Fertilization Failure / Poor embryo quality: How far to invest? by Andreia Fontoura Oliveira

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 Video type: Communication Knowledge Field: Clinical medicine Language: Portuguese

Fertilization Failure / Poor Embryo Quality: How far to Invest?

Falha de Fertilização / Má qualidade embrionária: Até onde investir?

Fontoura Oliveira, A.1, Veiga, M.2, Silva, F.3, Pinelo, S.3, Pires, I.3 and Felgueira, E.3

1) Hospital Center of Médio Ave, Santo Tirso, Portugal; 2) Hospital of Cascais, Cascais, Portugal; 3) Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal.

Filmed: 25/09/2021 Submitted: 24/03/2022 Published: 09/05/2022
CITE THIS VIDEO-ARTICLE

Fontoura Oliveira, A. (2022). Fertilization failure / poor embryo quality: How far to invest?. AcademyOn(4)Retrieved from https://www.academy-on.com/videos/ms-andreia-fontoura-oliveira-4

SYNOPSIS

Data regarding fertilization failure (FF) or poor embryo quality (PEQ) after a 1st cycle of IVF/ICSI is still scarce. This communication presents a retrospective study including all 1st cycles of IVF/ICSI that resulted in FF or PEQ. The author evaluates the success rates of subsequent cycles and explains how far to invest in repeated ART in these couples.

São escassos os dados sobre falha de fertilização (FF) ou má qualidade embrionária (MQE) após um ciclo de FIV/ICSI. Esta comunicação apresenta um estudo retrospetivo incluindo todos os 1º ciclos de FIV/ICSI que resultaram em FF ou MQE. O autor avalia as taxas de sucesso dos ciclos subsequentes e explica até onde investir em técnicas de PMA nestes casais.

AUTHOR BIOGRAPHY

Andreia Fontoura Oliveira, born in Porto, Portugal, in 1992, graduated in Medicine (MSc) by Faculdade de Medicina da Universidade do Porto in 2016. Worked as a general resident in Centro Hospitalar de Vila Nova de Gaia during 2017 and started her specialization in Gynecology and Obstetrics in 2018 at Centro Hospitalar do Médio Ave – Department of Gynecology and Obstetrics, where she is currently working, with particular interest in the field of endoscopic surgery and fertility. Additionally, she works as a professional trainer in Obstetrics and Gynecology, training medical students and young doctors to access to medical specialty. She also engaged in different volunteer projects, namely as a volunteer tutor in a fundraising project and as a volunteer doctor in an elderly care facility.

ABSTRACT

Several factors have already been associated with the success of Assisted Reproduction Techniques (ART). In unsuccessful cases, data regarding total fertilization failure (FF) or poor embryo quality (PEQ) after a 1st cycle of IVF/ICSI is still scarce. Our aim was to evaluate the success rates of subsequent cycles of IVF/ICSI in couples who experienced FF or PEQ in the 1st cycle of treatment. We performed a retrospective study between 01/2015 and 12/2020 including all 1st cycles of IVF/ICSI which resulted in FF or in embryos without quality to transfer/cryopreserve. The sample was divided in 2 groups: FF and PEQ. For each group, the couples that underwent a 2nd or 3rd cycle of IVF/ICSI were identified and cycles where compared. Outcome was defined as the evaluation of fertilization, embryo utilization, pregnancy and delivery rates in the 2nd and 3rd cycles of IVF/ICSI. In this period, there were 2297 1st cycles of IVF/ICSI, of which 63 resulted in FF and 55 in PEQ. In the FF group, 49 of the 63 couples underwent through a 2nd cycle and 18 through a 3rd cycle. Average fertilization and embryo utilization rates were 54% and 57% in the 2nd cycle, and 43% and 61% in the 3rd. Embryos with quality were obtained in 38/49 couples in 2nd cycle, and in 13/17 couples in 3rd cycle. Pregnancy and delivery occurred, respectively, in 18/49 and 13/49 in the 2nd cycle, and in 7/17 and 6/17 in the 3rd. In the PEQ group, 38 of the 55 couples underwent through a 2nd cycle, and 9 through a 3rd. Average fertilization and embryo utilization rates were 56% and 52% in the 2nd cycle, and 49% and 50% in the 3rd. Embryos with quality were obtained in 32/38 couples in 2nd cycle, and in 6/9 in 3rd cycle. Pregnancy and delivery occurred, respectively, in 15/38 and 11/38 in the 2nd cycle, and in 3/9 and 2/9 in the 3rd. Hence, despite the unsuccess in the 1st cycle of IVF/ICSI, success rates in subsequent cycles were high, appearing to be cost-effective to invest in ART in this context.

