Comment:This distribution includes new publications on the relationship between culture media and birth outcomes. Of interest to all. Some of these links may be a few weeks old!. Mailouts will now include occasional comments on listing and the latest IVFlab products added to IVFlabonline. Let me know if they are of interest to you or a waste to space. Comments to office@fertaid.com
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PIVET rFSH dosing algorithms for individualized controlled ovarian stimulation enables optimized pregnancy productivity rates and avoidance of ovarian
Consequently, application of both these algorithms in our in vitro fertilization clinic allows the use of both the rFSH products, with very similar results, and they can be considered validated on the basis of effectiveness and safety, clearly avoiding ovarian hyperstimulation syndrome.
The ratio between inner cell mass diameter and blastocyst diameter is correlated with successful pregnancy outcomes of single blastocyst transfers
Conclusion(s).The ICM-to-blastocyst diameter ratio is a predictor of implantation and live birth in single-blastocyst transfers, offering a simple, noninterfering method to select blastocysts with high developmental capacity.
Are extremely high progesterone levels still an issue in IVF?
Conclusions: These results show that extremely marked progesterone elevation throughout controlled ovarian stimulation does not impair blastocyst development and implantation potential in the context of a “freeze-all” strategy. Based on this, adoption of the “freeze-all” strategy represents a valuable tool in treating premature luteinization. In contrast, cycle cancellation—likely the most frequently used method for management of this complicatio
While pipetting techniques have served embryology well in the past, advanced handling and manipulation technologies will be required to efficiently implement and commercialize the basic biological advances made in recent years. Microfluidic systems can be used to handle gametes, mature oocytes, culture embryos and perform other basic procedures in a microenvironment that more closely mimics in vivo conditions. The use of microfluidic technologies
Microfluidic devices for the study of sperm migration
Only a very small percentage of inseminated sperm reach the ampulla in the periovulatory period, indicating that strong selection pressures act on sperm during migration. A better understanding of how sperm interact with the female tract would inspire improvements in diagnosis of fertility problems and development of novel-assisted reproductive technologies that minimize damage to sperm and mimic natural selection pressures on sperm.
Proof of concept: preimplantation genetic screening without embryo biopsy through analysis of cell-free DNA in spent embryo culture media
Conclusion(s): We demonstrate two novel findings: the presence of free embryonic DNA in spent media and a result that is consistent with trophectoderm biopsy. Improvements in DNA collection, amplification, and testing may allow for PGS without biopsy in the future.
There is now evidence that the environment the early embryo is exposed to can cause reprogramming of embryonic growth leading to alterations in fetal growth trajectory, birthweight, childhood growth and long-term disease including Type II diabetes and cardiovascular problems. The mechanism for this is likely to be epigenetic changes during the preimplantation period of development.
Influence of embryo culture medium (G5 and HTF) on pregnancy and perinatal outcome after IVF: a multicenter RCT
Embryo culture media used in IVF affect not only treatment efficacy but also perinatal outcome. This suggests that the millions of human embryos that are cultured in vitro each year are sensitive to their environment. These findings should lead to increased awareness, mechanistic studies and legislative adaptations to protect IVF offspring during the first few days of their existence.
First randomized trial shows IVF culture media affect the outcomes of embryos and babies
Fertility experts are calling on the companies who make the solutions in which embryos are cultured during in vitro fertilization (IVF) to give a clear list of ingredients following publication of a trial that shows that the composition of these laboratory cultures affects the outcomes of the resulting embryos and babies in terms of the number of viable embryos created, the rates of successful implantation in the womb, pregnancy rates and babies'
An excellent summary on the risks associated with embryo culture media.
