RESEARCH QUESTION: Is polycystic ovary syndrome (PCOS) in women with normal body mass index (BMI) associated with adverse obstetric and perinatal outcomes following frozen embryo transfer (FET)? DESIGN: This retrospectiv...RESEARCH QUESTION: Is polycystic ovary syndrome (PCOS) in women with normal body mass index (BMI) associated with adverse obstetric and perinatal outcomes following frozen embryo transfer (FET)? DESIGN: This retrospective study included women with PCOS and normal BMI who underwent FET between 2010 and 2023. The control group comprised women with male factor infertility and normal BMI. The main outcomes were obstetric and perinatal complications. A generalized estimating equation logistic regression accounted for data clustering and adjusted for confounders. Propensity score matching (PSM) was used to confirm the findings. RESULTS: This study included 707 women with PCOS and 5692 controls. For singleton pregnancies, multivariable analyses showed no significant increase in risk for gestational diabetes mellitus [adjusted OR (aOR) 1.13, 95% CI 0.65-1.97], hypertensive disorders of pregnancy (aOR 1.62, 95% CI 0.61-4.32), abnormal placentation (aOR 0.89, 95% CI 0.33-2.42), preterm premature rupture of membranes (aOR 1.38, 95% CI 0.49-3.94) or caesarean section (aOR 1.12, 95% CI 0.78-1.61) for women with PCOS. All birth outcomes were similar between the groups [preterm birth (aOR 1. 86, 95% CI 0.81-4.28), low birthweight (aOR 1.33, 95% CI 0.52-3.43), small for gestational age (aOR 0.59, 95% CI 0.24-1.44), and large for gestational age (LGA) (aOR 1.01, 95% CI 0.68-1.51)]. For twin pregnancies, the above-listed outcomes were also comparable, except the odds of LGA infants were significantly lower in women with PCOS (aOR 0.42, 95% CI 0.21-0.86). PSM confirmed these findings. CONCLUSIONS: Among women with normal BMI, PCOS is not associated with increased obstetric and perinatal complications compared with controls following FET.
France's universal public funding of assisted reproductive technology represents a major achievement for reproductive equity. By removing financial barriers, it has broadened access to fertility care while ensuring high...France's universal public funding of assisted reproductive technology represents a major achievement for reproductive equity. By removing financial barriers, it has broadened access to fertility care while ensuring high standards of safety, traceability and clinical outcomes. Public oversight has further strengthened quality assurance through mandatory ISO 15189 accreditation of IVF laboratories and implementation of EU Tissues and Cells regulations. However, expanding entitlement without a proportional reinforcement of resources, staffing, laboratory capacity, reimbursement levels and donor availability has generated structural tensions. Complex regulatory demands impose substantial administrative and financial burdens on centres, diverting time and investment from patient care. Inadequate funding of IVF units, persistent shortages of gamete donors and rising overhead costs have created waiting lists and inequitable delays. France also prohibits certain internationally accepted procedures, such as preimplantation genetic testing for aneuploidies, restricting clinical autonomy and patient choice. These unintended effects risk undermining the very principles of universality, equity and quality that underpin France's policy. Comparison with Belgium, the UK, Spain and Quebec, systems that pair broad coverage with more flexible regulation or reimbursement, helps identify ways to rebalance access, oversight and innovation. We propose pragmatic policy adjustments, including realistic reimbursement of laboratory costs, streamlined accreditation, targeted donor-recruitment incentives and evidence-based reconsideration of prohibited techniques.
