Genera

@drbarisata @juanjo_fraire @GLiperis @LaurCraciunas @SCobanMune @MicahJHillDO @PaolaVigano3 #eshrejc Agree 100% we shall start talking about family planning and not a single child. Even because the replacement rate is 2.1 babies per couple.

@juanjo_fraire @Genera_pma @GLiperis @LaurCraciunas @SCobanMune @MicahJHillDO @PaolaVigano3 The decision to accumulate depends on purpose. If it is a child now, not multiple children in the future, transfer now. Decision depends on age, ovarian reserve and the number of desired children. But for poor prognosis patients accumulation can also decrease dropouts. #ESHREjc

Q4: Based on the results in this article📰, how should we counsel patients who have experienced 2-3 failed euploid blastocyst transfers and have 2-3 remaining blastocysts of low morphological grade❓🤔#Eshrejc @MicahJHillDO @drbarisata @PaolaVigano3 @Genera_pma @LaurCraciunas

@GLiperis @LaurCraciunas @SCobanMune @MicahJHillDO @drbarisata @PaolaVigano3 #eshrejc Well cost-effectiveness and risk analysis are required here in my view. Provided that the patients does not dropout and is willing to go another stimulation (psychologically, physically and economically), you can try another cycle. In Italy we have no choice due to Law40

@LaurCraciunas @SCobanMune @MicahJHillDO @drbarisata @PaolaVigano3 @Genera_pma Perhaps @Genera_pma can shed some light on this as they have shown that slow-developing or reduced quality embryos can still result in LBR. The question is whether patients would be willing to transfer sub-optimal embryos with reduced chances or initiate another cycle #ESHREjc

@juanjo_fraire @LaurCraciunas @ESHRE @PirteaP @NMacklon @drbarisata @maclaudiaa @PaolaVigano3 @MicahJHillDO @JuanchoGVelasco #eshrejc Love this paper and the concept of the endometrium being a biosensor on reproductive incompetence. We discussed this (as many other authors did) in our studies on the miRNAs released in the culture media during IVF pubmed.ncbi.nlm.nih.gov/31419301/

@LaurCraciunas @ESHRE @PirteaP @NMacklon @drbarisata @Genera_pma @maclaudiaa @PaolaVigano3 Similar to the endometrium being a biosensor of embryo quality? What do you think? @MicahJHillDO @PaolaVigano3 @PirteaP @Genera_pma @JuanchoGVelasco @drbarisata academic.oup.com/biolreprod/art…

Q3. #ESHREjc @ESHRE

@drbarisata @GLiperis @juanjo_fraire @LaurCraciunas @ESHRE @PirteaP @PaolaVigano3 @MicahJHillDO @kashish__ @SCobanMune @NMacklon @JuanchoGVelasco #eshrejc That is indeed the point that also with eshre we tried to make, coming up with a statistically-based definition. Not too far from what the Lugano consensus did. RIF might just be an epiphenomenon of IVF in most cases academic.oup.com/hropen/article… fertstert.org/article/S0015-…

@GLiperis @juanjo_fraire @LaurCraciunas @ESHRE @PirteaP @PaolaVigano3 @MicahJHillDO @Genera_pma @kashish__ @SCobanMune @NMacklon @JuanchoGVelasco Another important point we are trying to make is that all relevant investigations should be complete before any transfer, the “RIF” concept has little relevance. We tried to explain this here pubmed.ncbi.nlm.nih.gov/34332750/ #ESHREjc

Q1. Gill et al, defined their unit of analysis 🔍as euploid blastocysts transferred (instead of the transfer of an euploid blastocyst). How are DETs affecting the calculation 🧮 of CLBR? Should the CLBR calculation in general be based only on euploid blastocysts? #ESHREjc @ESHRE

@GLiperis @PaolaVigano3 @PirteaP @LaurCraciunas @MicahJHillDO @juanjo_fraire @SCobanMune @kashish__ #eshrejc they cannot at least across different clinics. Still that is a factor to be considered and that should be acknowledged to the patients. Plus chromosomal aneuplodies are not everything that matters, there Is also ploidy issues or segmentals just to mention other issues

@PaolaVigano3 @PirteaP @LaurCraciunas @MicahJHillDO @juanjo_fraire @SCobanMune @kashish__ The question here is whether embryologists can accurately identify embryo quality characteristics such as reduced ICM or TE quality worse than BB #ESHREjc

Q2: Not all euploid embryos implant, suggesting that embryo quality goes beyond ploidy. What embryological reasons could explain why euploid embryos do not implant? Can current and emerging technologies aid in identifying embryos that could lead to success? #ESHREjc #ESHRE

@SCobanMune @GLiperis @juanjo_fraire @ESHRE @PirteaP @PaolaVigano3 @LaurCraciunas @MicahJHillDO @drbarisata @kashish__ @NMacklon #ESHRE jc We tend to discourage it Especially in view of GILL’s data the chance is not lower if they failed previously Perhaps a different discussion might be done in case of embryos lower than BB or day7 euploid, but still I see the risks of multiple pregnancy much worse

@GLiperis @juanjo_fraire @ESHRE @PirteaP @PaolaVigano3 @LaurCraciunas @MicahJHillDO @drbarisata @Genera_pma @kashish__ @NMacklon In our current practice we go with single euploid embryo. But of course it can be change according to patient history too. #ESHREjc

@juanjo_fraire @LaurCraciunas @ESHRE @PirteaP @PaolaVigano3 @MicahJHillDO @drbarisata @GLiperis @kashish__ @SCobanMune @NMacklon @JuanchoGVelasco #ESHREjc Well, with euploid blastocysts I will highly discourage a double ET

