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Abstracts of the 14th Red Lara Taller General,
Mérida, Mexico, 06-9 March 2019
Issue date 2019 Apr-Jun.
This is an Open Access article distributed under the terms of the
Creative Commons Attribution License, which permits unrestricted use,
distribution, and reproduction in any medium, provided the original work is
properly cited.
To evaluate the use of the known implantation data algorithm
KIDscore™ D5 (Vitrolife®,
Canadá) as an additional tool to morphologic assessment and preimplantation
genetic testing for aneuploidies (PGT-A) to improve implantation and ongoing
pregnancy rates.
Methods:
Design: Retrospective Cohort Study. A total of 912 embryos from 270 patients
that underwent an IVF treatment at INMATER Fertility Clinic in Lima - Perú,
between October 2016 and June 2018, were analyzed. All embryos were cultured
for up to 5 or 6 days in the Embryoscope® time-lapse
incubator (Vitrolife®, Canada) and
evaluated using the KIDscore ™ D5 algorithm (KS5).
778 (85.31%) of these embryos were also biopsied for PGT-A screening. A
total of 184 single embryo transfers (68% of patients), were performed
during this period and the embryos transferred were classified into four
groups: 1) Euploid embryos transferred without considering their KS5 score
in the selection process (n=86), 2) Euploid embryos transferred considering
their KS5 score in the selection process (n=48), 3) Embryos transferred
without considering their KS5 score in the selection process and that were
not evaluated by PGT-A (n=40) and 4) Embryos transferred considering their
KS5 score in the selection process and that were not evaluated by PGT-A
(n=10). Implantation and ongoing pregnancy rates were compared between the
groups and between euploid embryos with the highest/best KS5 score (KS5=6,
n=25) and euploid embryos with the lowest/worst KS5 score (KS5=1, n=51).
Correlation between KS5 score and embryo euploidy rate was also
evaluated.
Results:
Implantation rate and ongoing pregnancy rates was found to be significantly
higher in euploid embryo transfers when taking into account their KS5 score
in the embryo selection process compared to euploid embryo transfers where
selection was based on morphology (75.00% vs. 50.00%;
p=0.002 and 66.66% vs 48.83%; p=0.037
respectively). Additionally, implantation rates were significantly higher
for blastocysts with highest KS5 score (KS5=6) compared to lowest (KS5=1)
(80.00% vs. 49.02%; p=0.045), and ongoing pregnancy rates
was not found with significantly (72.00% vs 47.06%;
p=0.105). Euploidy rate was significantly higher in the
group of embryos with KS5=6 than in the group of embryos with KS5=1 (61.88%
vs. 48.33%; p=0.006).
Conclusion:
Embryo selection by the use of the KS5 algorithm score improves implantation
rates of single euploid blastocysts transfers. Furthermore, embryos with the
highest KS5 score have a higher probability of being euploid and
implanting.
JBRA Assist Reprod. 2019 Apr-Jun;23(2):179–181.
O-02. Associated factors to pregnancy in intrauterine
insemination
To define the factors associated with clinical pregnancy after intrauterine
insemination.
Methods:
Retrospective study in 633 infertility couples, which made 1053 cycles of
intrauterine insemination. We analyze the clinical pregnancy rate associated
with different factors through the Chi-square test or Fisher's exact
test.
Results:
The clinical pregnancy rate was 8.2% per insemination cycle and 13.6% for
treated couple. The factors with greater association to clinical pregnancy
were: to have more than 2 follicles, to perform the procedure without
difficulty, to have 3 years or less of infertility, cervical factor as
indication, use of gonadotropins and age less than 38 years.
Conclusion:
Intrauterine insemination requires to be accompanied by proper selection and
couples' preparation.
JBRA Assist Reprod. 2019 Apr-Jun;23(2):179–181.
O-03. Blastocyst contractions are strongly related with aneuploidy,
lower implantation rates and slower embryo cleavage timing: time lapse
study
We set out to identify contraction (CT) patterns in human blastocyst and
their correlation with their ploidy status (PGT-A analysis), the time they
took to reach blastocyst and the pregnancy rate.
Methods:
Design: Retrospective study. 912 embryos from 270 patients that went through
our center were evaluated. All embryos were cultivated in the Embryoscope
incubator. From 912 embryos that started the cohort, 778 were tested for
aneuploidy using an NGS platform in a reference laboratory. Blastocyst
contractions (CT) were evaluated using the "embryo drawing tool" to obtain
the CT percentage. 182 SET were performed, and the mean patient age was
30.44 years, ranging from 24 to 39 years.
