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Papers by Mai Tam
Embryo and oocyte maturation • Qualitative and quantitative grading of human blastocysts and its ... more Embryo and oocyte maturation • Qualitative and quantitative grading of human blastocysts and its association with live-birth rate and neonatal outcome (Ebner) • Prediction of embryonic development and clinical outcome following ICSI according to the stages of nuclear maturation division (Nagayoshi) Culture and incubator conditions • Development of a new procedure to reduce the amount of recipient cytoplasm (mitochondria) at the MII karyoplast transfer for the treatment of mitochondrial diseases (Tanaka) MII, metaphase II; IVF, in vitro fertilisation Morphokinetic studies • Retrospective validation of Eeva™ at large scale: Correlation between Eeva™ categories and blastocyst formation rate (Basile) • An automated time-lapse embryo selection algorithm is correlated with embryo implantation potential; clinical validation of Eeva™ (Aparicio-Ruiz) Topic: Embryology and Embryo Technology Metabolomics and biomarkers • A new strategy to diagnose embryo viability combining protearray and time-lapse technologies (Meseguer) • Screening of oocyte quality in human IVF: proof of principle of follicular fluid biomarkers (Chen) PGS, preimplantation genetic screening; Eeva, early embryo viability assessment; ICSI, intracytoplasmic sperm injection; MI, metaphase I Embryo and oocyte maturation P-242 -Prediction of embryonic development and clinical outcome following ICSI according to the stages of nuclear maturation division M Nagayoshi Poster Study background and aim Background • Pre-ovulatory oocytes collected after controlled ovarian stimulation are considered mature with the extrusion of the first polar body at ICSI • However, embryonic development varies following ICSI for morphologically mature oocytes Nagayoshi M. Poster. P242 Aim To investigate whether it is possible to predict embryonic development and clinical outcome according to the stages of nuclear maturation division. Study materials and methods • A retrospective study in 53 patients (83 cycles) under 38 years of age on 211 oocytes was performed • Oocyte retrieval was conducted under the control of GnRH antagonist + hMG followed by ICSI • Embryos were cultured for 5 days in medium until blastocyst stage • MII chromosomes were identified using an inverted microscope equipped with Nomarski optics • MII oocytes were divided into 3 groups and their relationship with clinical outcome investigated -Group A: oocytes that had the MII chromosomes arranged in two lines -Group B: oocytes at pro-metaphase II not yet arranged in two lines -Group C: oocytes with irregularly arranged chromosomes GnRH, gonadotrophin-releasing hormone; HMG, human menopausal gonadotrophin Nagayoshi M. Poster. P242 The use of oocytes not yet at MII phase results in decreased fertilisation, blastocyst and pregnancy rates • The proportion of grouped oocytes according to the stages of MII chromosomes were 78.1% (165/211) in group A, 7.1% (15/211) in group B, and 14.7% (31/211) in group C Group Fertilisation rates , % (n) Cleavage rates, % (n) Blastocyst rates , % (n) Pregnancy rates , % (n) Miscarriage rates , % (n) A oocytes with MII chromosomes arranged in two lines 79.4 (131/165) 80.2 (105/131) 58.0 (76/131) 44.7 (34/76) 11.8 (4/34) B oocytes at prometaphase II 73.3 (11/15) 63.6 (7/11) 36.4 (4/11) 25.0 (1/4) 100 (1/1) C oocytes with irregularly arranged chromosomes 54.8 (17/31) 70.6 (12/17) 17.6 (3/17) 0 (0/3) -Nagayoshi M. Poster. P242
fi (N Kaartinen). Noora Kaartinen graduated from Tampere University Medical School in 2002. She c... more fi (N Kaartinen). Noora Kaartinen graduated from Tampere University Medical School in 2002. She completed her specialization in Obstetrics and Gyneacology in 2013, and has since worked as a consultant at the Department of Obstetrics and Gynecology of Tampere University Hospital. She works in the IVF unit and is carrying out her reserch project on IVF treatments. Abstract In many clinics, good-quality embryos are selected for embryo transfer and cryopreservation at the cleavage stage, and poor-quality embryos are discarded. The aim of this retrospective study was to examine how many repeated IVF cycles could be avoided by culturing the cleavage stage poor-quality embryos to blastocyst stage and transferring them after vitrification and warming (604 IVF and intracytoplasmic sperm injection [IVF–ICSI] cycles were included). Poor-quality cleavage stage embryos not eligible for transfer or cryopreservation were cultured until day 5 or 6, and those developing to the blastocyst stage were vitrified. The rate of vit-rified blastocysts and clinical pregnancy and delivery rate of the warmed blastocysts was evaluated. The effect of the extended culture on the cumulative delivery rate, and the number of avoided new treatment cycles was calculated. The surplus blastocysts resulted in clinical pregnancy, spontaneous abortion and delivery rates of 24.6%, 27.3% and 17.2% respectively. The use of surplus blasto-cysts raised cumulative delivery rate from 43% to 47% and 53 repeated new cycles were avoided. This study shows that the cumulative delivery rate can be increased, and repeated IVF–ICSI treatments avoided by using blastocysts developing from poor-quality cleavage stage embryos, which otherwise would have been discarded.
