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Summary: The aim was to study whether a limited exposure of embryos outside the incubator has an effect on embryo development, blastocyst quality and euploid outcomes. This retrospective study was performed at ART Fertility Clinics, Abu Dhabi, United Arab Emirates (UAE) between March 2018 and April 2020 and included 796 mature sibling oocytes that were split randomly between two incubators after intracytoplasmic sperm injection (ICSI): an EmbryoScope™ (ES) incubator and a benchtop incubator, G185 K-SYSTEMS (KS). The fertilization, cleavage, embryo/blastocyst qualities, useable blastocyst and euploid rates were assessed to evaluate the incubator performance. In total, 503 (63.2%) mature oocytes were cultured in the EmbryoScope and 293 (36.8%) in the K-SYSTEMS. No differences were observed in fertilization rate (79.3% vs 78.8%, P = 0.932), cleavage rate (98.5% vs 99.1%, P = 0.676) and embryo quality on Day 3 (P = 0.543) between both incubators, respectively. Embryos cultured in the EmbryoScope, had a significantly higher chance of being biopsied (64.8% vs 49.6%, P < 0.001). Moreover, a significantly higher blastocyst biopsy rate was observed on Day 5 in the EmbryoScope (67.8% vs 57.0%, P = 0.037), with a highly significant increased euploid rate (63.5% vs 37.4%, P = 0.001) and improved blastocyst quality (P = 0.008). We found that exposure of embryos outside the incubator may negatively affect the in vitro blastocyst development and euploid rate on Day 5. [ABSTRACT FROM AUTHOR]

Study Question: Is the time interval between ovulation triggering and oocyte denudation/injection associated with embryological and clinical outcome after ICSI?Summary Answer: Expanding the time interval between ovulation triggering and oocyte denudation/injection is not associated with any clinically relevant impact on embryological or clinical outcome.What Is Known Already: The optimal time interval between ovulation triggering and insemination/injection appears to be 38-39 h and most authors agree that an interval of >41 h has a negative influence on embryological and clinical pregnancy outcomes. However, in ART centres with a heavy workload, respecting these exact time intervals is frequently challenging. Therefore, we questioned to what extent a wider time interval between ovulation triggering and oocyte injection would affect embryological and clinical outcome in ICSI cycles.Study Design, Size, Duration: A single-centre retrospective cohort analysis was performed including 8811 ICSI cycles from 2010 until 2015. Regarding the time interval between ovulation triggering and oocyte injection, seven categories were considered: <36 h, 36 h, 37 h, 38 h, 39 h, 40 h and ≥41 h. In all cases, denudation was performed immediately prior to injection. The main outcome measures were oocyte maturation, fertilization and embryo utilization rate (embryos adequate for transfer or cryopreservation) per fertilized oocyte. Clinical pregnancy rate (CPR) and live birth rate (LBR) were considered as secondary outcomes. Utilization rate, CPR and LBR were subdivided into two groups according to the day of embryo transfer: Day 3 or Day 5.Participants/materials, Setting, Methods: During the study period, oocyte retrieval was routinely performed 36 h post-triggering except in the <36 h group. The interval of <36 h occurred only if OR was carried out before the planned 36 h trigger interval and was followed by immediate injection. Only cycles with fresh autologous gametes were included. The exclusion criteria were: injection with testicular/epididymal sperm, managed natural cycles, conventional IVF, combined conventional IVF/ICSI, preimplantation genetic testing and IVM cycles. Female age, number of oocytes, pre-preparation sperm concentration, post-preparation sperm concentration and motility, day of transfer, number of embryos transferred and quality of the best embryo transferred were identified as potential confounders.Main Results and the Role Of Chance: Among the seven interval groups, adjusted mean maturation rates ranged from 76.4% to 83.2% and differed significantly (P < 0.001). Similarly, there was a significant difference in adjusted mean fertilization rates (range 69.2-79.3%; P < 0.001). The adjusted maturation and fertilization rates were significantly higher when denudation/injection was performed >41 h post-triggering compared to 38 h post-triggering (reference group). Oocyte denudation/injection at <36 h post-triggering had no significant effect on maturation, fertilization or embryo utilization rates compared to injection