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23 results

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  • Reproductive outcomes with delayed blastocyst development: the clinical value of day 7 euploid blastocysts in frozen embryo transfer cycles

  • Andrea Abdala, Ibrahim Elkhatib, Aşina Bayram, Ahmed El-Damen, Laura Melado, Daniela Nogueira, Barbara Lawrenz, Human M. Fatemi
  • Journal:
    Zygote / Volume 31 / Issue 6 / December 2023
    Published online by Cambridge University Press:
    13 November 2023, pp. 588-595

  • Embryos of optimal development reach blastocyst stage 116 ± 2 h after insemination. Usable D7 blastocysts represent nearly 5% of embryos in IVF with acceptable pregnancy and live birth rates, however data are still limited. Therefore, this study aimed to analyze the ongoing pregnancy rate (OPR) of D7 blastocysts in single euploid frozen embryo transfer (FET) cycles. An observational study was performed including 1527 FET cycles with blastocysts biopsied on D5 (N = 855), D6 (N = 636) and D7 (N = 36). Blastocysts were classified as good (AA/AB/BA), fair (BB) or poor (AC/BC/CC/CA/CB) (Gardner scoring). FETs were performed in natural cycles (NC) or hormone replacement therapy (HRT) cycles. Patient’s age differed significantly between D5, D6 and D7 blastocysts FET cycles (33.2 ± 5.6, 34.4 ± 5.3 and 35.9 ± 5.2, P < 0.001). OPRs were higher when D5 euploid blastocysts were transferred compared with D6 and D7 (56.0% vs. 45.3% and 11.1%, P < 0.001). Poor quality blastocysts were predominant in D7 blastocyst FET cycles (good quality: 35.4%, 27.2%, 5.6%; fair quality: 52.1%, 38.5%, 11.1%; poor quality: 12.5%, 34.3%, 83.3%, P < 0.001 for D5, D6 and D7 blastocysts; respectively). OPR was significantly reduced by D7 blastocyst FETs (OR = 0.23 [0.08;0.62], P = 0.004), patient’s BMI (OR = 0.96 [0.94;0.98], P < 0.001), HRT cycles (OR = 0.70 [0.56;0.88], P = 0.002) and poor quality blastocysts (OR = 0.33 [0.24;0.45], P < 0.001). OPR is significantly reduced with D7 compared with D5/D6 euploid blastocysts in FET cycles. The older the patient, the more likely they are to have an FET cycle with blastocysts biopsied on D7, therefore culturing embryos until D7 can be a strategy to increase OPR outcomes in patients ≥38 years.

  • Chapter 9 - Preparation for Optimal Endometrial Receptivity in Cryo Cycles

  • Edited by Human M. Fatemi, Barbara Lawrenz
  • Book:
    Individualized In-Vitro Fertilization
    Published online:
    12 February 2021
    Print publication:
    04 March 2021, pp 112-120

  • Summary

    Despite the various advances and increasing success rates of assisted conception treatment in recent years, implantation continues to be a rate limiting step (). The first successful IVF treatment performed by the pioneers Patrick Steptoe and Robert Edwards which led to the birth of Louise Joy Brown in 1978, was achieved in a fresh embryo transfer cycle. The subsequent implementation of cryopreservation techniques in the IVF laboratory facilitated the cryopreservation and storage of supernumerary embryos which were not chosen for a fresh transfer. Laboratory techniques have improved significantly over the years and due to the improved survival rates of cryopreserved oocytes, cleavage and blastocyst-stage embryos, cryopreservation of gametes and embryos has become part of everyday routine clinical practice ().

  • Chapter 1 - Individualized Ovarian Stimulation for Normal and High Responders

  • Edited by Human M. Fatemi, Barbara Lawrenz
  • Book:
    Individualized In-Vitro Fertilization
    Published online:
    12 February 2021
    Print publication:
    04 March 2021, pp 1-13

  • Summary

    Despite the notion that the first baby, Louise Brown, was born in 1978 following IVF performed in a natural menstrual cycle, ovarian stimulation became the golden standard of care in clinical IVF, since the number of oocytes retrieved is directly associated with pregnancy and life birth rates (, ). The aim should be to titrate the stimulation in such a way that the optimal number of follicles develops. Too few follicles (also referred to as low response) usually means poor IVF outcome, whereas too many developing follicles induce a risk for developing OHSS and possibly reduce the chance of success with increasing number of oocytes, if stimulation is not adjusted toward the end of the follicular phase (, ).

  • Chapter 4 - Individualized Luteal Phase Support

  • Edited by Human M. Fatemi, Barbara Lawrenz
  • Book:
    Individualized In-Vitro Fertilization
    Published online:
    12 February 2021
    Print publication:
    04 March 2021, pp 39-49

  • Summary

    In ovarian stimulation cycles for IVF/ICSI, a defective luteal phase occurs in almost all patients as a result of the multifollicular development and supraphysiological hormonal levels, which inhibit the LH secretion by the pituitary via negative feedback actions at the level of the hypothalamic-pituitary axis. Progesterone is crucial to induce secretory transformation of the endometrium after previous estrogenization, a process which will finally result in a receptive endometrium. Consequently, luteal phase support (LPS) represents an essential part of ART treatment in case of a planned fresh embryo transfer, as it is crucial to counterbalance the luteal phase insufficiency.

Individualized In-Vitro Fertilization
  • Delivering Precision Fertility Treatment
  • Edited by Human M. Fatemi, Barbara Lawrenz
  • Published online:
    12 February 2021
    Print publication:
    04 March 2021
  • The increasing understanding of individual differences in response to in-vitro fertilization (IVF) treatment, resulting from genetic and ethnical differences, has increased the potential for individualized treatment for patients, resulting in improved pregnancy and live-birth outcomes. This illustrated book summarizes, and provides updates on, the most recent developments in individualized infertility treatment and embryo selection techniques. Individualization is not only confined to the different steps in the ovarian stimulation process and the luteal phase support, but also to embryo selection techniques, which include, among others, the analysis of embryo development pattern and genetic testing. Chapters cover a multitude of topics, ranging from oocyte maturation and immunological testing to fertilization technique in the IVF laboratory and preparation for optimal endometrial receptivity in cryo cycles. Essential reading for IVF specialists and embryologists in IVF Clinics and also an important text for medical consultants specializing in reproductive medicine, gynecology and embryology.

Case Studies in Assisted Reproduction
  • Common and Uncommon Presentations
  • Edited by Nick S. Macklon, Human M. Fatemi, Robert J. Norman, Pasquale Patrizio
  • Published online:
    05 February 2015
    Print publication:
    22 January 2015
  • Clinical case studies have long been recognized as a useful adjunct to problem-based learning and continuing professional development. They emphasize the need for clinical reasoning, integrative thinking, problem-solving, communication, teamwork and self-directed learning - all desirable generic skills for health care professionals. This volume contains a selection of cases on assisted reproduction that will inform and challenge reproductive medicine practitioners at all stages in their careers. Both common and uncommon cases are included. The aim is to reinforce diagnostic skill through careful analysis of individual presenting patterns, and to guide treatment decisions. Each case consists of a clinical history, examination findings and special investigations, before a diagnosis is made. Clinical issues raised by each case are discussed and major teaching points emphasized. Selective references are provided. The book provides a useful complementary adjunct to existing textbooks of reproductive medicine, and an excellent resource for teaching and continuing professional development.

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