L. Mains

Achievement test performance in children conceived by IVF

BACKGROUND Long-term follow-up studies of children conceived by IVF are limited. We examine academic performance on standardized tests [Iowa Tests of Basic Skills/Educational Development (ITBS/ITED)] of children conceived by IVF. METHODS Parents of children 8-17 years of age at the onset of the study (March 2008) who were conceived by IVF at the University of Iowa Hospitals and Clinics and living in the state of Iowa were contacted by mail. Parents completed questionnaires on their childs health and education and parental education. ITBS/ITED scores from school grades 3-12 were obtained on IVF children and a group of anonymous children matched by grade, year, gender and school district. Scores were analyzed using linear mixed models. RESULTS Four hundred and ninety-seven couples were contacted. Two hundred and ninety-five couples (463 children) agreed to participate (59.4% of parents), with ITBS/ITED scores available on 423 children (91.4% of participants). IVF children scored higher than the national mean (P < 0.0001) across all grades and subtests and higher than their matched peers for grades 3-11. A trend toward lower test scores in multiple gestations was present (but not significant). Factors found to affect test scores included parental level of education, maternal age, divorce and childs BMI. Cryopreservation, length of embryo culture and method of insemination did not affect scores. CONCLUSIONS IVF children scored higher on standardized tests than their matched peers, suggesting that IVF does not have a negative effect on cognitive development. However, long-term follow-up of IVF children is still limited. Further research should be performed on the effect of multiple gestation on academic performance.

Identification of apolipoprotein A1 in the human embryonic secretome

OBJECTIVE To identify factors secreted by the human embryo and correlate levels with embryo morphology and pregnancy outcome. DESIGN A laboratory-based study of human embryo protein synthesis and secretion and a retrospective analysis of spent embryo culture media as it relates to pregnancy outcome. SETTING University-based academic IVF program. PATIENT(S) IVF patients who had donated cryopreserved human pronuclear-stage embryos. Patients undergoing fresh IVF cycles resulting in a blastocyst transfer who donated spent media drops. INTERVENTION(S) In vitro embryo culture and collection of spent media. MAIN OUTCOME MEASURE(S) Protein analysis and identification by two-dimensional gel electrophoresis and mass spectrometry, ApoA1 quantification by ELISA, and mRNA analysis by quantitative reverse transcriptase-polymerase chain reaction. RESULT(S) By protein gel electrophoresis, apolipoprotein A1 (ApoA1) was increased in the culture media from good-quality blastocysts (n = 6 embryos) compared to either cleavage-arrested embryos (n = 6 embryos) or poor-quality blastocysts (n = 6 embryos) using spent media from culture days 4 and 5, respectively. Apolipoprotein A1 concentrations were 23.1% greater in day 5 spent culture media from good-grade blastocysts (n = 30) when compared to poor-grade embryos (n = 30). However, in a group of patients (n = 20) with transfer of two good-quality blastocysts, ApoA1 levels from day 5 spent media did not correlate with embryo implantation and pregnancy. Quantitative reverse transcriptase-polymerase chain reaction confirmed the presence of ApoA1 mRNA transcripts in human blastocysts. CONCLUSION(S) Apolipoprotein A1 is produced by human preimplantation embryos, and increased levels are present in spent culture media containing blastocysts of higher morphologic grade. These results suggest a role for lipoproteins in early embryologic development.

Skewed X inactivation and IVF-conceived infants

The objective of this study was to investigate whether skewed X chromosome inactivation (XCI) is associated with IVF. A retrospective cohort study was performed comprising 30 female infants conceived by IVF and 44 naturally conceived control infants matched for gestational age and sex. Cord blood DNA samples were obtained and XCI patterns were analysed using a methylation-sensitive assay. Eight IVF samples and 13 control samples were excluded from the study because they were either homozygous or alleles were too similar for the assay to determine skewing. Mildly skewed XCI (80-90% inactivation of one allele) was present in two of 22 (9.1%) IVF samples and two of 31 (6.5%) control samples. Extremely skewed XCI (>90% inactivation of one allele) was found in two of 22 (9.1%) IVF samples and none of 31 control samples. Neither difference was statistically significant. However, the mean degree of skewed XCI in the IVF group was 72.0% and in the control group was 62.4% (P=0.002). Larger studies are needed to clarify the relationship between IVF and skewed XCI.

Sextuplets: an unusual complication of single embryo transfer

OBJECTIVE To describe an unusual case of a sextuplet gestation after IVF and transfer of a single blastocyst. DESIGN Case report. SETTING University-based IVF clinic. PATIENT(S) A 32-year-old female with secondary infertility undergoing IVF-ET. INTERVENTION(S) Transvaginal oocyte retrieval, transfer of a single blastocyst, and multifetal pregnancy reduction. MAIN OUTCOME MEASURE(S) Ultrasound determination of pregnancy viability. RESULT(S) Six intrauterine gestational sacs, each with a fetus having cardiac activity, reduced to a triplet gestation. CONCLUSION(S) Physicians should consider advising patients undergoing IVF-ET to abstain from unprotected intercourse at least 4 days before the anticipated oocyte retrieval. Incomplete aspiration of ovarian follicles is uncommon but not rare and can lead to a higher order multiple pregnancy if recent unprotected intercourse has occurred in this setting.

Embryo Transfer in IVF: Evidence-Based Clinical Practice

Since the first pregnancy using in vitro fertilization (IVF) was achieved nearly 30 years ago, many aspects of this procedure have undergone significant progress. In contrast, the technique of embryo transfer (ET) has remained relatively unchanged. A simple yet critical element in the final step of IVF, embryo transfer, has received little attention until recently. As poor implantation rates have increasingly hindered the growing success of IVF, the procedure of embryo transfer is now under great scrutiny. While poor embryo quality or suboptimal uterine receptivity may be responsible for implantation failures, the transfer technique itself is now also recognized as an important determinant of IVF success. Optimizing the technique of embryo transfer should take several factors into consideration.