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Abstract Objective It is known that the single embryo transfer (SET) is the best choice to reduce multiples and associated risks. The practice of cryopreserving all embryos for posterior transfer has been increasingly performed for in vitro fertilization (IVF) patients at the risk of ovarian hyperstimulation syndrome or preimplantation genetic testing for aneuploidy. However, its widespread practice is still controverse. The aim of this study was to evaluate how effective is the transfer of two sequential SET procedures compared with a double embryo transfer (DET) in freeze-only cycles. Methods This retrospective study reviewed 5,156 IVF cycles performed between 2011 and 2019, and 506 cycles using own oocytes and freeze-only policy with subsequent elective frozen-thawed embryo transfers (eFET) were selected for this study. Cycles having elective SET (eSET, n = 209) comprised our study group and as control group we included cycles performed with elective DET (eDET, n = 291). In the eSET group, 57 couples who had failed in the 1st eSET had a 2nd eFET, and the estimated cumulative ongoing pregnancy rate was calculated and compared with eDET. Results After the 1st eFET, the ongoing pregnancy rates were similar between groups (eSET: 35.4% versus eDET: 38.5%; p =0.497), but the estimated cumulative ongoing pregnancy rate after a 2nd eFET in the eSET group (eSET + SET) was significantly higher (48.8%) than in the eDET group (p < 0.001). Additionally, the eSET +SET group had a 2.7% rate of multiple gestations, which is significantly lower than the eDET group, with a 30.4% rate (p < 0.001). Conclusion Our study showed the association of freeze-only strategy with until up to two consecutive frozen-thawed eSETs resulted in higher success rates than a frozenthawed DET, while drastically reducing the rate of multiple pregnancies.

Resumo Objetivo Sabe-se que a transferência de embrião único (SET) é a melhor escolha para reduzir as gestações múltiplas e riscos associados. A prática da criopreservação de todos os embriões para transferência posterior tem sido cada vez mais utilizada para fertilização in vitro (FIV), em especial quando há risco de síndrome de hiperestimulação ovariana ou realização de teste genético pré-implantacional. Entretanto, sua utilização disseminada ainda é controversa. O objetivo deste estudo foi avaliar a eficácia de duas SET sequenciais em comparação com uma transferência de embrião dupla (DET) em ciclos de FIV onde todos os embriões foram criopreservados. Métodos Neste estudo retrospectivo foram revisados 5.156 ciclos de FIV realizados entre 2011 e 2019, e 506 ciclos usando oócitos próprios e criopreservação de todos os embriões com transferências eletivas subsequentes de embriões descongelados, foram selecionados para este estudo. Ciclos com transferência eletiva de embrião único (eSET, n = 209) compuseram nosso grupo de estudo e como grupo de controle incluímos os ciclos com transferência eletiva de dois embriões (eDET, n = 291). No grupo eSET, 57 casais que falharam na 1ª tentativa de eSET tiveram uma 2ª eFET e a taxa de gravidez em curso cumulativa foi estimada para o grupo eSET e comparada com o grupo eDET. Resultados Após a 1ª eFET, as taxas de gravidez em curso foram semelhantes entre os grupos (eSET: 35,4% versus eDET: 38,5%; p = 0,497), mas a taxa de gravidez em curso cumulativa estimada após a 2ª eFET no grupo eSET (eSET + SET) foi significativamente maior (48,8%) do que no grupo eDET (p <0,001). Além disso, as taxas de gestação múltipla foram expressivamente inferiores no grupo eSET + SET (2,7%) quando comparado ao grupo eDET (30,4%; p < 0,001). Conclusão Nosso estudo mostrou que a associação das estratégias de congelamento de todos os embriões com até duas eSETs sequenciais resultou em maiores taxas de sucesso do que uma DET com embriões descongelados, além de reduzir drasticamente a ocorrência de gestações múltiplas.

