Morphokinetic analysis of early human embryonic development and its relationship to endometriosis resection: a retrospective time-lapse study using the KIDScore™ D3 and D5 implantation data algorithm.

RESEARCH QUESTION: Does complete resection of endometriosis improve embryo quality as assessed by morphokinetic parameters using time-lapse microscopy? DESIGN: For this retrospective study we analysed 237 fertilised, cultured and transferred embryos from 128 fresh IVF and/ or ICSI transfer cycles. Endometriosis was confirmed or excluded by laparoscopy. Patients were stimulated with recombinant FSH using GnRH agonist and antagonist protocols. After fertilisation, a time-lapse incubation system was used for observation. Embryo quality was assessed using the KIDScore™ D3 and D5 implantation data algorithm. RESULTS: The analysis showed a median KIDScore™ D5 of 2.6 (on a scale of 1 to 9.9) for embryos from patients with endometriosis without complete resection. The control group without endometriosis achieved a score of 6.8 (p = 0.003). The median score for embryos from endometriosis patients with complete resection was 7.2, which was a significant increase compared to embryos from patients without complete resection (p = 0.002). We observed an effect size of r = 0.4 for complete resection versus no resection of endometriosis using the KIDScore™ D5. There were no differences in KIDScore™ D3 between the three patient groups. Pregnancy and miscarriage rates showed the same clinical trends. In three of our four case series of patients who underwent IVF/ ICSI cycles before and after complete resection, we found a marked improvement in embryo quality after complete resection. CONCLUSIONS: Complete resection of endometriosis could significantly improve the otherwise poor embryo quality of patients undergoing IVF-procedures. The data, therefore, strongly support recommending surgery to patients with endometriosis prior to assisted reproduction.

Contaminated by Its Prior Use: Strategies to Design and Market Refurbished Personal Care Products.

Refurbishment is an effective circular strategy to lengthen a product's lifetime. However, refurbished products that are intimately used, such as personal care products, cause a feeling of unease in consumers because they are perceived to be contaminated. In 15 in-depth online interviews with female users of intense pulsed light (IPL) device living in the Netherlands, we explored why consumers have contamination concerns regarding an IPL device and proposed strategies to decrease these. Participants felt that refurbished personal care products with signs of wear-and-tear were a riskier choice and expected that the device would malfunction, have a shorter product lifetime, and would be contaminated due to the previous use. Based on the location and amount of wear-and-tear, participants made inferences on how the prior user had treated the device. While light wear-and-tear indicated normal use, heavy wear-and-tear was interpreted as a sign of bad treatment by the previous user. To keep refurbished personal care products at their highest value, we suggest five design strategies to minimize contamination concerns by designing a product that smells and looks hygienic after multiple lifecycles: (1) using colors that evoke associations with hygiene, (2) making signs of wear-and-tear less visible, (3) using smooth (cleanable) materials, (4) minimizing the number of split lines in the product, and (5) giving refurbished products a clean product smell. For refurbished personal care products with signs of wear-and-tear that cannot be eliminated, we propose mitigating consumers' contamination concerns with marketing strategies, such as fostering a good brand image, offering refurbished products at a lower price, with an extended warranty, and underlining expert check-ups and standards during refurbishment.