Impact of whole systems traditional Chinese medicine on in-vitro fertilization outcomes.

Patients undergoing IVF may receive either acupuncture or whole-systems traditional Chinese medicine (WS-TCM) as an adjuvant IVF treatment. WS-TCM is a complex intervention that can include acupuncture, Chinese herbal medicine, dietary, lifestyle recommendations. In this retrospective cohort study, 1231 IVF patient records were reviewed to assess the effect of adjuvant WS-TCM on IVF outcomes compared among three groups: IVF with no additional treatment; IVF and elective acupuncture on day of embryo transfer; or IVF and elective WS-TCM. The primary outcome was live birth. Of 1069 non-donor cycles, WS-TCM was associated with greater odds of live birth compared with IVF alone (adjusted odds ratio [AOR] 2.09; 95% confidence interval [CI] 1.36 to 3.21), or embryo transfer with acupuncture only (AOR 1.62; 95% CI 1.04 to 2.52). Of 162 donor cycles, WS-TCM was associated with increased live births compared with all groups (odds Ratio [OR] 3.72; 95% CI 1.05 to 13.24, unadjusted) or embryo transfer with acupuncture only (OR 4.09; 95% CI: 1.02 to 16.38, unadjusted). Overall, IVF with adjuvant WS-TCM was associated with greater odds of live birth in donor and non-donor cycles. These results should be taken cautiously as more rigorous research is needed.

Resultados del uso de un sistema cerrado (S3) en la vitrificación de blastocistos humanos / Results following the use of a closed system (S3) for vitrification of human blastocysts

Este artículo describe el uso de un sistema cerrado de vitrificación que es fácil de usar y permite que los blastocitos sean vitrificados en un recipiente seguro y cerrado. Este sistema no utiliza dimetil sulfóxido (DMSO) como crío-protector y se le denomina vitrificación S3. Blastocistos humanos fueron vitrificados en los días 5 y 6 de desarrollo (día de recuperación es igual a día 0). Se conservó solo blastocistos completos de alta calidad o avanzados en el desarrollo. Se realizó un total de 139 transferencias, con una tasa de supervivencia global de 81%. La tasa de embarazos nacidos y en curso es de 58%, con una tasa de implantación de 48% para todos los pacientes en todos los grupos de edad. Los resultados globales obtenidos con este sistemacerrado son alentadores.

This paper describes the use of a closed vitrification system that is easy to use and allows the blastocysts to be vitrified in a closed secure container. This system does not use dimethylsulphoxide (DMSO) as a cryoprotectant as well. This system is referred to as S3 vitrification. Human blastocysts were vitrified on Days 5 and 6 (Day ofretrieval equals Day 0). Only high quality full blastocysts or greater in development were preserved. A total of 139 transfers have been performed with an overall survival rate of 81%. The delivery/ongoing pregnancy rates are 58% with a 48% implantation rate for all patients in all age groups. The overall outcomes achieved with this closed system are encouraging.

A new safe, simple and successful vitrification method for bovine and human blastocysts.

This study examined a new method for vitrification of blastocysts that is safe, simple and easy to learn and use. Current vitrification techniques have shortcomings that include the use of dimethyl sulphoxide, one of the more toxic cryoprotectants, and minute containers that are difficult to handle and are usually open to contamination. Cell handling and loading times are very short, which allows no room for user-associated errors and increases the difficulty of the procedure. This study describes a method of vitrification without these shortcomings. Human and bovine blastocysts were exposed to a series of three cryoprotectant solutions and loaded into a 0.25 ml sterile straw, heat sealed at both ends and vitrified. This technique allowed sufficient time for cryoprotectant exposure, loading, sealing and vitrification. Research blastocysts were thawed, cultured for 24 h, and stained for cell viability. The majority survived and on average had few lysed cells. In clinical studies from three different centres, 81.4% of vitrified blastocysts were intact after thawing. Out of 43 transfers with 76 blastocysts replaced, 44.7% implanted, 43.4% yielded a fetal heart beat, and a total of 32 babies have been delivered or are ongoing. The overall clinical pregnancy per transfer rate was 60.4%. The high survival rates and clinical pregnancy rates obtained with this new, safe and easy-to-use vitrification procedure are encouraging.

Embryonic development and pregnancies following sequential culture in human tubal fluid and a modified simplex optimized medium containing amino acids.

Pregnancies following human blastocyst transfers were established using a protein supplemented modified potassium simplex optimized medium containing amino acids (KSOM(AA)). Zygotes were first cultured for 2 days in protein supplemented human tubal fluid medium. Resulting embryos (day 3) were subsequently cultured in protein supplemented KSOM(AA) until day 5 of development. Pregnancy and implantation rates were noted after culture and transfer of blastocysts following this culture scheme. The impact of conventional insemination, intracytoplasmic sperm injection (ICSI) and maternal age on developmental rates as well as pregnancy rates was also evaluated. Maternal age had a significant impact (P < 0.05) on developmental rates of embryos until day 3 of culture. Overall, rate of blastocyst development for cultured day 3 embryos was 62%. Patients >39 years of age had lower (P < 0.05) rates of blastocyst development than patients in the younger subgroups. ICSI had no impact on developmental rates until day 3 of culture or rate of blastocyst development. Ongoing pregnancy and implantation rates following culture in KSOM(AA) were 51 and 37% respectively. These results indicate that KSOM(AA) supports high rate blastocyst development and resulting pregnancy rates.

Fertilization, embryonic development and pregnancy losses with intracytoplasmic sperm injection for surgically-retrieved spermatozoa.

Prior to the development of intracytoplasmic sperm injection (ICSI), azoospermic and severely oligozoospermic men had little to no chance of having a biological child. In this study, ICSI outcome in 454 transfers with ejaculated spermatozoa and 59 transfers with surgically retrieved spermatozoa were evaluated. Normal fertilization rate using ejaculated spermatozoa was 75% of 5995 oocytes, and 73% of 751 oocytes for surgically retrieved spermatozoa; with ongoing pregnancy rates of 53% (242/454) and 61% (36/59) respectively. Surgically retrieved spermatozoa significantly (P < 0.05) impacted 1PN oocytes (6.1%, 46/751), severely fragmented embryos (8.8%, 46/550) and incidence of pregnancy loss (11%, 4/36). When using ejaculated spermatozoa, incidence of 1PN oocytes, severely fragmented embryos and pregnancy loss was 2.9% (177/5995), 4.5% (200/4365), 2.4% (6/242) respectively.