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Resumen OBJETIVO: Evaluar la relación entre la ubicación de la burbuja de aire que contiene los embriones y las tasas de implantación y de gestación clínica. El secundario: estudiar la relación entre la posición de la punta de la cánula, el grosor endometrial y el desplazamiento de la burbuja con esos desenlaces reproductivos. MATERIALES Y MÉTODOS: Estudio retrospectivo, observacional y de análisis de imágenes ecográficas de transferencias de embrión único en estadio de blastocisto practicadas por un mismo especialista en la Fundación IVI, Valencia, España, entre septiembre de 2013 y febrero de 2021. Criterios de selección: grosor endometrial ≥ 6 mm en el último control ecográfico, ausencia de miomas, IMC menor de 30 kg/m2, transferencias atraumáticas efectuadas por el mismo especialista. En función de la ubicación de la burbuja de aire se establecieron tres grupos de estudio (alta: mayor de 0.98 cm, media: 0.98 a 1.44 cm y baja: mayor de 1.44 cm) y para evaluar la asociación entre las categorías se aplicó el cálculo de razón de momios (OR) e IC95%. RESULTADOS: Se estudiaron 342 transferencias de embrión único. La edad media de las pacientes fue 39.70 ± 4.5 años. La relación entre la distancia de la burbuja de aire al fondo uterino y la tasa de implantación fue de 61 ± 9% en el grupo de ubicación alta, 64 ± 9% en el grupo de ubicación media, y de 56 ± 1% en el grupo de ubicación baja (p = 0.437). No se observaron diferencias en la tasa de gestación evolutiva analizada mediante probabilidad de ocurrencia entre grupos, con frecuencias de 0.60 en comparación con 0.64 (OR: 1.42; IC95%: 0.83 a 2.44; p: 0.199) y en la ubicación alta con media, y frecuencias de 0.60 en comparación con 0.56 (OR: 1.22; IC95%: 0.72-2.08; p: 0.462) entre alta y baja. CONCLUSIONES: No se encontró asociación entre la ubicación de la burbuja y las tasas de implantación y de gestación evolutiva. El mayor desplazamiento de la burbuja se asoció con mayores tasas de gestación evolutiva.

Abstract OBJECTIVE: To evaluate the relationship between the location of the air bubble containing the embryos and the implantation and clinical gestation rates. Secondary: to study the relationship between the position of the cannula tip, the endometrial thickness and the displacement of the bubble with these reproductive outcomes. MATERIALS AND METHODS: Retrospective, observational, ultrasound image analysis study of single embryo transfers at blastocyst stage performed by the same specialist at the IVI Foundation, Valencia, Spain, between September 2013 and February 2021. Selection criteria: endometrial thickness ≥ 6 mm at the last ultrasound control, absence of fibroids, BMI less than 30 kg/m2, atraumatic transfers, performed by the same specialist. Based on the location of the air bubble, three study groups were established (high: greater than 0.98 cm, medium: 0.98 to 1.44 cm and low: greater than 1.44 cm) and the odds ratio (OR) and 95%CI were used to evaluate the association between the categories. RESULTS: A total of 342 single embryo transfers were studied. The mean age of the patients was 39.70 ± 4.5 years. The relationship between the distance of the air bubble to the uterine fundus and the implantation rate was 61 ± 9% in the high placement group, 64 ± 9% in the medium placement group, and 56 ± 1% in the low placement group (p = 0.437). No differences were observed in the evolutionary gestation rate analyzed by probability of occurrence between groups, with frequencies of 0.60 compared to 0.64 (OR: 1.42; 95%CI: 0.83 to 2.44; p: 0.199) and high to medium location, and frequencies of 0.60 compared to 0.56 (OR: 1.22; 95%CI: 0.72-2.08; p: 0.462) between high and low. CONCLUSIONS: No association was found between the air bubble localization and implantation or ongoing pregnancy rates. However, a greater displacement of the bubble was associated with higher ongoing pregnancy rates.

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OBJECTIVE: To evaluate the use of implantation data algorithm KIDscoreTM D5 (Vitrolife®, Canada) as an additional tool for morphological assessment and preimplantation genetic testing for aneuploidies (PGT-A) to improve implantation and ongoing pregnancy rates. MATERIALS AND METHODS: This study looked into 912 embryos from 270 patients who underwent IVF at the INMATER Fertility Clinic in Lima, Peru, between October 2016 and June 2018. All embryos were cultured for up to five or six days in an Embryoscope® time-lapse incubator (Vitrolife®, Canada) and evaluated based on the KIDscoreTM D5 algorithm (KS5). Biopsies for PGT-A screening were performed in 778 (85.31%) embryos. A total of 184 single embryo transfers (68% of patients) were performed during the study period and the embryos transferred were divided into four groups: 1) euploid embryos transferred without consideration to their KS5 scores (n=86); 2) euploid embryos transferred considering their KS5 scores (n=48); 3) embryos transferred without consideration to their KS5 scores and that were not evaluated by PGT-A (n=40); and 4) embryos transferred considering their KS5 scores and that were not evaluated by PGT-A (n=10). Implantation and ongoing pregnancy rates were compared between the groups and between euploid embryos with the highest KS5 scores (KS5=6, n=25) and euploid embryos with the lowest KS5 scores (KS5=1, n=51). The correlations between KS5 scores and embryo euploidy rates were also evaluated. RESULTS: Euploid embryo transfers in which KS5 scores were considered in the selection process had significantly higher Implantation and ongoing pregnancy rates compared to euploid embryo transfers in which selection was based on morphology (75.00% vs. 50.00%; p=0.002 and 66.66% vs. 48.83%; p=0.037, respectively). Additionally, implantation rates were significantly higher for blastocysts with the highest KS5 score (KS5=6) compared to blastocysts with the lowest score (KS5=1) (80.00% vs. 49.02%; p=0.045). Ongoing pregnancy rates were not significantly different (72.00% vs. 47.06%; p=0.105). Euploidy rates were significantly higher in the group of embryos with KS5=6 than in the group of embryos with KS5=1 (61.88% vs. 48.33%; p=0.006). CONCLUSION: Embryo selection based on the KS5 algorithm score improved the implantation rates of single euploid blastocyst transfers. Furthermore, embryos with the highest KS5 score had a higher probability of being euploid and implanting.

