Blastocysts from partial compaction morulae are not defined by their early mistakes.

RESEARCH QUESTION: Is partial compaction during morula formation associated with an embryo's developmental ability and implantation potential? DESIGN: Retrospective analysis of data from 196 preimplantation genetic testing for aneuploidy (PGT-A) cycles. Embryos starting compaction were grouped according to the inclusion or not of all the blastomeres in the forming morula (full compaction or partial compaction). The possible effect of maternal age and ovarian response on compaction was analysed. Morphokinetic characteristics, blastocyst formation rate, morphology and cytogenetic constitution of the obtained blastocysts were compared. Comparisons of reproductive outcomes after the transfer of euploid blastocysts from both groups were established. Finally, in a subset of embryos, the chromosomal constitution concordance of the abandoned cells and the corresponding blastocyst through trophectoderm biopsies was assessed. RESULTS: A total of 430 embryos failed to include at least one cell during compaction (partial compaction group [49.3%]), whereas the 442 remaining embryos formed a fully compacted morula (full compaction group [50.7%]). Neither female age nor the number of oocytes collected affected the prevalence of partial compaction morulae. Morphokinetic parameters were altered in embryos from partial compaction morulae compared with full compaction. Although an impairment in blastocyst formation rate was observed in partial compaction morulae (57.2% versus 70.8%, P < 0.001), both chromosomal constitution (euploidy rate: partial compaction [38.4%] versus full compaction [34.2%]) and reproductive outcomes (live birth rate: partial compaction [51.9%] versus full compaction [46.2%]) of the obtained blastocysts were equivalent between groups. A high ploidy correlation of excluded cells-trophectoderm duos was observed. CONCLUSIONS: Partial compaction morulae show a reduced developmental ability compared with full compaction morulae. Resulting blastocysts from both groups, however, have similar euploidy rates and reproductive outcomes. Cell exclusion might be a consequence of a compromised embryo development regardless of the chromosomal constitution of the excluded cells.

Considerations for future modification of The Association for the Study of Reproductive Biology embryo grading system incorporating time-lapse observations.

The Association for the Study of Reproductive Biology (ASEBIR) Interest Group in Embryology (in Spanish 'Grupo de Interés de Embriología') reviewed key morphokinetic parameters to assess the contribution of time-lapse technology (TLT) to the ASEBIR grading system. Embryo grading based on morphological characteristics is the most widely used method in human assisted reproduction laboratories. The introduction and implementation of TLT has provided a large amount of information that can be used as a complementary tool for morphological embryo evaluation and selection. As part of IVF treatments, embryologists grade embryos to decide which embryos to transfer or freeze. At the present, the embryo grading system developed by ASEBIR does not consider dynamic events observed through TLT. Laboratories that are using TLT consider those parameters as complementary data for embryo selection. The aim of this review was to evaluate review time-specific morphological changes during embryo development that are not included in the ASEBIR scoring system, and to consider them as candidates to add to the scoring system.

Predicting the likelihood of live birth: an objective and user-friendly blastocyst grading system.

RESEARCH QUESTION: Can day-5 blastocysts be ranked according to their likelihood of live birth using an objective and user-friendly grading system? DESIGN: A retrospective multicentre study conducted between 2017 and 2019, including 1044 day-5 blastocysts. Blastocyst expansion degree, trophectoderm and inner cell mass quality were assessed morphologically and morphometrically. Several analyses were conducted: the association between the qualitative and quantitative assessment for the blastocyst expansion degree and the number of trophectoderm cells; the effect of the embryo quality on day 3 and the contribution of the three blastocyst parameters to live birth, with logistic regression; and a decision tree with the most significant variables to create the new scoring system. RESULTS: Cut-off points were found to discriminate between expanding and expanded blastocysts (165 µm for blastocyst diameter) and between trophectoderm grades (A: ≥14 cells; B: 11-13 cells; C: ≤10 cells). When the embryos reached the blastocyst stage, their quality on day 3 did not add predictive value for implantation and live birth. In the logistic regression analysis, the only parameter capable of significantly predicting the live birth likelihood was the trophectoderm grade: A versus C (OR 1.95, 95% CI 1.26 to 3.0); B versus C (OR 1.71, 95% CI 1.22 to 2.4). The decision tree supported the finding that the trophectoderm grade had the highest predictive value for a live birth, followed by the blastocyst expansion degree in a second step. CONCLUSIONS: This new method makes objective blastocyst assessment feasible, allowing for standardization and exportation to other laboratories worldwide.

