The prolonged lockdown of health facilities providing non‐urgent gamete cryopreservation—as currently recommended by many reproductive medicine entities and regulatory authorities due to the SARS‐CoV‐2 pandemic will be detrimental for subgroups of male infertility patients. We believe the existing recommendations should be promptly modified and propose that the same permissive approach for sperm banking granted for men with cancer is expanded to other groups of vulnerable patients. These groups include infertility patients (eg, azoospermic and cryptozoospermic) undergoing medical or surgical treatment to improve sperm quantity and quality, as well as males of reproductive age affected by inflammatory and systemic auto‐immune diseases who are about to start treatment with gonadotoxic drugs or who are under remission. In both scenarios, the “fertility window” may be transitory; postponing diagnostic semen analysis and sperm banking in these men could compromise the prospects of biological parenthood. Moreover, we provide recommendations on how to continue the provision of andrological services in a considered manner and a safe environment. Our opinion is timely and relevant given the fact that fertility services are currently rated as of low priority in most countries.
Purpose: To report the utilization of diagnostic intracytoplasmic sperm injection (D-ICSI), an ICSI cycle performed in the natural cycle, to obtain information about embryo development potential after sperm injection into zona pellucida (ZP)-free oocytes. Materials and Methods: We report the case of a couple with primary unexplained infertility with a history of previous failed, in vitro fertilization intracytoplasmic sperm injection (IVF-ICSI) cycles characterized by the presence of ZP-free oocytes. Whole exome sequencing (WES) was carried out to analyse the possible genetic basis of oocyte abnormality. Results: Diagnostic ICSI provided information about the embryo development potential from ZP-free oocytes and allowed better planning of the subsequent ICSI cycle. WES revealed that the absence of ZP was likely to be due to a new (ZP1) mutation. The subsequent ICSI cycle resulted in the delivery of a healthy baby. Discussion: To the best of our knowledge, our report is the first to describe the use of D-ICSI to determine the feasibility of embryo development and implantation in a patient with ZP1 mutation, resulting in the subsequent delivery of a healthy baby. We used ‘diagnostic’ ICSI in the normal menstrual cycle to explore the feasibility of embryo development after sperm injection into ZP-free oocytes. Our results may expand the spectrum of diagnostic procedures associated with unexplained infertility.
Summary The aim of this study was to assess mitochondrial DNA analysis as a predictor of the pregnancy potential of biopsied preimplantation embryos. The study included 78 blastomeres biopsied from day 4 cleavage stage euploid embryos. The embryo karyotype was confirmed by 24-chromosome preimplantation genetic testing for aneuploidies using the Illumina Next-Generation Sequencing (NGS) system. Mitochondria viability ratios (mtV) were determined from BAM files subjected to the web-based genome-analysis tool Galaxy. From this cohort of patients, 30.4% of patients (n = 34) failed to establish pregnancy. The mean mtV ratio [mean = 1.51 ± 1.25–1.77 (95% CI)] for this group was significantly (P < 0.01) lower compared with the embryo population that resulted in established pregnancies [mean = 2.5 ± 1.82–2.68 (95% CI)]. mtV multiple of mean (MoM) values were similarly significantly (P < 0.01) lower in blastocysts failing to establish pregnancy. At a 0.5 MoM cut-off, the sensitivity of mtV quantitation was 35.3% and specificity was 78.2%. The positive predictive value for an mtV value > 0.5 MoM was 41.4%. This study demonstrates the clinical utility of preimplantation quantification of viable mitochondrial DNA in biopsied blastomeres as a prognosticator of pregnancy potential.
