No benefit of culturing embryos in a closed system compared with a conventional incubator in terms of number of good quality embryos: results from an RCT.

STUDY QUESTION: Does culture in a closed system result in an increased number of good quality embryos (GQE) on Day 2 compared with culture in a conventional system? SUMMARY ANSWER: Culture in a closed system up to 2 days after microinjection results in similar embryo development and morphological quality compared with culture in a conventional incubation system. WHAT IS KNOWN ALREADY: Time-lapse imaging (TLI) incubators are rapidly being introduced into IVF laboratories worldwide, despite the lack of large prospective randomized trials demonstrating improvement in embryo development or pregnancy rates. STUDY DESIGN, SIZE, DURATION: A randomized controlled trial including 364 patients (365 cycles) was conducted between May 2010 and February 2014. After oocyte collection, randomization was carried out and all of a patients' oocytes were allocated to culture in either a conventional incubator or a closed incubator system in proportion 1:2 until embryo transfer on Day 2. A total of 1979 oocytes were injected and cultured in the closed system, and 1000 in the standard incubator. The primary end-point was the number of GQE in the two groups. PARTICIPANTS/MATERIALS, SETTINGS, METHODS: In total, 364 patients undergoing their first IVF cycle using ICSI, where at least one oocyte was retrieved, were randomized in a university hospital setting. Two hundred and forty patients were randomized for culture in a closed system and 124 patients for culture in the conventional incubator system (control group). Embryo assessments and final morphological scoring before transfer and cryopreservation were carried out at the same time points for embryos cultured in the conventional incubator and in the closed system. MAIN RESULTS AND THE ROLE OF CHANCE: There was no significant difference in the mean ± SD number of GQEs between groups: 2.41 ± 2.27 for the closed system group and 2.19 ± 1.82 for the control group (P = 0.34, difference 0.23, 95% confidence interval 0.69; -0.24). No significant differences were found in the number of 4-cell embryos, implantation-, pregnancy- or ongoing pregnancy rates. A significantly higher miscarriage rate was found in the TLI group compared with the control group (33.3 and 10.2%, P = 0.01). LIMITATIONS, REASONS FOR CAUTION: Culture media, temperature and gas levels were similar in the open and closed incubator systems, but different culture dishes were used. Culturing embryos for longer time period (to the blastocyst stage) may give different results. Only ICSI patients were included, which may limit the generalizability of the results. Finally, the number of GQEs on Day 2 was used as a surrogate outcome for live birth. WIDER IMPLICATIONS OF THE FINDINGS: The results are consistent with other, smaller randomized trials showing no difference in embryo quality when comparing culture in a conventional incubator with that of a closed TLI incubator system.

Efeitos da idade da matriz leve e do período de armazenamento de ovos incubáveis no rendimento de incubação / Effects of ages of light breeder hens and storage period of hatchable eggs on the incubation efficiency

Avaliaram-se os efeitos da idade das matrizes leves e do período de armazenamento dos ovos sobre o rendimento de incubação. Foram utilizados 7.224 ovos da linhagem Dekalb, distribuídos de acordo com delineamento experimental inteiramente casualizado, sendo a altura de bandeja uma covariável. Os tratamentos foram definidos pelas idades das matrizes (32 e 57 semanas de idade) e o período de armazenamento dos ovos (três, cinco e sete dias), totalizando seis tratamentos com 14 repetições. A idade das aves influenciou o peso do ovo. Houve aumento na perda de peso dos ovos das matrizes de 32 e 57 semanas de idade, durante o armazenamento (10,48 e 14,16 por cento, respectivamente) e na transferência (10,40 e 12,07 por cento, respectivamente). Verificou-se maior taxa de eclosão (86,90 por cento) em ovos produzidos pelas matrizes novas. Independentemente da idade da matriz, à medida que aumentou o período de armazenamento, houve diminuição na taxa de eclosão dos ovos férteis (86,06 e 82,39 por cento, para as matrizes de 32 e 57 semanas de idade, respectivamente). As matrizes com 57 semanas de idade produziram pintos mais pesados e com menor relação peso do pinto/peso do ovo.

