Euploid Status and Single Embryo Transfer Success is Independent

#083
Euploid Status and Single Embryo Transfer Success is Independent of Day 5 and Day 6 Blastocyst
Development.
INTRODUCTION
RE Anderson, MD, J Whitney, BS, S Zozula, BS, N Nugent, MS and MC Schiewe, PhD
361 Hospital Road, Suites 333 / 433; Newport Beach, CA 92663
Hands –On View
Early embryo aneuploidy is widely accepted as a major reason of implantation
failures. The goal of many IVF programs is to offer high success without the
risk of multiple gestations through single embryo transfers (SET). The use of
Preimplantation Genetic Screening (PGS) is considered a valuable ART tool to
help clinicians choose only top quality, genetically euploid embryos for SET.
VS dish
Set-up
Weld seal
A.1
CBS straw
*
*
B.1-3
Dyed tip
A.2-3
Wiped dry
Vitrifying
A.1
B.1
see QC panels below
Warming
EXPERIMENTAL DESIGN & METHOD
Euploidy was determined through PGS/vitrification-all cycles with biopsy
between 1/1/2012 and 12/31/2013, resulting in 244 cycles and 1259 blastocysts.
All blastocysts were biopsied on Days 5 or 6 and required a 3BB or better
grade. Pregnancy results were based on 108 (average age: 35.6) vitrifiedwarmed single euploid embryo transfers.
Patients autonomously chose PGS-trophectoderm biopsy/vitrification-all
cycles. Embryos were laser hatched on Day 3 and herniating blastocysts were
biopsied (quality grade 3BB or better) on Day 5 or 6. Euploidy results were
determined on every patient enrolled and pregnancy outcomes were based on
non-donor, single embryo transfers only.
Quick cut and tip
B.7
microSecure
Vitrification
micro Cap bulb for easy
=
Focal Points
evacuation of contents
Southern California Ctr. Reproductive Medicine (SCCRM)
Fresh Donor Egg Pregnancy Outcomes
Dr. RE Anderson *2010-2014*
2012-2013 Vitrified Single, Euploid ET Cycles (VFET)
100
SUPERIOR QUALITY CONTROL CHARACTERISTICS of µS-VTF
VTF BLs
Patients
%
90
80
86%
100
100
80
79%
60
* Validated rapid cooling and warming rates
74%
%
83.6
75.4
70
Combines the practical use of 2 FDA approved devices for the purpose of vitrification
CBS™0.3 ml Embryo Straws – 1st FDA approved straw for cryostorage – superior, repeatable weld seals
Sterile Flexipets ™ (Cook 300µm ID) – Approved for oocyte & embryo pipetting
Shortened (2-3 cm) at base using sharp, clean dissection scissors to accommodate it fitting inside the CBS straw
with a air space buffer for sealing {near the base end}
4. After pipetting BLs into the tip, the VTF tip is easily disconnected from the pipettor and safely WIPED DRY with
sterile gauze before loading it in the CBS straw. The low volume (2-3 µl) capillary effect prevents any fluid from
dripping out;
B.  The CBS straw offers: 1. Dual color labeling using colorized rods and labels; 2. Tamperproof, internalized label; 3.
Straw can be aspetically prepared / labeled / partially-sealed in advance (Weld seals); 4. The weighted label rod
prevents the straws from floating; 12 mm goblet stores up to 8 straws.
5. ASPETIC CLOSED CONTAINER SYSTEM with unparalleled Safety , Security, Simplicity, Low Cost
6. Upon warming, the straw is identified, grasped, tapped and cut near the hydrophobic plug upon removal from LN2;
The sealed end (opposite labeled end) is secured and the opened straw is tipped downward (60°), tapped and the
tip allowed to free-fall into the warm 0.5M Sucrose solution bath. After 5-10 sec, the tip is initially placed onto a
Drummond MicroCap Pipettor before a Stripper device.
7. Individual eggs/BLs are easily viewed coming out of each flexipet before translucent change in
T1
solution, this phenomenon is especially evident with oocytes.
T1
T1 translucence can make searching
difficult , but not so with µS-VTF !
40
83.7
72.1
60
50
A. 
1. 
2. 
3.
REFERENCE: SCHIEWE, MC. microSecure Vitrification. J.Clin. Embryol. 2010; 13:33-51
B.6
B.6
Free-fall
RESULTS
Day 5 euploidy rate (50.4%) showed no difference (p=0.56)
compared to Day 6 (48.6%). No significance was observed
with SET ongoing/live birth for Day 5 at 75.4% versus Day 6
at 72.1% (p=1.00). Furthermore, the data revealed no
differences in Day 5 and Day 6 implantation rates (83.6%
versus 83.7%; p=0.798). There was a trend toward increased
spontaneous abortions, %SAB, with Day 6 blastocysts being
13.9% compared to 4.2% for Day 5 (p=0.13). Age
stratification of the data reveals no significant differences,
although a majority of our Day 6 SABs did occur in the 35-37
year old age group where 91.7% produced a viable sac, but
only 58.3% sustained the pregnancy. Physiologic patient
variation is likely a more critical factor than age in
influencing pregnancy outcomes.
A.4
Experimental Questions
Are there differences in euploidy rates between Day 5 and Day 6 blastocysts?
Does the day of blastocyst development predict implantation or ongoing/live
birth rates in single euploid vitrified blastocyst transfers?
Direct
plunge
#083
50.4
40
48.6
30
20
20
10
0
1
2
3
% Clinical Pregnancy Live Birth Rate Implanta7on Rate (Data represents 86 Fresh ET cycles performed between Jan. 2010 and Dec. 2013)
DISCUSSION
0
1
VTF Survival
2
BL Euploid
Rate
Day 5 BL
SET Live3 Births
4
Implantation
Rate
Day 6 BL
Advanced growing blastocysts have long been thought to have higher euploidy and success rates.
This study indicates that when corrected for aneuploidy, day of blastocyst development does not
influence success. The trend we observed with higher SAB rates with Day 6 embryos appeared
correlated to “B quality” TE grades (subject of a separate Oral presentation). With a demand for
high SET take home baby rates, the need to better assess blastocysts beyond quality grades and
developmental pace is necessary to increase IVF success. The perceived emphasis for faster
growing embryos places higher importance for transferring Day 5 blastocysts versus Day 6 when
equal quality embryos are available. A prospective randomized trial could eliminate this perceived
importance and correct for embryologist bias in the future. Overall, our goal at SCCRM / SCIRS is
“One embryo – One baby”™.