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OBJECTIVES: This study aimed to identify human blastocyst contraction patterns and their correlations with ploidy status (PGT-A analysis), the time it took for embryos to reach the blastocyst stage, and pregnancy rates. METHODS: The study included 912 embryos from 270 patients seen in our center. All embryos were cultivated in an Embryoscope incubator. An NGS platform was used to test 778 of the 912 embryos initially included in the study for aneuploidy at a reference laboratory. Blastocyst contractions were evaluated using the embryo drawing tool to compute percent contraction. A total of 182 single-embryo transfers were performed. The mean age of the included patients was 30.44 years (24-39 years). RESULTS: The embryos were divided into two groups, the first with embryos that contracted (CT group) and the second with embryos that did not contract, herein referred to as expanding-only embryos or solo expanding (SE group). In terms of ploidy status, 58.33% of the embryos in the SE group were euploid, while 53.58% of embryos in the CT group were aneuploid. The difference between the groups was statistically significant (p=0.029), showing that embryos that do not contract have a higher chance of being euploid than embryos that contract. Pregnancy rates were also significantly higher among embryos in the SE group than in the CT group (63.10% vs. 46.67%; p=0.012). Finally, we saw that embryos in the CT group took significantly longer to reach the blastocyst stage compared to embryos in the SE group (p=0.004). Patient age was not significantly different between the CT and SE groups, indicating that age might not be a factor in embryo contraction. CONCLUSION: Two of the traits for which the embryos included in this study were compared were statistically different. Embryos in the CT group had lower implantation rates, took longer to reach the blastocyst stage, and had a higher chance of being aneuploid, regardless of maternal age. Therefore, embryo contraction might be a useful parameter in the selection of embryos for transfer.

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Objetivo: Estimar o impacto orçamentário em cinco anos da incorporação da técnica de SET (single embryo transfer) sequencial no Sistema de Saúde Suplementar brasileiro (SSSB). Métodos: Foram consideradas taxas de nascidos vivos de 41% e de gemelaridade de 2% e 30% para SET e DET (double transfer embryo), respectivamente. Os custos dos procedimentos foram, em sua maioria, obtidos das tabelas SIMPRO, CBHPM e CMED. Para a estimativa da população elegível, foram consideradas mulheres de 20 a 35 anos registradas no Datasus e taxas de infertilidade e de uso de fertilização in vitro (FIV) da literatura. Estimou-se em 20% e 80% o uso de SET sequencial e DET, respectivamente, com incorporação da primeira em 45%, 50%, 55%, 65% e 75% dos casos nos cinco anos subsequentes. Resultados: Considerando cenários com reembolso de um a dois ciclos de SET sequencial e inclusão ou não do valor dos medicamentos, o impacto orçamentário em cinco anos seria entre R$ 10.231.387 e R$ 16.123.874 em operadoras de grande porte, R$ 1.054.174 e R$ 1.661.297 em operadoras de médio porte e R$ 173.700 e R$ 273.738 em operadoras de pequeno porte. Em cenário com aumento progressivo do uso de SET sequencial sem alteração no modelo de reembolso atual, foi estimada economia de R$ 59.319.276 para o SSSB em cinco anos. Conclusões: O uso de SET sequencial (vs. DET) em procedimentos de FIV é potencialmente menos oneroso para o SSSB referente a custos de pré-natal, parto e complicações. Em cenário de incorporação progressiva, o custo incremental foi estimado em R$ 8-13 mil/paciente.