Male and female blastocysts: any difference other than the sex?

RESEARCH QUESTION: Is there any imbalance in the sex ratio at the blastocyst stage of human embryos? And what is the sex ratio in euploid, transferred, implanted blastocysts and at birth? DESIGN: Embryos from 646 women undergoing 921 preimplantation genetic testing for aneuploidy (PGT-A) cycles from September 2017 to February 2020 were included. Data from the chromosomal constitution of 2637 biopsied blastocysts were retrospectively analysed. Trophectoderm samples were analysed by next-generation sequencing. Embryos were categorized as euploid, mosaic or aneuploid. A total of 548 blastocysts diagnosed as euploid were warmed and transferred in a subsequent single-embryo transfer cycle. RESULTS: The blastocyst sex ratio was skewed in favour of male sex with 53.1% (1401/2637) of blastocysts diagnosed as male and 46.9% (1236/2637) as female (sex ratio 1.13, 95% confidence interval [CI] 1.05-1.22). Following biopsy and PGT-A, 41.2% (1086/2637) of blastocysts were classified as euploid, 7.7% (202/2637) as mosaic and 51.2% (1349/2637) as aneuploid. More chromosome euploidy was observed among female than male blastocysts (adjusted odds ratio 1.29, 95% CI 1.08-1.55) after adjusting for female age, male age and gonadotrophin dose. Euploid blastocysts were comparable between the sexes (sex ratio 0.99, 95% CI 0.88-1.11). No significant differences were observed between the sexes in implantation (sex ratio 0.86, 95% CI 0.68-1.08), miscarriage (sex ratio 1, 95% CI 0.51-1.97) or live birth rate (sex ratio 0.85, 95% CI 0.66-1.08). CONCLUSIONS: More male than female embryos develop to the blastocyst stage. Male blastocysts exhibit a higher aneuploidy rate. The capacity to implant and lead to a live birth is similar between the sexes.

The effect of trophectoderm biopsy technique and sample handling on artefactual mosaicism.

PURPOSE: To determine whether embryo mosaicism prevalence in preimplantation genetic testing for aneuploidy (PGT-A) cycles is associated with the trophectoderm biopsy technique used (a. number of laser pulses or b. the use of flicking or pulling) or the time to tubing. METHODS: Prospective observational study performed in a single IVF-PGT-A setting from May 2019 to May 2021. Trophectoderm biopsies were analysed by next-generation sequencing. Mosaicism was analysed in relation to the biopsy methodology (number of laser pulses and pulling vs flicking), time elapsed from biopsy to tubing (min), and time of sample cryostorage from tubing to amplification (days). As a secondary objective, the number of laser pulses and biopsy methodology were studied in relation to clinical outcomes of transferred euploid blastocysts. RESULTS: None of the analysed variables were associated to mosaicism prevalence. Multivariable regression analysis demonstrated that mosaicism prevalence was comparable either when  > 3 laser pulses were used as compared to ≤ 3 (13.9% vs 13.8%, aOR = 0.8726 [0.60-1.28]) and pulling compared to flicking (13.1% vs 14.0%, aOR = 0.86 [0.60-1.23]). Moreover, neither the number of laser pulses during biopsy (> 3 vs ≤ 3) nor the technique used (pulling vs flicking) were associated with clinical pregnancy after the transfer of frozen-thawed euploid blastocysts (54.9% vs 55.2%, aOR = 1.05 [0.53-2.09]; 61.1% vs 52.9%, aOR = 1.11 [0.55-2.25], respectively). CONCLUSION: Our results suggest that, as long as the biopsy and tubing procedures are performed following standardized high quality procedures, no specific approach would increase the generation of artefactual mosaicism as a result of trophectoderm biopsy. Trophectoderm biopsies should be performed regardless of the methodology but always aiming on minimising blastocyst manipulation.

Morphokinetics and in vitro developmental potential of monopronucleated ICSI zygotes until the blastocyst stage.