Comment
This free article by Dr Sunde in Human Reproduction should be on the reading list of all new IVF staff (and all others). For some older embryologists who may remember making their own culture media each week, this article will cause them to reflect on the primitive nature of IVF in the early days. When commercial media started to become available, it was not surprising that almost all embryologists quickly put away their water purification vessels and chemical bottles and relished the ease of performing IVF. Home made preparations were really only suitable for simple media formulations, appropriate for smaller clinics and were difficult to complete a quality assessment before use but may have been considerably cheaper. There was also the increasing litigation risk. |Since the 1990s, all IVF scientists and clinicians use only commercial media and have long since forgotten what is in the media they use each day. Media companies have provided little or basic information on their formulations which have become more complicated over time - both seeking the holy grail in additives and also from a fear of complications. So much so that the selection of which media to use has become almost an impossible task, the decision given more to costs, delivery and after sales (and conference) services. Yet this article should cause everyone to reflect on the possible implications of their own, their clinicians (owners) or financial officers (cost) choices. |At the end of the day, IVF is not about success rates or activity, it is about babies that grow into children and adults. The choice of culture media is just one of many decisions embryology labs make but as this article points out, it may be one that has a long lasting (and most likely unknown during the working lives of embryologists and doctors) effects. In reality, most if not all current culture media will produce similar standard outcomes since it is other environmental or technical aspects that have largely improved success rates. Changes to the way embryo culture is performed (eg time-lapse imagery) is driving choices such as continuous or stepped formulations. Also changes to media now require significant investment by companies to meet international standards will see fewer new developments going forward. Other recent articles by Kleijkers , et.al. have suggested that culture media age and formulations may influence birthweight and birthweight has been linked to adult illness. So there is some published data to support claims of long term risks. |There are few embryologist in the whole world who could clearly explain what each component of the media they are using is there for and what its function is. There is a case therefore, for media companies to ensure the education of their clients allows them to make an informed choice but few, if any, companies will detail their formulations because of commercial confidence. What is lacking is ongoing data for scientist to use to allow them to make a decision. It almost requires each clinic to conduct their own assessments in-house - data that is rarely published. This does not mean that scientists should not be concerned by or ignorant of what each component is actually doing. The liability and responsibility of using the media is the clinics. |The article by Dr Sunde asks that clinics approach the use of culture media with this long term risks in mind, to ensure the documentation trail is complete and that the manufacturers recommendations are followed. No mixing of media, no unnecessary prolonged usage etc. One complication I can see is that many clinics are using complex databases to manage the QC information but these systems are regularly changed and there is no certainty the data will be retained long term. How clinics can keep their information for a long time is a real problem. I guess one question is how long is reasonable? |At this point I can see a case for media manufacturers to produce a single use product for each step of the IVF chain - one pack per client, one use and no repeat sampling.|
Title
Embryonic cell-free DNA in spent embryo culture media
Summary
Embryonic DNA can be isolated in culture medium that may be used for PGS
Comment
I thought this was a fantastic article that may well be the first in a new way to approach genetic analysis of embryos. That DNA can be detected in embryo culture media and if confirmed by other studies that this is from the embryo is fascinating. Is culture media routinely tested for DNA and if not, this paper may well suggest it should be. Embryo culture is not routinely performed as a DNA free process and how would this requirement alter how IVF is performed. A thousand questions spring to mind from this paper but as a proof-of-concept, it may be a hallmark publication. Of course time will tell if PGS without biopsy is the new PGD. Interested in any comments readers may make.
Title
PIVET algorithm for control of OHSS
Summary
The PIVET algorithm seeks to modify the FSH dose to patient factors to minimise excessive oocytes
Comment
Pioneer clinic PIVET has further developed its rFSH dosing Algorithms to enable precision by applying small increments based on 6 variables namely age and antral follicle count grading with adjustments for anti-Mullerian hormone level, BMI, day-2 FSH and smoking history. This has been enabled by the introduction of rFSH pens with metered dosing of ~8.3 IU or 12.5 IU per click. Close adherence to the Algorithms provides a mean of 10.0 oocytes per woman <40 years with few cases exceeding 15 oocytes and potentially complete avoidance of OHSS. The starting dose was <150 IU for 24% of cases and dosage adjustment was infrequently required, even when the start dose was <=75 IU. Luteal support schedules were adjusted according to oocyte numbers retrieved and livebirth productivity rates per initiated cycle was 57% for women <30 years, 52% for age group 30-34 years and 33% for those aged 35-39 years. These high rates are achieved with a single embryo transfer policy being 80% overall and >90% for <35 years.|This study indicates that ovarian stimulation by gonadotrophins can indeed be conducted safely even when antral follicle counts are high (40% displayed AFC >=20 follicles and included young women in low BMI categories). These data could now be compared with other strategies to avoid OHSS, namely IVM protocols and freeze-all regimens. PIVET is extending its Algorithm studies to include the long acting gonadotrophin corifollitropin, and plans to develop specific computer applications (Apps) to present comprehensive protocols which adjust for not only the ovarian stimulation schedule, but also ovarian Trigger adjustments and optimized luteal support schedules. Such developments should remove the guess-work and variable responses associated with current systems of COH (controlled ovarian stimulation).| Overall the long-term expectations are to simplify treatment schedules, reduce the need for monitoring and enable a smaller staffing structure to manage the majority of infertility cases. Cost-benefits should automatically ensue, reducing the expense for the increasing number of women desiring to access ART services.| Dr John Yovich|
IVFLabOnline - Recent Enteries to IVFLabOnlines product listings.see IVFLabonline
In-line filter for cylinder and house gasses
O2, N2, CO2, and tri-gas. Aire~LifeLine provides in-line air filtration with top of the line protection, delivering a better and more consistent yield of cylinder and house gasses for a wide range of med
Vit Kit - Warm NX is an adaptable, cost-effective system for use in the thawing of oocytes, pronuclear zygotes, cleavage stage embryos, and blastocyst stage embryos. Unlike many vitrification kits that feature a mono-buffered system and M199 base med
Vit Kit - Freeze NX is an adaptable, cost-effective system for use in the vitrification of oocytes, pronuclear zygotes, cleavage stage embryos, and blastocyst stage embryos. Vit Kit - Freeze NX is the latest advancement in vitrification media aimed t
S-Cryolock is the slimmer version of the original. It is a versatile, simple and efficient vitrification device that is intended for the holding, cryopreservation and storage of oocytes or embryos in liquid nitrogen.
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