Objective: To estimate the five-year budget impact of incorporating the sequential single embryo transfer (SET) technique into the Brazilian Supplementary Healthcare System (BSHS). Methods: Live birth rates of 41% and multiple pregnancy rates of 2% and 30% were considered for SET and DET (double transfer embryo), respectively. The costs of the procedures were mostly obtained from e SIMPRO, CBHPM and CMED tables. To estimate the eligible population, we considered women aged 20-35 years registered in DATASUS, and infertility and in vitro fertilization (IVF) rates from the literature. The use of sequential SET and DET was estimated as 20% and 80%, respectively, with incorporation of the first in 45%, 50%, 55%, 65% and 75% of cases in the subsequent five years. Results: Considering scenarios with reimbursement of 1 to 2 cycles of sequential SET and inclusion or not of the drugs in the reimbursement, the budget impact in five years would be between BRL 10,231,387-16,123,874 in large operators, BRL 1,054,174-1,661,297 in midsize operators and BRL 173,700-273,738 in small operators. In a scenario of progressive increase of the use of sequential SET with no change in the current reimbursement model, we estimated a saving of BRL 59,319,276 for the BSHS in five years. Conclusions: The use of sequential SET (vs. DET) in IVF procedures is potentially less costly for BSHS for prenatal, child-birth and complication costs. In the scenario of progressive incorporation and full reimbursement of the procedure, the incremental cost was estimated at BRL 8-13 thousands/patient.

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Objectives:To identify contraction (CT) patterns in human blastocysts using a Time-Lapse incubator and to correlate them with their ploidy status by PGT-A analysis, the time they took to reach blastocyst state, implantation rate and clinical pregnancy rate. Design: Retrospective cohort study. Interventions: From October 2016 through May 2018, 270 patients were evaluated, 912 embryos were cultivated in the Time-Lapse (Embryoscope™, Vitrolife) incubator; 778 of them were tested for aneuploidy using an NGS platform in a reference laboratory. Vitrification was performed according to the result of embryo development and awaiting the NGS result, followed by devitrification and transfer of a single embryo. Blastocyst contractions (CT) were determined using the EmbryoViewer (EmbryoViewer™ drawing tools) in order to obtain area, percentage of contraction and the various types of contractions, and these were compared with the NGS genetic study result. 182 transfers were performed to patients with an average age of 30.4 years, range 24 to 39 years. Finally, we obtained the correlation of implantation rate and clinical pregnancy of euploid embryos transferred in the program of assisted reproduction. Results: Embryos were separated into two groups according to contraction during their development: those that contracted (CT) and those that did not, named "only expanding" (OE). OE embryos were euploid in 58.3%, while 53.6% of CT embryos were aneuploid, with a statistically significant difference (p=0.029), meaning that OE embryos had higher chances of being euploid than CT embryos. Pregnancy rate was also higher in OE embryos (63.1% vs. 46.7% in CT embryos; p=0.012). CT embryos took longer to reach the blastocyst stage compared to OE embryos (p=0.004). Women's age had no correlation with embryo contraction. Conclusions: In this study, embryos who showed contractions had a higher chance of aneuploidy, a lower implantation rate, and required longer to reach the blastocyst stage. The simple fact of observing contractions in an embryo could be useful to decide to transfer another embryo without contractions. Further studies are necessary to prove these findings.

