Effect of embryo selection based morphokinetics on IVF/ICSI outcomes: evidence from a systematic review and meta-analysis of randomized controlled trials.

PURPOSE: Debate exists for the optimal tool to select embryos for transfer in assisted reproductive technology (ART). Time-lapse monitoring (TLM) is a noninvasive tool suggested where each embryo can be captured every 5-20 min. Given the inconsistency in the existing studies, we conducted this meta-analysis of RCTs to summarize the evidence available concerning the predictive ability of morphokinetics compared with the routine assessment of embryo development in ART. METHODS: The primary databases MEDLINE, EMBASE, Cochrane, NHS, WHO, and Other Non-Indexed Citations were consulted for RCTs that have been published until November 2018, with no language restriction. RESULTS AND CONCLUSION: Our review includes 6 RCTs (n = 2057 patients). The data showed an improvement (~ 9%) in live birth TLM (OR 1.43; 95% CI 1.10-1.85; P = 0.007), with low-quality evidence. There was no evidence of a significant difference between both groups concerning ongoing pregnancy, clinical pregnancy and implantation rates. The data further showed that morphokinetics is associated with decreased early pregnancy loss rate. These estimates must be interpreted with caution owing to the statistical and clinical heterogeneities and the consequent difficulty in drawing any meaningful conclusion.

Revisiting the management of recurrent implantation failure through freeze-all policy.

OBJECTIVE: To determine whether a freeze-all policy for in vitro human blastocysts improves the ongoing pregnancy rate in patients with recurrent implantation failure (RIF). DESIGN: Prospective cohort study. SETTING: Single private center. PATIENT(S): A total of 171 women with RIF divided into two groups: freeze-all policy group (n = 81) and fresh embryo transfer (ET) group (n = 90). INTERVENTION(S): Freeze-all policy. MAIN OUTCOME MEASURE(S): Ongoing pregnancy rate. RESULT(S): The clinical pregnancy rate (52% vs. 28%; odds ratio [OR] 1.86; 95% confidence interval [CI], 1.29-2.68) and ongoing pregnancy rate (44% vs. 20%; OR 2.2; 95% CI, 1.04-3.45) were statistically significantly higher in the freeze-all group than the fresh ET group, respectively. The implantation rate was also statistically significant (freeze-all group 44.2% vs. fresh ET group 15.8%; OR 2.80; 95% CI, 2.00-3.92). CONCLUSION(S): The freeze-all policy statistically significantly improved the ongoing pregnancy and implantation rates. Thus, a freeze-all policy is likely to be the new key to helping open the black box of RIF. These findings also are useful for further investigating the adverse effect of controlled ovarian stimulation on in vitro fertilization outcomes.

Prophylactic treatment for preeclampsia in high-risk teenage primigravidae with nitric oxide donors: a pilot study.

OBJECTIVES: Preeclampsia is associated with significant morbidity and mortality especially in high-risk groups. Impairment of endogenous nitric oxide has been shown to be associated with the disease and prophylactic therapy may ameliorate this condition and improve pregnancy outcome. This study valuated nitric oxide donors prophylactic treatment for preeclampsia in high-risk teenage primigravidae. METHODS: The study included three hundred primigravidae aged ≤ 20 years with singleton pregnancy. Abdominal pulsed color Doppler ultrasound was done at 24 weeks gestation and pregnancies with uterine artery diastolic notch were randomly allocated to a control group received placebo vaginal tablets and a study group received isosorbid mononitrate 20 mg tablet once daily applied vaginally until delivery. OUTCOMES: Incidence of preeclampsia and maternal, fetal, and neonatal outcome in both groups. RESULTS: The study group had significant lower incidence of preeclampsia, preterm birth, intrauterine growth restriction and of neonatal admission to the intensive care (p < 0.05). CONCLUSIONS: Nitric oxide donors prophylactic treatment for preeclampsia in high-risk teenage pregnancies decrease the incidence of preeclampsia and improve maternal, fetal, and neonatal outcomes. Further studies on larger sample size are required to confirm these results.