Vários fatores têm sido implicados no sucesso das técnicas de Procriação Medicamente Assistida (PMA). Em caso de insucesso, são ainda escassos os estudos sobre as situações de falha de fertilização (FF) ou má qualidade embrionária (MQE) após um ciclo de FIV/ICSI. O nosso objetivo foi avaliar as taxas de sucesso dos ciclos subsequentes de FIV/ICSI em casais com FF ou MQE no 1º ciclo de tratamento. Foi realizado um estudo retrospetivo entre 01/2015 e 12/2020 que incluiu todos os 1º ciclos de FIV/ICSI da unidade de PMA em que ocorreu FF ou obtenção de embriões sem qualidade para transferir/criopreservar. Dividiu-se a amostra em 2 grupos: FF e MQE. Para cada grupo, os casais submetidos a 2º e 3º ciclos de FIV/ICSI foram identificados e os ciclos comparados. Definiu-se como outcome a avaliação das taxas de fertilização, utilização embrionária, gravidez e de nascimento nos 2º e 3º ciclos de FIV/ICSI. Neste período, realizaram-se 2297 1º ciclos de FIV/ICSI, verificando-se FF em 63 e MQE em 55. No grupo da FF, dos 63 casais, 49 avançaram para 2º ciclo e 18 para 3º. As taxas de fertilização e de utilização embrionária médias foram de 54% e 57% no 2º ciclo, e de 43% e 61% no 3º. Obteve-se embriões de qualidade em 38 dos 49 casais em 2º ciclo e 13 dos 17 casais em 3º ciclo. A ocorrência de gravidez e nascimento foi, respetivamente, de 18/49 e 13/49 no 2º ciclo, e de 7/17 e 6/17 no 3º. No grupo da MQE, dos 55 casais, 38 avançaram para 2º ciclo e 9 para 3º. As taxas de fertilização e utilização embrionária médias foram de 56% e 52% no 2º ciclo, e de 49% e 50% no 3º. Obteve-se embriões de qualidade em 32 dos 38 casais em 2º ciclo e 6 dos 9 casais em 3º ciclo. A ocorrência de gravidez e nascimento foi, respetivamente, de 15/38 e 11/38 no 2º ciclo, e de 3/9 e 2/9 no 3º. Assim, apesar do insucesso no 1º ciclo de tratamento, as taxas de sucesso nos ciclos subsequentes foram altas em ambos os casos, parecendo custo-efetivo investir em técnicas de PMA neste contexto

 KEYWORDS

Assisted reproduction, Fertilization failure, Embryo quality.
Procriação medicamente assistida, Falha de fertilização, Qualidade embrionária.

 ACKNOWLEDGMENTS

We would like to express our gratitude to the entire Medicine Reproduction Unit of Centro Hospitalar de Vila Nova de Gaia/Espinho for the collaboration in the collection of the data to perform this study.

 DISCLOSURES

The author certifies that there is no actual or potential conflict of interest in relation to this video article.

REFERENCES

Mahutte NG, Arici A. Failed fertilization: is it predictable? Curr Opin Obstet Gynecol. 2003;15:211–218. https://doi.org/10.1097/00001703-200306000-00001

Kahyaoglu, I., Demir, B., Turkkanı, A., Cınar, O., Dilbaz, S., Dilbaz, B., Mollamahmutoglu, L. (2014). Total fertilization failure: is it the end of the story? , J Assist Reprod Genet, 2014, 31, 1155-1160. https://doi.org/10.1007/s10815-014-0281-5

Van der Westerlaken, L., Helmerhorst, F., Dieben, S., Naaktgeboren, N. (2005). Intracytoplasmic sperm injection as a treatment for unexplained total fertilization failure or low fertilization after conventional in vitro fertilization. Fertility and Sterility, 83, 612-617. https://doi.org/10.1016/j.fertnstert.2004.08.02

Kinzer, D., Barrett, C. B., Powers, R. (2008). Prognosis for clinical pregnancy and delivery after total fertilization failure during conventional in vitro fertilization or intracytoplasmic sperm injection. Fertility and Sterility, 90, 284-8. https://doi.org/10.1016/j.fertnstert.2007.06.025

Kirillova, A., Lysenkov, S., Farmakovskaya, M., Kiseleva, Y., Martazanova, B., Mishieva, N., Abubakirov, A., Sukhikh, G. (2020). Should we transfer poor quality embryos? Fertil Res and Pract, 6, 2. https://doi.org/10.1186/s40738-020-00072-5

SCIENTIFIC EVENT

XXXVII Reproductive Studies Journeys, September 24-25, 2021, Lisbon, Portugal.
Organized by: Portuguese Society of Reproductive Medicine


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