Broojeni JV, Elmahdy M, Mitchell S
… +14 more, Rezaei M, Saharan A, Elhady G, Safwat S, Bareke E, Abdelrazek I, Xu C, Li L, Buckett W, Ao A, Miron P, Majewski J, Abdalla E, Slim R
RESEARCH QUESTION: How can the effectiveness of exome sequencing be improved for diagnosing infertility, and what are the key challenges and lessons learned from analysing nine unrelated cases? DESIGN: Nine unrelated inf...RESEARCH QUESTION: How can the effectiveness of exome sequencing be improved for diagnosing infertility, and what are the key challenges and lessons learned from analysing nine unrelated cases? DESIGN: Nine unrelated infertility cases referred between 2019 and 2024 were analysed in this study. Exome sequencing was conducted on probands and other family members when needed. Sanger sequencing was used for segregation analysis, and consequences on splicing were investigated on mRNA from patient cells and minigene assay. RESULTS: Nine causative variants were identified, including six novel, in nine genes, TUBB8, PATL2, CCDC39, STAG3, KIAA0319, FBXO43, AGBL5/BBS7, PLCZ1 and HS6ST1, across diverse reproductive phenotypes, including oocyte maturation arrest, early embryonic arrest, spermatogenic failure and syndromic infertility. KIAA0319 was also identified as a novel candidate gene for male infertility. CONCLUSIONS: Variant segregation in family members and the possibility of re-contacting the patients for further evaluations and questions were crucial to maximize diagnostic yield and reach robust conclusions. This study underscores the need for multidisciplinary collaboration between reproductive medicine specialists and geneticists to facilitate the complexity of infertility, improve its diagnostic yield and counsel patients.
Sperm donation offers a parenthood option for fertility patients, including azoospermic men, single women and same-sex female couples. Despite increasing use of donor spermatozoa, and change in demographics of recipients...Sperm donation offers a parenthood option for fertility patients, including azoospermic men, single women and same-sex female couples. Despite increasing use of donor spermatozoa, and change in demographics of recipients, the psychological impact of being a recipient of donor spermatozoa has not been reported extensively. The objective of this study was to investigate the psychosocial impact of being a recipient of donor spermatozoa. The attitudes, treatment experiences and disclosure decisions among recipients of donor spermatozoa were investigated. Secondary aims included exploration of pursuing cross-border reproductive care (CBRC) for treatment with donor spermatozoa. A systematic search, following the PRISMA guidelines, of two computerized databases with no time restriction was conducted. Data were extracted using thematic analysis. Heterosexual couples, same-sex female couples and single women were included. Actual recipients harboured positive attitudes with little regret. Earlier studies found greater levels of secrecy, whereas recent studies reported greater openness. Attitudes towards donors were unique to individual groups. Although the need for psychological support for fertility patients is well established, this was not universally implemented. With significant change in demographics, individualized counselling is essential to address the psychosocial needs of recipients. Lack of standardization of guidelines and laws is leading to CBRC, which may reduce the quality of care.
RESEARCH QUESTION: Are serum oestradiol concentrations associated with the oestradiol/total oocyte ratio, and the oestradiol/metaphase II (MII) oocyte ratio with embryo morphokinetics and clinical outcomes in patients un...RESEARCH QUESTION: Are serum oestradiol concentrations associated with the oestradiol/total oocyte ratio, and the oestradiol/metaphase II (MII) oocyte ratio with embryo morphokinetics and clinical outcomes in patients undergoing frozen-thawed embryo transfer after intracytoplasmic sperm injection (ICSI)? DESIGN: A total of 16,760 embryos from 2584 women treated between March 2019 and December 2022 at a private university-affiliated IVF centre were analysed. Embryos were grouped into quartiles according to serum oestradiol concentrations on the day of oocyte maturation triggering, and morphokinetic and ICSI outcomes were compared. The oestradiol/MII and oestradiol/total oocyte ratios were also evaluated. Linear and non-linear spline regression models were applied to explore potential non-linear associations. RESULTS: Spline analyses identified non-linear associations between oestradiol concentrations and embryological and clinical outcomes. Faster development and higher KIDScores were observed along the ascending portion of the spline curve (mid-range oestradiol; β = 2.0, P ≤ 0.003), whereas estimates shifted direction at the upper end of the distribution (β = -3.2; P < 0.001). Probabilities of implantation and pregnancy followed similar non-linear patterns, with higher model-predicted estimates up to the inflection point (implantation: β = 1147.0, P = 0.026; pregnancy: β = 107.6, P < 0.001) and attenuated estimates thereafter. Miscarriage rates were higher at the upper end of the oestradiol distribution (β = 37.6, P = 0.004). CONCLUSIONS: Serum oestradiol concentrations showed continuous, non-linear associations with embryo morphokinetics and clinical outcomes, characterized by higher model-predicted estimates along the ascending portion of the spline curve and lower estimates beyond its upper inflection.
