Risk factors for poor oocyte yield and oocyte immaturity after GnRH agonist triggering.

STUDY QUESTION: What are the potential risk factors for poor oocyte recuperation rate (ORR) and oocyte immaturity after GnRH agonist (GnRHa) ovulation triggering? SUMMARY ANSWER: Lower ovarian reserve and LH levels after GnRHa triggering are risk factors of poor ORR. Higher BMI and anti-Müllerian hormone (AMH) levels are risk factors of poor oocyte maturation rate (OMR). WHAT IS KNOWN ALREADY: The use of GnRHa to trigger ovulation is increasing. However, some patients may have a suboptimal response after GnRHa triggering. This suboptimal response can refer to any negative endpoint, such as suboptimal oocyte recovery, oocyte immaturity, or empty follicle syndrome. For some authors, a suboptimal response to GnRHa triggering refers to a suboptimal LH and/or progesterone level following triggering. Several studies have investigated a combination of demographic, clinical, and endocrine characteristics at different stages of the treatment process that may affect the efficacy of the GnRHa trigger and thus be involved in a poor endocrine response or efficiency but no consensus exists. STUDY DESIGN, SIZE, DURATION: Bicentric retrospective cohort study between 2015 and 2021 (N = 1747). PARTICIPANTS/MATERIALS, SETTING, METHODS: All patients aged 18-43 years who underwent controlled ovarian hyperstimulation and ovulation triggering by GnRHa alone (triptorelin 0.2 mg) for ICSI or oocyte cryopreservation were included. The ORR was defined as the ratio of the total number of retrieved oocytes to the number of follicles >12 mm on the day of triggering. The OMR was defined as the ratio of the number of mature oocytes to the number of retrieved oocytes. A logistic regression model with a backward selection method was used for the analysis of risk factors. Odds ratios (OR) are displayed with their two-sided 95% confidence interval. MAIN RESULTS AND THE ROLE OF CHANCE: In the multivariate analysis, initial antral follicular count and LH level 12-h post-triggering were negatively associated with poor ORR (i.e. below the 10th percentile) (OR: 0.61 [95% CI: 0.42-0.88]; P = 0.008 and OR: 0.86 [95% CI: 0.76-0.97]; P = 0.02, respectively). A nonlinear relationship was found between LH level 12-h post-triggering and poor ORR, but no LH threshold was found. A total of 25.3% of patients suffered from oocyte immaturity (i.e. OMR < 75%). In the multivariate analysis, BMI and AMH levels were negatively associated with an OMR < 75% (OR: 4.34 [95% CI: 1.96-9.6]; P < 0.001 and OR: 1.22 [95% CI: 1.03-1.12]; P = 0.015, respectively). Antigonadotrophic pretreatment decreased the risk of OMR < 75% compared to no pretreatment (OR: 0.72 [95% CI: 0.57-0.91]; P = 0.02). LIMITATIONS, REASONS FOR CAUTION: Our study is limited by its retrospective design and by the exclusion of patients who had hCG retriggers. However, this occurred in only six cycles. We were also not able to collect information on the duration of pretreatment and the duration of wash out period. WIDER IMPLICATIONS OF THE FINDINGS: In clinical practice, to avoid poor ORR, GnRHa trigger alone should not be considered in patients with higher BMI and/or low ovarian reserve, balanced by the risk of ovarian hyperstimulation syndrome. In the case of a low 12-h post-triggering LH level, practicians must be aware of the risk of poor ORR, and hCG retriggering could be considered. STUDY FUNDING/COMPETING INTEREST(S): None. TRIAL REGISTRATION NUMBER: N/A.

[Interest of iDAScore (intelligent Data Analysis Score) for embryo selection in routine IVF laboratory practice: Results of a preliminary study]. / Intérêt de l'iDAScore (intelligent Data Analysis Score) dans la pratique quotidienne d'un laboratoire de FIV pour la sélection embryonnaire : résultats d'une étude préliminaire.