(L Rienzi). Laura Rienzi, Senior Clinical Embryologist, has 20 years experience in the field of a... more (L Rienzi). Laura Rienzi, Senior Clinical Embryologist, has 20 years experience in the field of assisted reproductive technology. She has academic degrees in biology and reproductive medicine, and has written almost 100 articles, reviews and book chapters. Laura is President of the Italian Society of Reproductive Embryology and Research, and Laboratory Director of four IVF centres in Italy. Her current areas of interest include human embryo culture, studies of gamete, zygote and embryo, as well as cryopreservation. Laura has played a key role in the clinical application of oocyte vitrification in Italy. Abstract Recent studies involving a limited number of patients have indicated a correlation between aneuploidy and various morphokinetic parameters during preimplantation development. The results among different groups, however, have been inconsistent in identifying the parameters that are able to predict chromosomal abnormalities. The aim of this study was to investigate whether aneuploidy of human blastocysts was detectable by specific morphokinetic parameters in patients at increased risk of aneuploidy because of advanced maternal age, history of unsuccessful IVF treatments, or both. A longitudinal cohort study was conducted using 455 blastocysts from 138 patients. Morphokinetic features of preimplantation development were detected in a timelapse incubator. Blastocysts were subjected to trophectodermal biopsy and comprehensive chromosomal screening. Analyses were conducted by means of logistic mixed-effects models, with a subject-specific intercept. No statistical correlation between 16 commonly detected morphokinetic characteristics of in-vitro embryo development and aneuploidy was found. Results suggest that morphokinetic characteristics cannot be used to select euploid blastocysts in poor-prognosis patients regarded as candidates for pre-implantation genetic screening.
Objective: To study the relation of dietary phytoestrogens intake and clinical outcomes of women ... more Objective: To study the relation of dietary phytoestrogens intake and clinical outcomes of women undergoing infertility treatment with the use of assisted reproductive technology (ART). Design: Prospective cohort study. Setting: Fertility center. Patient(s): A total of 315 women who collectively underwent 520 ART cycles from 2007 to 2013. Intervention(s): None. Main Outcome Measure(s): Implantation, clinical pregnancy, and live birth rates per initiated cycle. Result(s): Soy isoflavones intake was positively related to live birth rates in ART. Compared with women who did not consume soy isoflavones, the multivariable-adjusted odds ratios of live birth (95% confidence interval) for women in increasing categories of soy isoflavones intake were 1.32 (0.76-2.27) for women consuming 0.54-2.63 mg/d, 1.87 (1.12-3.14) for women consuming 2.64-7.55 mg/d, and 1.77 (1.03-3.03) for women consuming 7.56-27.89 mg/d. Conclusion(s): Dietary soy intake was positively related to the probability of having a live birth during infertility treatment with ART. (Fertil Steril Ò 2015;103:749-55. Ó2015 by American Society for Reproductive Medicine.)
