Surveying the worldwide community of ART specialists about vitrification, GnRH trigger and differed ET: Ask IVF-worldwide

Problem statement and background data
Embryo vitrification – first described 25 years ago – was recently adapted to general use in ART. Practically, vitrification has enabled to cryopreserve and de-vitrify zygotes (day-1) and blastocyst-stage embryos with nearly no losses. These outstanding results have triggered enthusiasm and outlined several immediate clinical indications for vitrifyingembryos and differing ET:

How to maximize pregnancy rates in ART: Debate on differing embryo transfers (ET)

Practically from incept, ART has been associated with controlled ovarian stimulation (COS) in order to foster multiple oocyte harvests. We all recognize that COS improves ART outcome by the sheer fact that more oocytes are inseminated and thus, more embryos are available to chose from at the time of embryo transfer (ET). Yet, it is also well established that the functionality of the endometrium – its receptivity to embryo implantation – is impaired by the very mechanisms at the core of the COS process itself. The harm caused by COS on endometrial quality is taken as the primary explanation

Double stimulation and egg collection, the best protocol for poor responders

Comments by:
Michael Alper , USA
Sherman Silber, USA
Dominique De Ziegler, France

Norbert Gleicher, USA

The below protocol was developed by Prof. Kuang and his team at the Shanghai Ninth People's Hospital affiliated to Shanghai Jiao Tong University School of Medicine, China. The unit performed more than 7,000 IVF cycles a year with 100% of Frozen Thawed Embryo transfer with 55-60% pregnancy rate in women age below 38 y.o..
This protocol is based on double stimulation during the same cycle, using letrozole, clomid, hMG and GnRH-agonist. The unique of this protocol is that there is the second stimulation takes place during the luteal phase, it allows retrieving more oocyte (which suits the poor responder group) with the eradication of OHSS.

New research discovers the mechanism responsible for the destruction of oocytes and infertility caused by chemotherapy, as well as a potential method of protecting the ovaries and preserving fertility

In a study published today in Science Translational Medicine a team of researchers from the Center for Fertility Preservation at Sheba Medical Center in Tel Hashomer, in conjunction with Bar Ilan University, present findings that show the mechanism responsible for the destruction of eggs and infertility that occurs with chemotherapy treatments. Co-treatment with the immunomodulator, AS101, during chemotherapy successfully prevented the damage to fertility. This study was selected by the journal for international media release. The study was conducted at the Center for Fertility Preservation at Sheba Medical Center, headed by Prof. Dror Meirow, in collaboration with Prof. Benjamin Sredni, Director of the Cancer AIDS and Immunology Research Institute at Bar Ilan University.

 

Blastocentesis, a new approach to test embryo health and viability

Before vitrification, blastocoelic fluid (0.3-0.5 nl) is withdrawn from human blastocysts by microsuction and (usually) discarded. The metabolomic of blastocoele fluid was studied using Rapid Resolution-Reverse Phase (RR-RP) and mass spectrometry coupled to HPLC (RR-RP-HPLC-ESI-MS). The characterization of DNA fragments present in this fluid, and the evaluation of these fragments as potential target for Preimplantation Genetic Diagnosis was performed by using, real-time PCR based on SYBR green chemistry, Whole Genome Amplification techniques and -subsequently- Next Generation Sequencing approaches.

Aneuploidism , monogenic diseases and possibly embryo markers of its own viability could be detected in the blastocoele to improve embryo transfer efficiency.

Data will be presented at the
OVARIAN CLUB III
The Inverse Pyramid: Regulating Follicle Number and Oocyte Quality
Paris, France • November 14 - 17, 2013
http://www.comtecmed.com/oc/2013/pre_program.aspx