The aim of this study was to provide a more comprehensive understanding of 1PN intracytoplasmic sperm injection (ICSI) zygotes. To achieve this objective, we assessed whether all 1PN-derived embryos showed a similar morphokinetic pattern, and if the morphokinetic behaviour of 1PN-derived embryos was comparable with that of 2PN-derived embryos. In total, 149 1PN ICSI zygotes (study group) and 195 2PN ICSI zygotes (control group) were included in the study. Embryo development potential was evaluated in terms of blastocyst rate. Morphokinetic parameters, including the pronucleus diameter and kinetics of in vitro development, were also analyzed. Embryos derived from 1PN ICSI zygotes showed impaired development compared with 2PN-derived embryos, with blastocyst rates of 28.9% and 67.2%, respectively. The diameter of the pronucleus of 1PN zygotes was larger than that of 2PN zygotes. When compared with 2PN-derived embryos, those derived from 1PN zygotes had a visible pronucleus for a shorter time, in addition to a longer syngamy time and slower kinetic behaviour from two to nine cells. When 1PN-derived blastocysts and 2PN-derived blastocysts were compared, the developmental kinetics were similar in both groups, except for a delayed and longer duration of the compaction phase in 1PN-derived embryos. In conclusion, monopronucleated ICSI zygotes present differences in developmental capacity and morphokinetic behaviour compared with 2PN ICSI zygotes, showing particular morphokinetic parameters related to pronucleus formation. Only the 1PN ICSI-derived embryos that reached the blastocyst stage have similar morphokinetic development to blastocysts from 2PN zygotes.

Deconstructing the myth of poor prognosis for fast-cleaving embryos on day 3. Is it time to change the consensus?

PURPOSE: To determine the developmental competence of fast-cleaving D3 embryos. METHODS: Retrospective study including 4028 embryos from 513 PGT-A cycles performed between July 2014 and June 2017. Embryos were cultured in time-lapse incubators and biopsied at blastocyst stage. Embryos were classified in groups according to the number of cells on D3 (from 2-cell to ≥13 -cell and compacted). A generalized linear mixed model adjusted for confounding factors was performed to assess the chance to give rise to an euploid blastocyst in each group compared with the chance of 8-cell embryos. Implantation and live birth rates were also analyzed. RESULTS: The statistical analysis showed that embryos with 9 to 11 cells had a slightly lower euploid blastocyst rate than 8-cell embryos (OR (95% CI) 0.77 (0.61-0.96)) while embryos with more than 11 cells were found to be just as likely to give rise to an euploid blastocyst as the 8-cell embryos (OR (95% CI) 1.20 (0.92-1.56)). Conversely, slow-cleaving embryos had a significantly lower euploid blastocyst rate than 8-cell embryos (OR (95% CI) 0.31 (0.24-0.39)). Moreover, euploid blastocysts derived from fast-cleaving embryos and from 8-cell embryos exhibit similar live birth rates. No significant differences were found in the chance to give rise a live birth between 8-cell and 9- to 11-cell embryos (OR (95% CI) 1.23 (0.70-2.15)) and > 11-cell embryos (OR (95% CI) 1.09 (0.57-2.09)). CONCLUSIONS: Embryos with more than 11 cells exhibit similar developmental competence to 8-cell embryos. Their poor prognosis should be reconsidered.

Selecting embryos with the highest implantation potential using data mining and decision tree based on classical embryo morphology and morphokinetics.

PURPOSE: The objective of this work was to determine which embryonic morphokinetic parameters up to D3 of in vitro development have predictive value for implantation for the selection of embryos for transfer in clinical practice based upon information generated from embryo transfers with known implantation data (KID). METHODS: A total of 800 KID embryos (100% implantation rate (IR) per transfer and 0% IR per transfer) cultured in an incubator with Time-Lapse system were retrospectively analysed. Of them, 140 embryos implanted, whereas 660 did not. RESULTS: The analysis of morphokinetic parameters, together with the embryo morphology assessment on D3, enabled us to develop a hierarchical model that places the classical morphological score, the t4 and t8 morphokinetic values, as the variables with the best prognosis of implantation. CONCLUSION: In our decision tree, the classical morphological score is the most predictive parameter. Among embryos with better morphological scores, morphokinetics permits deselection of embryos with the lowest implantation potential.

