Parameters impacting the live birth rate per transfer after frozen single euploid blastocyst transfer.

BACKGROUND:To assess the predictive value of patient characteristics, controlled ovarian stimulation and embryological parameters on the live birth outcome of single euploid frozen-warmed blastocyst transfer (FBT). METHODS:This was a retrospective cohort study including 707 single FBTs after preimplantation genetic testing for aneuploidy (PGT-A) that were performed from October 1, 2015, to January 1, 2018. The effects of patient-, cycle- and embryology-related parameters on the live birth outcome after FBT were assessed. RESULTS:In the subgroup analysis based on live birth, patients who achieved a live birth had a significantly lower body mass index (BMI) than patients who did not achieve a live birth (22.7 (21.5-24.6) kg/m2 vs 27 (24-29.2) kg/m2, p<0.001). The percentage of blastocysts with inner cell mass (ICM) A or B was significantly higher among patients achieving a live birth, at 91.6% vs. 82.6% (p<0.001). Day-5 biopsies were also more prevalent among patients achieving a live birth, at 82.9% vs 68.1% (p<0.001). On the other hand, the mitochondrial DNA (mtDNA) levels were significantly lower among cases with a successful live birth, at 18.7 (15.45-23.68) vs 20.55 (16.43-25.22) (p = 0.001). The logistic regression analysis showed that BMI (p<0.001, OR: 0.789, 95% CI [0.734-0.848]), day of trophectoderm (TE) biopsy (p<0.001, OR: 0.336, 95% CI [0.189-0.598]) and number of previous miscarriages (p = 0.004, OR: 0.733, 95% CI [0.594-0.906]) were significantly correlated with live birth. Patients with elevated BMIs, cycles in which embryos were biopsied on day-6 and a higher number of miscarriages were at increased risks of reduced live birth rates. CONCLUSION:A high BMI, an embryo biopsy on day-6 and a high number of miscarriages negatively affect the live birth rate after single euploid FBT

#ESHREjc report: trick or treatment—evidence based use of add-ons in ART and patient perspectives

Extract The September ESHRE Journal Club discussed a paper from Lensen et al. (2021) about the prevalence and pattern of add-on use in ART. The paper was based on an online national survey in Australia for women having ART treatment over a 3-year period. Survey questions covered demographics, IVF history and the use of IVF add-ons. This survey showed that 82% of the 1590 eligible patients have used at least one add-on during treatment and usually at an additional cost (72% of cases). The majority of patients shared the decision of add-on use with their fertility specialist and placed a high level of importance on safety and efficacy based on scientific evidence. The study also highlighted a high proportion of patient regret (83%) after unsuccessful treatments and when the specialist had a larger contribution in the decision to use add-ons (75%). Due to large add-on utilization, it was interesting for Journal Club participants to discuss whether their use is supported by scientific evidence and how this evidence is disseminated. What is the regulatory framework around add-on use and what are patients’ perspectives? The ESHRE Journal Club with 45 participants, experts Raj Mathur and Christos Venetis, as well as a representative from the patient association Fertility Europe, discussed the topic on Twitter; >800k impressions were recorded over the 24-h period

#ESHREjc report: diagnosing endometriosis loosens the Gordian knot of infertility treatment

Extract The path to the characterization of endometriosis since its first discovery by Karl von Rokitansky 150 years ago has been a rocky one (von Rokitansky, 1860). Linking histology to clinical observations was perplexed by infamous theories, such as Sigmund Freud’s attributing endometriosis symptoms to ‘hysteria’, but eventually defined a milestone that allowed progress into the development of endometriosis diagnostics. Laparoscopic surgery has been the gold standard to reliably visualize endometriosis lesions for years but non-invasive imaging methods are emerging (Leonardi et al., 2020). The recent ESHRE guidelines call for a refinement of the concept of surgery as the only diagnostic tool, calling it ‘an outdated dogma’ (Members of the Endometriosis Guideline Core Group et al., 2022). If we consider the general lack of awareness, the differences in symptomatology, the many unknown aspects of its pathophysiology, and finally the debate about diagnostic gold standard, it is not surprising that diagnosing endometriosis can take up to 7 years (Arruda et al., 2003)

#ESHREjc report: failed fertilization: is genetic incompatibility the elephant in the room?

Extract Failed fertilization: is genetic incompatibility the elephant in the room? A recently published opinion paper by Dr Jukka Kekäläinen hypothesized that cryptic female choice (CFC), i.e. female-driven mechanisms that act primarily prior to or during fertilization and bias it towards the sperm of specific males, could also be involved in human fertilization (Kekäläinen, 2021). As the human species is labelled inefficient with regards to reproduction and the success rate of ART has not increased in the last decades (Gleicher et al., 2019), the idea that gamete compatibility could be the missing puzzle piece to complete our understanding of the intricate process of fertilization and partly explain the phenomenon of fertilization failure, is fascinating. Kekäläinen (2021) focused on evolutionary genetics in animal reproductive physiology and rationalized the hypothesis of gamete compatibility in humans, but did not elaborate on the possible clinical consequences of his theory. Defining the potential clinical relevance of genetic compatibility is an ambitious undertaking and one which led to a multidisciplinary discussion involving experts in evolution, genetics and reproductive medicine at the live edition of the ESHRE Journal Club at the 38th ESHRE annual meeting (see Fig. 1 for a graphical summary of the main points of the discussion)