Using the Society for Assisted Reproductive Technology Clinic Outcome System morphological measures to predict live birth after assisted reproductive technology

Capsule:
There is a significant association between the embryo quality parameters reported to the Society for Assisted Reproductive Technology Clinic Outcome Reporting System and live birth.

Authors:
Barbara Luke, Sc.D., M.P.H., Morton B. Brown, Ph.D., Judy E. Stern, Ph.D., Sangita K. Jindal, Ph.D., Catherine Racowsky, Ph.D., G. David Ball, Ph.D.

Volume 102, Issue 5, Pages 1338–1344

Abstract:

Objective:
To model morphological assessments of embryo quality that are predictive of live birth.

Design:
Longitudinal cohort using cycles reported in the Society for Assisted Reproductive Technology Clinic Outcomes Reporting System (SART CORS) between 2007 and 2011.

Setting:
Clinic-based data.

Patient(s):
Fresh autologous assisted reproductive technology (ART) cycles with ETs on day 3 or day 5 and morphological assessments reported (25,409 cycles with one embryo transferred and 96,093 cycles with two embryos transferred). Live-birth rates were modeled by morphological assessments using backward-stepping logistic regression for cycle 1 and over five cycles, separately for day 3 and day 5 transfers and number of embryos transferred (1 or 2). Additional models for each day of transfer also included the number of oocytes retrieved and the number of embryos cryopreserved.

Intervention(s):
None.

Main Outcome Measure(s):
Live births.

Result(s):
Morphological assessments of grade, stage, fragmentation, and symmetry were significant for the day 3 models; grade, stage, and trophectoderm were significant in the day 5 model; inner-cell mass was significant in the models when two embryos were transferred. Number of oocytes retrieved and number of embryos cryopreserved were significant for both day 3 and day 5 models.

Conclusion(s):
These findings confirm the significant association between embryo quality parameters reported to SART CORS and live-birth rate after ART.

Is frozen embryo transfer cycle associated with a significantly lower incidence of ectopic pregnancy An analysis of more than 30000 cycles

Capsule:
Frozen-thawed embryo transfer has been associated with a significantly lower risk of ectopic pregnancy (EP) compared with fresh cycles. Ovarian stimulation might be associated with an increased risk of EP.

Authors:
Bo Huang, Ph.D., Dan Hu, M.D., Kun Qian, Ph.D., Jihui Ai, Ph.D., Yufeng Li, Ph.D., Lei Jin, Ph.D., Guijin Zhu, M.D., Hanwang Zhang, Ph.D.

Volume 102, Issue 5, Pages 1345–1349

Abstract:

Objective:
To analyze the incidence of ectopic pregnancy (EP) in fresh compared with frozen-thawed cycles.

Design:
Retrospective cohort study.

Setting:
Teaching hospital in the People’s Republic of China.

Patient(s):
31,925 women undergoing in vitro fertilization–embryo transfer (IVF-ET) from January 2006 to December 2013.

Intervention(s):
Fresh IVF-ET compared with frozen-thawed ET (FET).

Main Outcome Measure(s):
Incidence of EP with fresh IVF-ET compared with frozen-thawed ET cycles, clinical pregnancy rate, and rate of EP per clinical pregnancy.

Result(s):
For the fresh IVF cycles, 19,173 patients underwent oocyte retrieval; 15,042 had an ET, 6,431 of these patients (42.7%) had a clinical pregnancy, and among these 297 (1.97%) appeared to have an EP. The group of patients undergoing frozen-thawed ET (12,752 patients) included 12,255; there were 5,564 pregnancies (45.4%) and 124 ectopic implants (1.01%). The incidence of an EP per clinical pregnancy was 4.62% for the fresh transfer group compared with 2.22% for the frozen-thawed cycle group; this difference was statistically significant. In addition, the fresh ET cycles had the highest risk of EP, followed by day-3 embryo FET cycles; blastocyst FET cycles had the lowest risk of EP, and the differences were all statistically significant.

Conclusion(s):
Frozen-thawed ET cycles were associated with a statistically significantly lower risk of EP when compared with fresh cycles. These findings are consistent with ovarian stimulation being associated with an increased risk of EP.

Microdissection testicular sperm extraction in men with Sertoli cell only testicular histology

Capsule:
Diagnostic testis biopsy in nonobstructive azoospermia has little value, even when uniform Sertoli cell–only pattern is seen. When both testis volume and follicle-stimulating hormone are considered, sperm retrieval rates are 7%–45%.

Authors:
Boback M. Berookhim, M.D., M.B.A., Gianpiero D Palermo, M.D., Ph.D., Nikica Zaninovic, Ph.D., Zev Rosenwaks, M.D., Peter N. Schlegel, M.D.

Volume 102, Issue 5, Pages 1282-1286

Abstract:

Objective:
To study the outcomes of microdissection testicular sperm extraction (microTESE) among men with pure Sertoli cell–only histology on diagnostic testicular biopsy.

Design:
Retrospective cohort study.

Setting:
Tertiary referral center.

Patient(s):
Six hundred forty patients with pure Sertoli cell–only histology on testicular biopsy who underwent microTESE by a single surgeon.

Intervention(s):
MicroTESE.

Main Outcome Measure(s):
Sperm retrieval rates.

Result(s):
Overall, 44.5% of patients with Sertoli cell only had sperm retrieved with microTESE. No difference was noted in sperm retrieval rates based on testis volume (≥15 mL vs. <15 mL, 35.3% vs. 46.1%, respectively). Patients with ≥15 mL testicular volume and FSH 10–15 mU/mL had the worst prognosis, with a sperm retrieval rate of 6.7%.

Conclusion(s):
Patients with previous testicular biopsy demonstrating Sertoli cell–only histology can be counseled that they have a reasonable likelihood of sperm retrieval with the contemporary delivery of microTESE. Given this finding, the utility of testicular biopsy before microTESE is further questioned.

Articles of Special Interest

Using the Society for Assisted Reproductive Technology Clinic Outcome System morphological measures to predict live birth after assisted reproductive technology

Friday, July 25, 2014
There is a significant association between the embryo quality parameters reported to the Society for Assisted Reproductive Technology Clinic Outcome Reporting System and live birth.

Is frozen embryo transfer cycle associated with a significantly lower incidence of ectopic pregnancy An analysis of more than 30000 cycles

Friday, July 25, 2014
Frozen-thawed embryo transfer has been associated with a significantly lower risk of ectopic pregnancy (EP) compared with fresh cycles. Ovarian stimulation might be associated with an increased risk of EP.

Microdissection testicular sperm extraction in men with Sertoli cell only testicular histology

Wednesday, July 23, 2014
Diagnostic testis biopsy in nonobstructive azoospermia has little value, even when uniform Sertoli cell–only pattern is seen. When both testis volume and follicle-stimulating hormone are considered, sperm retrieval rates are 7%–45%.

Female cystic fibrosis mutation carriers and assisted reproductive technology Does carrier status affect reproductive outcomes

Monday, July 14, 2014
Female cystic fibrosis (CF) carrier status does not appear to impact the chance of achieving pregnancy with assisted reproductive technology (ART). Further research is needed to investigate whether positive CF carrier status affects fertility in a non-ART context.