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Embryo development

Embryo development. Day 0. Day 1. Day 2. Day 3. Day 4. Day 5. Day 6. Embryo transfer. Replacing 1-2 embryos to reduce the risk of multiple pregnancies. IVF. An effective treatment for different causes of infertility Live birth rate 30-50% ~25-30% of embryos will implant.

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Embryo development

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  1. Embryo development Day 0 Day 1 Day 2 Day 3 Day 4 Day 5 Day 6

  2. Embryo transfer Replacing 1-2 embryos to reduce the risk of multiple pregnancies

  3. IVF • An effective treatment for different causes of infertility • Live birth rate 30-50% • ~25-30% of embryos will implant

  4. Factors affecting IVF success • Age of women • Number of treatment cycles • Ovarian response • Others: smoking, obesity, hydrosalpinges, uterine fibroids etc. • Endometrial receptivity

  5. Complications • Ovarian stimulation • Ovarian hyperstimulation syndrome (OHSS) • Ovarian carcinoma • Egg collection • Bleeding • Pelvic infection • Embryo transfer • Multiple pregnancy • Ectopic pregnancy • Psychological

  6. Reduction of multiple pregnancy • Reducing the number of embryos replaced i.e. replace SINGLE embryo or blastocyst • Fetal reduction

  7. 1+1 Vs 2 embryos (Thurin et al., NEJM, 2004)

  8. OHSS • 5 % moderate (Delvigne 2002) • 2% required hospitalization (Papanikolauo 2005) • Life-threatening condition • Estimated mortality 3/100,000 cycles

  9. OHSS • Ovarian enlargement and abdominal distension • Nausea, vomiting & abdominal pain • Decrease in urine output • Ascites, hydrothorax & generalized oedema • Haemoconcentration & thromboembolism • Liver failure and renal failure

  10. OHSS management • Reduced by identifying high risk patients and choosing appropriate stimulation protocols (GnRH antagonist protocol, mild stimulation, progesterone for luteal phase support) • In cases of excessive response – agonist to induce LH surge in antagonist cycles, freeze all embryos, hydroxyethyl starch and cabergoline

  11. OHSS-Principles of management • Careful monitor of vital signs, BW, abdominal girth, CBP, Hct, RFT, LFT, clotting studies • Pelvic U/S to assess ascites & ovaries • CXR if respiratory symptoms or signs • Mild/moderate can be managed as outpatient • Paracetamol/codeine for pain; avoid NSAID • Admit for inpatient management in severe cases

  12. OHSS-Principles of management • Adequate fluid intake – IV fluid (N/S and colloids) if the patient cannot tolerate oral fluid • Diuretics should be avoided unless oliguria persists despite adequate intravascular expansion and under careful haemodynamic monitoring • U/S guided paracentesis in case of tense ascites • Anticoagulation should be considered in patients admitted for severe or critical OHSS

  13. Congenital abnormalities • ~30% increase in the risk of birth defects following IVF (Hansen et al., HRU, 2013) • Higher rate of de-novo chromosomal anomalies in ICSI offsprings (1.6% Vs 0.5%) • mainly higher no. of sex chromosomal anomalies and partly a higher no. autosomal structural anomalies (Bonduelle et al., 2002)

  14. 1.32 (1.24, 1.42)

  15. Neonatal outcomes of singletons following ART Vs spontaneous conceptions Relative risk (95% CI) Very preterm (< 32 weeks) 3.27 (2.03 to 5.28) Preterm (< 37 weeks) 2.04 (1.80 to 2.32) Very low birth weight (< 1500 g) 3.00 (2.07 to 4.36) Low birth weight (< 2500 g) 1.70 (1.50 to 1.92) Small for gestational age 1.40 (1.15 to 1.71) Caesarean section 1.54 (1.44 to 1.66) NICU admission 1.27 (1.16 to 1.40) Perinatal mortality 1.68 (1.11 to 2.55) (Helmerhorst et al., BMJ, 2004)

  16. Longterm health outcomes • May increase the incidence of high blood pressure, elevated fasting glucose, total body fat composition, advancement of bone age and potentially subclinical thyroid disorder • Increase the incidence of cerebral palsy and neurodevelopmental delay related to prematurity and low birthweight • Potential increase in the prevalence of early adulthood clinical depression and binge drinking (Hart and Norman, HRU, 2013)

  17. Thank you for attention

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