Objetivos. Estudiar los patrones de contracciones en blastocistos humanos mediante el uso de una incubadora time-lapse y correlacionarlos con su estado de ploidía por análisis PGT-A, el tiempo para alcanzar el estado blastocisto, la tasa de implantación y de embarazo clínico. Diseño. Estudio de cohortes retrospectivo. Intervenciones. Entre octubre 2016 y mayo 2018, se evaluó 270 pacientes; se hizo cultivo extendido de 5 a 6 días a 912 embriones en la incubadora time-lapse (Embryoscope, Vitrolife), y a 778 se les estudió para aneuploidía usando una plataforma NGS en un laboratorio de referencia. Hubo posterior vitrificación, según resultado del desarrollo embrionario y en espera del resultado del NGS, seguido de desvitrificación y transferencia de embrión único. Se determinó las contracciones del blastocisto (CTB) mediante la herramienta de dibujo del embrión EmbryoViewer (EmbryoViewer drawing tools), de manera de obtener el área, porcentaje de contracción y los diferentes tipos de contracciones, y se comparó los embriones con el resultado del estudio genético mediante NGS. Se transfirió 182 embriones en pacientes de 30,4 años promedio, rango entre 24 y 39 años. Finalmente, se correlacionó la tasa de implantación y embarazo clínico de los embriones euploides que fueron transferidos, en el programa de reproducción asistida. Resultados. Se separó los embriones en dos grupos de acuerdo a las contracciones durante su desarrollo, en aquellos que las tuvieron (CT) y aquellos que no, denominados 'solo expanding' (SE). Los embriones SE fueron euploides en 58,3%, mientras los embriones CT fueron aneuploides en 53,6%, con significancia estadística (p=0,012). Ello indica que la mayoría de los embriones euploides hacen 'solo expanding' durante su desarrollo, mientras que la mayoría de los embriones aneuploides (53,9%) hacen contracciones durante su desarrollo (p=0,029). Del mismo modo, la tasa de embarazo clínico de los embriones SE euploides fue 63,1% frente a 46,7% de los embriones CT, p=0.012. Finalmente, los embriones euploides CT tardaron más en convertirse en blastocistos tempranos que los embriones SE, p=0.004. La edad de la mujer no representó un factor para contracción embrionaria. Conclusiones. Los resultados obtenidos en este estudio muestran que los embriones que muestran contracciones, sin importar que tan intensas sean, están relacionados con mayor probabilidad de aneuploidías, menor tasa de implantación y ritmos de división lentos. El simple hecho de observar contracciones en un embrión podría ser útil para decidir transferir otro embrión que no las haya tenido. Se requiere más estudios para comprobar estos hallazgos.

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Intracytoplasmic sperm injection (ICSI) is an in vitro fertilization technique in which a sperm is injected through a micropipette to achieve fertilization. This technique, widely used in assisted reproduction, causes a moderate deformation of the oocyte membrane, which becomes harmful in some cases. The Piezo-ICSI technique minimizes this deformation because the Piezo device generates submicron vibration in the ICSI micropipette that crosses the zona pellucida without generating any resistance. There is no prior evidence of a pregnancy obtained through this technique in Latin America. Therefore, we present this report as the first case of a 16-week clinical pregnancy with present heartbeat from an embryo fertilized using the Piezo-ICSI technique.

La inyección intracitoplasmática del espermatozoide al ovulo (ICSI) es una técnica de fertilización in vitro en la que un espermatozoide es inyectado al ovocito utilizando una micropipeta biselada, para conseguir la fecundación. Esta técnica, ampliamente usada en reproducción asistida, genera una deformación moderada de la membrana del ovocito, llegando a ser, en algunos casos, nocivo para este. Utilizando la técnica Piezo-ICSI, esta deformación se minimiza, ya que el dispositivo Piezo genera vibración submicrónica en la micropipeta de ICSI, y atraviesa la zona pelúcida sin generar resistencia alguna. No existe evidencia que esta técnica haya logrado un embarazo en América Latina, por lo tanto, se presenta el siguiente reporte como el primer caso de embarazo clínico con actividad cardiaca de 16 semanas de gestación proveniente de un embrión fecundado con la técnica de Piezo-ICSI.

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Objectives: To determine if the use of the KIDScore 5 algorithm (known implantation data) can help select between euploid embryos in order to improve pregnancy and implantation rates in patients undergoing assisted reproductive procedures. Methods: Retrospective cohort study in a fertility clinic, from October 2016 to December 2018, of 1 049 embryos from 328 patients. All the embryos were cultured in the Time-Lapse, Embryoscope® incubator (Vitrolife®, Canada) for 5-6 days. Of these, 896 embryos (85.4%) were biopsied and analyzed by NGS, and assessed with the predictive KIDScore 5 algorithm (Vitrolife®, Canada). The 153 remaining embryos (14.6%) were assessed with the predictive KIDScore 5 algorithm only. 256 single euploid embryos were transferred in couples undergoing IVF treatments at the Inmater clinics laboratory of assisted reproduction in Lima - Peru. Results: The implantation rate was significantly higher (p = 0.004) in euploid embryos transferred when selected by the KIDScore 5 algorithm (Group 2) versus those selected using only genetic study by NGS technology (Group 1) (71.2% vs. 48.8%). The rate of implantation of the euploid embryos transferred with KIDScore value = 6 versus those transferred with KIDScore = 1 was statistically different (73.5% vs. 50.8%; p = 0.030). When assessing the relationship between the rate of euploid embryos versus the result of the KIDScore 5 value, we found highly significant differences in the rates of euploid embryos with values 6 and 5 versus those with KIDScore 0 and 1 (60.5% vs. 45.7%; p = 0.0004). Conclusions: The embryo selection with the KIDScore 5 algorithm offers advantage on implantation and pregnancy rates only when euploid embryos are transferred. Its use as an additional criterion to embryo selection should be considered when accompanied by genetic study of the embryos to be transferred. Euploid embryos with a higher value in the KIDScore 5 algorithm scale have better rates of implantation and euploidy than embryos with the minimum value of this algorithm.

