BACKROUND: The goal of assisted reproduction is for a couple treated with IVF techniques to end the treatment by giving birth to a healthy baby. A neccessary presumption for success is the identification of the best embryo with high implantation and developmental potential. One option is to select an euploid embryo by invasive preimplantaion genetic testing for aneuploidy (PGT-A) or it is possible to select the best embryo by non-invasive time-lapse monitoring (TLM), specifically based on morphokinetic parameters and morphological markers that are able to identify an embryo with high developmental potential. MATERIALS AND METHODS: The study involved a total of 1060 embryos (585 euploid and 475 aneuploid embryos after PGT-A) with good morphology from 329 patients in the period 01/2016-10/2021. All embryos were cultured in a time-lapse incubator, trophectoderm (TE) cells biopsies for PGT-A examination were performed on day 5 (D5) or day 6 (D6) of culture. During the study period, 225 frozen embryo transfers (FET) of one euploid embryo were performed. Based on the treatment outcome, the embryos were divided into 2 groups - euploid embryos, which led to the birth of a healthy child, and euploid embryos that did not show fetal heartbeat (FHB) after FET. RESULTS: Based on the statistical analysis of the embryos without implantation and the embryos with live birth, it is clear that the morphokinetic parameters t5 (time of division into 5 cells) and tSB (time of start of blastulation) are significantly different. CONCLUSION: The results suggest that of the morphokinetic parameters tSB and t5 are predictive indicators for selecting an embryo with high developmental potential and with a high probability of achieving the birth of a healthy child.
- MeSH
- Aneuploidy MeSH
- Blastocyst * MeSH
- Genetic Testing methods MeSH
- Embryo Implantation MeSH
- Humans MeSH
- Live Birth * MeSH
- Infant, Newborn MeSH
- Embryo Transfer methods MeSH
- Retrospective Studies MeSH
- Pregnancy MeSH
- Check Tag
- Humans MeSH
- Infant, Newborn MeSH
- Pregnancy MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
AIMS: The aim of this study is to determine whether the risk of preterm births differs according to the conception method: with or without ART and according to the ART method used (in-vitro fertilisation (IVF) with fresh embryo transfer, frozen embryo transfer (FET) and oocyte receipt (OoR)). METHODS: The research is based on individualised anonymised data on deliveries in Czechia in 2013-2018 (n=651,049) obtained from the National Health Information System. We employ the survival analysis approach applying survival functions (Life tables method) and Cox regression to model the risk of preterm births according to the conception method when controlling for a set of covariates. RESULTS: The results revealed that the risk of preterm births in singleton pregnancies is higher for ART-treated women (1.56 to 2.06 depending on the ART method) than for non-ART-treated women. The proportion of preterm births differs according to the ART method; the highest proportion was observed for OoR mothers. CONCLUSIONS: Overall, the differences between ART-treated mothers according to the conception method are due mainly to the structural differences between mothers. When controlling for the covariates (Cox regression model), no significant differences were observed concerning the risk of preterm births for women who underwent fresh IVF, FET and OoR.
- MeSH
- Reproductive Techniques, Assisted * statistics & numerical data MeSH
- Adult MeSH
- Fertilization in Vitro * statistics & numerical data MeSH
- Humans MeSH
- Infant, Newborn MeSH
- Premature Birth * epidemiology MeSH
- Embryo Transfer statistics & numerical data MeSH
- Risk Factors MeSH
- Pregnancy MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Infant, Newborn MeSH
- Pregnancy MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Geographicals
- Czech Republic MeSH
Background and Objectives: The aim of our single-center cohort study was the determination of the influence of the intrauterine lavage of granulocyte colony-stimulating growth factor (G-CSF) on clinical pregnancy rate in patients with a history of implantation failure older than 40 years. Materials and Methods: The study was conducted in Ferticare Prague SE between May 2018 and June 2020. Overall, 115 patients were distributed into two arms, with 48 subjects in the experimental and 67 in the control arm. All women have had a previous history of unsuccessful history of infertility treatment with their own genetic material and at least one ineffective cycle with the donated oocytes. The experimental arm underwent the intrauterine lavage of 0.5 mL of pure G-CSF from 120 to 48 h prior to embryo transfer. Results: The clinical pregnancy rate was 63.3% in the experimental arm and 47.8% in the control arm (p = 0.097 for Pearsonߣs χ2, and p = 0.133 for Fisher's exact test). However, the mean endometrial thickness on the day of embryo transfer did not appear to be statistically different (p = 0.139). Only the difference in endometrium thickness growth was statistically significant (p = 0.023). The increase in pregnancy rate is still encouraging for the future, even if it is not significant. Conclusion: Our study suggests the trend of increased pregnancy rate after the intrauterine G-CSF lavage in the interval of 120-48 h prior to embryo transfer.
