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Is there a relation between the time to ICSI and the reproductive outcomes?
This study indicates that in vitro ageing of mature oocytes significantly affects the chances to become pregnant. Effect on live birth rates, although not evident in this study, cannot be excluded. Limiting incubation time of mature oocytes in the embryology laboratory should improve reproductive results for patients using their own oocytes and with a transfer of fresh embryos.
220. Is there a relation between the time to ICSI and the reproductive outcomes? [Forum/Discussion]
from: Administrator (office@fertaid.com), Australia on 16/04/2018 8:42:32 AM Profession:
Comment: The take home message is that there is a 7% decrease in pregnancy rate for each hour ICSI is delayed after OPU and poor rates after 9 hours
Submission In this well presented paper from a Spanish clinic, the authors used Witness oocyte and embryo tracking tool to explore the relationship between the time of egg collection (OPU), oocyte denuding (DN) and ICSI injection to pregnancy (both biochemical, clinical and live birth). The study used almost 1500 consecutive cycles using 36Hr OPU, microdrop culture and day 2/3 transfers. they looked at cases where all ova were M2, mixed or M1 at denuding. Overall, there was 292 minutes between OPU and ICSI but this varied considerably. They looked at both fresh and cumulative pregnancy rates.
The authors noted that there was a marginally improvement in the fertilization rate with delayed in the OPU-ICSI time but a slow and steady decline in the biochemical and clinical pregnancy rate (but less so for ongoing and live birth pregnancies). In short, they argued that for every hour between OPU and ICSI, the pregnancy rate was reduced by about 7% and that after 9 hours oocyte culture, the pregnancy rates were very poor. The take home message is that it is always better to perform the ICSI process sooner rather than later.
Of course, with ovarian stimulation, all follicles (and the oocyte within) will be recruited at different times, will be at varying stages of development and maturation and respond differently to the ovulation trigger. The skill of the clinician is to gauge the optimal time to induce ovulation and perform the oocyte recovery. The skill of the embryologist is to appreciate all the oocytes/embryos will be slightly different in their maturation and ageing and try to identify the optimal oocytes for transfer several days later. What no one knows is when the follicles may naturally ovulate. AIH studies suggest ovulation usually occurs between 38 hrs and 44 hrs. One needs to look at their own data in this light.
How clinics manage the egg collections and transfers is highly variable with some clinics using a structure timetable with rostered clinicians while others adjust times to suit the patients owns doctors timetable. The reason this is important is that an overarching rule is that the oocytes need to be inspected at a clinic designated time for fertilisation check (normally about 18 hrs post injection). Therefore the duration between collection and injection (fertilisation) may vary between cases. Since IVF these days is about micromanaging each procedure, this paper suggests that if the OPU->ICSI times is variable then this may contribute the myriad of variables that influence each clients and the clinics overall success rate. Maybe one KPI is the number of cases where the injection was performed between agreed times.
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