Objetivos. Evaluar si el uso del algoritmo KIDScore 5 (known implantation data) puede ayudar a seleccionar entre los embriones euploides, para mejorar las tasas de embarazo e implantación en pacientes sometidas a procedimientos de reproducción asistida. Métodos. Estudio de cohorte retrospectivo en una clínica de fertilidad, desde octubre 2016 a diciembre 2018. Se estudió 1 049 embriones provenientes de 328 pacientes. Todos los embriones fueron cultivados en la incubadora Time-Lapse, Embryoscope® (Vitrolife®, Canadá) durante 5 a 6 días. De estos, 896 embriones (85,4%) fueron biopsiados y analizados mediante NGS y recibieron una valoración otorgada por el algoritmo predictivo KIDScore 5 (Vitrolife®, Canadá). Los 153 embriones restantes (14,6%) únicamente recibieron la valoración mediante el algoritmo predictivo KIDScore 5. Se realizó 256 transferencias únicas de embriones euploides en parejas sometidas a tratamientos de FIV en el laboratorio de reproducción asistida de la Clínica Inmater, Lima - Perú. Resultados. La tasa de implantación de los embriones euploides transferidos con valores de KIDScore = 6 versus los transferidos con valores de KIDScore = 1 tuvo diferencia estadísticamente significativa (73,5% vs. 50,8%; p=0,030). Al evaluar la relación entre la tasa de euploidia embrionaria versus el resultado del valor de KIDScore 5, se obtuvo diferencias altamente significativas en las tasas de euploidia en los embriones con resultados de KIDScore 6 y 5 versus los de KIDScore 0 y 1 (60,5% vs. 45,7%; p=0,0004). Conclusiones. La selección embrionaria con ayuda del algoritmo KIDScore 5 ofrece ventaja en las tasas de implantación y embarazo únicamente cuando se transfieren embriones euploides. Su uso como criterio adicional a la selección embrionaria debiera ser considerado siempre que se acompañe estudio genético a los embriones a transferir. Los embriones euploides con valor más alto en la escala del algoritmo KIDScore 5, tienen mejores tasas de implantación y euploidía que los embriones con el valor mínimo de dicho algoritmo.

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OBJECTIVE: Multiple embryos have been transferred to compensate for low implantation rates, which in turn, increase the likelihood of multiple pregnancies. Despite the publication of clinical guidelines and a reduction in the number of embryos transferred, double embryo transfer still is the most common practice. There is no clear evidence of who should receive the single embryo transfer (SET), and it is more commonly indicated for patients of good prognosis. However, it is not clear how much the presence of other infertility factors can affect the SET prognosis. The aim of this study was to evaluate differences in clinical pregnancy rates (CPR) of frozen-thawed SET cycles for women presenting with different infertility factors. METHODS: Retrospective cohort study evaluating 305 frozen-thawed SET cycles performed in the last 10 years in a private IVF center. We included patients undergoing ovarian stimulation cycles, using ejaculated sperm and a frozen-thawed ET. Embryos were routinely vitrified and warmed up, and the blastocysts were transferred after endometrium preparation. The cycles were categorized according to the infertility factor classified by the Society for Assisted Reproductive Technologies (SART) as anatomic female factor (n=55), endocrine female factor (n=26), endometriosis (n=37), male factor (n=60), ovarian insufficiency (n=26), unexplained (n=24), multiple factors (n=45) and other (n=32). CPR were compared between the groups and the multivariate analysis was performed to evaluate the association of each infertility factor and the CPR, adjusted for confounders. RESULTS: The women varied in age from 18 to 44 years (35.9±3.8), presented Body Mass Index of 22.4±3.1kg/m2, baseline serum FSH of 7.4±8.3 IU/ml, and had a mean of 11.0±8.4 MII oocytes recovered and 6.4±5.3 embryos cryopreserved. The CPR, according to infertility factors were: anatomic female factor (25.9%), endocrine female factor (30.8%), endometriosis (27.8%), male factor (20.7%), ovarian insufficiency (21.7%), unexplained (9.5%), multiple factors (17.1%) and other (20.7%). Multivariate analysis did not show significant association of infertility factors and CPR adjusted for confounders. CONCLUSIONS: Patients presenting different infertility factors seem to have a satisfactory CPR for a SET cycle, except those with unexplained infertility. This is a preliminary outcome and the number of patients by category is small; in addition, the retrospective characteristics of the study are its limitations. Overall, our findings suggest that patients presenting any infertility factor, except unexplained infertility, are suitable to receive a SET with satisfactory outcomes.

