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Athayde Wirka K.,Auxogyn | Chen A.A.,Auxogyn | Conaghan J.,Pacific Fertility Center | Gvakharia M.,Fertility Physicians of Northern California | And 4 more authors.
Fertility and Sterility | Year: 2014

Objective To characterize atypical dynamic embryo phenotypes identified by time-lapse microscopy, evaluate their prevalence, and determine their association with embryo development. Design Retrospective multicenter cohort study. Setting Five IVF clinics in the United States. Patient(s) Sixty-seven women undergoing IVF treatment with 651 embryos. Intervention(s) Embryo videos were retrospectively analyzed for atypical phenotypes. Main Outcome Measure(s) Identification of four groups of atypical embryo phenotypes: abnormal syngamy (AS), abnormal first cytokinesis (A1cyt), abnormal cleavage (AC), and chaotic cleavage (CC). Prevalence and association with embryo morphology and development potential were evaluated. Result(s) A high prevalence of atypical phenotypes was observed among embryos: AS 25.1% (163/649), A1cyt 31.0% (195/639), AC 18% (115/639) and CC 15% (96/639). A high percentage of embryos with atypical phenotype(s) had good quality on day 3 (overall grade good or fair): AS 78.6% (70/89); A1cyt 79.7% (94/119), AC 86.4% (70/81), and CC 35.2% (19/54), but the blastocyst formation rates for these embryos were significantly lower compared with their respective control groups: AS 21.5% vs. 44.9%, A1cyt 21.7% vs. 44.6%, AC 11.7% vs. 43.1%, and CC 14.0% vs. 42.3%. Conclusion(s) Embryos exhibiting atypical phenotypes are highly prevalent in human embryos and show significantly lower developmental potential than control embryos. Clinical Trial Registration Number NCT01369446. Copyright © 2014 American Society for Reproductive Medicine, Published by Elsevier Inc. Source

Conaghan J.,Pacific Fertility Center
Seminars in Reproductive Medicine | Year: 2014

Time-lapse imaging of preimplantation embryos is a relatively new and developing technology that may allow embryologists to be more objective in scoring embryos, and allow better selection of embryos for transfer and cryopreservation. The technology is easily assimilated into the in vitro fertilization (IVF) laboratory and is used with any preferred culture medium and culture environment. Embryos are loaded into dedicated culture dishes or trays which allow for individual embryo tracking and in some devices, group culture and individual embryo scoring at the same time. The embryos are imaged at regular intervals without removal from the culture environment, and the images can be viewed individually or stitched together to form a video showing complete development from oocyte to blastocyst. Automated or manual review of time-lapse videos can assist in identifying embryos with normal developmental profiles, and in deselecting embryos for consideration for transfer based on abnormal phenotypes. Time-lapse data are used in conjunction with traditional embryo scoring based on morphology to make embryo selection decisions. Improved embryo selection for transfer could allow for more widespread use of elective single embryo transfer without compromising pregnancy rates after IVF. Copyright © 2014 by Thieme Medical Publishers, Inc. Source

Harris S.,Methodist Hospital | Conaghan J.,Pacific Fertility Center | Papadakis M.,Carolinas Medical Center | Basuray R.,University of Kentucky | Battaglia D.,Oregon Health And Science University
Fertility and Sterility | Year: 2010

A misconception in the field of reproductive medicine is that there is a significant risk of cross-contamination during gamete or embryo cryostorage. This article is a review of the available literature on animal models and human IVF and it suggests otherwise. There is a negligible risk of cross-contamination in IVF working conditions. Copyright © 2010 American Society for Reproductive Medicine, Published by Elsevier Inc. Source

Hardarson T.,Fertilitetscentrum | Bungum M.,Skane University Hospital | Conaghan J.,Pacific Fertility Center | Meintjes M.,Frisco Institute for Reproductive Medicine | And 4 more authors.
Fertility and Sterility | Year: 2015

Objective To study whether a culture medium that allows undisturbed culture supports human embryo development to the blastocyst stage equivalently to a well-established sequential media. Design Randomized, double-blinded sibling trial. Setting Independent in vitro fertilization (IVF) clinics. Patient(s) One hundred twenty-eight patients, with 1,356 zygotes randomized into two study arms. Intervention(s) Embryos randomly allocated into two study arms to compare embryo development on a time-lapse system using a single-step medium or sequential media. Main Outcome Measure(s) Percentage of good-quality blastocysts on day 5. Result(s) Percentage of day 5 good-quality blastocysts was 21.1% (standard deviation [SD] ±21.6%) and 22.2% (SD ±22.1%) in the single-step time-lapse medium (G-TL) and the sequential media (G-1/G-2) groups, respectively. The mean difference (-1.2; 95% CI, -6.0; 3.6) between the two media systems for the primary end point was less than the noninferiority margin of -8%. There was a statistically significantly lower number of good-quality embryos on day 3 in the G-TL group [50.7% (SD ±30.6%) vs. 60.8% (SD ±30.7%)]. Four out of the 11 measured morphokinetic parameters were statistically significantly different for the two media used. The mean levels of ammonium concentration in the media at the end of the culture period was statistically significantly lower in the G-TL group as compared with the G-2 group. Conclusion(s) We have shown that a single-step culture medium supports blastocyst development equivalently to established sequential media. The ammonium concentrations were lower in the single-step media, and the measured morphokinetic parameters were modified somewhat. Clinical Trial Registration Number NCT01939626. © 2015 The Authors. Source

Li L.,Pacific Fertility Center | Ferin M.,Columbia University | Sauer M.V.,Columbia University | Lobo R.A.,Columbia University
Journal of Assisted Reproduction and Genetics | Year: 2012

Purpose: We aimed to characterize the association between levels of serum and follicular fluid (FF) adipocytokines, reflected by the leptin to adiponectin ratio (L:A ratio), and oocyte quality and in vitro embryo development in women undergoing assisted reproduction. We also aimed to assess whether follicular hormonal pathways mediate this interaction. Methods: We prospectively collected FF from up to four individual preovulatory follicles (n = 76) and fasting sera from women (n = 31) without endocrinopathies undergoing in vitro fertilization (IVF) at a university-based center for assisted reproduction. Leptin, total adiponectin, insulin, insulin-like growth factor 1 (IGF-1), and ovarian steriods were measured using enzyme immunoassay. Oocyte maturity, fertilization, and embryo development were assessed. Results: FF leptin was similar to serum levels while FF adiponectin was lower. FF leptin (27.10 ± 4.05 ng/mL) and the L:A ratio (11.48E-3 ± 2.57E-3) were related to FF insulin (R 2 = 0.370 and 0.419, p < 0.001) but not to ovarian steroids or IGF-1, whereas FF adiponectin (4.22 ± 0.52 ug/mL) correlated only with leptin (R 2 = -0.138, p = 0.001). Oocytes from a high FF L:A ratio environment were 81 % (RR 1.81 [95%CI 0.97-3.37]) more likely to undergo successful cleavage and 117 % (RR 2.17 [95 % CI 1.06-4.44]) more likely to obtain viable cleavage morphology compared to a low FF L:A ratio environment, even when adjusted for FF insulin, an independent predictor of cleavage. Conclusions: Certain adipocytokines, particularly the L:A ratio in the FF of the preovulatory follicle, are related to successful in vitro embryo development. This action may be independent of FF insulin. © 2012 Springer Science+Business Media New York. Source

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