INTRODUCTION: Embryo selection is a major challenge in ART, especially since the generalization of single embryo transfer, and its optimization could lead to the improvement of clinical results in IVF. Recently, several Artificial Intelligence (AI) models, based on deep-learning such as iDAScore, have been developed. These models, trained on time-lapse videos of embryos with known implantation data, can predict the probability of pregnancy for a given embryo, allowing automatization and standardization in embryo selection. MATERIAL AND METHODS: In this study, we have compared the hierarchical categorization of 311 D5 blastocysts of iDAScore v1.0 and the embryologists of our unit. These 311 D5 blastocysts have been classified as top (70.1%), good (Q+: 10.6%) and poor (Q-: 19.3%) quality by embryologists according to Gardner classification. Median iDAScores were [9.9-8.4],]8.4-7.5] and]7.5-2.1] for top, good and poor-quality blastocysts respectively. RESULTS: We observed a significantly concordant categorization between iDAScore and embryologists for top, good and poor-quality blastocysts (respectively, 89.5, 36.4 and 48.3%, P < 10-4). Moreover, the hierarchical categorization of the three best blastocysts between iDAScore and the embryologists was as follow: 1st rank: 71.9%; 2nd rank: 61.6%; 3rd rank: 56.8% (P=0.07). One hundred and fifty-one blastocysts with known implantation data were analyzed. The iDAScore of blastocysts that implanted was significantly higher than those that did not implant (implantation+: 9.10±0.57; implantation-: 8.70±0.95, P=0.003). CONCLUSION: This preliminary study shows that iDAScore is able to perform a reproducible, reliable and immediate hierarchical classification of blastocysts. Moreover, this tool can identify the blastocysts with the highest implantation potential. If these results confirmed on a larger scale of embryos and patients, IA could revolutionize IVF laboratories by standardizing embryo hierarchical selection.

[Impact of the type of incubator (non-humidified versus humidified) on embryo culture media osmolality]. / Impact du type d'incubateur (atmosphère humidifiée versus sec) sur l'osmolalité des milieux de culture embryonnaire.

INTRODUCTION: Benchtop incubators with small individual chambers have been developed in order to improve the stability of embryo culture conditions reducing the environmental stress during the embryo development. These new dry incubators were designed without any air humidification system in order to prevent bacterial proliferation and to enable the use of time-lapse system. However, an elevated evaporation of the culture media could occur in these conditions. The main objective of the study is to analyse the impact of the used incubator type on the embryo culture media osmolality. MATERIALS AND METHODS: Microdrops of 50µL of culture media were placed in 60mm diameter culture dishes, and quickly covered with either 7 or 8mL of mineral oil in an IVF workstation with laminar airflow. Two series of culture dishes have been randomly placed either in a humidified incubator or in a dry benchtop incubator. The microdrops of each culture dishes were sampled at D0, D1, D2, D3, and D5 respectively to measure the osmolality in triplicate using a cryoscopic osmometer. The mean values of osmolality in each incubator have been compared respectively on D0, D1, D2, D3 and D5 with appropriate statistical tests, and considered statistically significant when P<0.05. RESULTS: The osmolality of the microdrops placed in the dry benchtop incubator differed significantly after the third day of culture, regardless of the level of mineral oil in the culture dishes. Indeed, using Petri dishes covered respectively with 7 or 8mL of mineral oil, osmolality values of samples from the dry incubator were significantly higher than those from the humidified one, at D3 and D5 (D3/7mL: 273±2.1 vs. 268±1.0mOsm/kg; P=0.02; D3/8mL: 282±8.0 vs. 270±0.7mOsm/kg; P=0.04) and D5 (D5/7mL: 283±1.5 vs. 270±3.6mOsm/kg; P=0.004; D5/8mL: 287±5.6 vs. 268±2.3mOsm/kg; P=0.005). Furthermore, the analysis on paired samples showed that the osmolality in the dry benchtop incubator at D5 using 7mL of oil (283±1.5mOsm/kg; P=0.003) and at D3 (273±2.1mOsm/kg; P=0.016) and D5 (287±5.6mOsm/kg; P=0.009) using 8mL of oil was significantly higher than that measured at D0 (265±1.9mOsm/kg). CONCLUSION: A significant increase of the embryo culture media osmolality was observed in the dry benchtop incubator with ambient hygrometry in our standard conditions. Adding 1mL of oil was not sufficient to reduce the evaporation of the media. Although maintained at a physiological level, the impact of the osmolality changes on the in vitro embryo development has to be further determined.