Reproductive biomedicine online最新文献

Although single women and lesbian couples are given access to donor spermatozoa, all kinds of restrictions limit their actual use of donor insemination. These restrictions are frequently justified by the increase in safety (lowering the genetic risk) or well-being of donor-conceived persons. However, these restrictions directly result in stratified reproduction in which only the rich (those with the necessary financial means) and the straight (those who conform to dominant views of parenthood) are allowed to reproduce.

Trophectoderm-based preimplantation genetic testing for aneuploidies (PGT-A) is used worldwide as a means of selecting embryos with high potential for achieving a live birth. However, trophectoderm analysis may be impaired through embryonic mosaicism, leading to genetically healthy embryos being falsely discarded, and thus even reducing cumulative live birth rates. Polar body biopsy, a technique applied since the early days of preimplantation testing, has been abandoned by most IVF centres. In comparison to trophectoderm analysis, however, polar body biopsy might even have certain advantages over trophectoderm PGT-A. This Countercurrent contribution discusses the newest clinical evidence, as well as ethical and cost-efficiency considerations, and argue that polar body analysis should be reconsidered.

Research question: Could a predictive model, using data from all US fertility clinics reporting to the Society for Assisted Reproductive Technology, estimate the likelihood of patients using their stored oocytes?

Design: Multiple learner algorithms, including penalized regressions, random forests, gradient boosting machine, linear discriminant analysis and bootstrap aggregating decision trees were used. Data were split into training and test datasets. Patient demographics, medical and fertility diagnoses, partner information and geographic locations were analysed.

Results: A total of 77,631 oocyte-cryopreservation cycles (2014-2020) were analysed. Patient age averaged 34.5 years. Treatment indications varied: planned (35.6%), gender-related (0.1%), medically indicated (15.5%), oncologic (5.7%) and unknown (42.3%). Infertility diagnoses were less common: unexplained infertility (1.8%), age-related infertility (3.2%), diminished ovarian reserve (9.9%) and endometriosis (1.6%). An ensemble model combining bootstrap aggregation classification and regression trees, stochastic gradient boosting and linear discriminant analysis yielded the highest predictive accuracy on test set (balanced accuracy: 0.83, sensitivity: 0.76, specificity: 0.91), with a receiver operating characteristic curve of 0.90 and precision-recall curve and area under the curve of 0.57. Key factors influencing the likelihood of returning for oocyte use included patient age, presence of a partner, race or ethnicity, the clinic's geographic region and oocyte cryopreservation indication.

Conclusions: This model demonstrated significant predictive accuracy, and is a valuable tool for patient counselling on oocyte cryopreservation. It helps to identify patients more likely to use stored oocytes, enhancing healthcare decision-making and the efficiency of gamete storage programmes. The model can be applied to self-financed and insurance-funded cycles.

Research question: What are the clinical effects of using culture media supplemented with antioxidants (AOX) throughout the IVF process?

Design: Prospective randomized single-centre study. Cumulus-oocyte complexes and semen samples collected from 127 treatment cycles were divided evenly between the study arm (culture media with AOX) and the control arm (culture media without AOX). The primary endpoint was the good-quality blastocyst (GQB) rate on day 5-6 per metaphase II (MII) oocyte.

Results: Fertilization rate and day 5-6 blastocyst rate per MII oocyte differed significantly in favour of the study arm, whereas GQB rate did not. A subgroup analysis, stratified by maternal age, revealed significant improvements in the study arm for day 3 embryo development rate, day 5-6 blastocyst rate, GQB rate and blastocyst utilization rate for patients aged 35-40 years, while the impacts on these endpoints were much smaller in patients aged <35 years. Ninety-four single vitrified blastocyst transfers (SVBT) were performed in each arm. The blastocysts derived from the study arm showed better results of SVBT for patients aged 35-40 years, defined by embryo implantation rate, fetal heartbeat rate and live birth rate, whereas these variables did not differ significantly between the two arms when assessing the results for patients of all ages and patients aged <35 years.

Conclusions: Embryo development and SVBT outcomes of treatment cycles of patients aged 35-40 years improved significantly when using AOX-supplemented culture media throughout the IVF process.

Research question: What are the trends and impact of new technologies on the effectiveness and safety of assisted reproductive technology (ART) performed in Latin America during 2021?

Design: This was a retrospective collection of cycle-based multinational data obtained from ART procedures performed by 204 accredited institutions in 16 countries.

Results: In total 127,351initiated cycles resulted in 20,032 deliveries and 22,708 births. ART utilization showed great variability, from 623.5 cycles/million inhabitants in Uruguay to fewer than 35 in Guatemala and El Salvador. The proportion of women aged ≥40 years increased to 35.8%, while that of women ≤34 years dropped to 23.9%. Nonetheless, the proportion of single-embryo transfers (SET) increased from 11.9% in the previous decade to 42.4% in 2021. Of 22,708 babies born, 76.8% were singletons, 22.3% twins and 1.0% triplets or more. Intracytoplasmic sperm injection represented 84.5% of fertilization techniques, and blastocyst transfer increased from 49.6% in 2016 to 79.3% in 2021. The delivery rate after fresh blastocyst elective SET was significantly higher than after the transfer of one frozen embryo from a freeze-all cycle (P < 0.0001). The number of aspirations leading to preimplantation genetic testing has increased 2.8 times in 5 years and significantly increased delivery rates/transfer at all ages, including in oocyte donation (P ≤ 0.002), and reduced miscarriage in women ≥35 years old. In oocyte donation, delivery rates after the fresh transfer of embryos from vitrified-warmed oocyte cycles generated similar outcomes to frozen embryo transfer. Perinatal mortality increased from 7.7‰ in singletons to 21.3‰ in twins.

Conclusion: The systematic collection of cycle-based multinational data contributes to cooperative sustained development and helps implement evidence-based reproductive decisions.