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DOC. DR. H. NADIR CIRAY, Ph.D BAHCECI TUP BEBEK LABORATUARLARI DIREKTORU PowerPoint Presentation
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DOC. DR. H. NADIR CIRAY, Ph.D BAHCECI TUP BEBEK LABORATUARLARI DIREKTORU. DEFINITIONS. SET : MANDATORY SINGLE EMBRYO TRANSFER E-SET : ELECTIVE SINGLE EMBRYO TRANSFER (TWIN-PRONE PATIENTS) E-SFET : ELECTIVE SINGLE FROZEN EMBRYO TRANSFER

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DOC. DR. H. NADIR CIRAY, Ph.D BAHCECI TUP BEBEK LABORATUARLARI DIREKTORU


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slide1

DOC. DR. H. NADIR CIRAY, Ph.D

BAHCECI TUP BEBEK LABORATUARLARI DIREKTORU

definitions

DEFINITIONS

SET: MANDATORY SINGLE EMBRYO TRANSFER

E-SET: ELECTIVE SINGLE EMBRYO TRANSFER (TWIN-PRONE PATIENTS)

E-SFET: ELECTIVE SINGLE FROZEN EMBRYO TRANSFER

SBT: SINGLE BLASTOCYST TRANSFER (IN COUNTRIES WITHOUT FUNDING?)

current problems solutions
CURRENT PROBLEMS & SOLUTIONS

TOO MANY EMBRYOS ARE TRANSFERRED

THE EDUCATION OF EMBRYOLOGISTS ARE NOT SUFFICIENT

THE DATA ACQUISITION METHODS ARE POOR & NOT ACCESSIBLE

OBSTACLES TO BEST PRACTISE (e.g., FINANCIAL DISINCENTIVES)

eSET STRATEGIES SHOULD BE IMPLEMENTED

STRICT REGULATIONS IN ACCREDITATION OF EMBRYOLOGISTS

OBJECTIVE & RELIABLE DATA ACQUISITION

REIMBURSEMENT

why multiple pregnancies have been increased over years lab perspective
WHY MULTIPLE PREGNANCIES HAVE BEEN INCREASED OVER YEARS (LAB PERSPECTIVE)

INCREASE IN EXPERIENCE OF EMBRYO CULTURE

BETTER CULTURE MEDIA (e.g., BLASTOCYST)

BETTER CATHETER DESIGN FOR ATRAUMATIC TRANSFERS

ICSI; MALE FACTOR CAN BE TREATED

BETTER CRYOPRESERVATION

BETTER DEFINITION AND WIDER USE OF EMBRYO MORPHOLOGY TO DEFINE STAGE-SPECIFIC NORMAL DEVELOPMENT

question
QUESTION

WHICH EMBRYO CRITERIA ARE THE BEST TO CHOOSE THE HIGHEST IMPLANTATION POTENTIAL EMBRYO AND HOW TO MAKE EMBRYOLOGISTS AGREE ON THIS POINT?

one healthy baby at a time embryologists are key

ONE HEALTHY BABY AT A TIME-embryologists are key-

Jointly agreed mission statement

GOOD CLINICAL Judgment

GUIDELINES to give advice on how to adapt (utd+tsrm)

Evidence-based approach to judge embryo quality

Optimum time of embryo transfer

Importance of effective cryopreservation program

Regional workshops

HIGH QUALITY EMBRYOLOGY

EMBRYO CRYOPRESERVATION

E-set in appropriate situations

how to select embryo for eset
HOW TO SELECT EMBRYO FOR eSET
  • MORPHOLOGY
    • 2PN-EC-4 CELL-8 CELL- MORULA-BLASTOCYST
    • TIME OF EVENTS (SEQUENTIAL OBSERVATION)
    • USER’S EXPERIENCE & KNOWLEDGE (AN EVEN 6-CELL EMBRYO IS ABNORMAL!)
  • NON-INVASIVE TESTING OF CULTURE MEDIA
    • UNDER RESEARCH
    • NOT USER-DEPENDENT
  • PGD
    • ANEUPLOIDY RATE %30- %70
    • MATTER OF DEBATE
    • CRYOPRESERVATION AFTER BIOPSY?
morphology
MORPHOLOGY

TIMELY AND SEQUENTIAL OBSERVATION OF EMBRYOS

pgd for embryo selection in advanced age
PGD FOR EMBRYO SELECTION IN ADVANCED AGE

EUROPEAN STUDIES

USA GROUPS

BRUSSELS: SIMILAR DELIVERY RATE

AMSTERDAM: DECREASED DELIVERY RATE IN PGD PATIENTS

SEVERE CRITICISM!

pgd for embryo selection in younger patients staessen et al 2007
PGD FOR EMBRYO SELECTION IN YOUNGER PATIENTS (STAESSEN ET AL., 2007)

EXPERIMENT

CONTROL

P > 0.05

MEAN AGE 29.9

N: 91

ONGOING PR %47.4

MEAN AGE 29.9

N: 84

ONGOING PR %42.8

pgd for embryo selection
PGD FOR EMBRYO SELECTION

CONTROL

EXPERIMENT

IVF / ICSI

e SET / SET

IVF / ICSI

PGD

e SET / SET

optimum day for transfer 1 et
OPTIMUM DAY FOR TRANSFER (≥1 ET)

DAY 3

DAY 5

EQUAL CLINICAL PREGNANCY RATES

LOWER IR

MORE TO FREEZE

HIGHER IR

LESS TO FREEZE

optimum day of transfer set papanikolaou zech racowsky
OPTIMUM DAY OF TRANSFER (SET)PAPANIKOLAOU, ZECH, RACOWSKY

DAY 3

DAY 5

LOWER CPR

MORE TO FREEZE

LOWER RISK OF NO ET

HIGHER BIRTH RATE AFTER THAW CYCLE

HIGHER CPR

LESS TO FREEZE

HIGHER RISK OF NO ET

LOWER BIRTH RATE AFTER THAW CYCLE

optimum day of set

OPTIMUM DAY OF SET

PAPANIKOLAOU, ZECH, RACOWSKY

≤3 8 CELL EMBRYOS AT DAY 3

ET AT DAY 3

≥4 8 CELL EMBRYOS AT DAY 3

ET AT DAY 5

question20
QUESTION

SHOULD EMBRYO CULTURE DURATION BE MINIMIZED DUE TO EPIGENETIC / IMPRINTING DISORDERS?

PATIENT PROFILE?

DRUGS?

LABORATORY? MEDIA?

(DEFINITELY IN MOUSE)

process in belgium
PROCESS IN BELGIUM

2000- HEALTH AUTHORITIES IMPOSED BETTER REINBURSEMENT FOR ART (ONLY CLINICAL PROCEDURES AND DRUGS USED TO BE COVERED) WITH THE CONDITION THAT TWINNING DECREASES FROM %25-30 TO %10 IN TWO YEARS WITHOUT TRIPLETS

EXTRA FUNDING CREATED BY REDUCING CARE OF PREMATURELY BORN BABIES DIVERTED TO REIMBURSE LAB MANIPULATIONS

ALL CENTRES ACCEPTED

2003- PUT INTO LAW