Time-lapse imaging of preimplantation embryos is increasingly being employed in assisted reproduction treatment. This technique has facilitated the use of objective algorithms based on embryo morphokinetic variables for embryo selection. A recent study has detailed the use of time-lapse imaging using defined morphokinetic data for detecting embryos at risk of having aneuploid chromosome structure, without the need to perform preimplantation genetic screening.
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Several investigators have evaluated the significance of stress in assisted reproduction cycles. A recent prospective cohort pilot study highlights that stress and anxiety levels in women undergoing in vitro fertilization (IVF) therapy remain significantly high throughout the treatment. Accordingly, researchers underscore the need to explore various modalities to reduce stress experienced by women during IVF cycles.
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Various modalities, such as coasting, cycle cancellation, dopamine agonists, and cryopreservation of all embryos, have been investigated to prevent ovarian hyperstimulation syndrome (OHSS) in women undergoing assisted reproduction. A recent retrospective cohort study, published in the journal Archives of Obstetrics and Gynecology, reports the effectiveness of cabergoline therapy to prevent moderate-to-severe OHSS in such patients without compromising pregnancy rates.
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Chronic uterine inflammation, one of the factors implicated in repeated implantation failure (RIF), is associated with high intrauterine matrix metalloproteinase (MMP) activity. Significantly higher intrauterine MMP activity has been reported in infertile women with RIF compared to their fertile counterparts. A recent retrospective study reports that a two-week course of antibiotics and corticosteroids reduces MMP activity and improves the uterine environment, facilitating successful implantation in such patients.
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The standard overnight co-incubation of spermatozoa and oocytes has been compared with the brief co-incubation insemination protocol by numerous investigators in the past. However, it remains unclear whether reduction in the sperm-oocyte co-incubation time improves or negatively affects the outcomes of in vitro fertilization (IVF) therapy. According to a recent Cochrane review, the brief gamete co-incubation insemination protocol may improve the rates of ongoing as well as clinical pregnancy in infertile women undergoing IVF therapy.
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It has been a routine practice to transfer multiple embryos in most IVF patients to overcome low implantation rates and achieve satisfactory pregnancy rates. Consequently, the risk of multiple pregnancies is greater in IVF patients with associated adverse impact on mother and child. Single embryo transfers (SETs) have been promoted as the only efficient way to prevent multiple pregnancies in IVF. Several trials have compared SETs with double embryo transfers (DETs), and a recent study has demonstrated that transfer of a single, chromosomally normal embryo offers pregnancy rates comparable to a DET.
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Opinions vary on the importance of polar body morphology in predicting fertilization and embryo development. Most contemporary publications propose that fragmented polar body is not prognostic for oocyte fertilization or embryo development. However, a recent study demonstrates that the fertilization probability of an oocyte with fragmented polar bodies is far less compared to an oocyte with normal polar bodies.
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The prognosis of successful IVF outcomes in women with low ovarian response fulfilling the Bologna criteria is very poor. A recent retrospective pilot trial reports that corifollitropin alfa followed by highly purified human menopausal gonadotrophin (hp-HMG) in a GnRH antagonist protocol results in promising pregnancy rates in poor ovarian responders fulfilling the Bologna criteria. However, these results were seen only in poor ovarian responders <40 years of age.
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Microbial colonization of the female upper genital tract even in the absence of symptomatic infection has been well documented in previous trials. A recent study demonstrates that the presence of microbes in the follicular fluid collected at the time of transvaginal oocyte retrieval adversely affects the outcomes of in vitro fertilization (IVF) therapy.
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Previous studies indicate that autoimmune antibodies may have an impact on implantation failure in in vitro fertilization-embryo transfer (IVF-ET) cycles. A recent observational, case-controlled clinical trial highlights that high circulating anti-placenta-specific 1 (PLAC1) antibody levels could be associated with an increased likelihood of repeated IVF-ET implantation failure.
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