Utilización de plasma rico en plaquetas en la profilaxis del daño cutáneo inducido por radioterapia: modelo experimental / Use of platelet rich plasma as prophylactic method for skin damage after radiotherapy: experimental study

Introducción y Objetivos. La radioterapia conlleva la aparición de complicaciones cutáneas que afectan a la calidad de vida del paciente y en algunos casos condicionan la reconstrucción. El plasma rico en plaquetas (PRP) es una terapia emergente; se trata de una sustancia autóloga, biocompatible, segura y económica. Está descrito su uso en disminución de la inflamación local, de los tiempos de curación de las heridas, en el tratamiento de lesiones por radioterapia y últimamente en el campo de la Medicina Estética mejorando la calidad de la piel. Nuestro estudio analiza el uso del PRP en la profilaxis de las lesiones cutáneas inducidas por radioterapia evaluando un modelo experimental. Material y Métodos. Realizamos un ensayo clínico controlado, doble ciego, en animales: 12 ratas Wistar, 2 para la obtención del PRP y 10 para el análisis clínico e histológico. Resultados. Del análisis clínico destacamos que de los sectores sin PRP previo a la radioterapia: 8 ratas presentaron alopecia y 7 hipopigmentación. La alopecia fue total en un 60%, parcial en 20% y un 20% no presentó alopecia. En los sectores con PRP: 4 presentaron alopecia y 3 hipopigmentación. La alopecia fue parcial en un 40%, un 60% no presentó alopecia y no hubo casos de alopecia total. Los resultados del análisis histológico demostraron un 100% de atrofia leve-moderada para los sectores con PRP. Por contrapartida, los sectores sin PRP presentaron 80% de atrofia moderada-severa y un 20% de atrofia leve-moderada. Conclusiones. Existe un beneficio en el uso del PRP como profilaxis de la alopecia (p<0.05) e hipopigmentación (p<0.1) inducido por radioterapia en un modelo experimental (AU)

Background and Objectives. Radiotherapy is usually associated with skin complications that affect the quality of life of patients and in some cases can also affect the timing of the reconstruction. The plateletrich plasma (PRP) is an emerging therapy; is autologous, safe and economic. Current use of PRP includes: efficacy in decreasing local inflammation, enhance wound healing, treatment of skin ulcers caused by radiotherapy and its use extends to the field of aesthetic plastic surgery improving the quality of the skin. The authors made an experimental trial to analyze the use of PRP as a prophylaxis method for skin damage after radiotherapy. We analyze the benefits of PRP as a prophylaxis method for skin damage after radiotherapy using an experimental model. Methods. We conduct a double blind trial with rats. Twelve Wistar rats were used, 2 for obtaining the PRP and 10 for clinical and histological analysis. Results. Data collected from the clinical analysis showed that those areas without PRP: 8 rats presented alopecia and 7 hypopigmentation. Total alopecia was present in 60%, partial alopecia in 20%, and 20% did not present alopecia. In those areas with PRP before radiotherapy: 4 presented alopecia and 3 hypopigmentation. There were no cases of total alopecia, 60% did not present alopecia and 40% presented partial alopecia. Data collected from the histological analysis showed 100% of mild-moderate atrophy in those areas with PRP. On the other hand, 80% of moderate-severe atrophy and 20% of mildmoderate atrophy was present on those areas without PRP. Conclusions. The authors showed the benefit of PRP as a prophylaxis method for alopecia (p<0.05) and hypopigmentation (p<0,1) produced after radiotherapy in this experimental model (AU)

Does culture medium influence offspring birth weight?

OBJECTIVE: To determine whether the type of medium used to culture human embryos in vitro influences neonatal birth weight after IVF/intracytoplasmic sperm injection (ICSI). DESIGN: A prospective study and a retrospective study. SETTING: Private assisted reproduction center. PATIENT(S): The prospective study included 449 IVF/ICSI cycles from August to December 2008. The retrospective analysis was performed for 2,518 IVF/ICSI cycles from October 2006 to December 2010. INTERVENTION(S): In the prospective study, patients were randomized for embryo culture in Cook or Vitrolife medium. The retrospective study was performed with three different culture media (MediCult, Cook, and Vitrolife). MAIN OUTCOME MEASURE(S): Mean birth weight, adjusted for gestational age and gender (z score) of newborns. RESULT(S): In the prospective study, the average z score was -0.19 ± 0.85 in Cook and 0.08 ± 1.40 in Vitrolife. In the retrospective study, the z scores obtained in each group were as follows: Cook, -0.14 ± 0.96; MediCult, 0.06 ± 1.13; and Vitrolife, 0.03 ± 1.05. No significant differences were observed regarding the birth weight of children born in the different groups in both studies. CONCLUSION(S): The results do not show any relationship between the medium used for in vitro culture and mean birth weight adjusted for gestational age and gender of singletons born after IVF/ICSI.

