Optimal euploid embryo transfer strategy, fresh versus frozen, after preimplantation genetic screening with next generation sequencing: a randomized controlled trial.

OBJECTIVE: To compare two commonly used protocols (fresh vs. vitrified) used to transfer euploid blastocysts after IVF with preimplantation genetic screening. DESIGN: Randomized controlled trial. SETTING: Private assisted reproduction center. PATIENT(S): A total of 179 patients undergoing IVF treatment using preimplantation genetic screening. INTERVENTION(S): Patients were randomized at the time of hCG administration to either a freeze-all cycle or a fresh day 6 ET during the stimulated cycle. MAIN OUTCOME MEASURE(S): Implantation rates (sac/embryo transferred), ongoing pregnancy rates (PRs) (beyond 8 weeks), and live birth rate per ET in the primary transfer cycle. RESULT(S): Implantation rate per embryo transferred showed an improvement in the frozen group compared with the fresh group, but not significantly (75% vs. 67%). The ongoing PR (80% vs. 61%) and live birth rates (77% vs. 59%) were significantly higher in the frozen group compared with the fresh group. CONCLUSION(S): Either treatment protocol investigated in the present study can be a reasonable option for patients. Freezing all embryos allows for inclusion of all blastocysts in the cohort of embryos available for transfer, which also results in a higher proportion of patients reaching ET. These findings suggest a trend toward favoring the freeze-all option as a preferred transfer strategy when using known euploid embryos. CLINICAL TRIAL REGISTRATION NUMBER: NCT02000349.

Use of suboptimal sperm increases the risk of aneuploidy of the sex chromosomes in preimplantation blastocyst embryos.

OBJECTIVE: To compare autosomal and sex chromosome aneuploidy rates of embryos derived from sperm with abnormal and normal parameters. DESIGN: Retrospective cohort study. SETTING: Assisted reproduction center. PATIENT(S): Three thousand eight hundred thirty-five embryos generated from 629 couples undergoing IVF. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Incidence of aneuploidy in the trophectoderm of blastocyst embryos derived from standard IVF embryos and intracytoplasmic (ICSI) males with normal and oligozoospermic semen samples, in couples with donor eggs (mean maternal age, 25.0 years) and their own eggs (mean maternal age, 35.4 years). RESULT(S): The rate of sex chromosome aneuploidy was significantly (around threefold) higher in the oligozoospermic group compared with in both control groups (standard vs. ICSI insemination). This applied whether donor (young) or own (older) eggs were used. Significant differences were seen in the oligozoospermic samples for autosomes 1, 2, 11 (own eggs), and 18 (donor eggs) compared with both control groups; however, no significant difference was seen between each of the treatment groups for the overall rate of autosomal aneuploidy. No significant differences were seen between the two control groups (normozoospermic males, standard vs. ICSI insemination) in either of the egg group types for any chromosome pairs. CONCLUSION(S): Severe male factor infertility is associated with a significant increase in the occurrence of sex chromosome abnormalities in blastocyst embryos compared with in embryos derived from normal semen samples. Aneuploidy rates in embryos derived from sperm with normal parameters were not significantly different whether ICSI or standard insemination was used to achieve fertilization. These results highlight severe male factor infertility as a possible referral category for preimplantation comprehensive chromosomal screening.

Proximal occlusion of hydrosalpinx by hysteroscopic placement of microinsert before in vitro fertilization-embryo transfer.

OBJECTIVE: To describe proximal occlusion of a hydrosalpinx by hysteroscopic placement of a microinsert before IVF-ET. DESIGN: Case report. SETTING: Health maintenance organization and tertiary-care assisted reproductive technology unit. PATIENT(S): Obese, infertile woman with pelvic adhesive disease and unilateral hydrosalpinx. INTERVENTION(S): Hysteroscopic placement of a microinsert into the proximal segment of a fallopian tube that was distally obstructed by hydrosalpinx. No intraoperative or postoperative complications occurred with hysteroscopic placement of microinsert. MAIN OUTCOME MEASURE(S): Nonincisional proximal tubal occlusion under local anesthesia and intravenous sedation. Pregnancy by IVF-ET. RESULT(S): No intraoperative or postoperative complications with hysteroscopic placement of microinsert were seen. After uterine transfer of three embryos, dichorionic-diamniotic twins were delivered by cesarean section at 34 weeks of gestation. CONCLUSIONS(S): Hysteroscopic placement of a microinsert to proximally occlude a hydrosalpinx might be an alternative to laparoscopic proximal tubal occlusion or salpingectomy in patients with tubal disease planning IVF-ET.