- MeSH
- Oocyte Donation * methods MeSH
- Adult MeSH
- Granulocyte Colony-Stimulating Factor * therapeutic use MeSH
- Embryo Implantation * drug effects MeSH
- Cohort Studies MeSH
- Humans MeSH
- Embryo Transfer methods MeSH
- Pregnancy MeSH
- Pregnancy Rate MeSH
- Pregnancy Outcome * MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Pregnancy MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
Absolutní uterinní faktor infertility je podmíněn vrozenou nebo získanou absencí dělohy či přítomností nefunkční dělohy u žen, které se chtějí stát biologickými matkami. Osobní reprodukční zkušenost může dnes ženám bez dělohy poskytnout transplantace dělohy v kombinaci s metodami asistované reprodukce. V raném období výzkumu byla v zájmu minimalizace rizika předčasného porodu a dalších komplikací souvisejících s těhotenstvím doporučena k transplantaci pouze děloha od dárkyně s anamnézou jednoho až tří dokončených těhotenství. Ke snížení rizika předčasného porodu by se u příjemkyň dělohy mělo trvat spíše na jednočetném těhotenství než na darování dělohy od ženy s alespoň jedním porodem v anamnéze. Mírné zúžení v místě anastomózy vaginální manžety děložního štěpu a neovaginy příjemkyně jsme předpokládali, ale rozsah první vaginální stenózy časně po transplantaci dělohy byl přesto nepříjemným překvapením. Gynekolog by měl pro prevenci potransplantační vaginální striktury zhodnotit tvar a rozměry děložního čípku dárkyně, porovnat je s rozměry neovaginy a poševní klenby příjemkyně a provést anastomózu děložního hrdla k neovagině tak, aby byl zajištěn volný přístup k děložnímu hrdlu pro provedení cervikální biopsie kvůli kontrole rejekce štěpu a pro hladké zavedení katétru pro transfer embrya do děložní dutiny.
Absolute uterine factor infertility is conditioned by the congenital or acquired absence of the uterus or the presence of a nonfunctioning uterus in women who wish to become biological mothers. Uterine transplantation along with assisted reproductive techniques can provide this option for women without a uterus. In the early research period, to minimize the risk of preterm birth and other pregnancy-related complications, the uterus of a donor with a history of one to three successfully completed pregnancies was recommended for transplantation. We believe that insisting on a singleton pregnancy is necessary to reduce the risk of premature birth in uterus recipients, rather than insisting on donating a uterus from a woman with a history of at least one birth. Mild post-transplant narrowing of the vaginal-neovaginal anastomosis was expected; however, the first severe vaginal stricture revealed soon after transplantation was an unpleasant surprise. To prevent post-transplant vaginal stricture, gynecologic surgeons should evaluate the shape and size of the donor’s cervix, compare it with the size of the recipient’s neovagina and vaginal vault, and perform a vaginal-neovaginal anastomosis to ensure free access for post-transplant cervical biopsies to reveal signs of subclinical rejection and smooth insertion of the embryo transfer catheter into the uterine cavity.
- MeSH
- Humans MeSH
- Parity MeSH
- Premature Birth * etiology MeSH
- Embryo Transfer methods MeSH
- Reproductive Techniques MeSH
- Risk Factors MeSH
- Constriction, Pathologic etiology prevention & control MeSH
- Uterus * abnormalities transplantation MeSH
- Vagina surgery pathology MeSH
- Donor Selection methods MeSH
- Infertility, Female surgery etiology MeSH
- Check Tag
- Humans MeSH
- Keywords
- zygotic splitting,
- MeSH
- Twins, Monozygotic MeSH
- Fertilization in Vitro methods MeSH
- Gravidity MeSH
- Incidence MeSH
- Humans MeSH
- Embryo Transfer methods instrumentation MeSH
- Twinning, Monozygotic MeSH
- Pregnancy, Multiple * statistics & numerical data MeSH
- Check Tag
- Humans MeSH
- Female MeSH
- Publication type
- Review MeSH
STUDY QUESTION: Do embryologists from different European countries agree on embryo disposition decisions ('use' or 'discard') about Day 7 (>144 h post-insemination) and/or low-quality blastocysts (LQB;
- MeSH
- Aneuploidy MeSH
- Blastocyst * physiology MeSH
- Humans MeSH
- Embryo Transfer methods MeSH
- Retrospective Studies MeSH
- Artificial Intelligence * MeSH
- Maternal Age MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- MeSH
- Reproductive Techniques, Assisted * economics statistics & numerical data trends MeSH
- Fertilization in Vitro statistics & numerical data legislation & jurisprudence MeSH
- Cryopreservation statistics & numerical data MeSH
- Gestational Carriers legislation & jurisprudence MeSH
- Sperm Retrieval statistics & numerical data legislation & jurisprudence MeSH
- Preimplantation Diagnosis statistics & numerical data MeSH
- Embryo Transfer statistics & numerical data MeSH
- Pregnancy Reduction, Multifetal statistics & numerical data legislation & jurisprudence MeSH
- Universal Health Insurance standards MeSH
