K. Lundin

ESHRE PGD Consortium/Embryology Special Interest Group—best practice guidelines for polar body and embryo biopsy for preimplantation genetic diagnosis/screening (PGD/PGS)

In 2005, the European Society for Human Reproduction and Embryology (ESHRE) Preimplantation Genetic Diagnosis (PGD) Consortium published a set of Guidelines for Best Practice to give information, support and guidance to potential, existing and fledgling PGD programmes (Thornhill AR, De Die-Smulders CE, Geraedts JP, Harper JC, Harton GL, Lavery SA, Moutou C, Robinson MD, Schmutzler AG, Scriven PN et al. ESHRE PGD Consortium best practice guidelines for clinical preimplantation genetic diagnosis (PGD) and preimplantation genetic screening (PGS). Hum Reprod 2005;20:35-48.). The subsequent years have seen the introduction of a number of new technologies as well as the evolution of current techniques. Additionally, in light of ESHREs recent advice on how practice guidelines should be written and formulated, the Consortium believed it was timely to revise and update the PGD guidelines. Rather than one document that covers all of PGD as in the original publication, these guidelines are separated into four new documents that apply to different aspects of a PGD programme; Organization of a PGD centre, fluorescence in situ hybridization-based testing, amplification-based testing and polar body and embryo biopsy for preimplantation genetic diagnosis/screening (PGD/PGS). Here we have updated the sections that pertain to embryology (including cryopreservation) and biopsy of embryos prior to PGD or PGS. Topics covered in this guideline include uses of embryo biopsy, laboratory issues relating to biopsy, timing of biopsy, biopsy procedure and cryopreserving biopsied embryos.

The interface between assisted reproductive technologies and genetics: technical, social, ethical and legal issues

The interface between assisted reproductive technologies (ART) and genetics comprises several sensitive and important issues that affect infertile couples, families with severe genetic diseases, potential children, professionals in ART and genetics, health care, researchers and the society in general. Genetic causes have a considerable involvement in infertility. Genetic conditions may also be transmitted to the offspring and hence create transgenerational infertility or other serious health problems. Several studies also suggest a slightly elevated risk of birth defects in children born following ART. Preimplantation genetic diagnosis (PGD) has become widely practiced throughout the world for various medical indications, but its limits are being debated. The attitudes towards ART and PGD vary substantially within Europe. The purpose of the present paper was to outline a framework for development of guidelines to be issued jointly by European Society of Human Genetics and European Society of Human Reproduction and Embryology for the interface between genetics and ART. Technical, social, ethical and legal issues of ART and genetics will be reviewed.

Prediction of ovarian hyperstimulation syndrome in women undergoing in vitro fertilization

Objective. Ovarian hyperstimulation syndrome (OHSS) is a severe side effect of in vitro fertilization (IVF). The aim of this study was to identify independent predictors which could be used to identify IVF patients at risk for OHSS. Design. A prospective observational study. Setting: University hospital. Population. Six hundred and twenty‐four consecutive patients treated with conventional IVF or intracytoplasmic sperm injection. Methods. Observational clinical data were compared. Main outcome measures. Patients who developed OHSS were compared with patients who did not develop OHSS using univariate and multivariate analyses. Results. Twenty‐eight patients developed OHSS considered as severe and requiring hospitalization. Independent predictors of OHSS were number of follicles at oocyte aspiration, number of aspirated oocytes and total number of medium/large‐sized follicles before hCG. When these variables were combined in a receiver operating characteristic (ROC) curve they showed a sensitivity of 82.1% and a specificity of 90% for OHSS. The only independent predictor of OHSS before the ovulatory dose of hCG was total number of medium/large‐sized follicles before hCG. A corresponding ROC found a sensitivity of 82.1% and specificity of 79.4%. Conclusion. Prediction of OHSS that is of severity requiring hospitalization can be done with reasonable high sensitivity and specificity both before and after the ovulatory dose of hCG.

