Blastocyst culture at The Bridge Centre London. Shaun Rogers Laboratory Manger

Transcription

1 Blastocyst culture at The Bridge Centre London Shaun Rogers Laboratory Manger

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3 About the Bridge Centre Founded in 1986, Bridge was one of the first fertility centres Individualised approached to identifying patient treatment strategies Treat a range of couples; those referred from NHS partner hospitals, commissioning groups and private self referrers Specialist IVF unit offering all treatment modalities Treat patients each year

4 No. of cycles Workload by month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Mean cycles per month St Hel Cycles SOH Cycles Croydon Cycles Kingston Cycles Satellite Cycles Bridge + WS-PCT Cycles

5 Bridge IVF Success Rates Age IVF/ICSI Live Birth Rates 2011 Bridge Success Rate National Average < % 32.5% % 28% % 20.2% % 12.9% % 5.7% Over 44 (n=29) 3.4% 2.3%

6 PGD-A CHG array - Complex losses and gains

7 Pro Active blastocyst culture policy started in 2009

8 Why change?

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10 Was it broken? Did our Multiple pregnancy strategy need modification?

11 The literature supports eset and blastocyst transfer One versus two embryo transfer after IVF and ICSI: a randomized study Hannu Martikainen et al the Finnish ET Study Group Hum. Reprod. (2001) 16 (9): doi: /humrep/ Selective single blastocyst transfer reduces the multiple pregnancy rate and increases pregnancy rates: a pre- and postintervention study Y Khalaf, T El-Toukhy, A Coomarasamy, A Kamal, V Bolton, and P Braude BJOG. Feb 2008; 115(3): Parenting stress and psychosocial well-being among parents with twins conceived naturally or by reproductive technology H. Colpin et al Hum. Reprod. (1999) 14 (12): doi: /humrep/

12 HFEA UK IVF Regulator

13 HFEA direction to reduce multiple pregnancy Expert Group on Multiple Births after IVF formed One child at a time Report published in 2006 Public consultancy process initiated in 2007 HFEA Multiple Birth Minimisation Strategy to reduce the incidence of twins or triples to 10% or less Clinics directed to implement a staged approach to reducing multiple births With HFEA enforcement in the form of license conditions Clinics to develop a Minimisation Strategy Single embryo transfer policy Clinics to show a reduction in multiple births from 24% Further reduction of multiple births to a maximum of multiple birth rate of 10% by October 2012 HFE Act 1990 is similar to Law 3305/2005

14 HFEA Directive

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16 Change Management Practice modification to ensure compliance Created an eset policy to enable an MBMS Reviewed culture procedures Evaluated culture ethos Implemented changed Evaluated performance

17 eset policy based on Blastocyst Transfer All patients under 38 3 x 8 cell top grade embryos (6 x 6-8 cells in 2009) Patient choice (2010 onwards) History of previous pregnancy or blastocyst formation in a previous cycle One good quality blastocyst plus one to freeze 2014 All patients regardless of age! 2 x 6-8 cell embryos on day 3* (*with the required counselling) One good quality blastocyst

18 Change Management Practice modification to ensure compliance Created an eset policy to enable an MBMS Reviewed culture procedures Evaluated culture ethos Implemented changed Evaluated performance

19 Blastocyst?

20 More like it!

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22 Culture System Egg collect in Hepes Insemination in Fertilisation Media QAF Sperm Preparation Media Embryo Transfer or/and Vitrification Change over 1 Cleavage Media Day 1 QAC Change over 2 Blastocyst Media Day 3 QAB

23 Culture system

24 Change Management Practice modification to ensure compliance Created an eset policy to enable an MBMS Reviewed culture procedures Evaluated culture ethos Implemented changed Evaluated performance

25 Moved away from the use of 70 litre incubators

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27 % BT37 - Do they work? P1 P2 P3 P4 P5 P6 P7 P8 Cleavage rate Blast utilisation rate P1 P2 P3 P4 P5 P6 P7 P8 MEAN SD Cleavage rate Blast utilisation rate

28 Change Management Practice modification to ensure compliance Created an eset policy to enable an MBMS Reviewed culture procedures Evaluated culture ethos Implemented changed Evaluated performance

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30 Did it work?