RESEARCH QUESTION: Does frozen embryo transfer improve pregnancy outcomes compared with fresh embryo transfer in women with ovarian endometriosis (OEM) undergoing their first IVF/intracytoplasmic sperm injection cycle? D...RESEARCH QUESTION: Does frozen embryo transfer improve pregnancy outcomes compared with fresh embryo transfer in women with ovarian endometriosis (OEM) undergoing their first IVF/intracytoplasmic sperm injection cycle? DESIGN: A retrospective cohort study analysed 550 women aged 20-40 years with ultrasound-confirmed OEM who underwent their first assisted reproduction cycle between January 2020 and December 2023. Participants underwent either fresh embryo transfer (n = 170) or frozen embryo transfer (n = 380). Baseline characteristics including ovarian reserve markers, stimulation protocols, and embryo features were compared. Clinical outcomes assessed were clinical pregnancy, live birth, implantation, pregnancy loss, preterm birth, and neonatal complications. Multivariate regression models adjusted for potential confounders. Subgroup analyses considered progesterone concentration, oocyte yield, status of adenomyosis, prior surgery or medical therapy for OEM, endometrial preparation protocols, and stages of transferred embryos. RESULTS: Women in the frozen embryo transfer group had a shorter duration of infertility and higher levels of ovarian reserve markers. Unadjusted analysis showed higher implantation, clinical pregnancy and live birth rates in the frozen embryo transfer group; however, after adjustment, no significant differences were observed in implantation rate [adjusted relative risk (RR) 0.89, 95% CI 0.67-1.19], clinical pregnancy rate (adjusted RR 0.90, 95% CI 0.68-1.19), live birth rate (adjusted RR 0.94, 95% CI 0.67-1.32), and other pregnancy and neonatal outcomes. Subgroup analyses confirmed these findings. CONCLUSIONS: Frozen embryo transfer does not confer a benefit over fresh embryo transfer for improving the live birth rate or reducing pregnancy complications in women with OEM. Fresh embryo transfer remains a viable and potentially more time- and cost-efficient option in this patient population.
RESEARCH QUESTION: What is the optimal equilibration time and liquid volume of the thawing solution for blastocyst one-step warming, and do different thawing solutions and those with differing osmolarities affect surviva...RESEARCH QUESTION: What is the optimal equilibration time and liquid volume of the thawing solution for blastocyst one-step warming, and do different thawing solutions and those with differing osmolarities affect survival and recovery? DESIGN: Survival, recovery and recovery times of blastocysts were investigated after one-step warming under various conditions. Study 1: blastocysts were randomly allocated to four groups (63 blastocysts/group) based on thawing solution volume and exposure time (group 1: 1000 µl/60 s; group 2: 1000 µl/30 s; group 3: 500 µl/60 s; group 4: 500 µl/30 s); study 2: comparison of thawing solutions from two manufacturers (Irvine Scientific and Kitazato) (115 blastocysts/group); study 3: evaluation of thawing solutions with different osmolarities: Vit Kit-Warm NX Thawing Solution (1641 mOsm), Vit Kit-Warm NX Dilution Solution (896 mOsm), Continuous Single Culture-NX (264 mOsm), and Global Total (266 mOsm) (68 blastocysts/group). RESULTS: No difference in survival, recovery (95.2-100%) rates and recovery times were observed among groups in study 1. In study 2, no difference in survival rate and recovery time was observed between groups; however, Irvine Scientific (24/24 [100%]) recovered significantly more low-grade blastocysts than Kitazato (9/12 [75.0%]). In study 3, no difference in survival (95.5-100%) and recovery (92.6-100%) rates was observed. Regarding recovery time, dilution solution was significantly faster than Global Total (P < 0.05). CONCLUSIONS: One-step warming was effective under various osmotic pressure conditions and offered a simplified approach to embryo culture. The study was small and limited by the single-centre design. The method should be further investigated under optimal conditions.