The effects of ages of light breeder hens and storage period of hatchabe eggs on the incubation efficiency were evaluated. A total of 7,224 Dekalb hatching eggs were assigned according to the sample random design, and the hatching tray height was considered a co-variable. The treatments were defined according to the breeder hens ages (32 and 57-week-old) and the period of storage of eggs (three, five, and seven days), with 14 replications. The age of the hen affected the weight of the eggs. There was loss of weight of the eggs of 32 and 57-week-old breeder hens during storage (10.48 and 14.16 percent, respectively) and transference (10.40 and 12.07 percent, respectively) according to the aging of the breeder hen. Eggs produced by the younger breeder hens had a higher hatching rate; however, no matter the age of the breeder hen, there was a decrease of the hatching rate of fertile eggs (86.06 and 82.39 percent, for the 32 and 57-week-old breeder hens, respectively) whenever the storage period was increased. The 57-weekold breeder hens produced heavier chicks and lower chick/egg weight coefficient.

Is fine morphology of the human sperm nuclei affected by in vitro incubation at 37 degrees C?

OBJECTIVE: Incubation of ejaculated spermatozoa at 37 degrees C is recommended for IVF-intracytoplasmic sperm injection. Preselection of sperm cells with morphologically normal nuclei before microinjection, adapted in our laboratory, is usually a time-consuming procedure. Therefore, we aimed to verify whether incubation at 37 degrees C could affect the morphologic integrity of sperm nuclei. DESIGN: Time-kinetics studies testing fine morphology of the sperm nuclei upon prolonged in vitro incubation. SETTING: Male Fertility Laboratory at Bar-Ilan University, Ramat Gan, Israel. PATIENT(S): Forty-two males selected at random, who were referred for sperm preselection before ICSI. MAIN OUTCOME MEASURE(S): Morphologic integrity of the sperm nuclei, obtained by motile sperm organelle morphology examination. RESULT(S): After 2 hours of incubation at 37 degrees C a significant decrease occurred in the morphologic integrity of the sperm nuclei, compared with the initial state (4.7% +/- 2.8% vs. 6.8% +/- 3.5%, t = 3.2, Por=2 hours) sperm manipulations for assisted reproduction therapy should be performed at 21 degrees C rather than 37 degrees C.

Successful treatment of a critically burnt neonate (case-report).

In a health institution in 2000, a premature neonate suffered critical burns. In the submitted case-report the authors describe the successful treatment of this quite exceptional case. Indirectly, they thus also draw attention to the very positive role played by interdisciplinary collaboration under such unusual circumstances.

O berçário de alto risco e o ruído das incubadoras / High risk newborns and the noise in the incubators

A Academia Americana de Pediatria sugere que o nível de exposiçäo à ruído permitido ao recém-nascido näo ultrapasse os 58 dB (A)(Laura e col., 1986). Este estudo investigou os níveis de ruído aos quais os bebês de alto risco estäo expostos em incubadoras de 3 maternidades: 2 na cidade de Säo Paulo e 1 na cidade do Rio de Janeiro. Na maternidade A foram encontrados níveis que variavam de 63 a 69 dBA de ruído contínuo e de 82 a 91 dB linear de impacto de abertura e de 88 a 92 dB linear de fechamento. Na maternidade B foram encontrados níveis que variavam de 59 a 69 dBA de ruído contínuo, de 76 a 88 dB linear de abertura das portinholas e de 81 a 126 dB linear de fechamento. Na maternidade C foram encontrados níveis que variavam de 63 a 70 dBA, de 91 a 94 na abertura das portinholas e de 98 a 114 dBA no fechamento. Este trabalho apresenta valores que devem ser discutidos por todos os profissionais que trabalham diretamente com os bebês na tentativa de minimizar os níveis de ruídos e os riscos que essa exposiçäo possa oferecer