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

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

  2. 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?)

  3. 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

  4. 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

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

  6. STUDIES ON IMPLANTATION POTENTIAL OF EMBRYOS (1999-2004)

  7. 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

  8. 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?

  9. MORPHOLOGY TIMELY AND SEQUENTIAL OBSERVATION OF EMBRYOS

  10. PGD FOR EMBRYO SELECTION IN ADVANCED AGE EUROPEAN STUDIES USA GROUPS BRUSSELS: SIMILAR DELIVERY RATE AMSTERDAM: DECREASED DELIVERY RATE IN PGD PATIENTS SEVERE CRITICISM!

  11. 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

  12. PGD FOR EMBRYO SELECTION CONTROL EXPERIMENT IVF / ICSI e SET / SET IVF / ICSI PGD e SET / SET

  13. OPTIMUM DAY FOR TRANSFER (≥1 ET) DAY 3 DAY 5 EQUAL CLINICAL PREGNANCY RATES LOWER IR MORE TO FREEZE HIGHER IR LESS TO FREEZE

  14. 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

  15. 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

  16. CPR IN THE GERMAN HOSPITAL (DAYS)

  17. IMPLANTATION RATE IN THE GERMAN HOSPITAL

  18. TRANSFER DAYS IN THE GERMAN HOSPITAL

  19. SACS IN THE GERMAN HOSPITAL

  20. QUESTION SHOULD EMBRYO CULTURE DURATION BE MINIMIZED DUE TO EPIGENETIC / IMPRINTING DISORDERS? PATIENT PROFILE? DRUGS? LABORATORY? MEDIA? (DEFINITELY IN MOUSE)

  21. 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

  22. IS IMPLANTATION MERELY ABOUT EMBRYOS?

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