RESEARCH QUESTION: What is the effect of male type 2 diabetes mellitus (T2DM) on semen parameters, surgical sperm retrieval (SSR) rates and cumulative live birth rate (CLBR) in couples undergoing assisted reproductive te...RESEARCH QUESTION: What is the effect of male type 2 diabetes mellitus (T2DM) on semen parameters, surgical sperm retrieval (SSR) rates and cumulative live birth rate (CLBR) in couples undergoing assisted reproductive technology (ART), when controlling for confounders? DESIGN: Single-centre retrospective cohort study (couples: n = 1462; T2DM: n = 293; non-diabetic: n = 1169) were selected from 44,630 initial cycles using 1:4 propensity score matching for male age, body mass index and female prognostic factors. RESULTS: The T2DM group had a significantly higher SSR rate (22.2% versus 4.9%, P < 0.001; adjusted OR 4.80, 95% CI 3.24 to 7.12). Semen volume was reduced (2.2 versus 3.0 ml, P < 0.001) and sperm concentration was higher (52.0 versus 43.8 million/ml, P = 0.003) in the T2DM group, but no significant differences were found in total sperm count, progressive motility, morphology, fertilization rate or available embryos. The CLBR was comparable between the T2DM and non-diabetic groups (45.4% versus 47.9%, P = 0.467; adjusted OR 0.81, 95% CI 0.59 to 1.11). Subgroup analysis of T2DM patients based on glycated haemoglobin levels (<7.0%, 7.0-8.4%, >8.4%) revealed that poorer glyacemic control was associated with longer diabetes duration, higher FSH levels and reduced semen volume, but it did not significantly affect the SSR rate, other semen parameters or CLBR. CONCLUSION: Although male T2DM is strongly associated with surgical sperm retrieval, it does not impair conventional semen quality or cumulative live birth rate in ART. Furthermore, within the T2DM population, varying degrees of glycaemic control do not significantly affect ART outcomes.
RESEARCH QUESTION: What is the feasibility of three-dimensional power Doppler ultrasound to predict clinical pregnancy outcome following frozen embryo transfer (FET) in patients with internal adenomyosis (ADM)? DESIGN: T...RESEARCH QUESTION: What is the feasibility of three-dimensional power Doppler ultrasound to predict clinical pregnancy outcome following frozen embryo transfer (FET) in patients with internal adenomyosis (ADM)? DESIGN: This prospective observational study included 61 patients undergoing assisted reproductive technology (ART) who were diagnosed with internal ADM using pelvic magnetic resonance imaging between 10 December 2023 and 1 March 2025. In addition, 116 patients with tubal factor infertility, undergoing ART during the same period, were included as controls. The endometrial blood flow index was measured on ultrasound the day before embryo transfer. The flow index, demographic data and FET outcomes were compared between the two groups. RESULTS: One-way analysis of variance revealed significant differences in the clinical pregnancy rate between the two groups (internal ADM: 20/61, 32.79%; control, 65/116, 56.03%; P = 0.003). The mean ± SD flow index in the internal ADM group (14.74 ± 5.16) was lower than in the control group (17.05 ± 6.65; P = 0.019). Univariate logistic regression analysis revealed that the flow index affected the clinical pregnancy rate significantly, with an OR of 1.126 (95% CI 1.064-1.193; P = 0.001). Multivariable logistic regression of FET outcomes indicated that the flow index affected the clinical pregnancy rate significantly (OR = 1.112, 95% CI 1.049-1.180; P = 0.001). The optimum cut-off value for the flow index to predict pregnancy was 15.84 [area under the curve (AUC) 0.728, 95% CI 0.654-0.802; P = 0.001], and the combination of flow index and cancer antigen 125 (CA125) yielded improved predictive performance (AUC 0.805, 95% CI 0.740-0.870; P = 0.001). CONCLUSIONS: Endometrial blood perfusion is reduced in patients with internal ADM, and is associated with a lower pregnancy rate. The combination of flow index and serum CA125 provides an effective predictive model for clinical pregnancy prior to FET in this population.