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INTRODUCTION: Assisted reproductive technologies (ARTs) are associated with potential risks, mainly related to multiple pregnancies, which are around 20% to 25%. Iatrogenic multiple pregnancies due to ovarian stimulation with multiples embryos transferred can be avoided by the elective single-embryo transfer (eSET), a growing practice worldwide. Adequately applied eSET, which impact on the incidence of complications without compromising treatment success, is still a challenge. The aim of this study was to compare the cumulative success rates of elective transfer of 2 embryos when transferred one by one (eSET), versus the success rates of elective double-embryo transfer (DET) in a single procedure, in a good prognosis population. METHODS: This study evaluated 610 good prognosis infertile couples undergoing ART, split into 2 groups: eSET group which included those receiving first eSET (n = 237) and for those who did not become pregnant, they could receive a second frozen-thawed SET; and eDET group (n = 373) who received elective transfer of 2 good quality embryos in the first transfer. RESULTS: Clinical pregnancy outcomes after a transfer of 2 embryos were similar between the groups (DET: 46.6% vs accumulated SET: 45.9%; P = .898). Multiple pregnancy rate was significantly lower in the group receiving transfer of 2 embryos, one by one, compared to DET (DET: 32.2% vs accumulated SET: 6.7%; P < .001). CONCLUSIONS: The eSET policy should be stimulated for good prognosis couples, as it maintains the accumulated clinical pregnancy rates, avoids multiples pregnancies, and consequently the maternal and neonate complication and indirect costs of treatment when considering spending on the obstetrics are reduced.

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OBJECTIVE: To describe a patient selection method for elective single embryo transfer (eSET), emphasizing inclusion criteria and results. METHODS: This retrospective study included all cases seen in a private clinic between June 2011 and December 2016, in La Paz, Bolivia (3600 meters above sea level). Elective single embryo transfer was the method of choice in 34 IVF/ICSI cycles, all in the blastocyst stage. Gardner's blastocyst classification criteria were used. Between the two stages of the study (July 2015), each embryo grade implantation rate was recalculated, which led to the expansion of the inclusion criteria. RESULTS: The clinical pregnancy rate of the 34 cases in the first transfer group was 55.9% (19/34). Twin or multiple pregnancies did not occur. The cumulative pregnancy rate to date is 64% [(19+3)/34]. The first stage comprised 2.56% (12/468) of the patients offered elective single embryo transfers; the implantation rate was 58.3% (7/12). In the second stage, 14.29% (22/154) of the patients were eligible, and the implantation rate was 54.55% (12/22). CONCLUSIONS: The implementation of an eSET program based on in-depth morphological embryo assessment combined with the calculation of the implantation potential of each embryo grade led to acceptable clinical outcomes and fewer multiple pregnancies in patients transferred two embryos. Each clinic should be aware of the implantation rates of each embryo grade in its own setting.

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Resumen OBJETIVO Comunicar los resultados obtenidos del análisis del estudio genético preimplantación para aneuploidias en dos centros de reproducción asistida de México en un periodo de tres años, utilizando dos diferentes técnicas moleculares. MATERIALES Y MÉTODOS Estudio observacional, retrospectivo, en donde se reporta el resultado de blastocistos sometidos a preimplantación para aneuploidias durante 2014-2017, en dos centros de reproducción asistida (Ciudad de México y Guadalajara). RESULTADOS Se analizaron 404 blastocistos de 129 pacientes (edad promedio 39 ± 4 años). Los embriones se dividieron en dos grupos según la técnica aplicada: 76 por a-CGH y 328 por secuenciación de nueva generación. El porcentaje de embriones euploides fue de 33%. Las aneuploidias numéricas fueron las más frecuentes. Hasta la terminación del estudio se habían transferido 69 embriones euploides con tasas de implantación de 78% para secuenciación de nueva generación y de 57% para a-CGH. CONCLUSIONES La tasa de implantación reportada en este estudio fue mayor con el análisis de preimplantación para aneuploidias por secuenciación de nueva generación. Los resultados reportados en nuestra experiencia soportan la necesidad de favorecer una opción de transferencia de embrión único. Es importante reconocer los retos de las nuevas tecnologías y la necesidad de técnicas moleculares más sensibles.