There is good evidence that fertilization and pregnancy rates are similar to IVF/ICSI with fresh ... more There is good evidence that fertilization and pregnancy rates are similar to IVF/ICSI with fresh oocytes when vitrified/warmed oocytes are used as part of IVF/ICSI for young women. Although data are limited, no increase in chromosomal abnormalities, birth defects, and developmental deficits has been reported in the offspring born from cryopreserved oocytes when compared to pregnancies from conventional IVF/ICSI and the general population. Evidence indicates that oocyte vitrification and warming should no longer be considered experimental. This document replaces the document last published in 2008 titled, ''Ovarian Tissue and Oocyte Cryopreservation,'' Fertil Steril 2008;90:S241-6. (Fertil Steril Ò 2013;99:37–43.
Objective: To determine the optimal polar bodies (PB) angle for higher subsequent embryo implanta... more Objective: To determine the optimal polar bodies (PB) angle for higher subsequent embryo implantation potential. Design: Prospective study. Setting: Academic fertility center. Patient(s): From January to July 2015, 116 patients were recruited in their first IVF-ET cycles. Intervention(s): At the pronuclear stage, PB angle was measured with the use of E-ruler 1.1. Main Outcome Measure(s): The primary outcome measure was good-quality embryo rate. Secondary measures were clinical pregnancy rate (CPR) and embryo implantation rate (IR). Result(s): A total of 1,103 oocytes were retrieved. PB angle was measured in 454 zygotes, and 164 of their subsequent embryos were transferred into the uterus. All-or-none implantation took place in 129 embryos, and 89 patients accepted fresh embryo(s) transfer with known PB angle. By means of receiver operating characteristic analysis, the optimal PB angle for subsequent embryo implantation was 24.25 . Based on this cutoff value, 454 zygotes were divided into two groups: small-angle and large-angle. A higher percentage of small-angle zygotes developed into good-quality embryos (70.97% vs. 58.58%). CPR and IR both decreased progressively from purely small-angle embryos to mixed embryos to purely large-angle embryos (CPR: 72.41% vs. 38.46% vs. 26.47%, respectively; IR: 63.27% vs. 26.92% vs. 16.67%, respectively). Conclusion(s): Noninvasive assessment of PB angle is a viable technique for zygote selection and should be included in embryo selection parameters.
Teaching Documents by Mai Tam
Embryo and oocyte maturation • Qualitative and quantitative grading of human blastocysts and its ... more Embryo and oocyte maturation • Qualitative and quantitative grading of human blastocysts and its association with live-birth rate and neonatal outcome (Ebner) • Prediction of embryonic development and clinical outcome following ICSI according to the stages of nuclear maturation division (Nagayoshi) Culture and incubator conditions • Development of a new procedure to reduce the amount of recipient cytoplasm (mitochondria) at the MII karyoplast transfer for the treatment of mitochondrial diseases (Tanaka) MII, metaphase II; IVF, in vitro fertilisation Morphokinetic studies • Retrospective validation of Eeva™ at large scale: Correlation between Eeva™ categories and blastocyst formation rate (Basile) • An automated time-lapse embryo selection algorithm is correlated with embryo implantation potential; clinical validation of Eeva™ (Aparicio-Ruiz) Topic: Embryology and Embryo Technology Metabolomics and biomarkers • A new strategy to diagnose embryo viability combining protearray and time-lapse technologies (Meseguer) • Screening of oocyte quality in human IVF: proof of principle of follicular fluid biomarkers (Chen) PGS, preimplantation genetic screening; Eeva, early embryo viability assessment; ICSI, intracytoplasmic sperm injection; MI, metaphase I Embryo and oocyte maturation P-242 -Prediction of embryonic development and clinical outcome following ICSI according to the stages of nuclear maturation division M Nagayoshi Poster Study background and aim Background • Pre-ovulatory oocytes collected after controlled ovarian stimulation are considered mature with the extrusion of the first polar body at ICSI • However, embryonic development varies following ICSI for morphologically mature oocytes Nagayoshi M. Poster. P242 Aim To investigate whether it is possible to predict embryonic development and clinical outcome according to the stages of nuclear maturation division. Study materials and methods • A retrospective study in 53 patients (83 cycles) under 38 years of age on 211 oocytes was performed • Oocyte retrieval was conducted under the control of GnRH antagonist + hMG followed by ICSI • Embryos were cultured for 5 days in medium until blastocyst stage • MII chromosomes were identified using an inverted microscope equipped with Nomarski optics • MII oocytes were divided into 3 groups and their relationship