferable for PGT due to analysis of more cells and lower mosaicism compared to cleavage stage biopsy.
- While blastocyst transfer improves outcomes in good prognosis patients, it may also be associated with risks like preterm birth, monozygotic twinning, and perinatal outcomes that require more research. Selection of embryos likely to reach blastocyst stage could help reduce
Fertility preservation options are important for cancer patients of reproductive age undergoing treatment. For women, established options include embryo freezing for married patients and oocyte freezing for single patients, both of which require delaying cancer treatment. Ovarian tissue freezing can be done at any age or relationship status and does not delay treatment, but reimplantation success is currently low. For pre-pubertal patients, ovarian tissue or testicular tissue freezing are the only available options. Future methods may allow in vitro gamete maturation or stem cell derived gametes. Multidisciplinary care and individualized counseling are key to help patients preserve their fertility whenever possible before cancer treatment.
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
Ovarian Stimulation in IUI- Overview Sr. Jyoti BhaskarLifecare Centre
The document discusses ovarian stimulation protocols for intrauterine insemination (IUI) in subfertile women. It provides information on the rationale for controlled ovarian hyperstimulation (COH) in IUI, including increasing the number of eggs and overcoming subtle defects. The aim of COH is to recruit multiple follicles, control ovulation timing, prevent premature LH surges, time insemination, and increase pregnancy rates. Optimal stimulation results in 2-3 follicles ≥18-19mm in size and a thick, trilaminar endometrium. Gonadotropins are more effective than anti-estrogens like clomiphene citrate for IUI, and low
This study evaluated the use of blastocyst biopsy and array comparative genomic hybridization (aCGH) for preimplantation genetic diagnosis in 12 patients with chromosomal translocations. The diagnostic efficiency was 90.2% and euploidy rate was 32.7%. Ten cycles of thawed embryo transfer resulted in three live births and three ongoing pregnancies, for an ongoing pregnancy rate of 60% per transfer cycle. Prenatal diagnoses confirmed the PGD/aCGH results. The strategy demonstrates promising outcomes and may provide a more effective approach than traditional methods like fluorescence in situ hybridization. Larger studies are still needed to verify the results.
This document discusses preimplantation genetic screening (PGS) with fresh embryo transfer. It provides information on various PGS techniques including array comparative genomic hybridization (aCGH) and next generation sequencing (NGS). Key points discussed include the benefits of blastocyst biopsy over earlier stages and of comprehensive chromosome analysis over earlier PGS methods. Data is presented on euploidy rates, implantation rates, and the elimination of the maternal age effect with current PGS techniques. Both fresh and frozen embryo transfer are considered.
This document discusses preimplantation genetic screening (PGS) with fresh embryo transfer. It provides an overview of PGS using comprehensive chromosome analysis (CCA) with blastocyst biopsy and either fresh embryo transfer or frozen embryo transfer. Key advantages of CCA with blastocyst biopsy include improved implantation rates, elimination of the negative effect of maternal age on implantation, and the ability to perform embryo banking which facilitates multiple cycles for patients with poor prognosis. Controlled studies show no difference in outcomes between fresh versus frozen embryo transfer when using PGS with CCA.
This document discusses preimplantation genetic screening (PGS) with fresh embryo transfer. It provides an overview of PGS using comprehensive chromosome analysis (CCA) with blastocyst biopsy and either fresh embryo transfer or frozen embryo transfer. Key advantages of CCA with blastocyst biopsy include improved implantation rates, elimination of the negative effect of maternal age on implantation, and the ability to perform embryo banking which facilitates multiple cycles for patients with poor prognosis. Controlled studies show no difference in outcomes between fresh versus frozen embryo transfer when using PGS with CCA.
This document discusses preimplantation genetic screening (PGS) with fresh embryo transfer. It provides information on various PGS techniques including array comparative genomic hybridization (aCGH) and next generation sequencing (NGS). Key points discussed include the benefits of blastocyst biopsy over earlier stages and of comprehensive chromosome analysis over earlier PGS methods. Data is presented on euploidy rates, implantation rates, and the elimination of the maternal age effect with current PGS techniques. Both fresh and frozen embryo transfer are considered.