Abstract OBJECTIVE Communicate the results obtained from the analysis of the preimplantation genetic study for aneuploidy in two centers of assisted reproduction in Mexico in a period of three years, using two differentmolecular techniques. MATERIALS AND METHODS Descriptive, retrospective study, which reports the blastocysts PGT-A results, over 2014-2017, in two Fertility Centers (Ciudad de México and Guadalajara). The embryos where divided in two groups by their molecular techniques studied: 76 by a-CGH and 328 by NGS RESULTS We analyzed a total of 404 blastocysts from 129 patients (mean age 39 ± 4 years), with two different molecular techniques: a-CGH and NGS. The euploid embryos percentage was 33%. The numerical aneuploidies were the most frequent. Up to the ending of the study, 69% of the euploid embryos had been transferred. The implantation rates were 78% for those analyzed by NGS and 57% with a-CGH. CONCLUSIONS The implantation rate was bigger with the PGT-A by NGS. Our results reported, supports a single embryo transfer policy. It is important to recognize the challenges of new technologies and the need for more sensitive molecular techniques.

RESUMO

Resumen OBJETIVO: analizar las tasas de implantación y embarazo en ciclos de fertilización in vitro con transferencia electiva de un solo blastocisto, con control del factor embriónico mediante transferencia de embriones euploides. MATERIALES Y MÉTODOS: estudio retrospectivo de pacientes atendidas entre los años 2010 a 2015 en un centro privado, en protocolo de fertilización in vitro y que tuvieron, por lo menos, un embrión euploide disponible para transferencia. Para fines de estudio las pacientes se dividieron en dos grupos: 1) transferencia de embriones frescos y 2) embriones desvitrificados. Las variables categóricas se analizaron con χ2 y prueba exacta de Fisher; las variables continuas con t de Student. Se estableció significación estadística con un valor de p < 0.05. Para el análisis estadístico se usó SAS-STAT versión 9.4. RESULTADOS: se incluyeron 637 ciclos (frescos: 243 vs criopreservados: 394). La tasa de embarazo fue de 75.5% (n = 289) vs 66.3% (n = 159), embarazo clínico 62.5% (n = 235) vs 53.1% (n = 127) que fue estadísticamente significativo a favor de los ciclos criopreservados. Las tasas de embarazo múltiple fueron bajas (1.7 vs 1.6%) en ambas cohortes. CONCLUSIONES: la transferencia de un solo embrión disminuye significativamente la incidencia de embarazos múltiples y la morbilidad materna y neonatal. El mejor pronóstico en ciclos de fertilización in vitro homólogos se consigue con la transferencia de un solo embrión genéticamente equilibrado, en un ciclo posterior de preparación endometrial sintética o natural.

Abstract OBJECTIVE: To analyze the implantation and pregnancy rates in cycles of in vitro fertilization with elective transfer of a single blastocyst, with control of the embryonic factor by transfer of euploid embryos. MATERIALS AND METHODS: Retrospective analysis who included patients that underwent IVF and had at least one euploid embryo available for transfer between 2010 and 2015 on a single academic private practice. Cohorts were segregated in fresh embryo transfers (ET) vs frozen/thawed ET. Categorical variables were analyzed with χ2 and Fisher test when appropriate. Continuous variables were analyzed with Students t test. P value < 0.5 was established as statistically significant. SAS/STAT 9.4 was used for analysis. RESULTS: Six hundred and thirty-seven euploid SETs cycles (fresh cycle: n = 243; frozen/thaw cycle: n = 394) were identified. Pregnancy (75.5% (n=289) vs 66.3% (n = 159)) and clinical pregnancy rates (PR) (62.5% (n = 235) vs 53.1% (n = 127)) were statistically higher in the frozen/thaw cycles. Low rates of multiple pregnancies (1.7 and 1.6%) were observed in both cohorts. CONCLUSIONS: In one of the largest studies to date, a euploid SET during a frozen/thaw cycle showed significantly improved pregnancy and clinical PR compared to embryo transfer in fresh cycles. Single embryo transfer significantly reduces the incidence of multiple gestation and improves maternal and neonatal outcomes. An optimal outcome is achieved by the performance of a SET in FET cycles.