Results:
Embryos was divided in two groups, those that contracted (CT) and those that
did not, we call them "solo expanding" (SE). When this was compared to
ploidy status the embryos that SE showed 58.33% to be euploid while 53.58%
of embryos that CT where aneuploid. This was statistically significant
(p=0.029) showing that embryos that don't contract SE
have higher chances of being euploid that embryos that contract CT. When we
compared pregnancy rates, we also saw an increase in embryos that SE
(63.10%) with embryos that CT (46.67%), this was also statistically
significant (p=0.012). Finally, we saw that embryos that CT
take longer to reach blastocyst stage compared to SE embryos. This also was
significant (p=0.004). Finally we evaluated if the patients
age an impact on whether the embryo was CT or SE and found no difference,
showing that age should not be a factor y embryo contraction.
Conclusion:
The results in this study show statistically significance in two analyzed
traits. We showed that CT embryos show a higher chance of being aneuploid,
and that they have a lower implantation rate. Also, we showed that embryos
that CT take longer to reach blastocyst stage. All this was showed to happen
regardless of maternal age. This proves that looking for embryo contractions
could be helpful for selecting an embryo for transfer.
JBRA Assist Reprod. 2019 Apr-Jun;23(2):179–181.
O-04. Immature oocyte incidence: Contributing factors and effects on
mature sibling oocytes in intracytoplasmic sperm injection
cycles
The aim of this study was to investigate which factors contribute to the
incidence of immature oocytes (germinal vesicle -GV- and metaphase I -MI-)
and how they impact the intracytoplasmic sperm injection (ICSI) outcomes of
sibling mature oocytes.
Methods:
Data from 3,920 cycles performed from June/2010 to August/2016 in a private
university-affiliated IVF center were evaluated for the influence of
controlled ovarian stimulation protocol (COS) on immature oocytes incidence
and its effects on ICSI outcomes.
Results:
MI (p=0.004) and GV (p=0.029) number were
negatively correlated with gonadotropin dose. Patients stimulated by rFSH
had increased GV/oocyte rate in both GnRH agonists
(p<0.001) and antagonist (p=0.042)
protocols, in comparison to rFSH associated with rLH protocol. MI and
GV/oocyte rates were negatively correlated to fertilization
(p<0.001), high-quality embryo on days two
(p<0.001) and three (p<0.001),
blastocyst (p<0.001), implantation (MI/oocyte
p<0.001; GV/oocyte p=0.033) and
pregnancy (MI/oocyte p=0.002; GV/oocyte
p=0.013) rates. Cycles above a 10.5% MI/oocyte cut-off were
correlated to higher response to ovarian stimulation, poor embryo
development and almost two times lower pregnancy rate. Immature oocyte
incidence is affected by COS and impacts on ICSI outcomes.
Conclusion:
Our evidence suggests that oocytes derived from a cohort with high incidence
of maturation fail may have detrimental clinical outcomes.
Footnotes
RED LARA Award
Best Oral Presentation.
14th RED LARA Taller General, Mérida, Mexico - 2019
JBRA Assist Reprod. 2019 Apr-Jun;23(2):179–181.
O-05. Serum microRNA profiling for the identification of predictive
molecular markers of the response to controlled ovarian
stimulation
To identify potential microRNA (miRNA) biomarkers of poor, normal and hyper
responses to controlled ovarian stimulation (COS).
Methods:
In the present study, 40 serum samples derived from patients undergoing COS
were analysed. Ten samples were used to standardise the detection of miRNAs
in serum. The remaining 30 samples were split into three groups depending on
the patient's response to COS: poor response (PR group, n=10), normal
response (NR group, n=10), and hyper response (HR group, n=10). Aberrantly
expressed miRNAs were identified by using a large-scale expression analysis
platform. Gene set enrichment analysis was performed to assess the
biological processes potentially modulated by the identified miRNAs.
Results:
Twenty-two miRNAs were exclusively detected in the PR or HR groups when
compared with the NR group. From those, 11 presented poor dissociation
curves and were excluded from further analysis. A bioinformatic analysis
revealed that the selected 11 miRNAs target several genes involved in GnRH,
oestrogen and prolactin signalling, oocyte maturation, female pregnancy, and
meiosis.
Conclusions:
The large-scale analysis of miRNA expression identified distinct miRNA
profiles for poor and hyper response to COS, which potentially modulate key
processes for human assisted reproduction. All evidence suggest that the
serum microRNA profiling may discriminate patients who will respond in an
exacerbated manner to those who will respond insufficiently to the COS.
Further studies may validate these miRNAs, allowing for the
individualisation of treatment and successful outcomes.
JBRA Assist Reprod. 2019 Apr-Jun;23(2):179–181.
O-06. First custom next-generation sequencing infertility panel in
Latin America: design and first results
To present the development of the first custom genetic panel for diagnosis of
male and female infertility in Latin America.