Endometriosis and IVF: are agonists really better? Analysis of 1180 cycles with the propensity score matching.

OBJECTIVE: To compare the outcomes of patients with confirmed endometriosis undergoing in vitro fertilization (IVF)-embryo transfer (ET) treated with either gonadotropin-releasing hormone agonist (GnRHa) or gonadotropin-releasing hormone antagonist (GnRHant) using the propensity score (PS) matching. DESIGN: Observational, retrospective analysis from January 2000 to December 2010. SETTING: Private tertiary fertility clinic. PATIENT(S): Patients with endometriosis confirmed by ultrasound or surgery (American Fertility Society; AFS grades I-IV) that underwent an IVF-ET, stimulated with standard controlled ovarian hyperstimulation (COH) and GnRHa or GnRHant. INTERVENTION(S): A PS was assigned to all patients, which calculates the conditional probability of receiving a certain treatment; a higher PS (1) meant a higher probability of receiving treatment with GnRHa, and a lower PS (0) meant a higher probability of receiving GnRHant. The PS was calculated with a logistic regression model adjusted specifically for age, follicle stimulating hormone, antral follicle count and previous IVF cycles. All patients were divided into three groups according to their PS. MAIN OUTCOME MEASURE(S): pregnancy rate (PR) per cycle. RESULTS: 1180 patients were analyzed. Raw PR per cycle was 41.8% and 23.4%, and PR per ET was 44.3 and 27%, respectively. PR per cycle: 41.9 versus 30% in group A; in group B, 39.7% versus 36.4% and in group C, 15.4% versus 18.9%. The overall odds ratio for PR adjusted by PS was 1.10 [0.58-2.19]. CONCLUSIONS: After matching patients by PS, PR after COH with either GnRHa or GnRHant may be equally effective.

Causas de invalidantes laborales en el personal de enfermería / Causes of working disability in the nursing personnel

El estudio de las enfermedades relacionadas con las profesiones es una actividad que se inicia en años recientes. La profesión de enfermería no está excluida de favorecer la aparición de procesos patológicos si no se tienen en cuenta ciertas medidas de prevención, además de la protección con que cuenta todo trabajador en Cuba. Se realizó un estudio descriptivo retrospectivo de los 479 certificados médicos expedidos a enfermeros en los años 2002-2003 en el hospital "Amalia Simoni" y que constituyeron la totalidad de los certificados expedidos en este período. El objetivo del estudio fue identificar las causas de invalidantes laborales y proponer una estrategia de intervención para lograr una mayor calidad en la salud del trabajador de enfermería. En el año 2003 el número de certificados médicos presentados, 248 (52(por ciento), fue discretamente mayor que los de 2002. Predominó el grupo de afecciones del sistema osteomioarticular en 151 pacientes (31,5(por ciento) y dentro de este grupo, fueron mayoritarias las sacrolumbalgias en 45 pacientes (29,8(por ciento). Los enfermeros más afectados fueron los asistenciales y el servicio de medicina, el que más certificados médicos presentó. Los datos se obtuvieron del libro registro de certificados médicos de la vicedirección de enfermería. Se propone una estrategia de intervención que se basa en la aplicación, evaluación y control de un programa de clases sobre mecánica corporal para el mejoramiento de los problemas de salud que pudieran estar vinculados con el ejercicio de la profesión de enfermería(AU)

Causas de invalidantes laborales en el personal de enfermería / Causes of working disability in the nursing personnel

