The optimal frozen embryo transfer strategy for the recurrent implantation failure patient without blastocyst freezing: thawing day 3 embryos and culturing to day 5 blastocysts.

This study aimed to investigate the optimal frozen embryo transfer (FET) strategy for recurrent implantation failure (RIF) patients with three consecutive failed cleaved embryo implantations and no blastocyst preservation. This retrospective analysis was divided into three groups based on the FET strategy: thawed day 3 embryo transfer (D3 FET group); and extended culture of frozen-thawed day 3 embryos to day 5 blastocysts transfer (D3-D5 FET group); thawed blastocyst transfer (D5 FET group). Transplant cycle data were compared between the three groups. In total, 43.8% of vitrified-thawed cleavage embryos developed into blastocysts. Analysis of the three transplantation strategies showed that, compared with the D3 FET group, D3-D5 had a significantly better hCG-positivity rate and live-birth rate (P < 0.05). Pregnancy outcomes in the D3-D5 FET group and D5 FET group were similar regarding hCG-positivity rate, implantation rate, clinical pregnancy rate, and live-birth rate. Our findings propose two potentially valuable transfer strategies for patients experiencing repeated implantation failures. The D3-D5 FET approach presents a greater potential for selecting promising embryos in cases without blastocyst preservation; however, this strategy does entail the risk of cycle cancellation. Conversely, in instances where blastocyst preservation is an option, prioritizing consideration of the D5 FET strategy is recommended.

Elevated estradiol levels in frozen embryo transfer have different effects on pregnancy outcomes depending on the stage of transferred embryos.

Supplementation with estradiol (E2) is routinely used in frozen embryo transfer (FET) cycles and embryo age plays an important role in conceiving. This study was to compare the effects of serum E2 levels on pregnancy outcomes between cleavage- and blastocyst-stage FET cycles using hormone replacement therapy. A total of 776 FET cycles (669 couples) performed from January 2016 to December 2019 were included in the present retrospective cohort study. Regarding cleavage-stage embryo transfers, E2 levels on progesterone initiation day were significantly lower in the ongoing pregnancy/live birth (OP/LB) group than in the non-OP/LB group (214.75 ± 173.47 vs. 253.20 ± 203.30 pg/ml; P = 0.023). In addition, there were downward trends in implantation, clinical pregnancy and OP/LB rates with increasing E2 levels. However, in blastocyst-stage embryo transfers, such trends were not observed, and E2 levels were not significant difference between the OP/LB group and the non-OP/LB group (201.66 ± 182.14 vs. 197.89 ± 212.83 pg/ml; P = 0.884). The results suggests that elevated progesterone-initiation-day E2 levels may negatively affect pregnancy outcomes during artificial cleavage-stage embryo transfers. However, it is not necessary to monitor E2 levels when transferring blastocysts in artificial FET cycles.

3D detection and extraction of bladder tumors via MR virtual cystoscopy.

PURPOSE: This paper proposes a pipeline for the detection and extraction of 3D regions of bladder tumors via MR virtual cystoscopy. METHODS: After the acquisition of volumetric bladder images with a high-resolution T2-weighted 3D sequence, the inner and outer surfaces of the bladder wall were segmented simultaneously by a coupled directional level-set method. Based on the Laplacian method, a potential field was built up between two surfaces so that the thickness of each voxel within the bladder wall was estimated. To detect bladder abnormalities, four volume-based morphological features, including bent rate, shape index, wall thickness, and a novel morphological feature, which reflects bent rate difference between the inner and outer surfaces, were extracted. The combination of these four features was used to detect seeds on the inner surface by using selected filtering criterion. Then all points on streamlines started from detected seeds formed 3D candidate regions. Finally the fuzzy c-means clustering with spatial information (sFCM) was used to extract tumors from surrounding bladder wall tissues in candidate regions. RESULTS: The proposed pipeline was evaluated by a database of MR bladder images acquired from ten patients with bladder cancer. To find an optimal feature combination for tumor detection, the performance of different combinations of these features was evaluated with different filtering criteria. With the combination of all four features, the computer-aided detection pipeline shows a high performance of 100 % sensitivity with 2.3 FPs/case. Comparing with tumor regions delineated by radiological experts, the average overlap ratio of tumor regions extracted by sFCM is 86.3 %. CONCLUSIONS: The experimental result demonstrates the feasibility of the proposed pipeline on the detection and extraction of bladder tumors. It may provide an effective way to achieve the goal of evaluating the whole bladder for tumor detection and local staging.