at 38 h. No effect of the time interval was observed on CPRs and LBRs, after adjusting for potential confounders. When oocyte injection was performed before 36 h the adjusted analysis showed that compared to 38 h after ovulation triggering the chance of having a live birth tends to be lower although the difference was not statistically significant (odds ratio 0.533, 95% CI: 0.252-1.126; P = 0.099). Injection ≥41 h post-triggering did not affect LBR compared to injection at 38 h post-ovulation.Limitations, Reasons For Caution: As this is a large retrospective study, the influence of uncontrolled variables cannot be excluded. These results should not be extrapolated to other ART procedures such as IVM, conventional IVF or injection with testicular/epididymal sperm.Wider Implications Of the Findings: Our results indicate that the optimal injection time window may be less stringent than previously thought as both embryological and clinical outcome parameters were not significantly affected in our analysis. This is reassuring for busy ART centres that might not always be able to follow strict time intervals.Study Funding/competing Interest(s): No funding. The authors declare no conflict of interest related to the present study.Trial Registration Number: N/A. [ABSTRACT FROM AUTHOR]

Study Question: Is elevated late-follicular phase progesterone (EP) associated with a deleterious impact on embryo quality (EQ) and cumulative live birth rates (LBRs)?Summary Answer: EP was associated with a decrease in embryo utilization and cumulative LBRs.What Is Known Already: Ovarian stimulation promotes the production of progesterone (P) which adversely affects IVF pregnancy outcomes. However, evidence regarding a potential association between EP an EQ is lacking.Study Design, Size, Duration: A retrospective analysis of all GnRH antagonist down-regulated ICSI cycles followed by a fresh embryo transfer (ET) between 2010 and 2015 was performed. The sample was stratified according to the following P levels on the day of ovulation triggering: ≤0.50, 0.51-1.49 and ≥1.50 ng/ml. The primary outcomes were embryo utilization rates (number of embryos transferred or cryopreserved) and cumulative LBR, defined as the occurrence of the first live-birth after either the fresh or one of the subsequent frozen ET.Participants/materials, Setting, Methods: Overall, 3400 cycles were included in the analysis, using multivariable regression to account for potential confounding.Main Results and the Role Of Chance: Female age and the number of oocytes retrieved increased significantly with increasing serum P values. Utilization rates decreased linearly as P increased for Day 3 embryos (72.3, 63.0 and 45.4%, respectively), while for Day 5 embryos only the EP group was associated with a significant decrease (48.8, 47.8 and 38.8%, respectively). EP was also associated with decreased fresh and cumulative LBRs.Limitations Reasons For Caution: The main limitations of this study were its retrospective nature and the fact that it was restricted to GnRH antagonist cycles.Wider Implications Of the Findings: These results raise the question whether EP may also be associated with a decrease in cumulative pregnancy outcomes by increasing embryo wastage. Further studies may evaluate the potential benefit of additional measures besides the freeze-all strategy to avoid this issue, such as lowering the stimulation dose or applying a step-down protocol.Study Funding/competing Interest(s): None. [ABSTRACT FROM AUTHOR]

Study Question: Does closed oocyte vitrification in an oocyte donation programme have an impact on obstetric and neonatal outcome?Summary Answer: Obstetric and neonatal outcomes after closed system vitrification of donor oocytes appear to be reassuring.What Is Known Already: The use of fresh oocytes has not been proved to be superior to the use of vitrified donor oocytes in terms of survival, embryo development and clinical pregnancies. Those studies used open devices to prove the non-superiority. Very limited information is available on the comparison of open and closed devices, and the results for survival, embryo development and pregnancy outcomes are conflicting. Data on obstetric and neonatal outcome from vitrified oocytes are scarce. Only one large report is available after the use of donor oocytes vitrified with an open device.Study Design, Size, Duration: Retrospective observational study performed at the Centre for Reproductive Medicine, UZ Brussel, Belgium. All 117 oocyte recipient cycles between March 2010 and August 2014 with the use of a closed vitrification device and leading