Investigating the impact of the timing of blastulation on implantation: management of embryo-endometrial synchrony improves outcomes.

Study Question: Do embryos with delayed blastulation have inferior reproductive potential or poorer outcomes due in part to embryo and endometrial synchrony?

Summary Answer: Diminished outcomes in embryos with delayed blastulation undergoing fresh embryo transfer (ET) may be attributed to a loss of embryonic-endometrial synchrony.

What Is Known Already: Embryos that blastulate slowly have lower sustained implantation rates (SIR) than those which blastulate normally on Day 5 (D5). Traditionally this has been attributed to reduced embryo quality; however, dyssynchrony with the endometrium is also a possibility and has not been fully described.

Sequential versus Monophasic Media Impact Trial (SuMMIT): a paired randomized controlled trial comparing a sequential media system to a monophasic medium.

Objective: To determine whether sequential or monophasic media is the more optimal formulation for blastocyst development and sustained implantation rates (SIR) in IVF.

Design: Paired randomized controlled trials.

Setting: Academic.

Blastocyst transfer is not associated with increased rates of monozygotic twins when controlling for embryo cohort quality.

Objective: To compare monozygotic twinning (MZT) rates in patients undergoing blastocyst or cleavage-stage ET.

Design: Retrospective cohort.

Setting: Academic research center.

Aneuploidy across individual chromosomes at the embryonic level in trophectoderm biopsies: changes with patient age and chromosome structure.

Purpose: To characterize each chromosome's risk for being involved in embryonic aneuploidy.

Methods: This is a retrospective cohort study conducted at a single, academic center. The cohort consisted of 15,169 consecutive trophectoderm biopsies which then underwent comprehensive chromosome screening utilizing validated real-time polymerase chain reaction (RT-PCR) or single nucleotide polymosphism (SNP) array platforms.

Endometrial infusion of human chorionic gonadotropin at the time of blastocyst embryo transfer does not impact clinical outcomes: a randomized, double-blind, placebo-controlled trial.

Objective: To determine whether endometrial hCG infusion at the time of human blastocyst transfer impacts implantation rates.

Design: Randomized double-blinded placebo-controlled trial.

Setting: Academic.

Examining the temperature of embryo culture in in vitro fertilization: a randomized controlled trial comparing traditional core temperature (37°C) to a more physiologic, cooler temperature (36°C).

Objective: To determine whether culture at a more physiologically cooler temperature, as suggested by limited human and animal data, would improve blastulation and pregnancy rates in human clinical IVF.

Design: Paired randomized controlled trial.

Setting: Academic.

Embryology training for Reproductive Endocrine fellows in the clinical human embryology laboratory.

Objective: To determine if comprehensive embryology training for clinical Reproductive Endocrinology fellows could be completed to a level of proficiency equivalent to that of experienced embryologists.

Method: Clinical fellows were integrated into the clinical embryology team and were trained to perform all the various procedures utilized in clinical embryology. The fellows were trained to the same standards as the clinical embryology staff and underwent the same certification and sign off procedures.

The nature of aneuploidy with increasing age of the female partner: a review of 15,169 consecutive trophectoderm biopsies evaluated with comprehensive chromosomal screening.

Objective: To determine the relationship between the age of the female partner and the prevalence and nature of human embryonic aneuploidy.

Design: Retrospective.

Setting: Academic.

Cleavage-stage biopsy significantly impairs human embryonic implantation potential while blastocyst biopsy does not: a randomized and paired clinical trial.

Objective: To determine if cleavage- or blastocyst-stage embryo biopsy affects reproductive competence.

Design: Paired randomized clinical trial.

Setting: Academic-assisted reproduction program.

Blastocyst biopsy with comprehensive chromosome screening and fresh embryo transfer significantly increases in vitro fertilization implantation and delivery rates: a randomized controlled trial.

Objective: To determine whether blastocyst biopsy and rapid quantitative real-time polymerase chain reaction (qPCR)-based comprehensive chromosome screening (CCS) improves in vitro fertilization (IVF) implantation and delivery rates.

Design: Randomized controlled trial.

Setting: Academic reproductive medicine center.

Comprehensive chromosome screening alters traditional morphology-based embryo selection: a prospective study of 100 consecutive cycles of planned fresh euploid blastocyst transfer.

Objective: To determine how often trophectoderm biopsy and rapid, real-time quantitative polymerase chain reaction (PCR)-based comprehensive chromosome screening (CCS) alters clinical management by resulting in the transfer of a different embryo than would have been chosen by traditional day 5 morphology-based criteria.

Design: Prospective.

Setting: Academic center for reproductive medicine.