RESEARCH QUESTION: Can specific conventional and advanced sperm characteristics more accurately predict fertilization and blastulation rates after sperm preparation compared with raw semen? DESIGN: Prospective study of 9...RESEARCH QUESTION: Can specific conventional and advanced sperm characteristics more accurately predict fertilization and blastulation rates after sperm preparation compared with raw semen? DESIGN: Prospective study of 90 infertile couples undergoing intracytoplasmic sperm injection (ICSI) with fresh autologous gametes. Semen parameters were obtained from the fresh ejaculate collected on the day of oocyte retrieval and used for ICSI. Sperm concentration and motility were assessed according to WHO 2021 guidelines; morphology was evaluated using Kruger classification with Spermoscan staining. Parameters were reassessed in processed samples following sperm preparation techniques. Acrosomal status, mitochondrial activity and DNA fragmentation were evaluated in raw and prepared semen. Fertilization and blastulation rates were subsequently calculated. Women aged under 36 years, with a BMI over 30 kg/m² and at least three oocytes retrieved, were included; cycles with testicular or embryo biopsies were excluded. Statistical methods included Spearman and Pearson correlations, linear regression, bootstrap analyses and FDR adjustment. RESULTS: Among analysed parameters, sperm vacuolization in prepared semen and mitochondrial activity in raw semen emerged as significant predictors of fertilization rate and blastulation rate, respectively. A higher percentage of vacuolated spermatozoa after preparation was associated with lower fertilization rate (R = -0.28, P = 0.008). Linear regression confirmed this association, described by the equation y = 79.78 - 1.39x, with an R² of 0.115 (P = 0.001). In raw semen, the percentage of spermatozoa with active mitochondria (SAM-RS%) was positively correlated with blastulation rate (R = 0.24, P = 0.035). Linear regression showed that higher SAM-RS% predicted increased blastulation rate, as described by the equation y = 21.14 + 0.37x, with an R² of 0.059 (P = 0.03). These associations remained statistically significant after bias-corrected bootstrap analyses and FDR adjustment. CONCLUSION: In prepared semen, vacuolated sperm percentage may predict fertilization rate, whereas the percentage of spermatozoa with active mitochondria in raw semen may predict blastulation rate.
New vitrification and warming protocols have recently been developed to shorten procedure times and reduce exposure to potentially harmful cryoprotectants (CPA). These protocols are often described as 'rapid' or 'ultra-f...New vitrification and warming protocols have recently been developed to shorten procedure times and reduce exposure to potentially harmful cryoprotectants (CPA). These protocols are often described as 'rapid' or 'ultra-fast' but these terms are misleading. Speed-related terminology in cryopreservation has historically referred to cooling and warming rates, and not the length of time samples spend in solutions. Using 'rapid' warming or 'ultra-fast' vitrification implies that the speed at which a sample goes from cryogenic temperature (-196°C) to body temperature (37°C) or vice versa has been increased. However, most newly proposed protocols shorten exposure times or eliminate steps without altering thermal kinetics or CPA uptake and removal dynamics. Calling them 'rapid' causes confusion and may mislead practitioners. Instead, protocols that only reduce time in CPA solutions or omit steps should be called 'shortened protocols'. Precise language is crucial to ensure clear communication, accurate data interpretation and proper clinical practice. Only protocols that physically speed up cooling or warming rates should be labelled 'rapid' or 'ultra-fast'.
RESEARCH QUESTION: Does programmed cycle frozen embryo transfer (PC-FET) increase the risk of placenta accreta spectrum (PAS) compared with natural cycle FET (NC-FET), and does this risk vary according to facility-level...RESEARCH QUESTION: Does programmed cycle frozen embryo transfer (PC-FET) increase the risk of placenta accreta spectrum (PAS) compared with natural cycle FET (NC-FET), and does this risk vary according to facility-level utilization of PC-FET? DESIGN: This nationwide, cross-sectional study analysed 38,973 frozen embryo transfer deliveries identified in the Japanese perinatal registry database (2020-2022), linked to the assisted reproductive technology registry database (2019-2022). The primary exposure was PC-FET versus NC-FET. Facilities were stratified into tertiles based on the proportion of PC-FET (low, medium and high). The primary outcome was PAS, defined as either clinical or pathological. Morbid PAS was defined as PAS accompanied by haemorrhage >2000 ml or managed with balloon tamponade, compression sutures, embolization, or peripartum hysterectomy. OR and 95% CI were estimated with stabilized inverse probability of treatment weighting and multivariable regression. RESULTS: PAS occurred in 3.6% and 0.7% of PC-FET and NC-FET deliveries, respectively (OR 5.02, 95% CI 3.87-6.53). Morbid PAS occurred in 1.5% and 0.3% of PC-FET and NC-FET deliveries, respectively (OR 5.36, 95% CI 3.51-8.20). Facilities with a high proportion of PC-FET had a higher risk of PAS (OR 1.36, 95% CI 1.16-1.58) and morbid PAS (OR 1.34, 95% CI 1.07-1.70) compared with facilities with a low proportion of PC-FET. CONCLUSIONS: This study provides robust evidence that PC-FET increases the risk of PAS. Further research should explore the association between facility variations and the incidence of PAS.