This document discusses preimplantation genetic screening (PGS) with fresh embryo transfer. It provides an overview of PGS using comprehensive chromosome analysis (CCA) with blastocyst biopsy and either fresh day 5 or 6 embryo transfer or frozen embryo transfer. Key advantages of blastocyst biopsy and CCA include improved implantation rates, elimination of the negative effect of maternal age on implantation, and the ability to perform embryo banking which facilitates multiple cycles for patients with poor prognosis.
This document discusses preimplantation genetic screening (PGS) with fresh embryo transfer. It provides an overview of PGS using comprehensive chromosome analysis (CCA) with blastocyst biopsy and either fresh embryo transfer or frozen embryo transfer. Key advantages of CCA with blastocyst biopsy include improved implantation rates, elimination of the negative effect of maternal age on implantation, and the ability to perform embryo banking which facilitates multiple cycles for patients with poor prognosis. Controlled studies show no difference in outcomes between fresh versus frozen embryo transfer when using PGS with CCA.
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.
This study compared pregnancy outcomes of in vitro fertilization (IVF) patients who underwent single embryo transfer where the embryo was selected based on (1) morphology alone or (2) morphology assessed with array comparative genomic hybridization (aCGH). Patients were randomly assigned to one of the two selection methods. The clinical pregnancy and ongoing pregnancy rates were significantly higher in the group where aCGH was used in addition to morphology to select the embryo. No twin pregnancies occurred. The results suggest that aCGH may improve pregnancy outcomes compared to morphology alone by detecting chromosomal abnormalities.
This document summarizes several studies on preimplantation genetic screening (PGS) using array comparative genomic hybridization (aCGH). Key findings include:
1) A pilot study of PGS using aCGH in "good prognosis" IVF patients under 35 found a 49.4% aneuploidy rate and an ongoing clinical pregnancy rate of 69%.
2) A randomized controlled trial in patients under 35 found higher pregnancy and ongoing pregnancy rates with day 5 biopsy and day 6 transfer plus aCGH (70.9% and 69.1%) compared to the control group without aCGH (45.8% and 41.7%).
3) Data from over 2000 patients showed eup
This document discusses the genetic causes and management of recurrent spontaneous abortion (RSA). It defines RSA as three or more pregnancy losses before 20 weeks. Around 50% of RSA cases are considered unexplained. Genetic factors, including balanced translocations, account for around 2-5% of cases. Karyotyping of abortus and parental testing can identify chromosomal abnormalities. For repeated aneuploid miscarriages, high dose folic acid supplementation and timed intercourse may help prevent further aneuploid conceptions. Preimplantation genetic diagnosis (PGD) and screening (PGS) using technologies like comparative genomic hybridization (CGH) and array CGH can identify and select euploid embryos for transfer in cases involving
Introduction: Preimplantation genetic screening is alive and very well. Meldr...鋒博 蔡
This document compares different technologies for 24-chromosome copy number analysis in preimplantation genetic screening and diagnosis. It discusses the differences between screening and diagnostic tests, with screening tests being noninvasive, rapid and lower cost to select embryos, while diagnostic tests require higher accuracy. Technologies reviewed include fluorescence in situ hybridization, comparative genomic hybridization, array comparative genomic hybridization and next generation sequencing, with array CGH currently being the most widely used due to its accuracy and ability to analyze all chromosomes.
This document compares different technologies for 24-chromosome copy number analysis in preimplantation genetic screening and diagnosis. It discusses the differences between screening and diagnostic tests, with screening tests being noninvasive, low-cost and allowing analysis of all patients to prioritize embryos, while diagnostic tests require high accuracy. It reviews technologies for copy number analysis including chromosome spreading, array comparative genomic hybridization, quantitative PCR and next generation sequencing, discussing their advantages and limitations for screening and diagnosis.
This study evaluated the endometrial receptivity array (ERA) test in patients with recurrent implantation failure. The study found:
- Of 2110 patients with moderate recurrent implantation failure, those who underwent embryo transfer of euploid embryos after preimplantation genetic testing for aneuploidy (PGT-A) had higher implantation and ongoing pregnancy rates than those without PGT-A.
- For 488 patients with severe recurrent implantation failure, no statistically significant improvements were seen with PGT-A.