El estudio de las enfermedades relacionadas con las profesiones es una actividad que se inicia en años recientes. La profesión de enfermería no está excluida de favorecer la aparición de procesos patológicos si no se tienen en cuenta ciertas medidas de prevención, además de la protección con que cuenta todo trabajador en Cuba. Se realizó un estudio descriptivo retrospectivo de los 479 certificados médicos expedidos a enfermeros en los años 2002-2003 en el hospital Amalia Simoni y que constituyeron la totalidad de los certificados expedidos en este período. El objetivo del estudio fue identificar las causas de invalidantes laborales y proponer una estrategia de intervención para lograr una mayor calidad en la salud del trabajador de enfermería. En el año 2003 el número de certificados médicos presentados, 248 (52 por ciento), fue discretamente mayor que los de 2002. Predominó el grupo de afecciones del sistema osteomioarticular en 151 pacientes (31,5 por ciento) y dentro de este grupo, fueron mayoritarias las sacrolumbalgias en 45 pacientes (29,8 por ciento). Los enfermeros más afectados fueron los asistenciales y el servicio de medicina, el que más certificados médicos presentó. Los datos se obtuvieron del libro registro de certificados médicos de la vicedirección de enfermería. Se propone una estrategia de intervención que se basa en la aplicación, evaluación y control de un programa de clases sobre mecánica corporal para el mejoramiento de los problemas de salud que pudieran estar vinculados con el ejercicio de la profesión de enfermería(AU)

The study of the illnesses related with the professions is an activity that begins in recent years. The infirmary profession is not excluded of favoring the appearance of pathological processes if they are not kept in mind certain measures of prevention, besides the protection with which all worker counts in Cuba. He/she was carried out a retrospective descriptive study of the 479 medical certificates sent male nurses in the years 2002-2003 in the hospital Amalia Simoni and that they constituted the entirety of the certificates sent in this period. The objective of the study was to identify the causes of labor invalidantes and to propose an intervention strategy to achieve a bigger quality in the infirmary worker's health. In the year 2003 the number of presented medical certificates, 248 (52 percent), it was discreetly bigger than those of 2002. The group of affections of the system osteomioarticular prevailed in 151 patients (31,5 percent) and inside this group, they were majority the sacrolumbalgias in 45 patients (29,8 percent). The affected male nurses were the assistance ones and the medicine service, the one that more certified doctors presented. The data were obtained of the book registration of medical certificates of the infirmary vicedirección. He/she intends an intervention strategy that is based on the application, evaluation and control of a program of classes on corporal mechanics for the improvement of the problems of health that you/they could be linked with the exercise of the infirmary profession(AU)

Un inventario para medir calidad de vida familiar / An inventory to measure quality of familiar life

El objetivo de este estudio fue construir un inventario para la medición de la calidad de vida familiar en la población chilena. El "universo de conocimiento" fue definido como "un conjunto de propuestas teóricas para la medición de calidad de vida seleccionadas por ser paradigmáticas en este campo". Este conjunto de contenidos fue complementado por los resultados de un panel Delphi que representó una estimación del consenso local respecto de la medición de la calidad de vida familiar. En la primera parte del estudio se derivó un conjunto de descriptores a partir del universo de conocimiento elegido y la estimación hecha con el panel Delphi local. Este conjunto fue transformado en una lista de indicadores de inventario para autoinforme; la validez de constructo de este inventario preliminar fue asegurada por el consenso entre el universo de conocimiento y el panel local. La forma final del inventario incluye escalas y puntajes para cada indicador.

Evaluation of senior citizens' satisfaction in primary health centres as assessment of the academic model.

CONTEXT: Satisfaction is nowadays a valid measure of quality of care. Senior citizens are increasing in Chile and their treatment in primary care clinics, as well as the education of new professionals must take into consideration their special characteristics. GOAL: Our intention was to investigate the degree of satisfaction senior citizens had with their health service and to identify those aspects able to be modified at the Medical Faculty in order to improve education of health professionals. APPROACH: Three hundred elderly attending Primary Care Outpatient Clinics of the city of Temuco, Chile, were interviewed using a satisfaction questionnaire developed by the Medical Outcomes Study carried out in USA. FINDINGS: Senior citizens experience a high level on dissatisfaction with the health care they receive at the primary level. Doctors and nurses had a high qualification in relation to their technical skills, but a lower score if considering the education and information they give to patients. These results shall be used in order to modify attention to senior citizens as well as to include problems related to this group in the curricular reform plan and to improve attitudes of nursing and medical students.