A matched propensity score study of embryo morphokinetics following gonadotropin-releasing hormone agonist versus human
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ASSISTED REPRODUCTION TECHNOLOGIES
A matched propensity score study of embryo morphokinetics following gonadotropin-releasing hormone agonist versus human chorionic gonadotropin trigger Galia Oron 1,2 & Onit Sapir 1,2 & Avital Wertheimer 1,2 Ekaterina Shlush 1,2 & Avi Ben-Haroush 1,2
&
Yoel Shufaro 1,2 & Roni Bar-Gil 1,2 & Tamar Margalit 1,2 &
Received: 5 May 2020 / Accepted: 17 September 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose To compare morphokinetic parameters and quality of embryos derived from GnRH antagonist ICSI cycles triggered either with GnRH agonist or standard hCG between matched groups of patients. Methods Morphokinetic parameters of embryos derived from matched first GnRH antagonist ICSI cycles triggered by GnRH agonist or standard hCG between 2013 and 2016 were compared. Matching was performed for maternal age, peak estradiol levels, and number of oocytes retrieved. Outcome measures were: time to pronucleus fading (tPNf), cleavage timings (t2-t8), synchrony of the second and third cycles (S2 and S3), duration of the second and third cycle (CC2 and CC3), optimal cell cycle division parameters, and known implantation data (KID) scoring for embryo quality. Multivariate linear and logistic regression analyses were performed for confounding factors. Results We analyzed 824 embryos from 84 GnRH agonist trigger cycles and 746 embryos from 84 matched hCG trigger cycles. Embryos derived from the cycles triggered with hCG triggering cleaved faster than those deriving from GnRH agonist trigger. The differences were significant throughout most stages of embryo development (t3-t6), and a shorter second cell cycle duration of the hCG trigger embryos was observed. There was no difference in synchrony of the second and third cell cycles and the optimal cell cycle division parameters between the two groups, but there was a higher percentage of embryos without multinucleation in the hCG trigger group (27.8% vs. 21.6%, p < 0.001). Conclusion The type of trigger in matched antagonist ICSI cycles was found to affect early embryo cleavage times but not embryo quality. Keywords GnRH agonist trigger . Time lapse . Morphokinetic parameters
Introduction With the introduction of the time-lapse monitoring system (TMS), a continual assessment of embryo morphological changes could be performed. TMS allows embryo quality assessment by documenting timing of events and length of intervals in embryo development. Predictive software based on computerized algorithms is installed in current TMS,
* Galia Oron [email protected] 1
Infertility and IVF Unit, Helen Schneider Hospital for Women, Rabin Medical Center, Beilinson Hospital, 4941492 Petah Tikva, Israel
2
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
assisting embryologists in embryo evaluation and providing an objective scoring of the embryos, for embryo selection. In addition, the continuous documentation of embryo development inside the incubator provides a stable culture environment by limiting
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