@LaurCraciunas @ESHRE @PirteaP @PaolaVigano3 @MicahJHillDO @drbarisata @Genera_pma @GLiperis @kashish__ @SCobanMune @NMacklon Yes! So it will be detrimental to achieve a higher CLBR! In the case of Gill et al, the number of DETs seemed not so high thoug! Right? @Genera_pma @drbarisata @JuanchoGVelasco #ESHREjc

@juanjo_fraire @PirteaP @LaurCraciunas @MicahJHillDO @PaolaVigano3 @JuanchoGVelasco @drbarisata #ESHREjc It should not on a small scale Perhaps on a large scale

@PirteaP @LaurCraciunas @MicahJHillDO @PaolaVigano3 Would double euploid embryo transfers (DETs) affect the calculation of CLBR when compared to SETs? @Genera_pma @JuanchoGVelasco @drbarisata #ESHREjc

@juanjo_fraire #ESHREjc We tried to discuss this topic in the past To define ivf as journey and not a single attempt Gills paper well fits into this context rbmojournal.com/article/S1472-…

It seems the calculation of CLBR still follows some debate in our field 😅 #ESHREjc academic.oup.com/humrep/article…

@ESHRE @OUPMedicine @GLiperis @SCobanMune @kashish__ @juanjo_fraire @drbarisata @JuanchoGVelasco @fubaldi

@OUPMedicine @GLiperis @SCobanMune @kashish__ @juanjo_fraire And welcome to our authors @drbarisata @JuanchoGVelasco @fubaldi @Genera_pma #ESHREjc

Welcome everyone, we are back for the 42nd edition of the #ESHREjc 🙌

A very interesting program that covers from preconception to postnatal period. Looking forward to this 👌

@IreneCuevasSaiz @GLiperis #eshrejc we asked them to be honest, but clearly this cannot be absolutely kept under control. The good thing is that I knew the true outcome of those embryos, and the discard rate was rather low among euploid blast and LBs. Maybe, embryologists can distinguish low from too low

@GeneraLifeIT @GLiperis So, the question is the introduction of bias... are we more relaxed when participating in a "non-real" study about making decissions than in real cases? Would our decission be different in both cases. I think yes. #ESHREjc

When patients have more available embryos the embryologists tend to be more inclined to discard! Why is that & what other factors can affect the decision making? #ESHREjc

@OmarRawi89 @juliauraji #eshrejc not to my knowledge, but simply because the decisional support is currently based on prioritisation (i.e., transfer first or later) and not opportunity of clinical use (i.e., quality too low in this given couple for clinical use). Still, an interesting use case I think

@juliauraji No I don’t think so! @GeneraLifeIT might give us the right ☕️ on this 🤗 #ESHREjc

Q4: Patients' history, age and other factors can affect an embryologist's decision to: ❌discard 🤰🏼transfer ❄️cryopreserve and/or 🧬biopsy How important is individual patient circumstance, is there value in couple-oriented counseling, and can these be standardised? #ESHREjc

@SofiaMakieva #eshrejc @DeanMorbeck published a wonderful paper on the clinical value of C-grade blastocysts academic.oup.com/hropen/article…

Q2: The article found that the larger the embryo cohort⤴️, the higher the inclination to bin off ❌ poor quality embryos🥴. What are other deciding factors & is it possible to develop a discard policy without the use of 🆕 technologies? #ESHREjc #ESHREjcrt

@IreneCuevasSaiz @SCobanMune @alteri_ale @SofiaMakieva @juanjo_fraire @PisaturoValerio #eshrejc correct. Indeed they require a case by case patient centered decision. Therefore, standardisation is even more important

@GeneraLifeIT @SCobanMune @alteri_ale @SofiaMakieva @juanjo_fraire @PisaturoValerio UUUUmmmm, but what about the amount of available TE blastomeres? Not all LQB are suitable.... I mean... C TE includes a huge range of morphologies #ESHREjc

@catello_scarica @GLiperis @IreneCuevasSaiz @juanjo_fraire @PisaturoValerio @SCobanMune @ESHRE #eshrejc correct. This is the most likely explanation

@IreneCuevasSaiz @juanjo_fraire @PisaturoValerio @SCobanMune @ESHRE Absolutley agree! In fact, authors in the study found no agreeement of AI tools on discarding aneuploid embryos. This could be associeted to the fact that training sets for AI excluded PQB #ESHREjc

Q-3️⃣.The survey was conducted within the same private clinic🏨 network‼️ How might decisions differ between private and public clinics, as well as between different countries❓️🤔 @ESHRE #ESHREjc #ESHREjcrt

@juliauraji @juanjo_fraire @IreneCuevasSaiz #eshrejc yes correct. Yet it corresponded for all the embryologists

@juanjo_fraire @IreneCuevasSaiz @GeneraLifeIT I think it is based on location of clinic, not nationality, right? #ESHREjc

Q1: The distribution of 'discard' 👎🏼 or 'use' 👍🏼 choices by 🇮🇹embryologists are wider than others. Does this reflect a more varied opinion among 🇮🇹colleagues?  What are the reasons behind embryologist inter observer variability around the 🌎? #ESHREjc

@eficonstantinou #eshrejc absolutely. No doubt about that: we make decisions every day based on subjective assessments. One of the main advantages of AI will be standardisation even more than prediction

Hot topic for #eshrejc Underlines the need for standardisation among countries/ centers

@SCobanMune @alteri_ale @SofiaMakieva @juanjo_fraire @PisaturoValerio #eshrejc these embryos are more aneuploid and less competent, but apparently they are not more subject to an impact of the biopsy (I.e., pre-vitrification or post-warming degeneration) nor to higher risks of no result.

@alteri_ale @SofiaMakieva @juanjo_fraire @PisaturoValerio If it is with the good cells why not? #eshrejc