with clinical outcome investigated -Group A: oocytes that had the MII chromosomes arranged in two lines -Group B: oocytes at pro-metaphase II not yet arranged in two lines -Group C: oocytes with irregularly arranged chromosomes GnRH, gonadotrophin-releasing hormone; HMG, human menopausal gonadotrophin Nagayoshi M. Poster. P242 The use of oocytes not yet at MII phase results in decreased fertilisation, blastocyst and pregnancy rates • The proportion of grouped oocytes according to the stages of MII chromosomes were 78.1% (165/211) in group A, 7.1% (15/211) in group B, and 14.7% (31/211) in group C Group Fertilisation rates , % (n) Cleavage rates, % (n) Blastocyst rates , % (n) Pregnancy rates , % (n) Miscarriage rates , % (n) A oocytes with MII chromosomes arranged in two lines 79.4 (131/165) 80.2 (105/131) 58.0 (76/131) 44.7 (34/76) 11.8 (4/34) B oocytes at prometaphase II 73.3 (11/15) 63.6 (7/11) 36.4 (4/11) 25.0 (1/4) 100 (1/1) C oocytes with irregularly arranged chromosomes 54.8 (17/31) 70.6 (12/17) 17.6 (3/17) 0 (0/3) -Nagayoshi M. Poster. P242
fi (N Kaartinen). Noora Kaartinen graduated from Tampere University Medical School in 2002. She c... more fi (N Kaartinen). Noora Kaartinen graduated from Tampere University Medical School in 2002. She completed her specialization in Obstetrics and Gyneacology in 2013, and has since worked as a consultant at the Department of Obstetrics and Gynecology of Tampere University Hospital. She works in the IVF unit and is carrying out her reserch project on IVF treatments. Abstract In many clinics, good-quality embryos are selected for embryo transfer and cryopreservation at the cleavage stage, and poor-quality embryos are discarded. The aim of this retrospective study was to examine how many repeated IVF cycles could be avoided by culturing the cleavage stage poor-quality embryos to blastocyst stage and transferring them after vitrification and warming (604 IVF and intracytoplasmic sperm injection [IVF–ICSI] cycles were included). Poor-quality cleavage stage embryos not eligible for transfer or cryopreservation were cultured until day 5 or 6, and those developing to the blastocyst stage were vitrified. The rate of vit-rified blastocysts and clinical pregnancy and delivery rate of the warmed blastocysts was evaluated. The effect of the extended culture on the cumulative delivery rate, and the number of avoided new treatment cycles was calculated. The surplus blastocysts resulted in clinical pregnancy, spontaneous abortion and delivery rates of 24.6%, 27.3% and 17.2% respectively. The use of surplus blasto-cysts raised cumulative delivery rate from 43% to 47% and 53 repeated new cycles were avoided. This study shows that the cumulative delivery rate can be increased, and repeated IVF–ICSI treatments avoided by using blastocysts developing from poor-quality cleavage stage embryos, which otherwise would have been discarded.
(L Rienzi). Laura Rienzi, Senior Clinical Embryologist, has 20 years experience in the field of a... more (L Rienzi). Laura Rienzi, Senior Clinical Embryologist, has 20 years experience in the field of assisted reproductive technology. She has academic degrees in biology and reproductive medicine, and has written almost 100 articles, reviews and book chapters. Laura is President of the Italian Society of Reproductive Embryology and Research, and Laboratory Director of four IVF centres in Italy. Her current areas of interest include human embryo culture, studies of gamete, zygote and embryo, as well as cryopreservation. Laura has played a key role in the clinical application of oocyte vitrification in Italy. Abstract Recent studies involving a limited number of patients have indicated a correlation between aneuploidy and various morphokinetic parameters during preimplantation development. The results among different groups, however, have been inconsistent in identifying the parameters that are able to predict chromosomal abnormalities. The aim of this study was to investigate whether aneuploidy of human blastocysts was detectable by specific morphokinetic parameters in patients at increased risk of aneuploidy because of advanced maternal age, history of unsuccessful IVF treatments, or both. A longitudinal cohort study was conducted using 455 blastocysts from 138 patients. Morphokinetic features of preimplantation development were detected in a timelapse incubator. Blastocysts were subjected to trophectodermal biopsy and comprehensive chromosomal screening. Analyses were conducted by means of logistic mixed-effects models, with a subject-specific intercept. No statistical correlation between 16 commonly detected morphokinetic characteristics of in-vitro embryo development and aneuploidy was found. Results suggest that morphokinetic characteristics cannot be used to select euploid blastocysts in poor-prognosis patients regarded as candidates for pre-implantation genetic screening.