RESEARCH QUESTION: Can the analysis of TikTok posts related to fertility and assisted reproduction technology better characterize the types of information shared, potential biases, and relative engagement? DESIGN: Using...RESEARCH QUESTION: Can the analysis of TikTok posts related to fertility and assisted reproduction technology better characterize the types of information shared, potential biases, and relative engagement? DESIGN: Using a new TikTok account posing as a woman of reproductive age in September 2024, posts were gathered using fertility- and infertility-related search terms. Descriptive post statistics were extracted, and reviewers coded each post for perceived patient demographics, creator type, post content, type of fertility treatments mentioned, and emotional tone. RESULTS: In total, 1905 TikTok posts were reviewed, amounting to 1,808,310,047 cumulative views and 117,087,911 cumulative likes. The majority of content creators were patients with fertility challenges (66.82%), followed by physicians (12.39%). Personal posts related to experience were most common (61.36%), followed by educational posts (28.45%). The most popular search terms in terms of both views and likes were 'infertility', 'fertility' and 'IVF' (P < 0.0001). Posts deemed to have a positive emotional tone received significantly more likes than neutral posts (P < 0.05), despite having fewer overall views. While most posts were created by patients with a light skin tone (52.36%), these posts did not differ in emotional tone or receive more engagement. CONCLUSION: TikTok content about personal infertility experiences is more prevalent than content created by healthcare professionals, and broad terms such as 'infertility' and positive patient stories attract significantly more engagement than medical terminology or neutral information. It is suggested that physicians should use this information to better engage viewers on social media in order to provide balanced content and combat the spread of misinformation.
Direct evidence from live cell imaging and single-cell sequencing of disaggregated cells that mitotic abnormalities continue to occur in the trophectoderm at the blastocyst stage, resulting in clones of aneuploid cells,...Direct evidence from live cell imaging and single-cell sequencing of disaggregated cells that mitotic abnormalities continue to occur in the trophectoderm at the blastocyst stage, resulting in clones of aneuploid cells, has important implications for preimplantation genetic testing (PGT) for aneuploidies. Here we argue that, to improve accuracy and minimize the deselection of potentially viable embryos with only mitotic aneuploidies of unknown clinical significance, the use of methods that, up until now, have only been used for PGT for monogenic/single-gene defects could provide the answer. Genome-wide single-nucleotide polymorphism parental haplotyping (karyomapping) is a universal linkage-based method for tracking the inheritance of disease genes. However, the same method can be used for molecular karyotyping to identify meiotic trisomies and monosomies or segmental deletions by the presence of dual parental haplotypes, or absence of parental haplotypes, respectively. Combined with parental intensity analysis to detect mitotic aneuploidies with normal biparental inheritance, this allows meiotic and mitotic, whole and segmental chromosome aneuploidies to be identified. This provides the opportunity to prioritize the deselection of embryos with meiotic aneuploidies affecting the whole embryo while considering those with only mitotic aneuploidies for transfer, with appropriate genetic counselling.
Recent advances in IVF have shifted the focus towards maximizing treatment efficacy and efficiency. Traditionally, IVF success has been evaluated on a cycle-by-cycle basis. Advancements such as individualized ovarian sti...Recent advances in IVF have shifted the focus towards maximizing treatment efficacy and efficiency. Traditionally, IVF success has been evaluated on a cycle-by-cycle basis. Advancements such as individualized ovarian stimulation protocols, gonadotrophin-releasing hormone agonist triggers, cryopreservation techniques and embryo selection strategies, including preimplantation genetic testing for aneuploidies, have improved precision medicine in IVF, optimizing clinical outcomes. Despite these developments, certain patient groups - especially those with low ovarian response and/or advanced age - still face lower success rates per IVF cycle initiated. Considering the reproductive system's physiology, which often requires multiple attempts for success, and drawing from the experience of intrauterine insemination, a shift from a single-cycle focus to a multicycle strategy is now needed. A multicycle approach, adopting approaches such as oocyte/embryo accumulation from several stimulations or two consecutive stimulations (e.g. DuoStim), enables the advance planning of multiple attempts. It helps shorten time to pregnancy, reduces treatment discontinuation and offers support for patients facing setbacks. To be effective, this strategy must include personalized psychological counselling to manage emotional stress and prepare patients for possible failures, which are major causes of discontinuation. Evidence shows that well-informed, supported patients are more likely to persist in treatment, leading to higher cumulative success rates.
