Factors associated with decision outcomes along the planned oocyte cryopreservation pathway in a cohort of women who sought consultation before and during the COVID-19 pandemic.

PURPOSE: To identify factors associated with three decision outcomes along the planned oocyte cryopreservation (POC) pathway: fertility assessment completion, POC uptake, and multiple POC cycles uptake. METHODS: A single-site retrospective cohort study of 425 patients who sought POC consultation from 2018-2022 before and during the COVID-19 pandemic. RESULTS: The mean age of patients at consultation was 35.2 ± 4.0. 73% (n = 310) of the new consultations occurred since the COVID-19 pandemic. 335 patients completed fertility assessment following consultation. Of the 335 patients (78.8%) completing fertility assessment, 139 (32.7%) underwent at least one cycle. The odds of completing fertility assessment were 3.65 times greater for patients being seen pre-pandemic than for those being seen during the pandemic (p < 0.001). Not having a committed partner (OR 2.61, p < 0.001) and not having a prior pregnancy history (OR 1.99, p = 0.03) positively predicted POC uptake. Each additional number of cryopreserved MII oocytes in the first cycle reduced the odds of undergoing more cycles by 0.74 times (p < 0.001). Of the 196 patients with no POC uptake despite having a fertility consultation, 10 decided to do nothing, 16 decided to get pregnant with or without a partner, and the other 170 had not yet indicated their decision. CONCLUSION: Our centre experienced a surge of patients seeking POC consultation since the COVID-19 outbreak. Approximately one-third of these patients progressed to the POC stage. Our findings validate the complexity of POC decision-making and the value of providing ongoing decision support to patients along the POC pathway.

Personalization of IVF-ICSI workflow based on patient characteristics improves IVF laboratory outcomes and embryo ploidy by PGT-A.

BACKGROUND: Intracytoplasmic sperm injection (ICSI) has become a common method of fertilization in assisted reproduction worldwide. However, there are still gaps in knowledge of the ideal IVF-ICSI workflow including the optimal duration of time between induction of final oocyte maturation, oocyte denudation and ICSI. The aim of this study was to examine outcomes following different workflow protocols in IVF-ICSI procedures in blastocysts that have undergone undisturbed incubation and preimplantation genetic testing for aneuploidy (PGT-A) prior to transfer. METHODS: Retrospective secondary analysis of 113 patients (179 IVF cycles, 713 embryos), all of whom have gone through IVF-ICSI and PGT-A using undisturbed culture. Predictive test variables were the length of time from: trigger to OPU, OPU to denudation, and denudation to ICSI. Outcome metrics assessed were: maturation, fertilization, blastulation and euploid rates. Generalized Estimated Equations Linear Model was used to examine the relationship between key elements of a given cycle and continuous outcomes and LOESS curves were used to determine the effect over time. RESULTS: In a paired multi-regression analysis, where each patient served as its own control, delaying OPU in patients with unexplained infertility improved both maturation and blastulation rates (b = 29.7, p < 0.0001 and b = 9.1, p = 0.06, respectively). Longer incubation with cumulus cells (CCs) significantly correlated with improved ploidy rates among patients under 37, as well as among patients with unexplained infertility (r = 0.22 and 0.29, respectively), which was also evident in a multiple regression analysis (b = 6.73, p < 0.05), and in a paired analysis (b = 6.0, p < 0.05). Conversely, among patients with a leading infertility diagnosis of male factor, longer incubation of the denuded oocyte prior to ICSI resulted in a significantly higher euploid rate (b = 15.658, p < 0.0001). CONCLUSIONS: In this study we have demonstrated that different IVF-ICSI workflows affect patients differently, depending on their primary infertility diagnosis. Thus, ideally, the IVF-ICSI workflow should be tailored to the individual patient based on the primary infertility diagnosis. This study contributes to our understanding surrounding the impact of IVF laboratory procedures and highlights the importance of not only tracking "classic" IVF outcomes (maturation, fertilization, blastulation rates), but highlights the importance that these procedures have on the ploidy of the embryo.