Objective: To study the relation of dietary phytoestrogens intake and clinical outcomes of women ... more Objective: To study the relation of dietary phytoestrogens intake and clinical outcomes of women undergoing infertility treatment with the use of assisted reproductive technology (ART). Design: Prospective cohort study. Setting: Fertility center. Patient(s): A total of 315 women who collectively underwent 520 ART cycles from 2007 to 2013. Intervention(s): None. Main Outcome Measure(s): Implantation, clinical pregnancy, and live birth rates per initiated cycle. Result(s): Soy isoflavones intake was positively related to live birth rates in ART. Compared with women who did not consume soy isoflavones, the multivariable-adjusted odds ratios of live birth (95% confidence interval) for women in increasing categories of soy isoflavones intake were 1.32 (0.76-2.27) for women consuming 0.54-2.63 mg/d, 1.87 (1.12-3.14) for women consuming 2.64-7.55 mg/d, and 1.77 (1.03-3.03) for women consuming 7.56-27.89 mg/d. Conclusion(s): Dietary soy intake was positively related to the probability of having a live birth during infertility treatment with ART. (Fertil Steril Ò 2015;103:749-55. Ó2015 by American Society for Reproductive Medicine.)
There is good evidence that fertilization and pregnancy rates are similar to IVF/ICSI with fresh ... more There is good evidence that fertilization and pregnancy rates are similar to IVF/ICSI with fresh oocytes when vitrified/warmed oocytes are used as part of IVF/ICSI for young women. Although data are limited, no increase in chromosomal abnormalities, birth defects, and developmental deficits has been reported in the offspring born from cryopreserved oocytes when compared to pregnancies from conventional IVF/ICSI and the general population. Evidence indicates that oocyte vitrification and warming should no longer be considered experimental. This document replaces the document last published in 2008 titled, ''Ovarian Tissue and Oocyte Cryopreservation,'' Fertil Steril 2008;90:S241-6. (Fertil Steril Ò 2013;99:37–43.
Objective: To determine the optimal polar bodies (PB) angle for higher subsequent embryo implanta... more Objective: To determine the optimal polar bodies (PB) angle for higher subsequent embryo implantation potential. Design: Prospective study. Setting: Academic fertility center. Patient(s): From January to July 2015, 116 patients were recruited in their first IVF-ET cycles. Intervention(s): At the pronuclear stage, PB angle was measured with the use of E-ruler 1.1. Main Outcome Measure(s): The primary outcome measure was good-quality embryo rate. Secondary measures were clinical pregnancy rate (CPR) and embryo implantation rate (IR). Result(s): A total of 1,103 oocytes were retrieved. PB angle was measured in 454 zygotes, and 164 of their subsequent embryos were transferred into the uterus. All-or-none implantation took place in 129 embryos, and 89 patients accepted fresh embryo(s) transfer with known PB angle. By means of receiver operating characteristic analysis, the optimal PB angle for subsequent embryo implantation was 24.25 . Based on this cutoff value, 454 zygotes were divided into two groups: small-angle and large-angle. A higher percentage of small-angle zygotes developed into good-quality embryos (70.97% vs. 58.58%). CPR and IR both decreased progressively from purely small-angle embryos to mixed embryos to purely large-angle embryos (CPR: 72.41% vs. 38.46% vs. 26.47%, respectively; IR: 63.27% vs. 26.92% vs. 16.67%, respectively). Conclusion(s): Noninvasive assessment of PB angle is a viable technique for zygote selection and should be included in embryo selection parameters.