Clinical Assisted Reproduction: Acrosome Index Is Not an Absolute Predictor of the Outcome Following Conventional In Vitro Fertilization and Intracytoplasmic Sperm Injection

AbstractPurpose: To investigate if including evaluation of acrosome index (AI) in the semen analysis of teratozoospermic samples could help to predict for which patients intracytoplasmic sperm injection (ICSI) is necessary.nMethods: The fertilization rate, pregnancy rate, and percentage of good quality embryos were compared after performing conventional in vitro fertilization (IVF) and ICSI, respectively, using sibling oocytes. The role of AI was evaluated by dividing patients into two groups; Group A (AI < 7%) and Group B (AI ≥ 7%).nResults: A significant difference in fertilization rate was observed between Group A and B after conventional IVF. In Group A, the fertilization rate, embryo transfer rate, and percentage of good quality embryos were higher after ICSI than after IVF. In Group B, the fertilization and pregnancy rates were numerically but not significantly higher after IVF compared to ICSI.nConclusion: Evaluation of acrosome index will not accurately predict fertilization, although this study shows that a sperm sample with less than 5% normal forms and an AI greater than 7% may achieve a mean fertilization rate >70% after conventional IVF.

Effect of alfentanil dosage during oocyte retrieval on fertilization and embryo quality

OBJECTIVEnA possible negative effect of pain-relieving analgesics used during oocyte retrieval on fertilization and embryo development has been discussed. This study examines whether alfentanil dosage adversely affects fertilization and/or embryo quality.nnnSTUDY DESIGNnIn a retrospective observational study the effect of different doses of alfentanil on two primary endpoints, fertilization rate and good quality embryo (GQE) rate, were compared in 663 women.nnnRESULTSnIn group A (<or=0.5mg alfentanil) and group B (>0.5mg alfentanil) mean fertilization rate was 0.6+/-0.3 versus 0.6+/-0.2 (P=0.678, adjusted P=0.937, 95% CI for the difference -0.041; 0.044) and mean GQE rate was 0.6+/-0.3 versus 0.5+/-0.3 (P=0.207, adjusted P=0.179, 95% CI for the difference -0.015; 0.078), respectively. A paired comparison of 65 women who underwent repeated IVF cycles found that, compared with <or=0.5mg alfentanil, doses of >0.5mg alfentanil had no adverse effects on fertilization rate (mean difference 0.05+/-0.3, P=0.231, 95% CI -0.02; 0.12) or GQE rate (mean difference -0.02+/-0.4, P=0.970, 95% CI -0.12; 0.09).nnnCONCLUSIONnThe amount of alfentanil is not associated with adverse effects on fertilization rate, embryo development, or clinical pregnancy rate, which is reassuring and indicates that women can be offered adequate pain relief.

Spontaneous twin pregnancy with live births after cryopreservation and re-implantation of ovarian tissue

Methods A 27-year-old, 1-parous patient suffered from Hodgkin’s lymphoma in 2011. Pre-operative transvaginal sonography (TVS) revealed a normal uterus, the left side ovary with a unilocular cyst of 50 × 70 mm and the right ovary with 8 antral follicles. Laparoscopic stripping of left ovarian cyst and right-sided oophorectomy was performed with subsequent standard OTC of 15 cortical strips [5] before six chemotherapy treatments with BEACOPP (bleomicin, etoposide, adryamicin, cyclophosphamide, oncovin, procarbazine, prednisolone). Histology showed benign mucinous cystadenoma. After chemotherapy, patient experienced amenorrhea and climacteric symptoms that were treated by hormonal replacement therapy (HRT). HRT was ceased in October 2013 due to benign cysts in the breast, and the patient developed oligomenorrhea. Hormonal status after chemotherapy is presented in Fig. 1a. Patient was considered free of disease and tried to conceive for 1 year. In March 2015, TVS showed cyst on the left ovary and laparoscopic