31 Embryo Cleavage rate 98 Cleavage Rate % of pn s divided on day Yearly Average Mean Cleavage Rate 97.5%

32 Blastocyst Formation Rate 90 Blastocyst Formation Rate ,3 77,4 73,7 69,1 74, ,4 40 Blastocyst Formation Rate

33 Utilisation Rate % of 2PN Utilised in ET and Vitrification ,8 Blastocyst Utilisation D5/6 54,2 53,1 52, ,9 39,2 30 Blastocyst Utilisation Mean Utilisation Rate 47.3%

34 Ratio between Cleavage Stage Vs Blastocyst for Transfer 100% 90% 80% % 60% 50% Blastocyst Transfers Cleavage Stage Transfers 40% 30% % 10% 0%

35 Clinical Results Pregnancy Rate Multiple Pregnancy Results for the under 35 age group

36 Blastocyst Formation 100,0 90,0 80,0 70,0 60,0 71,8 68,8 66,0 62,5 72,0 62,4 60,0 57,5 75,0 73,2 68,0 61,8 76,2 100,0 70,8 81,0 73,8 KPI data Blastocyst Formation by Age Group ,5 64,9 64,8 64,9 64,2 60,6 60,0 55,6 56,9 57,9 56,9 53,1 74,6 71,0 50,0 <35 40,0 30,0 37,8 30, ,0 15,4 >44 10,0 0,0 May Jun Jul Aug Sep Oct Nov Dec 0,0 0,0

37 Blastocyst Utilisation KPI data - Blastocyst Utilisation by Age Group , ,8 42, , ,4 44, ,6 45,8 33,3 55,6 44, ,5 40,3 39,5 36,7 34,5 43,8 40,2 29,4 25,0 51,6 34,9 23,1 < > ,5 14, ,0 0 May Jun Jul Aug Sep Oct Nov Dec

38 Current Embryology Data PB2 Extrusion 2 cell 4 cell 2 PN 17hrs 8 cell Morula Blastocyst Hatching Blastocyst

39 Blastocyst Utilisation % of 2PN Utilised in D5 ET and Vitrification 70,0 KPI Data Utilisation ,0 53,9 50,0 43,9 45,7 48,0 40,0 30,0 20,0 10,0 0,0 Jan Feb Mar Apr Utilisation Rate 2014 Mean 47.9%

40 Current Data % of 2PN that form blastocysts and % of 2pns that form usable blastocysts D5/6 80,0 KPI Data - Blast fotmation rates ,0 63,9 71,3 62,5 63,4 60,0 50,0 40,0 35,1 41,4 35,2 38,5 blast formation blast utilisation 30,0 20,0 10,0 0,0 Jan Feb Mar Apr

41 Current Data 100,0 KPI Data - Blast Formation by Age Group ,0 80,0 70,0 60,0 50,0 76,6 71,0 69,0 65,1 64,3 61,0 56,3 53,2 75,8 64,0 53,7 52,2 75,0 68,6 58,7 58,8 56,1 < , , >44 20,0 10,0 0,0 0,0 0,0 0,0 Jan Feb Mar Apr

42 Current Data KPI Data - Blast Utilisation by Age Group , ,6 42,9 43,9 44, ,4 38,2 33,8 35,1 33, ,8 28,4 28, , Jan Feb Mar Apr < >44

43 Change Management Practice modification to ensure compliance Created an eset policy to enable an MBMS Reviewed culture procedures Evaluated culture ethos Implemented changed Evaluated performance

44 EmbryoScope Combined incubator and camera unit Tri gas system Image acquisition at set intervals 7 focal planes Fully automated detection and focusing Separate viewer system

45 In dish comparison between Global media with SAGE Human preimplantation embryo development in vitro: a morphological assessment of sibling zygotes cultured in a single medium or in sequential media Summers et al December 2013, Vol. 16, No. 4, Pages (doi: / )

46 D2/3 Fragmentation scores Poor (>50%) Fair (25-50%) Good (10-25%) Excellent (<10%) 10 0 D2 SAGE D2 Global D3 SAGE D3 Global P = P = 0.205

47 D5 Blastocyst Development <EB1 40 EB1 30 EB2 3 (full cavity) 20 4 (expanded cavity) 10 5 (hatching) 6 (hatched) 0 D5 SAGE P = D5 Global

48 D5/6 Blastocyst Utilisation D5 SAGE D5 Global D6 SAGE D6 Global P = P = Discarded Transfered Frozen

49 Conclusion No significant difference in embryo quality and utilisation Pregnancy rates difficult to determine due to mixed Global /SAGE embryo transfers

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51 Moved from a reliance on 70 litre incubators to mini incubation in the BT37 and

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54 Acknowledgements Past Staff Dr Alan Thornhill Bonnie Collins Jon Taylor Dr Lourdes Muriel Rios Diana Bui Julia Dobson Kate Bennett Dr Katie Finch Maggie Thyme Christiana Antoniadou Xavi Brunetti Aida Casanovas Sophie Bird Wafa Hamkari Roico Mendez Vega Emily Riches Rocky Goswami Amy Cohen Rhys Bellinge Maria Perez Stacey Wheat Mita Vaid Blair Sowry Charlotte Heavides Kathryn Sanders Laura Shinn Current Team Shaun Rogers Jolene Jordaan Christian Ottolini Trina Shah Natalie Moska David O Rouke Kimberley Hamza Siobhan Canning Sharon Walster Agnieskia Florek

55 THANK YOU FOR YOUR ATTENTION Σας ευχαριστώ για την προσοχή σας