Methods:
We developed a next-generation sequencing (NGS) panel that assesses genes
associated with infertility. The panel targeted exons and their flanking
regions. Selected intronic regions in CFTR gene were also
included. The FMR1 gene and Y chromosome microdeletions
were analyzed by other recommended methodologies. An in-house developed
bioinformatic pipeline was applied for the interpretation of the results.
Samples with known pathogenic variants, a clear infertility phenotype or
idiopathic infertility were evaluated.
Results:
A total of 75 genes were selected according to female pathologies (primary
ovarian insufficiency, risk of ovarian hyperstimulation syndrome, recurrent
pregnancy loss, oocyte maturation defects and embryo development arrest) and
male pathologies (azoospermia, severe oligospermia, asthenozoospermia and
teratozoospermia). 25 DNA samples were evaluated by the designed panel. Two
of the variants found were classified as pathogenic, enabling the diagnosis
of a woman with secondary amenorrhea and a man with
oligoasthenoteratozoospermia. Targeted NGS assay metrics resulted in a mean
of 180X coverage, with more than 98% of the bases covered ≥20X.
Conclusion:
Our custom gene sequencing panel was designed for the diagnosis of male and
female genetic infertility and revealed the underlying genetic cause of some
infertile patients. The application of this panel will allow us to achieve
more precise approaches in assisted reproduction.
JBRA Assist Reprod. 2019 Apr-Jun;23(2):179–181.
O-07. Obesity and the possibility of conceiving a child during
assisted reproduction treatment: An Argentine experience
The goal of this study was to examine the association between the BMI and the
possibility of conceiving a child through an assisted reproduction
treatment.
Methods:
A study of cases and controls matched by age was done, with 394 patients that
underwent treatment at GESTAR (assisted reproduction center), between the
2013-2017. The association between the BMI and the possibility of conceiving
a child was analyzed through logistic regression.
Results:
Amongst the cases (successful treatments) 14% were obese, while in the
control group (patients that did not get pregnant) obesity was 21%. A
significant difference (p<0,01) was seen in the BMI, the
number of recovered oocytes, normally fertilized oocytes and the number of
transferred embryos. The Odds Ratio (OR) in SPSS was equal to
0.26±(0.14, 0.50) IC95%, which indicates that conceiving a child by
assisted reproduction is 74 times lower in patients that are obese that in
patients not obese (p<0.001). And the Odds Ratio (OR)
calculated by logistic regression in Stata 11 was 0.80 ± (0.76, 0.86)
IC95% which indicates a 20% decrease in possibility of conceiving for each
point on the BMI scale.
Conclusion:
Obesity is associated to the diminishment of the possibility of conceiving a
child through assisted reproduction technologies.
JBRA Assist Reprod. 2019 Apr-Jun;23(2):179–181.
O-08. Regenerative therapy by endometrial mesenchymal stem cells in
thin endometrium with repeated implantation failure. A novel
strategy
Our primary objective was to evaluate the endometrial changes before and
after transfer of endometrial mesenchymal stem cells (enMSCs) in a
population of thinned endometrium with absence or hypo-responsiveness to
estrogen and repeated implantation failure (RIF). The secondary objective
was to evaluate the clinics results of the intervention in terms of clinical
pregnancy (CP), early abortions pregnancy on going and live birth delivery
rate (LBR) in in vitro fertilization (IVF) cycle.
Methods:
A longitudinal and experimental study. The intervention was defined as
"subendometrial inoculation of enMSCs," and the post-intervention changes
were evaluated by the variables: endometrial thickness (Eth), endometrial
flow cytometry (enFC), endometrial histopathology(enHP) and endometrial
immunohistochemistry (IHQ). The variables were analyzed after the
intervention (Post-treatment) regarding to previous values
(Pretreatment).
Results:
The comparison of Eth between pre and posttreatment with enMSCs leads to
5.24?1.24 mm vs 9.93?0.77 (p=0.000) respectively.
Endometrial Flow Cytometry show significant differences in favor of
Normalized variables in post-treatment, related with pretreatment, LT/Li,
Lb/Li, NK/Li, CD8/CD3+ and CD4/CD8 (p = 0.013,
0.002, 0.049, 0.000, 0.000) respectively. Only two variables Li/PC and
CD4/CD3 show NS (p = 0.167 and 0.118). Similar analysis is
performed on enHP with an increase the normal HP in post-treatment
(p=0.007). The CP rate was 79.31% (23/29), with a live
birth delivery rate of % 45.45%(10/22) and ongoing pregnancy 7/29
(24.14%).
Conclusion:
It was noted a significative increase in endometrial thickness and normalize
variables in enHP, enIHQ in post-treatment, previous, with enMSCs
subendometrial inoculation. As a result, the IVF after treatment with enMSCs
was a higher rate of CP and LBR.