- Fetal Research ethics legislation & jurisprudence MeSH
- Geographicals
- Czech Republic MeSH
- Germany MeSH
- Austria MeSH
- MeSH
- Reproductive Techniques, Assisted * economics classification statistics & numerical data trends MeSH
- Donor Conception statistics & numerical data MeSH
- Fertilization in Vitro statistics & numerical data MeSH
- Fertility Clinics statistics & numerical data MeSH
- Humans MeSH
- Preimplantation Diagnosis statistics & numerical data MeSH
- Embryo Transfer statistics & numerical data MeSH
- Data Collection statistics & numerical data MeSH
- Maternal Age MeSH
- Check Tag
- Humans MeSH
- Female MeSH
The increased interest in assisted reproduction through in vitro fertilization (IVF) leads to an urgent need to identify biomarkers that reliably highly predict the success of pregnancy. Despite advances in diagnostics, treatment, and IVF approaches, the 30% success rate of IVF seems insurmountable. Idiopathic infertility does not have any explanation for IVF failure especially when a patient is treated with a healthy competitive embryo capable of implantation and development. Since appropriate intercellular communication is essential after embryo implantation, the emergence of the investigation of embryonic secretome including short non-coding RNA (sncRNA) molecules is crucial. That's why biomarker identification, sncRNAs secreted during the IVF process into the blastocyst's cultivation medium, by the implementation of artificial intelligence opens the door to a better understanding of the bidirectional communication between embryonic cells and the endometrium and so the success of the IVF. This study presents a set of promising new sncRNAs which are revealed to predictively distinguish a high-quality embryo, suitable for an embryo transfer in the IVF process, from a low-quality embryo with 86% accuracy. The identified exact combination of miRNAs/piRNAs as a non-invasively obtained biomarker for quality embryo determination, increasing the likelihood of implantation and the success of pregnancy after an embryo transfer.
Transplantace dělohy představuje nadějnou metodu kauzální léčby absolutního uterinního faktoru neplodnosti u žen s chybějící či reprodukčně nefunkční dělohou. Léčba sterility pomocí transplantace dělohy je stále v experimentální fázi a pravidla provádění jednotlivých kroků této složité metody nejsou dosud jednoznačně stanovena. Potenciální příjemkyně dělohy podstupuje před transplantací stimulaci ovarií a oplodnění cestou in vitro fertilizace. Takto získaná embrya se kryoprezervují a uskladňují. Transfer jednoho embrya se provádí v odstupu po transplantaci, kdy příjemkyně dělohy užívá pouze nefetotoxická imunosupresiva. V první studii transplantace dělohy ve Švédsku se embryotransfery začaly provádět v odstupu 12 měsíců od transplantace. Vzhledem k rostoucím zkušenostem zejména s časnými rejekcemi po transplantaci dělohy a průběhy těhotenství byl v několika probíhajících studiích experimentálně zkrácen interval mezi transplantací a prvním embryotransferem na 6 měsíců. Hlavním důvodem včasného zahájení embryotransferů po transplantaci dělohy je zkrácení celkové doby podávání imunosuprese. Bezpečnost kratšího než ročního intervalu mezi transplantací dělohy a prvním embryotransferem po transplantaci by však měla být dále studována.
Uterus transplantation seems to be a promising method for the causal treatment of absolute uterine factor infertility in women with an absent or non-functional uterus. Since uterus transplantation is still experimental in nature, there are no strict guidelines regarding each step of this comprehensive treatment method. Prior to uterus transplantation, ovarian stimulation and in vitro fertilization are performed on the potential uterus recipient, and the obtained embryos are cryopreserved and stored for the transfers after transplantation when only non-fetotoxic maintenance immunosuppressants are administered. In the first human uterus transplantation study, the start of embryo transfers was set at 12 months after transplantation. Due to the growing experience, especially with early rejections after transplantation and the course of pregnancy, several ongoing studies have experimentally shortened the uterus transplant-to-embryo transfer interval to 6 months. Shortening the total time of immunosuppression administration after uterus transplantation is the main reason for early initiation of embryo transfers after transplantation. However, the safety of an interval of less than one year between uterine transplantation and the first post-transplant embryo transfer should be further studied.
- MeSH
- Fertilization in Vitro MeSH
- Humans MeSH
- Embryo Transfer * MeSH
- Pregnancy MeSH
- Uterus * transplantation MeSH
- Infertility, Female therapy MeSH
- Check Tag
- Humans MeSH
- Pregnancy MeSH
- Publication type
- Review MeSH
