Considerations for future modification of The Association for the Study of Reproductive Biology embryo grading system incorporating time-lapse observations.

The Association for the Study of Reproductive Biology (ASEBIR) Interest Group in Embryology (in Spanish 'Grupo de Interés de Embriología') reviewed key morphokinetic parameters to assess the contribution of time-lapse technology (TLT) to the ASEBIR grading system. Embryo grading based on morphological characteristics is the most widely used method in human assisted reproduction laboratories. The introduction and implementation of TLT has provided a large amount of information that can be used as a complementary tool for morphological embryo evaluation and selection. As part of IVF treatments, embryologists grade embryos to decide which embryos to transfer or freeze. At the present, the embryo grading system developed by ASEBIR does not consider dynamic events observed through TLT. Laboratories that are using TLT consider those parameters as complementary data for embryo selection. The aim of this review was to evaluate review time-specific morphological changes during embryo development that are not included in the ASEBIR scoring system, and to consider them as candidates to add to the scoring system.

The efficacy of novel centrifugation-free sperm selection (Io-Lix) on sperm parameters and ICSI reproductive outcomes.

RESEARCH QUESTION: What is the effect of a novel non-centrifugation method (Io-Lix) of sperm selection on sperm parameters and intracytoplasmic sperm injection (ICSI) reproductive outcomes? DESIGN: This pilot study elevated the capacity of the Io-Lix sperm selection protocol to improve sperm parameters (concentration, motility and sperm DNA fragmentation) of the neat ejaculate. Once established, the reproductive outcomes of Io-Lix selected spermatozoa were used for autologous and donor oocyte ICSI programmes and their efficacy compared with those using conventional swim-up. RESULTS: Io-Lix sperm selection resulted in lower sperm concentration yield (P < 0.001) and sperm DNA fragmentation (P < 0.001) but higher sperm motility (P < 0.001) when compared with spermatozoa in the neat ejaculate. When compared with swim-up sperm selection the Io-Lix protocol resulted in a 14.7% (P = 0.028) increase in pregnancy rate and 16.3% (P = 0.047) reduction in miscarriages in the autologous ICSI programme. A similar comparison of sperm selection procedures employed for a donor oocyte ICSI programme showed no difference in terms of their respective reproductive outcomes. CONCLUSIONS: The Io-Lix sperm selection protocol resulted in improved pregnancy rate and reduction in miscarriage when applied to autologous ICSI, which was attributed to a reduction in the proportion of spermatozoa with DNA damage post-selection. A similar finding was not apparent in the donor oocyte programme, which may be associated with the capacity of the donor oocyte to repair sperm DNA post-syngamy.

Evolución del método de fecundación in vitro en España: 1993-2010 / Evolution of in vitro fertilization in Spain: 1993-2010

Introducción: El objetivo del presente estudio fue comparar los cambios en el uso de la intracytoplasmatic sperm injection (ICSI) en España, así como discutir las posibles causas. Métodos: Se analizaron los datos del Registro de la Sociedad Española de Fertilidad (SEF) en el uso de fecundación in vitro (FIV)/ICSI entre los años 1993-2010 con ovocitos propios y donados. Además se analizaron las causas que indicaron la FIV/ICSI y el porcentaje de ciclos realizados con ovocitos propios a mujeres mayores de 40 años. Resultados: El uso de ICSI aumentó del 4% en 1993 al 89% en 2010 en ciclos de técnicas en reproducción asistida con ovocitos propios y del 59% en 1999 al 93% en 2008 en ciclos con ovocitos donados. En el periodo 1993-2001 se observa una disminución de indicaciones de FIV/ICSI por factor femenino y un aumento por factor masculino y esterilidad de origen desconocido (EOD), pero a partir de 2001 estos porcentajes permanecen estables. Una evolución similar se observa en el porcentaje de ciclos con ovocitos propios realizados a mujeres mayores de 40 años. Conclusiones: El uso de la ICSI va en aumento, pero es difícil determinar factores clínicos específicos que expliquen estas diferencias. Dado que la ICSI no proporciona mayores tasas de embarazo que la FIV convencional en parejas cuya causa de esterilidad no sea el factor masculino y además supone un incremento en los costes, algunas parejas estériles podrían beneficiarse de un uso menos frecuente de ICSI (AU)

Introduction: The aim of this study was to compare the changes in the use of intracytoplasmatic sperm injection (ICSI) in Spain and to discuss the possible causes for these changes. Methods: We analysed the data of the Spanish Fertility Society registry on the use of in vitro fertilization (IVF)/ICSI between 1993-2010 with own and donated oocytes. We also studied the reasons for indicating IVF or ICSI and the percentage of cycles performed with own oocytes in the case of women over 40 years. Results: The use of ICSI increased from 4% in 1993 to 89% in 2010 in assisted reproductive technology cycles with own oocytes, and from 59% in 1999 to 93% in 2008 for cycles with donated oocytes. In the 1993-2001 period, a decrease was observed in the indications for IVF/ICSI due to the female factor, together with an increase in these indications due to the male factor or to infertility of unknown origin. However, these percentages have remained stable since 2001. A similar trend has been observed in the percentage of cycles with own oocytes performed with women aged over 40 years. Conclusions: The use of ICSI is increasing, although it is difficult to determine the specific clinical factors that may explain these differences. Since ICSI does not produce higher pregnancy rates than conventional IVF in couples whose cause of infertility is not the male factor and it is also more costly, some infertile couples could benefit from less frequent use of ICSI (AU)

Defining poor and optimum performance in an IVF programme.

BACKGROUND: At present there is considerable interest in healthcare administration, among professionals and among the general public concerning the quality of programmes of assisted reproduction. There exist various methods for comparing and analysing the results of clinical activity, with graphical methods being the most commonly used for this purpose. As yet, there is no general consensus as to how the poor performance (PP) or optimum performance (OP) of assisted reproductive technologies should be defined. METHODS: Data from the IVF/ICSI register of the Spanish Fertility Society were used to compare and analyse different definitions of PP or OP. The primary variable best reflecting the quality of an IVF/ICSI programme was taken to be the percentage of singleton births per IVF/ICSI cycle initiated. Of the 75 infertility clinics that took part in the SEF-2003 survey, data on births were provided by 58. A total of 25 462 cycles were analysed. The following graphical classification methods were used: ranking of the proportion of singleton births per cycles started in each centre (league table), Shewhart control charts, funnel plots, best and worst-case scenarios and state of the art methods. RESULTS: The clinics classified as producing PP or OP varied considerably depending on the classification method used. Only three were rated as providing 'PP' or 'OP' by all methods, unanimously. Another four clinics were classified as 'poor' or 'optimum' by all the methods except one. CONCLUSIONS: On interpreting the results derived from IVF/ICSI centres, it is essential to take into account the characteristics of the method used for this purpose.