to a pregnancy beyond 20 weeks were included in this study.Participants/materials, Setting, Methods: All recipient warming cycles with a pregnancy beyond 20 weeks from vitrified donor oocytes: results from the fresh embryo transfers.Main Results and the Role Of Chance: For 117 recipient cycles, a total of 793 oocytes were warmed of which 657 (82.8%) survived and 499 (76.0%) were fertilized. Nineteen single and 98 double embryo transfers led to 95 singleton and 22 twin pregnancies. Hypertensive disorders, haemorrhages and gestational diabetes were reported in 22/112 (19.6%), 30/112 (26.8%) and 13/112 (11.6%) of the pregnancies, respectively. No major adverse neonatal outcomes were observed. Congenital malformations were observed in 11 out of 139 children; for one an elective termination was performed at 25 weeks.Limitations, Reasons For Caution: Since March 2010, almost all oocytes for donation are vitrified in our centre. Therefore, no recent data are available to control the outcomes of fresh oocyte donations.Wider Implications Of the Findings: The reassuring results obtained in the current study show that closed system vitrification devices for donor oocytes may be used as an alternative to open devices which have been linked to possible cross-contamination issues.Study Funding/competing Interests: None.Trial Registration Number: N/A. [ABSTRACT FROM AUTHOR]

Study Question: Is the survival of donor oocytes with the CryotopSC device superior to the survival with the closed CBSvit device?Summary Answer: The CryotopSC device and the CBSvit device showed similar survival rates.What Is Known Already: Health authorities are cautious about possible cross contamination during liquid nitrogen storage or handling when working with open vitrification devices. At present, the use of open devices is still allowed since little information is available on the efficiency of closed devices.Study Design, Size, Duration: A prospective randomized sibling oocyte study was performed in the Centre for Reproductive Medicine (UZBrussel) between January 2014 and July 2015. The survival after warming and the embryological outcome of donor oocytes vitrified using two devices was compared: the CBSvit device (closed vitrification and closed storage) and the CryotopSC device (open vitrification and closed storage). A difference of 10% was defined to prove the superiority of the CryotopSC device. In total, 250 warmed oocytes were needed in each arm.Participants/materials, Setting, Methods: Oocytes from 48 donors were included in the study: 253 vitrified with the CBSvit device and 257 with the CryotopSC device. Equal numbers of oocytes from both devices and originated from the same donor cycle were allocated to each of 78 recipients, in order to exclude donor and recipient (male factor) effects.Main Results and the Role Of Chance: There were no differences found between the CBSvit and the CryotopSC in terms of survival after warming (93.7 versus 89.9%) or fertilization per injected oocyte (74.3 versus 81.4%). The degeneration rate after ICSI was significantly higher for the CBSvit device: 11.4 versus 6.1% (P = 0.041). A significantly higher number of zygotes in the CryotopSC group finished their first mitosis 25-27 h post-injection (34.1 versus 52.1%, P = 0.001). On Day 3, the overall embryo quality distribution did not vary between groups, but a significantly higher cell number was obtained in the CryotopSC device: 6.8 ± 2.8 versus 7.6 ± 2.8 (P = 0.01). The utilization rate per mature oocyte, per surviving oocyte or per fertilized oocyte did not differ. The embryos with the highest quality were selected for transfer on Day 3. The clinical pregnancy rate per transfer cycle was 36.5%.Limitations, Reasons For Caution: The results of this study should not be extrapolated to other female groups, since oocytes from young fertile donors were used in this study.Wider Implications Of the Findings: In many countries, the use of open devices is still allowed due to the limited reports on the efficiency of closed devices. Knowing the caution of health authorities about the use of open devices, there is an urgent need for efficiency studies with closed devices. The results obtained in the current study shows the efficiency of a safe closed vitrification device, leaving behind any concern about possible cross contamination during handling or storage.Study Funding/competing Interests: No funding was obtained. The authors have no conflict of interest to declare.Trial Registration Number: NCT01952184.Trial Registration Date: 24 September 2013.Date Of First Patient's Enrolment: 23 January 2014. [ABSTRACT FROM AUTHOR]

