Extending the culture of cleavage-stage embryos to the blastocyst stage after warming increases the chance of live birth: does it have a regenerative effect?

PURPOSE: We aimed to evaluate the effect of extending the culture of cleavage-stage embryos to the blastocyst stage in vitrified-warmed cycles on pregnancy outcomes. METHODS: This is a retrospectively designed pilot study of a single center. All patients who applied for freeze-all cycle procedures during in vitro fertilization treatment were included in the study. Patients were classified into three subgroups. The embryos obtained were frozen at the cleavage or blastocyst stage. After a warming process, the cleavage-stage embryos were divided into two subgroups: the first group of embryos was transferred (vitrification day 3-embryo transfer (ET) day 3 (D3T3)) on the warming day; for the second group, the embryo culture was extended to the blastocyst stage (vitrification day 3-ET day 5 (after the extension of the embryo culture to the blastocyst stage), (D3T5)). Frozen blastocyst-stage embryos were transferred after warming (vitrification day 5-ET day 5 (D5T5)). Hormone replacement treatment was the only endometrial preparation regimen given during the embryo transfer cycle. The main outcome of the study was live birth rates. The clinical pregnancy rate and positive pregnancy test rate were determined as the secondary outcomes of the study. RESULTS: The study included a total of 194 patients. The positive pregnancy test rates (PPR) and clinical pregnancy rates (CPR) of the D3T3, D3T5, and D5T5 groups were 14.0% and 59.2%; 43.8% and 9.3%; and 56.3% and 39.6%, respectively (p < 0.001 and p < 0.001). The live birth rates (LBR) of patients in the D3T3, D3T5, and D5T5 groups were 7.0%, 44.7%, and 27.1%, respectively (p < 0.001). In subgroup analysis of patients with a poor number of 2PN embryos (defined as having < = 4 2PN embryos), the D3T5 group had significantly higher PPR (10.7%, 60.6%, 42.4%; p < 0.001), CPR (7.1%, 57.6%, 39.4%; p < 0.001), and LBR (3.6%, 39.4%, 21.2%; p: 0.001). CONCLUSION: Extending the culture after warming to the blastocyst stage may be a better alternative than a cleavage-stage embryo transfer.

Neutrophil to Lymphocyte ratio in the diagnosis of adnexal torsion.

Adnexal torsion (AT) is a condition in which there is sometimes difficulty in making a preoperative diagnosis since there are no routine laboratory markers and this condition is usually intraoperatively diagnosed. Many of the studies have indicated that the neutrophil-to-lymphocyte ratio (NLR) is a significant inflammatory marker in various diseases. In this study, we aimed to investigate the diagnostic efficacy of the NLR on the diagnosis of AT. Patients surgically treated for AT were analysed retrospectively. A total of 27 AT patients were included in the study (Group 1). Another 30 patients who were surgically treated for a unilateral ovarian mass and did not have torsion or malignity on the final histopathological examination were assigned to the control group (Group 2). White blood cells (WBCs), neutrophils, lymphocytes and the NLR were compared between groups. The mean WBC values for Groups 1 and 2 were 9.7 ± 1.8 and 7.6 ± 1.5 K/µL (P < 0.001), respectively. The mean neutrophil values were also significantly higher in Group 1 (P < 0.001). However, the mean lymphocyte values were significantly higher in Group 2 (P < 0.001). Mean NLR was significantly higher in Group 1 (P < 0.001). Sensitivity and specificity of WBC > 8.8 were 83.3% and 74.1%, respectively. Sensitivity and specificity of NLR > 3 were 88.9% and 100%, respectively. Furthermore, the area under the ROC curve (AUC) was 0.933 for the NLR and 0.830 for WBC. With respect to the diagnosis of adnexal torsion, an NLR > 3 was identified as a more sensitive marker than the high WBC count. Therefore, an NLR > 3 seems to be a valuable marker in cases where it is difficult to diagnose AT.