- The use of the ERA test did not significantly improve outcomes for either group.
- PGT-A may be beneficial for moderate recurrent implantation failure cases but not severe cases.
-
Preimplantation genetic screening (pgs) current ppt鋒博 蔡
This document summarizes preimplantation genetic testing techniques used to screen embryos for genetic disorders prior to implantation. It discusses the current status and future prospects of preimplantation genetic diagnosis (PGD) and preimplantation genetic screening (PGS). PGD determines an embryo's genotype to test for specific genetic disorders, while PGS assesses the embryo's chromosome number (karyotype) to screen for chromosomal abnormalities. The document outlines several techniques used for PGD and PGS, including multiplex PCR, fluorescence in situ hybridization (FISH), and whole genome amplification from single cells. It provides examples of how these techniques are applied to test for conditions like spinal muscular atrophy, sickle cell an
This document discusses preimplantation genetic testing (PGT), which includes preimplantation genetic diagnosis (PGD) and preimplantation genetic screening (PGS). PGD determines an embryo's genotype to test for genetic disorders, while PGS assesses the embryo's chromosome number. The document outlines the history and development of PGT, including key milestones. It also describes current technologies used for PGT, such as fluorescence in situ hybridization (FISH) and polymerase chain reaction (PCR). The document provides an example of how one clinic uses PGT to screen for chromosomal abnormalities and genetic disorders.
This document discusses preimplantation genetic testing (PGT), which includes preimplantation genetic diagnosis (PGD) and preimplantation genetic screening (PGS). PGD determines an embryo's genotype to test for genetic disorders, while PGS assesses the embryo's chromosome number. The document outlines the history and development of PGT, including key milestones. It also describes current technologies used for PGT, such as fluorescence in situ hybridization (FISH) and polymerase chain reaction (PCR). The document provides an example of how one clinic uses PGT to screen for chromosomal abnormalities with FISH and test for genetic disorders and HLA matching.
This document summarizes preimplantation genetic testing technologies used to screen embryos for genetic disorders prior to implantation. It discusses the current status and applications of preimplantation genetic diagnosis (PGD) and preimplantation genetic screening (PGS), which allow couples at risk of passing on genetic disorders to have unaffected children. Key technologies that enable and support PGD/PGS are also described, including intracytoplasmic sperm injection, laser-assisted embryo biopsy, sperm sorting, and cryopreservation of biopsied embryos. Current methods for PGD/PGS involving multiplex PCR, fluorescence in situ hybridization, and whole genome amplification from single cells are also summarized.
Preimplantation genetic screening (pgs) current ppt鋒博 蔡
This document summarizes preimplantation genetic testing techniques used to screen embryos for genetic disorders prior to implantation. It discusses the current status and future prospects of preimplantation genetic diagnosis (PGD) and preimplantation genetic screening (PGS). PGD determines an embryo's genotype to identify genetic disorders, while PGS assesses the embryo's chromosome number (karyotype) to screen for aneuploidies. The document outlines several techniques used for PGD and PGS, including multiplex PCR, fluorescence in-situ hybridization (FISH), whole genome amplification via multiple displacement amplification, and intracytoplasmic sperm injection (ICSI). It also discusses milestones in the development of
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.
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.
"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.
"Transforming Reproductive Medicine with AI"
Brief overview of the impact of AI on various fields, leading into its applications in reproductive medicine.
This document provides guidelines for elective single embryo transfer (eSET) compared to double embryo transfer (DET) following in vitro fertilization (IVF). It finds that while the cumulative live birth rate is lower for eSET than DET, eSET significantly reduces the risk of multiple pregnancies. The guidelines recommend eSET for good prognosis patients aged 35 or younger in their first or second IVF attempt with at least 2 good quality embryos. This is intended to minimize twin pregnancies while maintaining acceptable live birth rates overall.
