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Balaban B.,American Hospital | Brison D.,St Marys Hospital | Calderon G.,IVI Barcelona | Catt J.,Optimal IVF | And 18 more authors.
Human Reproduction | Year: 2011

BACKGROUND: Many variations in oocyte and embryo grading make inter-laboratory comparisons extremely difficult. This paper reports the proceedings of an international consensus meeting on oocyte and embryo morphology assessment. Methods Background presentations about current practice were given. Results The expert panel developed a set of consensus points to define the minimum criteria for oocyte and embryo morphology assessment. CONCLUSIONS It is expected that the definition of common terminology and standardization of laboratory practice related to embryo morphology assessment will result in more effective comparisons of treatment outcomes. This document is intended to be referenced as a global consensus to allow standardized reporting of the minimum data set required for the accurate description of embryo development. © The Author 2011. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved.


Conaghan J.,Pacific Fertility Center | Chen A.A.,Auxogyn Inc. | Chenette P.E.,Pacific Fertility Center | Boostanfar R.,HRC Fertility | And 6 more authors.
Fertility and Sterility | Year: 2013

Objective: To assess the first computer-automated platform for time-lapse image analysis and blastocyst prediction and to determine how the screening information may assist embryologists in day 3 (D3) embryo selection. Design: Prospective, multicenter, cohort study. Setting: Five IVF clinics in the United States. Patient(s): One hundred sixty women ≥18 years of age undergoing fresh IVF treatment with basal antral follicle count ≥8, basal FSH <10 IU/mL, and ≥8 normally fertilized oocytes. Intervention(s): A noninvasive test combining time-lapse image analysis with the cell-tracking software, Eeva (Early Embryo Viability Assessment), was used to measure early embryo development and generate usable blastocyst predictions by D3. Main Outcome Measure(s): Improvement in the ability of experienced embryologists to select which embryos are likely to develop to usable blastocysts using D3 morphology alone, compared with morphology plus Eeva. Result(s): Experienced embryologists using Eeva in combination with D3 morphology significantly improved their ability to identify embryos that would reach the usable blastocyst stage (specificity for each of three embryologists using morphology vs. morphology plus Eeva: 59.7% vs. 86.3%, 41.9% vs. 84.0%, 79.5% vs. 86.6%). Adjunctive use of morphology plus Eeva improved embryo selection by enabling embryologists to better discriminate which embryos would be unlikely to develop to blastocyst and was particularly beneficial for improving selection among good-morphology embryos. Adjunctive use of morphology plus Eeva also reduced interindividual variability in embryo selection. Conclusion(s): Previous studies have shown improved implantation rates for blastocyst transfer compared with cleavage-stage transfer. Addition of Eeva to the current embryo grading process may improve the success rates of cleavage-stage ETs. Copyright © 2013 American Society for Reproductive Medicine, Published by Elsevier Inc.


Vermilyea M.D.,University of Pennsylvania | Tan L.,Auxogyn Inc. | Anthony J.T.,University of Pennsylvania | Conaghan J.,Pacific Fertility Center | And 8 more authors.
Reproductive BioMedicine Online | Year: 2014

Computer-automated time-lapse analysis has been shown to improve embryo selection by providing quantitative and objective information to supplement traditional morphology. In this multi-centre study, the relationship between such computer-derived outputs (High, Medium, Low scores), embryo implantation and clinical pregnancy were examined. Data were collected from six clinics, including 205 patients whose embryos were imaged by the EevaTM System. The Eeva scores were blinded and not considered during embryo selection. Embryos with High and Medium scores had significantly higher implantation rates than those with Low scores (37% and 35% versus 15%; P < 0.0001; P = 0.0004). Similar trends in implantation rates were observed in different IVF centres each using their own protocols. Further analysis revealed that patients with at least one High embryo transferred had significantly higher clinical pregnancy rates than those with only Low embryos transferred (51% versus 34%; P = 0.02), although patients' clinical characteristics across groups were comparable. These data, together with previous research and clinical studies, confirm that computer-automated Eeva scores provide valuable information, which may improve the clinical outcome of IVF procedures and ultimately facilitate the trend of single embryo selection. © 2014 Reproductive Healthcare Ltd. All rights reserved.


Diamond M.P.,Wayne State University | Willman S.,Reproductive Science Center | Chenette P.,Pacific Fertility Center | Cedars M.I.,University of California at San Francisco
Journal of Assisted Reproduction and Genetics | Year: 2012

Purpose To provide a rationale for continuation of efforts to improve the outcome of Assisted Reproductive Technology outcomes, thereby increasing the likelihood of the live birth of healthy neonates. Methods Description of rationale and a framework leading to improvement in Assisted Reproductive Technology outcomes. Results The opportunity for improvement in the success rate for Assisted Reproductive Technology outcome is predicated on selection of the highest quality embryo(s) for transfer. However, such approaches must be balanced by a limit to the number of embryos transferred so as to reduce the risk for multiple births and particularly higher order multiple gestations. Blastocyst transfer offers one such successful approach, but is confounded by suggestions of an increased risk of both pregnancy complications and epigenetic disorders. Conclusion There is a need for development of approaches which, individually or in combination, may assist in the early detection of embryos destined to develop into blastocysts. © 2012 The Author(s).


Pomeroy K.O.,Arizona Reproductive Medicine Specialists | Harris S.,Methodist Hospital | Conaghan J.,Pacific Fertility Center | Papadakis M.,Carolinas Medical Center | And 2 more authors.
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.


Hardarson T.,Carlanderska Hospital | Bungum M.,Skåne 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.


DeUgarte D.A.,University of California at Los Angeles | DeUgarte C.M.,University of California at Los Angeles | DeUgarte C.M.,Pacific Fertility Center | Sahakian V.,University of California at Los Angeles | Sahakian V.,Pacific Fertility Center
Fertility and Sterility | Year: 2010

In a retrospective cohort review of third-party reproduction, we observed that surrogate body mass index (BMI) negatively impacts implantation rates in oocyte-donor in vitro fertilization cycles. A BMI ≥35 kg/m2 cutoff is associated with a statistically significant decrease in pregnancy rates but not miscarriage rates. © 2010 American Society for Reproductive Medicine.


Racowsky C.,Harvard University | Vernon M.,West Virginia University | Mayer J.,Jones Institute | Ball G.D.,Seattle Reproductive Medicine | And 6 more authors.
Fertility and Sterility | Year: 2010

Standardization of morphologic assessment for an embryo grading system was developed and is being implemented by the Society for Assisted Reproductive Technology (SART). A recent European consensus conference of embryologists from Europe and America is working toward adopting an embryo classification system modeled similarly to that of SART that, if adopted, would produce a de facto international standard to aid cross-border collaboration. © 2010 by American Society for Reproductive Medicine. © 2010 by American Society for Reproductive Medicine.


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.


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.

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