RESEARCH QUESTION: Should we discard embryos exposed to culture media contaminated with Enterococcus faecalis? DESIGN: This case report describes an IVF cycle in which the embryo culture medium was contaminated with E. f...RESEARCH QUESTION: Should we discard embryos exposed to culture media contaminated with Enterococcus faecalis? DESIGN: This case report describes an IVF cycle in which the embryo culture medium was contaminated with E. faecalis originating from the sperm sample. The collection and microbiological analysis of the contaminated culture media, as well as the embryological, clinical and neonatal outcomes, are presented. RESULTS: A couple, both aged 23 years, presented at Brussels IVF in 2023 for a second assisted reproductive technology attempt. Following oocyte retrieval, 14 oocytes underwent conventional IVF in culture media containing 10 µg/ml gentamicin sulphate, yielding 10 fertilized oocytes, and one blastocyst was vitrified on day 5. Contamination with amoxicillin-sensitive E. faecalis was detected on day 6 (after automated aerobic and anaerobic culture; BD Bactec). A sperm culture was performed 11 days later and tested positive for E. faecalis. After obtaining the patient's informed consent, the only vitrified embryo was transferred in a natural cycle. Prophylactic amoxicillin (three times a day for 5 days) was administered to the patient following transfer. Culture medium analysis post-warming (2.5 h culture) still detected E. faecalis, suggesting persistent contamination. A healthy female infant (2845 g) was born at 40 weeks of gestation. All culture media used contained 10µg/mL gentamicin sulphate. CONCLUSIONS: Treatment with prophylactic amoxicillin resulted in a healthy live birth from a blastocyst contaminated with E. faecalis, questioning the systematic discarding of embryos from contaminated culture medium.
RESEARCH QUESTION: Does the number of trophectoderm cells biopsied during blastocyst-stage preimplantation genetic testing for aneuploidy (PGT-A) affect diagnostic or clinical outcomes? DESIGN: This retrospective study i...RESEARCH QUESTION: Does the number of trophectoderm cells biopsied during blastocyst-stage preimplantation genetic testing for aneuploidy (PGT-A) affect diagnostic or clinical outcomes? DESIGN: This retrospective study included 660 blastocysts from 222 cycles, grouped according to the number of cells biopsied (two to four, five to six, seven or more). Next-generation sequencing (NGS) was used for genetic analysis. Diagnostic failure, aneuploidy, mosaicism, re-expansion and implantation rates were compared between the groups. Multivariable logistic regression adjusted for age, embryo quality, and morphological grade of trophectoderm cells. RESULTS: Diagnostic failure and mosaicism rates did not differ significantly between the groups. The aneuploidy rate differed significantly between the 2-4-, 5-6-, and ≥7-cell groups (56.7%, 43.1% and 57.8%, respectively; P = 0.010); this was associated with maternal age ≥35 years (adjusted OR 2.34, 95% CI 1.59-3.45; P < 0.001) and grade B trophectoderm cells compared with grade A trophectoderm cells (adjusted OR 1.55, 95% CI, 1.05-2.30; P = 0.028), but not with the number of cells biopsied. The blastocyst re-expansion rate was >98%, and the implantation rate was similar across the groups. CONCLUSIONS: Diagnostic failure rates may be comparable when different numbers of trophectoderm cells are biopsied, after adjustment for potential confounders in multivariable analyses. Minimizing the number of cells biopsied may reduce embryo injury, supporting the need for standardized biopsy protocols that consider both diagnostic yield and embryo preservation.