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,
The document discusses fallopian tube blockage, its causes such as pelvic inflammatory disease and endometriosis, and methods for testing and treating blocked tubes. Tests include hysterosalpingography (HSG), sonosalpingography (SSG), and laparoscopy, with laparoscopy being the most accurate but also invasive. Treatments involve medical management of underlying infections, surgical procedures like tubal flushing and recanalization, or in vitro fertilization (IVF) which has a higher success rate than tubal surgeries but is more expensive. The conclusion states that tubal testing is important for infertility evaluation but some tests are more accurate than others, and while tubal repair may work
Evaluation of Quality of Life in Infertile CouplesKaberi Banerjee
This study evaluated the quality of life of 600 infertile couples in India. The authors found that infertility caused stress and depression in many participants. Specifically:
- 40% of women and 37.5% of men reported issues with night sleep, while day sleep was less affected.
- Most participants reported feeling stressed due to infertility and social pressures. Women reported higher rates of stress than men.
- Around 69% of women and 52% of men experienced depression.
- Infertility had little impact on marital relationships for most couples.
The authors concluded that infertility is a stressful life event for many couples, affecting sleep and mental health, though social support from partners can help mitigate some negative impacts on quality of life
This document summarizes a panel discussion on the management of IVF pregnancies conducted by Delhi ISAR, Advance Fertility and Gynaecology Centre, and Madhukar Rainbow Group of Hospitals. The panelists provided expert opinions on topics like the choice of ART treatment, number of embryos to transfer, luteal phase support, anomaly screening, reduction of higher order multiples, antenatal follow-up, prevention of preterm labor, use of antenatal steroids, and delivery timing in twin pregnancies. The document emphasizes that IVF pregnancies require special care and management.
Psychosocial & Ethical Dilemma Surrounding Fertility Preservation in Young Ca...Kaberi Banerjee
Dr. Kaberi Banerjee is a renowned fertility specialist in India. She has over 8000 IVF and fertility cases and has received several national and international awards for her work. The document discusses the psychosocial and ethical issues surrounding fertility preservation in young cancer patients. It emphasizes the importance of counseling patients on their fertility options upon cancer diagnosis and coordinating care between oncologists and fertility specialists. Key considerations include obtaining proper consent for fertility preservation procedures in minor patients and addressing the ethical issues around experimental procedures, posthumous use of stored reproductive tissues, and risks to potential offspring.
This document provides information about Dr. Kaberi Banerjee, a medical director and chairperson in Delhi, India. It outlines her qualifications and experience in obstetrics, gynecology, and reproductive medicine. The document then discusses myomas (fibroids) and their relationship to infertility, outlining various diagnostic and treatment options for managing fibroids, including hysteroscopic resection, medical therapy, uterine artery embolization, and focused ultrasound surgery. Key considerations in treatment selection include fibroid location, size, number, and patient desire for future fertility.
Role of Hysteroscopy in Difficult Embryo TransfersKaberi Banerjee
Dr. Kaberi Banerjee is a highly experienced fertility specialist with over 8000 IVF cases. She has received numerous national and international awards for her work. Difficult embryo transfers can lower pregnancy rates due to trauma or infections. Hysteroscopy is useful for assessing the uterine cavity and cervical canal, allowing correction of issues like adhesions that cause difficult transfers. It may also enhance endometrial receptivity and allow easier transfers by studying cervical canal anatomy and lysing adhesions. While case studies support hysteroscopy, more randomized controlled trials are still needed related to corrective cervical canal surgeries.
Role of Subcutaneous G-CSF Infusion in Thin EndometriumKaberi Banerjee
Subcutaneous administration of granulocyte colony-stimulating factor (G-CSF) helped improve endometrial thickness and pregnancy rates in patients with thin endometrium undergoing ART cycles. In a study of 107 patients, those who received subcutaneous G-CSF (Group 1) in addition to sildenafil and aspirin had a significantly higher pregnancy rate of 59% compared to 27% for those who only received sildenafil and aspirin (Group 2). G-CSF works by increasing endometrial decidualization and proliferation. The study provides initial evidence that subcutaneous G-CSF may have a promising role in improving fertility outcomes for thin endometrium cases. Larger studies are still
Dr. Kaberi Banerjee is a renowned fertility specialist in India. She has over 8000 IVF cases and has received several national and international awards for her work. She discusses medically complicated IVF patients who have medical disorders that can affect fertility or aggravate during treatment. These include hypertension, diabetes, heart disease, epilepsy, blood clots, endocrine disorders, cancers, lupus, HIV, and obesity. For each condition, she outlines how it impacts fertility, any pre-IVF preparation needed, and management during ovarian stimulation and pregnancy to optimize outcomes.
