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Cumulative live birth rates following blastocyst- versus cleavage-stage embryo transfer in the first complete cycle of IVF: a population-based retrosp
Our findings show that blastocyst-stage embryo transfer may offer an improved chance of live birth in both the first fresh and the first complete cycle of IVF/ICSI compared to cleavage-stage transfer, even in couples with typically poorer prognoses..However, after accounting for the imbalance between exposures, blastocyst transfer did not significantly influence the odds of live birth over the first complete cycle.
The combined effect of obesity and aging on human sperm DNA methylation signatures: inclusion of BMI in the paternal germ line age prediction model
However, it is important to note that within each age category, high BMI individuals were predicted to be older on average than their actual age (about 1.4 years), which was not observed in the normal BMI group.
Preimplantation genetic testing for aneuploidy: are we examining the correct outcomes?
This article describes the concern that a focus on results from the first embryo transfer compared to cumulative outcomes falsely construes PGT-A as having superior outcomes, whilst its true benefit is not confirmed, and it cannot actually improve the true pregnancy outcome of an embryo pool.
The birth of a baby with mosaicism resulting from a known mosaic embryo transfer: a case report
This is the first reported case of true fetal mosaicism resulting in a live birth following the transfer of a known mosaic embryo. Worldwide, prenatal diagnosis has shown the depletion of mosaicism in embryos transferred after they have been reported as mosaics. Our case demonstrates the need for close prenatal monitoring and diagnosis by early amniocentesis, preferably at >14 weeks gestation.
One hundred mosaic embryos transferred prospectively in a single clinic: exploring when and why they result in healthy pregnancies
After euploid embryos, mosaic embryos can be considered for transfer, prioritizing those of the single segmental mosaic type. If a patient has mosaic embryos available that were generated at different ages, preference should be given to those made at younger ages.
Minimizing mosaicism: assessing the impact of fertilization method on rate of mosaicism after next-generation sequencing (NGS) preimplantation genetic
IVF and ICSI NGS PGT-A have similar rates of euploid, aneuploid, and no result embryos, though IVF may result in higher rates of mosaicism and demonstrates differences in proportions of mosaic and aneuploid subtypes compared to ICSI. ICSI may be preferable to conventional insemination to minimize the rate of mosaic results in NGS PGT-A cycles
DNA fragmentation of sperm: a radical examination of the contribution of oxidative stress and age in 16 945 semen samples
DNA and/or oxidative damage in sperm may be just as important to understand as the chromosomal aberrations that are carried in the oocyte. Further studies are needed to evaluate the effect of advancing paternal age on the male genome and, ultimately, on the health of the offspring.
Clinical Outcomes of Single Mosaic Embryo Transfer: High-Level or Low-Level Mosaic Embryo, Does it Matter?
Comparable live birth rate (LBR) but higher miscarriage rate (MR) was found in the high-level group. (LBR: low vs. high: 44.5% vs. 36%, p=0.45, MR: low vs. high: 5.1% vs. 30.7%, p=0.012). Analyses of TE and ICM from the remaining mosaic blastocysts show a poor concordance.
Developmental potential of aneuploid human embryos cultured beyond implantation
We show that while trisomy 15 and trisomy 21 embryos develop similarly to euploid embryos, monosomy 21 embryos exhibit high rates of developmental arrest, and trisomy 16 embryos display a hypo-proliferation of the trophoblast, the tissue that forms the placenta.
Preimplantation genetic testing for aneuploidy: are we examining the correct outcomes?
Summary
Comment
This paper is used as a lynchpin to explore the value of PGT-A. The decision to use PGT-A remains a clinic-based study where large scale, society organized RCT have not been organized following one in the early stages of PGT-A using day 3 embryos and PGS. Other techniques such as polar body biopsy was explored mainly because of legal limitation to embryo research. The amazing advances in genetic analysis have propelled PGT-A to an incomprehensible level compared to those employed even 10 years age. Matched with advances in embryo culture and cryostorage, the now standard is blastocyst biopsy and NGS. These makes all previous studies largely redundant. |
The authors summarized 6 RCT studies and concluded that PGT-A may be better if only the first embryo transfer was considered but there were no significant advantages when the cumulative pregnancy rates were the benchmark. They stressed that most professional groups do not recommend PGT-A and that RCT were sufficiently variable in design that they are at risk of being misleading. |
The authors discussed the one aspect of deceased time to pregnancy may be relevant since the first embryo transfer may more likely result in pregnancy due to superior embryo selection over the standard decisions made on embryo morphology. They pointed out that PGT-A has not been used for clients with recurrent miscarriages. |
PGT-A does involve the risk of physical and metabolic damage during the biopsy and concerns about how to manage those embryos diagnosed as mosaic. This risk involves the potential discarding of otherwise viable embryos and lack of evidence on the health of infants born after a low level of mosaicism was identified. The issue of counselling clients about these issue with PGT-A remains problematic. |
Finally, the authors addressed the elephant in the room and that is cost. Clients bear the cost of PG-A and clinics are variable in the promotion of this technology. This is an impediment to a fully well-designed clinical trial to identify whether the physical assault and efficacy of NGS tools to identify euploidy or any variation of aneuploidy and mosaicism. They implored future RCT to use cumulative pregnancy rates as the primary end-point rather than time to first pregnancy or the first transfer. |
The authors did not raise the arguments about whether trophectoderm biopsy of a few cells represents ICM euploidy status nor the prospect of PGT-A analysis of spent culture media. Both of these issues may contribute questions to be addressed in future trials. While some data exist of the health of children born after PGT-A, the real question is the health of children born after a diagnosis of embryos with low levels of mosaicism and still transferred. |
PGT-A is used to identify embryos that may be euploid. However, the large number of embryos that are either aneuploid or mosaic is the real issue since the techniques significantly reduces the number of embryo available for transfer relative to when PGT-A is not offered. If PGT-A was used as an experimental tool to try to ascertain why so many embryos are chromosomally abnormal, then PGT-A may lead to significantly better stimulation or culture systems. While clients need to pay for the technique, the scientific application will remain a secondary outcome. |
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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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