Performance of Day 5 KIDScore™ morphokinetic prediction models of implantation and live birth after single blastocyst transfer.

PURPOSE: While several studies reported the association between morphokinetic parameters and implantation, few predictive models were developed to predict implantation after day 5 embryo transfer, generally without external validation. The objective of this study was to evaluate the respective performance of 2 commercially available morphokinetic-based models (KIDScore™ Day 5 versions 1 and 2) for the prediction of implantation and live birth after day 5 single blastocyst transfer. METHODS: This monocentric retrospective study was conducted on 210 ICSI cycles with single day 5 embryo transfer performed with a time-lapse imaging (TLI) system between 2013 and 2016. The association between both KIDScore™ and the observed implantation and live birth rates was calculated, as well as the agreement between embryologist's choice for transfer and embryo ranking by the models. RESULTS: Implantation and live birth rate were both 35.7%. A significant positive correlation was found between both models and implantation rate (r = 0.96 and r = 0.90, p = 0.01) respectively. Both models had statistically significant but limited predictive power for implantation (AUC 0.60). There was a fair agreement between the embryologists' choice and both models (78% and 61% respectively), with minor differences in case of discrepancies. CONCLUSIONS: KIDScore™ Day 5 predictive models are significantly associated with implantation rates after day 5 single blastocyst transfer. However, their predictive performance remains perfectible. The use of these predictive models holds promises as decision-making tools to help the embryologist select the best embryo, ultimately facilitating the implementation of SET policy. However, embryologists' expertise remains absolutely necessary to make the final decision.

Attitude towards reciprocity as a motive for oocyte donation.

OBJECTIVE: Finding out whether patients would be motivated by reciprocity when considering donating oocytes to others. STUDY DESIGN: This is a prospective monocentric study in the CECOS of the Centre Hospitalier Universitaire (CHU) of Rennes (France) on the opinion of patients regarding reciprocity. Couples who had a child with donor sperm were asked whether they would consider oocyte donation as a way of giving something back. RESULTS: Twenty six couples and one man answered the questionnaire. About half of the respondents (49%) felt that they should contribute to the system from which they benefitted. Although the patients would benefit from a reduction in waiting time, this advantage was only important for one in four persons. The only items on which the answers between men and women were significantly different concerned the results of the donation: women would think more often about the potential recipient and the child and they more often wanted to know whether children were born from their donation. CONCLUSION: The results show that beside altruism, reciprocity may be an important moral reason for people to donate gametes.

Association between early ßhCG kinetics, blastocyst morphology and pregnancy outcome in a single-blastocyst transfer program.

OBJECTIVE(S): Beta human chorionic gonadotrophin (ß-hCG) is secreted by placenta and detectable in maternal serum a few days after embryo implantation. The evolution of ß-hCG serum levels is commonly used to confirm early pregnancy and differentiate normal pregnancies from others, either in spontaneous pregnancies or after IVF. However, little is known on the eventual link between blastocyst quality in IVF, pregnancy outcome, and ßhCG kinetics. The objective was to evaluate the association between early ßhCG rise, blastocyst morphology and pregnancy evolution in a single-blastocyst transfer program STUDY DESIGN: This retrospective cohort study was conducted in a University-affiliated IVF center in 441 couples undergoing 455 single blastocyst transfer cycles leading to a positive pregnancy test 12 days afterwards. The rate of rise of ß-hCG (ß-hCG kinetics) was calculated in each cycle and its association with blastocyst quality and pregnancy clinical outcome was evaluated. RESULTS: ß-hCG kinetics was significantly different according to blastocyst expansion, but with considerable overlap between groups. ß-hCG kinetics was also significantly different according to clinical outcome, with higher values in clinical pregnancies than in other groups. This remained true in subgroups' analysis according to blastocyst expansion and in top quality blastocysts. CONCLUSION(S): Early ß-hCG kinetics after single-blastocyst transfer is different according to pregnancy outcome and is only slightly influenced by blastocyst quality. These results confirm the interest of ß-hCG follow up in IVF pregnancies, and do not support the interest of building blastocyst-specific ß-hCG ranges in IVF cycles.

Clinical and biological specificity of beta-thalassemia intermedia: a case report.

We report the case of a nine-year-old girl, of Moroccan origin, hospitalised for fever and stomach ache. The clinical and biological investigations showed merely a moderate enlargement of the spleen associated with discrete regenerative hemolytic anemia. The etiologic analysis of the hemolysis was completed by the electrophoresis of hemoglobin (Hb) that revealed total absence of HbA, with the presence of 98.7% of HbF and 1.3% of HbA2. These results led to a diagnosis of ß0 thalassemia associated with an intermediate phenotype, i.e. beta thalassemia intermedia (BTI). The molecular study of the ß-globin gene evidenced a homozygous mutation at codon 35 of the exon 2 TAC>TAA (HBB: c.108C>A) leading to the premature stop codon. The study of several polymorphisms involved in the regulation of the expression of HbF concords with the intermediate phenotype found in the patient. This observation offers an opportunity to redefine BTI and further explore its clinical and genetic specificity.

[Acquired Pelger-Huët anomaly/abnormal chromatin clumping of granulocytes after allogeneic hematopoietic stem cell transplantation for acute myeloid leukaemia: medication or relapse? ]. / Anomalie de Pelger-Huët acquise/condensation anormale de la chromatine des granulocytes après allogreffe médullaire pour leucémie aiguë myéloïde : iatrogène ou signe de rechute ?

An acute myeloid leukemia was diagnosed in a 53-year-old female patient. She received an allogeneic stem cell transplant. After this transplant, some neutrophils with hyposegmented nucleus and abnormal chromatin clumping appeared in the peripheral blood, and their number gradually increased. The hypothesis of early relapse after transplant was ruled out and drug-related anomaly was suspected. The authors discuss about morphological features of constitutional and acquired Pelger-Huët anomaly. In the patient reported here, ciclosporine seemed to be involved in the phenomenon, as the morphological anomaly of the neutrophils gradually decreased after the drug was discontinued.

Type I hyperlipidaemia caused by lipoprotein lipase deficiency in a nurseling: the role of the clinical laboratory in processing biological samples and contributing to the diagnosis and therapeutic follow-up of patients.

We describe the case of a two-months-old nurseling admitted to the paediatric emergency unit for vomiting. Upon clinical examination, the paediatrician found the child pale with an alteration of the general condition, a tachycardia and severe hepatomegaly. Blood sampling revealed hyperlipasemia at 228 IU/L and lactescent plasma, prompting the biologist to complete the prescription by lipid profile analysis. Severe hypertriglyceridaemia peaking at 47 mmol/L was then identified. The hypothesis of acute pancreatitis due to familial chylomicronaemia was proposed. The diagnosis of type I hyperlipidaemia due to complete lipoprotein lipase deficiency was later confirmed by the molecular genetic identification of a homozygous mutation in the LPL gene encoding the enzyme. This disease is extremely rare, and occurrence of first clinical symptoms before one year of age is possible although exceptional. The treatment, including digestive rest and parenteral nutrition, allowed rapid improvement of the acute episode and long-term dietary management prevented recurrent acute pancreatitis. In addition to the importance of clinical and laboratory cooperation, this case report provides an opportunity for discussing the analytical interferences and pre-analytical procedures involved in the exploration of biological parameters in hyperlipaemic plasma.