Mono media is a single formulation. Mono formulations require less manipulation and are less expensive. Both formulations have attained good outcomes, but an adequately powered assessment including usable blastulation rates (USBR), ploidy risk, and SIR is lacking.DESIGN: Paired RCT. MATERIALS AND METHODS: Patients with normal ovarian reserve were recruited. A paired design allowed each patient to serve as their own control, eliminating many confounding variables seen in prior studies. After confirming fertilization, patients' zygotes were randomized (1:1 ratio) to either Seq media (Quinn's Advantage Cleavage Medium, Sage then Blast Assist, Origio) or Mono media (Continuous Single Culture; Irvine Scientific). Each culture system used separate incubators. Assessed endpoints for all embryos included USBR, blastulation timing (arrest vs day 5 vs 6) and ploidy status. Paired euploid blastocyst transfers, one from each group, were performed. DNA fingerprinting of concepti was used as needed to link each embryo to a definitive outcome. SIR was defined as the presence of a fetal heart beat at 8-9 weeks gestation. Statistical analysis performed via McNemar's Chi Square and Wilcoxon sum rank tests.RESULTS: 186 patients had their 2PN embryos (N¼2257) randomized to each culture system. Seq media had a higher blastulation rate then Mono media (p¼0.001, 55.5% vs. 46.0%). No differences were found in the day of blastulation (p¼0.4063) or in the aneuploidy rate (p¼0.5518). Of the 168 patients who had euploid blastocysts suitable for transfer, 126 completed a paired embryo transfer and 42 had a SET. Amongst the SETs, the SIR was equivalent (p¼1.0). Of the 126 double embryo transfers, 36 patients had one fetal heart beat at discharge, however there was no statistical difference in the likelihood of implantation between groups (p¼0.8642).CONCLUSIONS: This is the first randomized controlled trial to systematically examine paired euploid transfers of sibling zygotes cultured in in Seq vs. Mono media. This study demonstrates that the usable blastocyst rate is greatest after culture in Seq media in comparison to a Mono formulation; however no difference exists in SIR.Supported by: Irvine scientific provided Mono media.
Study question Is mitochondrial DNA viability ratio of day–4 biopsied embryos associated with embryo implantation potential? Summary answer The mitochondrial DNA viability ratio is significantly higher in embryos that implant. The score might help to select euploid embryos for single embryo transfer. What is known already Embryo euploidy is a critical factor for successful pregnancy outcomes. However, transfer of euploid embryos does not invariably result in implantation, thus indicating that other factors may play a role. Metabolic rates and adenosine triphosphate content vary significantly in oocytes and embryos and might affect embryo viability. Embryo function, indirectly measured by mitochondrial DNA viability ratio (mtV) has emerged as a potential quantitative biomarker for embryonic selection before the transfer, but clinical data remains limited. The purpose of this study is to characterize and compare mtV in euploidy day 4 embryos. Study design, size, duration Retrospective cohort study carried out between Jan. 2017 to Jan. 2020, involving 75 infertile couples undergoing IVF-ICSI with PGT-A and single embryo transfer (SET) of day 4 euploid embryos. Participants/materials, setting, methods We compared the mtV ratios of 34 non-pregnant patients with those of 41 patients who achieved clinical pregnancy after SET. The mtV ratio was obtained from a cohort of 75 euploidy embryos. The embryos were biopsied 80–85 hours post–ICSI and subjected to next-generation sequencing (NGS). The mtV was determined using Multiple of Mean (MoM) values, obtained by dividing the mtV ratio of individual embryos by the mean mtV value of all implanted embryos. Main results and the role of chance The mean mtV ratio (1.51; 95% confidence interval [CI] 1.25–1.77) of non-pregnant patients was significantly lower than those of pregnancy counterparts (2.5; 95% CI 1.82–2.68; p < 0.01). At a 0.5 MoM cutoff, the sensitivity and specificity of mtV ratio to discriminate between implanted embryos versus non-implanted embryos were 35.3% and 78.2%, respectively., with a positive predictive value (PPV) of 41.4%. Limitations, reasons for caution Our study is limited by the small sample size and lack of stratification by causes of female/male infertility. Endometrial receptivity issues, which could have contributed to implantation failure, was not evaluated. Wider implications of the findings: Assessment of mtV ratio could provide additional prognostic information for selecting euploid embryos for transfer in SET programs. Further research is warranted to establish the clinical utility of routine application of mtV evaluation in PGT programs. Trial registration number N/A
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.