This document provides information about Dr. Kaberi Banerjee, a medical director and chairperson in Delhi, India. It outlines her qualifications and experience in obstetrics, gynecology, and reproductive medicine. The document then discusses myomas (fibroids) and their relationship to infertility, outlining various diagnostic and treatment options for fibroids including hysteroscopic myomectomy, abdominal myomectomy, laparoscopic myomectomy, morcellation, medical management, uterine artery embolization, MRI-guided focused ultrasound, and vaginal occlusion of uterine arteries.
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.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
5. PGTa claims to reduce
implantation failure in IVF and
reduce the risk of miscarriages.
It is a very expensive test!
Is it true?
6.
7. Some Facts of
PGTa
• All cells in any embryo doesn’t
demonstrate aneuploidies i.e
chromosomal abnormalities.
There are only small number of
cells which shows abnormalities.
If embryo biopsy shows abnormal
DNA, it is not the whole cell will
be abnormal.
8. Some Facts of
PGTa
• It is also observed that abnormal cells
often self-destruct and some cells self-
correct by themselves. This self-correction
happens more in cells which makes baby
than the cells which makes placenta
(trophectoderm). For PGT-a, embryo
biopsy is taken from trophectoderm. This
shows that there is no benefit of doing
blastocyst stage embryo biopsy as cells
which are tested are of outer layer not the
inner layer which forms the baby.
9. The STAR Study
• A total of 661 women (average age 33.7 ± 3.6
years) were randomized to PGT-A (n = 330) or
morphology alone (n = 331).
• PGT-A did not improve overall pregnancy
outcomes in all women, as analyzed per embryo
transfer or per ITT. There was a significant
increase in OPR per embryo transfer with the
use of PGT-A in the subgroup of women aged
35-40 years who had two or more embryos that
could be biopsied, but this was not significant
when analyzed by ITT.
10. SHORT COMMUNICATION Open Access
Preimplantation genetic screening- the
required RCT that has not yet been carried
out
Raoul Orvieto1,2
Abstract
The utilization of trophectoderm biopsy combined with comprehensive chromosome screening (CCS) tests for
embryonic aneuploidy was recently suggested to improve IVF outcome, however, not without criticisms. The
ongoing discussion on the unrestricted clinical adoption of preimplantation genetic screening (PGS) has called for a
proper randomized controlled trial (RCT), aiming to further evaluate the cumulative live birth rates (LBRs) following
Orvieto Reproductive Biology and Endocrinology (2016) 14:35
DOI 10.1186/s12958-016-0171-z
• The utilization of trophectoderm biopsy combined
with comprehensive chromosome screening (CCS) tests
for embryonic aneuploidy was recently suggested to
improve IVF outcome, however, not without criticisms.
The ongoing discussion on the unrestricted clinical
adoption of preimplantation genetic screening (PGS) has
called for a proper randomized controlled trial (RCT),
aiming to further evaluate the cumulative live birth rates
(LBRs) following a single oocyte retrieval, utilizing all
fresh and frozen embryos. Since this study seems not to
appear for various reasons, we present herewith, the
hypothetical required RCT based on the hitherto
published literature.
• After implementing data from the hitherto published
literature on blastulation and aneuploidy rates, the rate
of mosaicism and technical errors and implantation
rates/LBRs of non-PGS day-3 and blastocyst and PGS
blastocyst, we could clearly demonstrate the superiority
of non-PGS embryo (day-3 and blastocyst) transfer over
PGS blastocyst transfer, in terms of cumulative LBR
(18.2–50 % vs 7.6–12.6 %, respectively).
• We therefore believe that until the proper, non-
hypothetical RCT on the efficacy of this procedure will
appear, PGS should be offered only under study
conditions, and with appropriate informed consents.
11. Overall same , but can show as 50% and 100%
Depends which data you want to show!
Non PGS-50%?
10
8
6
4
2+2
-ve/+ve
PGS-100%?
