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Fishel S.,CARE Fertility Group
Reproductive BioMedicine Online | Year: 2013

The wholesale introduction of any new procedure to medical practice requires an acceptance based on evidence-based medicine, which is primarily acquired using prospective randomized controlled trials. However, for self-funded treatments, as are the majority of IVF cycles, this has always been very difficult to achieve. Generally, new technologies are introduced and adopted by patients who have failed in previous attempts at IVF. Urging patients to enter into a prospective randomized controlled trial is problematic, especially when they are self-funding; eagerness to conceive when time is against them, and/or having undergone previously failed treatment attempts, convince most patients to fund the new technology/opportunity rather than risk falling into the control arm and repeating their previous failure(s). The UK is uniquely placed to advance IVF medicine by helping practitioners and patients gain access to vital trials through the National Health Service. © 2013, Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

Ciray H.N.,University of Leeds | Campbell A.,CARE Fertility Group | Agerholm I.E.,Fertility Clinic | Aguilar J.,University of Vigo | And 3 more authors.
Human Reproduction | Year: 2014

STUDY QUESTION Can the approach to, and terminology for, time-lapse monitoring of preimplantation embryo development be uniformly defined in order to improve the utilization and impact of this novel technology? SUMMARY ANSWER The adoption of the proposed guidelines for defining annotation practice and universal nomenclature would help unify time-lapse monitoring practice, allow validation of published embryo selection algorithms and facilitate progress in this field. WHAT IS KNOWN ALREADY An increasing quantity of publications and communications relating to time-lapse imaging of in vitro embryo development have demonstrated the added clinical value of morphokinetic data for embryo selection. Several articles have identified similar embryo selection or de-selection variables but have termed them differently. An evidence-based consensus document exists for static embryo grading and selection but, to date, no such reference document is available for time-lapse methodology or dynamic embryo grading and selection. STUDY DESIGN, SIZE AND DURATION A series of meetings were held between September 2011 and May 2014 involving time-lapse users from seven different European centres. The group reached consensus on commonly identified and novel time-lapse variables. PARTICIPANTS/MATERIALS, SETTING, METHODS Definitions, calculated variables and additional annotations for the dynamic monitoring of human preimplantation development were all documented. MAIN RESULTS AND THE ROLE OF CHANCE Guidelines are proposed for a standard methodology and terminology for the of use time-lapse monitoring of preimplantation embryo development. LIMITATIONS, REASONS FOR CAUTION The time-lapse variables considered by this group may not be exhaustive. This is a relatively new clinical technology and it is likely that new variables will be introduced in time, requiring revised guidelines. A different group of users from those participating in this process may have yielded subtly different terms or definitions for some of the morphokinetic variables discussed. Due to the technical processes involved in time-lapse monitoring, and acquisition of images at varied intervals through limited focal planes, this technology does not currently allow continuous monitoring such that the entire process of preimplantation embryo development may be visualized. WIDER IMPLICATIONS This is the first time that a group of experienced time-lapse users has systematically evaluated current evidence and theoretical aspects of morphokinetic monitoring to propose guidelines for a standard methodology and terminology of its use and study, and its clinical application in IVF. The adoption of a more uniform approach to the terminology and definitions of morphokinetic variables within this developing field of clinical embryology would allow practitioners to benefit from improved interpretation of data and the sharing of best practice and experience, which could impact positively and more swiftly on patient treatment outcome. © The Author 2014. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology.

Campbell A.,CARE Fertility Group | Fishel S.,CARE Fertility Group | Laegdsmand M.,Unisense FertiliTech
Reproductive BioMedicine Online | Year: 2014

In a previous paper, we had reported use of time-lapse monitoring to develop an aneuploidy risk classification model after identifying significant periblastulation delays in aneuploid embryos compared with euploid embryos. The model was validated subsequently in a second paper by retrospective assessment of transferred blastocysts that had also undergone time-lapse monitoring in which clinical pregnancy or live birth outcomes were established. A significant difference was seen for both outcome measures between embryos classified as low and medium risk by the model. Here we respond to the commentary entitled 'A cautionary note against embryo aneuploidy risk assessment using time-lapse imaging', which presented a case for our conclusions being unsound on the basis that maternal age, rather than aneuploidy, might be the cause of the developmental delays observed. We demonstrate that this is not the case and strengthen the argument that ploidy is a key factor influencing morphokinetics of blastulation. We also describe why the arguments made in the commentary based on comparisons between static standard observations and timings of the preimplantation embryo compared with those obtained from dynamic or time-lapse methodologies are inexact. © 2013, Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

Kirkegaard K.,Aarhus University Hospital | Kirkegaard K.,University of Aarhus | Campbell A.,CARE Fertility Group | Agerholm I.,Fertility Clinic | And 6 more authors.
Reproductive BioMedicine Online | Year: 2014

The goal of embryo selection models is to select embryos with the highest reproductive potential, whilst minimizing the rejection of viable embryos. Ultimately, any embryo selection model must be tested on clinical outcome. We therefore retrospectively tested a published blastocyst prediction model on a large combined set of transferred embryos with known clinical outcome. The model was somewhat effective in that we found a relative increase of 30% for implantation in the model-selected group of embryos. There was, however, a concomitant large rejection of embryos from our test cohort, which actually resulted in pregnancy. This hypothetical experiment highlights the limitations of predicting blastulation only. Crucially, it illustrates that both sensitivity and specificity are important parameters when developing embryo selection models for prospective clinical use. © 2014 Reproductive Healthcare Ltd. © 2014 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

Kwak-Kim J.,Rosalind Franklin University of Medicine and Science | Han A.R.,Rosalind Franklin University of Medicine and Science | Gilman-Sachs A.,Rosalind Franklin University of Medicine and Science | Fishel S.,CARE Fertility Group | Shoham Z.,Hebrew University
American Journal of Reproductive Immunology | Year: 2013

Problem: Reproductive immunology has evolved from basic research studies to clinical applications. In this study, we aim to investigate the actual application of reproductive immunology concepts and findings in clinical reproductive medicine such as recurrent pregnancy losses (RPL), repeated implantation failures (RIF), and failed in vitro fertilization (IVF) cycles. Method of Study: A web-based survey was performed on IVF-Worldwide.com. Collected data were analyzed by the computerized software. Results: A significant proportion of physicians recommend thrombophilia workups (86%), parental genetic study (79%), and immunologic evaluations (69%) to IVF candidates who have a history of RPL or chemical pregnancy losses. IVF physicians consider an immunologic workup when patients have two (30%) or three (21%) failed IVF cycles. Assays for anticardiolipin antibody, lupus anticoagulant, thyroid peroxidase antibody, and antinuclear antibody are the four most commonly ordered immunologic tests for RPL (88, 84, 50, 47% each) and RIF (68, 63, 38, 38% each). Cellular immune evaluations, such as NK assay, human leukocyte antigen study, Th1/Th2 study or immunophenotype assay, are less commonly ordered. Conclusions: Reproductive immunology principles have been applied to the clinical management of RPL, RIF, and failed IVF cycles, and a significant proportion of IVF physicians acknowledge the importance of immunologic alterations with reproductive outcomes. © 2012 John Wiley & Sons A/S.

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