This sibling oocyte study was designed to determine how embryo quality is influenced after sperm selection using microfluidic sperm sorting (MSS) technology compared to a standard density gradient centrifugation (DGC). A single-centre prospective non-inferiority sibling oocyte study was performed between October 2023 and February 2024, comparing DGC to MSS. Primary endpoint was embryo utilisation rate. Only ICSI cycles with ejaculated sperm and at least 6 mature oocytes (MII) were included. Sample-size calculation indicated a number of 253 MII for each arm. Each raw semen sample was split in two fractions processed by DGC and by MSS using Zymot 850µl® device. During ICSI, half of the MII were injected with sperm processed by DGC and the other half by MSS. The inseminated oocytes were individually cultured in cleavage/blastocyst medium (Origio) for maximum 7 days. The mean female age was 34.5±4.4 years and partner age was 37.5±5.5 years. Sperm concentration (x106/ml) was similar following DGC (2.9±1.2) or MSS (3.5±5.0) (p=0.16). Progressive motility (% A+B) was significantly lower following DGC vs MSS (74.0%±17.2 vs 89.9%±10.4 (p<0.01), respectively. The DFI of the raw semen samples was 5.6%±3.6. A number of 51 ICSI-cycles were included with 658 cumulus-oocyte-complexes retrieved of which 532 MII were randomized to either DGC (n= 265) or MSS (n=267) groups. Fertilisation rate was not significantly different between DGC and MSS (208/265, 78.5% vs 209/267, 78.3%, respectively; p=0.96). Similarly, good embryo quality on day 3 (159/208, 76.4% vs 161/209, 77.0%, respectively; p=0.97) and good blastocyst quality (≥Bl3BB) (86/208, 41.3% vs 76/209, 36.4%, respectively; p=0.30) were not different between the two groups. Utilisation rates (number of transferred and cryopreserved embryos) were similar between the two groups: both per MII (104/265, 39.2% vs 107/267, 40.1%, respectively; p=0.91) and per fertilised oocyte (104/208, 50.0% vs 107/209, 51.2%, respectively; p=0.88) in DGC vs MSS. Since fertilisation, embryo quality and utilisation rate are similar in both groups, the use of Zymot 850µl® device offers the advantage of eliminating the negative effects and time-consuming nature of centrifugation. Another advantage is that scheduling of semen samples can be planned more efficiently. [ABSTRACT FROM AUTHOR]

In conventional IVF (cIVF), extended exposure (16-20 hours) of oocytes to spermatozoa metabolic waste may negatively impact embryo development, emphasizing the importance of incubation time in the IVF procedure. We aimed to compare fertilization rates, embryo quality and utilization rates between short IVF (sIVF) incubation and cIVF as part of a validation study. The study was performed between October 2022-2023. sIVF incubation was performed and oocytes were denuded 6 hours later. Control patients underwent cIVF within the same study period, with denudation performed 16-20h post insemination. Fertilization rates, embryo quality and utilization rates were assessed and compared between the two groups. Regression analysis was performed considering age, age of partner, total COCs retrieved and number of previous cycles as potential confounders. Based on the time of oocyte retrieval, 24 cycles were included in sIVF (n=244 COCs) and 187 cycles in cIVF (n=1922 COCs). Patients were on average 34.1±4.2 and 32.3±4.8 years old, respectively. Fertilization rates per COC (52% and 53% respectively, p=0.742) and per mature oocyte (MII, 60% and 63% respectively, p=0.848) showed no significant differences. The incidence of abnormally fertilized oocytes (≥3 pronuclei) was significantly lower in sIVF (10% vs 13% respectively, p=0.040) when only mature oocytes were taken into account. Day 3 and day 5 rates of good quality embryos per fertilized oocyte (2PN) were comparable between sIVF and cIVF (day 3: 75% vs 77%, p=0.970; day 5: 28% vs 42%, p=0.174). No significant difference was found for utilization rates per COC, per MII, or per 2PN [19% vs 28% (p=0.450), 22% vs 33% (p=0.381), 37% vs 52% (p=0.173), respectively]. Linear regression analysis revealed no significant confounding effects on the tested variables. Heterogeneity and limited sample size are the main drawbacks of this study with a need for a prospective sibling oocyte study to further elucidate potential differences between sIVF and cIVF. To conclude, sIVF is comparable to cIVF in terms of fertilization rates, embryo quality and utilization rates. The lower rate of abnormally fertilized oocytes shows a potential advantage of a sIVF protocol. [ABSTRACT FROM AUTHOR]