10
8
6
4
2
+ve
Extra Cost
Freezing
Transfer Time
Extra Cost
PGS
Personnel
Laboratory
WaitingTime
12. Assumptions
• Blastulation Rate- 47%
• Aneuploidy Rate- 59%
• IR-D3 21-50%, Non PGS D5
38-47%, PGS D5 39-65%
• Mosaicism and Technical
Errors reduce LBR
SHORT COMMUNICATION Open Access
Preimplantation genetic screening- the
required RCT that has not yet been carried
out
Raoul Orvieto1,2
Abstract
The utilization of trophectoderm biopsy combined with comprehensive chromosome screening (CCS) tests for
embryonic aneuploidy was recently suggested to improve IVF outcome, however, not without criticisms. The
ongoing discussion on the unrestricted clinical adoption of preimplantation genetic screening (PGS) has called for a
proper randomized controlled trial (RCT), aiming to further evaluate the cumulative live birth rates (LBRs) following
a single oocyte retrieval, utilizing all fresh and frozen embryos. Since this study seems not to appear for various
reasons, we present herewith, the hypothetical required RCT based on the hitherto published literature.
After implementing data from the hitherto published literature on blastulation and aneuploidy rates, the rate of
mosaicism and technical errors and implantation rates/LBRs of non-PGS day-3 and blastocyst and PGS blastocyst,
we could clearly demonstrate the superiority of non-PGS embryo (day-3 and blastocyst) transfer over PGS blastocyst
transfer, in terms of cumulative LBR (18.2–50 % vs 7.6–12.6 %, respectively).
Orvieto Reproductive Biology and Endocrinology (2016) 14:35
DOI 10.1186/s12958-016-0171-z
13. For the propose of the analysis, we will assume that
each group yielded 100 day-3 embryos and that all
In a recent study [12] evaluating the accuracy of troph-
ectoderm multiple biopsies using next-generation
Fig. 1 The required hypothetical RCT
14. • Presented reanalysis here of the recently
published STAR study [8], which already has
been affecting IVF practice worldwide,
reveals significant shortcomings in the study’s
statistical analyses. Those, however, do not
change the principal conclusion of the STAR
study that PGT-A does not favorably affect IVF
outcomes by increasing pregnancy chances or
reducing miscarriage risks.
• The STAR study thus reveals that PGT-A
does not beneficially affect IVF outcomes in
confirmation of another relatively recent
study in women 37 years and older by Kang
et al. Like the STAR study, Kang et al. reported
seemingly improved live birth rates following
PGT-A but this outcome advantage, actually,
reversed itself after correct intent-to-treat
analysis of outcomes with reference cycle
start: Pregnancy as well as live birth rates,
indeed, ended up to be significantly higher in
control non-PGT-A patients (49.5 vs 21.5%
and 39.8 vs 19.9%).
• Considering all presented evidence here, it
is difficult to understand what further
argument can be made for the continuous
routine clinical utilization of PGT-A to improve
IVF outcomes.
•
COMMENTARY
Preimplantation genetic testing for aneuploidy (PGT-A)
—finally revealed
Raoul Orvieto1,2
& Norbert Gleicher3,4,5,6
Received: 10 December 2019 /Accepted: 27 January 2020 /Published online: 2 February 2020
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Keywords PGT-A . PGS . Live-birth rate . Intention to treat . RCT
Introduction
Natural fecundity of women decreases gradually and more
rapidly after age 37 years. This decrease is accompanied by
aneuploidies. The procedure was, ther
formed biopsying 1–2 blastomeres of d
embryos, often given the acronym PGS
This form of embryo testing has, sinc
Journal of Assisted Reproduction and Genetics (2020) 37:669–672
https://doi.org/10.1007/s10815-020-01705-w
15. 4/5/2021 Preimplantation genetic testing for aneuploidies (abnormal number of chromosomes) in in vitro fertilisation - Cornelisse, S - 2020 | Cochrane Library
Authors' conclusions
There is insu icient good‐quality evidence of a di erence in cumulative live birth rate, live birth rate a er the first embryo transfer, or miscarriage rate
between IVF with and IVF without PGT‐A as currently performed. No data were available on ongoing pregnancy rates. The e ect of PGT‐A on clinical
pregnancy rate is uncertain.
Women need to be aware that it is uncertain whether PGT‐A with the use of genome‐wide analyses is an e ective addition to IVF, especially in view of the
invasiveness and costs involved in PGT‐A. PGT‐A using FISH for the genetic analysis is probably harmful.
The currently available evidence is insu icient to support PGT‐A in routine clinical practice.
Plain language summary
Available in English Español ر Français 한국어 Bahasa Malaysia
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD005291.pub3/full 1/6
Cochrane Database of Systematic Reviews Review - Intervention New search
Abstract
Available in English Español ر Français 한국어
Background
In in vitro fertilisation (IVF) with or without intracytoplasmic sperm injection (ICSI), selection of the most competent embryo(s) for transfer is based on
morphological criteria. However, many women do not achieve a pregnancy even a er 'good quality' embryo transfer. One of the presumed causes is that
such morphologically normal embryos have an abnormal number of chromosomes (aneuploidies). Preimplantation genetic testing for aneuploidies (PGT‐
Preimplantation genetic testing for aneuploidies (abnormal number of chromosomes) in in vitro
fertilisation
,
Simone Cornelisse ,
Miriam Zagers ,
Elena Kostova ,
Kathrin Fleischer ,
Madelon Wely Sebastiaan Mastenbroek Authors' declarations of interest
Version published: 08 September 2020 Version history
https://doi.org/10.1002/14651858.CD005291.pub3
16. Preimplantation genetic
screening: what is the
clinical efficiency?
In the current practice of in vitro fertilization (IVF), preim-
plantation genetic screening (PGS) is increasingly used to
select embryos for transfer. This strategy is designed to maxi-
mize the probability of embryo implantation by eliminating
embryos with low implantation potential from the cohort.
However, PGS is inherently imperfect. Errors may occur dur-
ing the genetic analysis of the small amount of DNA collected.
More importantly, mitotic mosaicism, whose precise inci-
dence in the preimplantation embryo is not known, may
lead to sampling errors due to the intentionally limited collec-
tion of cells in the trophectoderm biopsy. In this manner,
abnormal cells may be collected in an otherwise euploid em-
bryo and vice versa. Therefore, it is inevitable that some
normal embryos will be discarded, leading to an overall
EI(idealized). The efficiency of the screening process can then
be expressed as:
Efficiency ¼
EIðscreenedÞ
EIðidealizedÞ
The percentage of embryos lost in the process can then be
calculated as:
% embryos lost ¼ 1 $ Efficiency
The depiction of this analysis is most easily demonstrated
in a graphic fashion. For this example, let us consider a hypo-
thetical cohort of embryos from ‘‘good-prognosis’’ patients
(2), under the age of 35 years, with multiple blastocysts in
the 4AA or 4BB category, an unscreened implantation rate
of 50%, and an ‘‘aneuploidy’’ rate of 40%. In the parlance
of this calculation:
EIðunscreenedÞ ¼ 0:50
INKLINGS
• Errors may occur during the genetic analysis of the small
amount of DNA collected.
• Mitotic mosaicism may lead to sampling errors
• Some normal embryos will be discarded, leading to an
overall decrease in the cumulative pregnancy rate
achievable by the eventual transfer of all embryos in the
cohort.
• Real possibility of damage to the blastocyst as result of the
trophectoderm biopsy.
• No studies have addressed the impact of trophectoderm
biopsy in embryos with less than ideal morphologic
characteristics, in older patients, or after an intervening
cryopreservation procedure.
17. Preimplantation genetic
screening: what is the
clinical efficiency?
In the current practice of in vitro fertilization (IVF), preim-
plantation genetic screening (PGS) is increasingly used to
select embryos for transfer. This strategy is designed to maxi-
mize the probability of embryo implantation by eliminating
embryos with low implantation potential from the cohort.
However, PGS is inherently imperfect. Errors may occur dur-
ing the genetic analysis of the small amount of DNA collected.
EI(idealized). The efficiency of the
be expressed as:
Efficiency ¼
EIðscreenedÞ
EIðidealizedÞ
The percentage of embryos lo
calculated as:
% embryos lost ¼ 1 $ Efficienc
The depiction of this analysis
in a graphic fashion. For this exam
INKLINGS
18. Clinical application of PGT‐A: is the price too high?
T El‐Toukhy
Guys and St. Thomas Hospital NHS Trust, London, UK
Linked article: This is a mini commentary on K Neumann et al., pp. 710–718 in this issue. To view this article visit
https://doi.org/10.1111/1471-0528.16089
Published Online 8 March 2020.
Pre‐implantation genetic testing for
aneuploidy (PGT‐A) continues to pro-
voke interest, discussion and debate in
the field of reproductive medicine.
The two touted benefits of compre-
hensive screening of pre‐implantation
embryos for chromosomal aneuploidies
in in vitro fertilisation (IVF) treat-
ment are improvement in the live
birth rate per cycle and reduction in
miscarriage risk.
Two recent large randomised trials
employing two different techniques
for PGT‐A (ESTEEM Trial – Verpoest
et al. Hum Reprod 2018;33:1767–76
et al., Reprod Biomed Online 2019;
39:617–23).
In this issue of our journal, the
study of Neumann et al. (BJOG
2020;127:710–8) focused on the
cost‐effectiveness of PGT‐A, using
data from the ESTEEM trial. The
study demonstrated the high cost
of preventing one miscarriage
through the application of PGT‐A,
in both high‐cost and low‐cost
healthcare settings. This result is con-
sistent with the conclusion of a ‘theo-
retical’ cost‐effectiveness study in a UK
setting (Scriven, Reprod Biol Endocrinol
cycles to achieve a live birth, it
would seem more reasonable to use
the limited resources for funding
more standard IVF cycles to achieve
more live births rather than chasing
the possibility of fewer miscarriages
and end up with fewer babies.
Although the initial PGT‐A results
involving day‐3 embryo biopsy and
fluorescence in situ hybridisation
were disappointing, it was expected
that improvement in blastocyst cul-
ture, embryo cryopreservation and
molecular genetic testing technolo-
gies would enable PGT‐A to achieve
Economic analysis of preimplantation genetic testing for aneuploidy
Pre‐implantation genetic testing for
aneuploidy (PGT‐A) continues to pro-
voke interest, discussion and debate in
the field of reproductive medicine.
The two touted benefits of compre-
hensive screening of pre‐implantation
embryos for chromosomal aneuploidies
in in vitro fertilisation (IVF) treat-
ment are improvement in the live
birth rate per cycle and reduction in
miscarriage risk.
Two recent large randomised trials
employing two different techniques
for PGT‐A (ESTEEM Trial – Verpoest
et al. Hum Reprod 2018;33:1767–76
and STAR Study – Munne et al. Fertil
Steril 2019;112:1071–9) have shown
no improvement in the live birth rate
per IVF cycle started in screened
cycles compared with no screening.
The ESTEEM trial did not show a
shorter time to pregnancy and the
STAR study did not show a reduc-
tion in the miscarriage rate associated
et al., Reprod Biomed Online 2019;
39:617–23).
In this issue of our journal, the
study of Neumann et al. (BJOG
2020;127:710–8) focused on the
cost‐effectiveness of PGT‐A, using
data from the ESTEEM trial. The
study demonstrated the high cost
of preventing one miscarriage
through the application of PGT‐A,
in both high‐cost and low‐cost
healthcare settings. This result is con-
sistent with the conclusion of a ‘theo-
retical’ cost‐effectiveness study in a UK
setting (Scriven, Reprod Biol Endocrinol
2017;15:49). Both studies highlighted
the financial burden of PGT‐A and
emphasised that applying PGT‐A to all
IVF cycles in women below the age of
40 years would be a very expensive
approach to reduce the risk of
miscarriage.
Although it is important not to
underestimate the emotional and
cycles to ach
would seem m
the limited r
more standard
more live birt
the possibility
and end up wi
Although th
involving day‐
fluorescence
were disappoi
that improvem
ture, embryo
molecular gen
gies would en
its potential
IVF outcome
Reprod 2014;2
recent publica
those improved
the study of N
2020;127:710–8
reminder of th
ased objective
19. • Any Intervention that claims to
increase the pregnancy rate in IVF
must stand the test of time…till
then must be clearly offered as an
experimental test and at least
should not financially drain the
patient.