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BJOG : An International Journal of... May 2016
Topics: Artificial Intelligence; Cardiotocography; Female; Fetal Hypoxia; Fetoscopes; Heart Rate, Fetal; History, 18th Century; History, 19th Century; History, 20th Century; History, 21st Century; Humans; Labor, Obstetric; Observer Variation; Obstetrics; Pregnancy
PubMed: 27101261
DOI: 10.1111/1471-0528.13844 -
Fertility and Sterility Nov 2014To investigate the prevalence and potential causes of reverse cleavage (RC) by human early-cleavage embryos and its associations with embryonic development and...
OBJECTIVE
To investigate the prevalence and potential causes of reverse cleavage (RC) by human early-cleavage embryos and its associations with embryonic development and implantation after transfer.
DESIGN
Clinical retrospective cohort study.
SETTING
Private fertility treatment center.
PATIENT(S)
A total of 126 consecutive in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) treatment cycles, with 353 IVF and 436 ICSI embryos cultured in the Embryoscope until day 3.
INTERVENTION(S)
None.
MAIN OUTCOME MEASURE(S)
Embryo assessment on day 3, incidence of abnormal division, embryo morphokinetic parameters, and fetal heart beat.
RESULT(S)
RC, referring to either blastomere fusion or failed cytokinesis, occurred up to three times per individual embryo in 27.4% of embryos during the first three cleavage cycles. A higher incidence was associated with GnRH antagonist cycles compared with agonist cycles (odds ratio [OR] 1.683), or with ICSI compared with IVF (OR 1.600). After ICSI, sperm progressive motility was associated with RC (area under the receiver operating characteristic curve: 0.573). Compared with RC-negative embryos, a lower proportion of RC-positive embryos reached 6-cell stage or beyond by day 3 (47.7% vs. 71.7%), and were more likely to have multinucleation at the 4-cell stage (10.1% vs. 5.0%). Embryos showing RC had significantly poorer performance in both conventional grading and morphokinetic parameters, and they implanted less (0/22 vs. 29/131) than those not showing RC.
CONCLUSION(S)
RC significantly compromised embryo development, culminating in poor implantation potential. For each embryo, it can occur on more than one occasion at any stage during the first 3 days of culture. It is associated with factors affecting both oocyte and sperm.
Topics: Adult; Cleavage Stage, Ovum; Cohort Studies; Embryo Culture Techniques; Embryo Transfer; Embryo, Mammalian; Equipment Design; Equipment Failure Analysis; Female; Fetoscopes; Humans; Infertility, Female; Microscopy, Video; Pregnancy; Pregnancy Outcome; Prevalence; Reproducibility of Results; Retrospective Studies; Sensitivity and Specificity; Time-Lapse Imaging; Treatment Outcome; Western Australia
PubMed: 25225070
DOI: 10.1016/j.fertnstert.2014.07.1235 -
Journal of Perinatal Medicine Nov 2011To improve neonatal outcome using ultrathin fetoscope for laser treatment of twin-to-twin transfusion syndrome.
OBJECTIVE
To improve neonatal outcome using ultrathin fetoscope for laser treatment of twin-to-twin transfusion syndrome.
METHODS
Retrospective cohort study of a series of 80 cases of twin-to-twin-transfusion syndrome prior to 26-weeks' gestation subjected to laser coagulation by means of a 1.0/1.2 mm fiber fetoscope with a sheath sectional area 2.65 mm(2)/3.34 mm(2) (n=27) and a 2.0 mm classic lens fetoscope with a sheath sectional area: 6.63 mm(2)/11.27 mm(2) (n=53).
RESULTS
The survival rates of at least one twin in the compared groups were 94.4% (classic optic) and 100% (ultrathin optic), for both twins: 75.5% and 83.3%, respectively. By decreasing sheath diameter a pregnancy was prolonged by an average of 21.3 days (P=0.0045), with a resulting increase in the recipient's weight of 389 g (P=0.0049) and an increase in the donor's Apgar score. However, the intervention with ultrathin optic took 11 min longer (P=0.031).
CONCLUSION
The reduction of the iatrogenic damage of the amniotic membrane using ultrathin fetoscope with a small sheath, significantly improves the neonatal outcome after laser treatment of twin-to-twin-transfusion syndrome. The operator should only commence working with the 1 mm fetoscope after the learning curve has been accomplished.
Topics: Adult; Arteriovenous Anastomosis; Cohort Studies; Female; Fetofetal Transfusion; Fetoscopes; Fetoscopy; Gestational Age; Humans; Infant, Newborn; Laser Coagulation; Pregnancy; Pregnancy Outcome; Retrospective Studies
PubMed: 21867454
DOI: 10.1515/jpm.2011.091 -
Journal of Visualized Experiments : JoVE Feb 2017We have developed a calibration target for use with fluid-immersed endoscopes within the context of the GIFT-Surg (Guided Instrumentation for Fetal Therapy and Surgery)...
We have developed a calibration target for use with fluid-immersed endoscopes within the context of the GIFT-Surg (Guided Instrumentation for Fetal Therapy and Surgery) project. One of the aims of this project is to engineer novel, real-time image processing methods for intra-operative use in the treatment of congenital birth defects, such as spina bifida and the twin-to-twin transfusion syndrome. The developed target allows for the sterility-preserving optical distortion calibration of endoscopes within a few minutes. Good optical distortion calibration and compensation are important for mitigating undesirable effects like radial distortions, which not only hamper accurate imaging using existing endoscopic technology during fetal surgery, but also make acquired images less suitable for potentially very useful image computing applications, like real-time mosaicing. In this paper proposes a novel fabrication method to create an affordable, sterilizable calibration target suitable for use in a clinical setup. This method involves etching a calibration pattern by laser cutting a sandblasted stainless steel sheet. This target was validated using the camera calibration module provided by OpenCV, a state-of-the-art software library popular in the computer vision community.
Topics: Algorithms; Calibration; Equipment Design; Fetoscopes; Fetoscopy; Humans; Image Processing, Computer-Assisted; Optics and Photonics; Reproducibility of Results; Software; Sterilization
PubMed: 28287588
DOI: 10.3791/55298 -
Fertility and Sterility Nov 2014To determine whether incubation in the integrated EmbryoScope time-lapse monitoring system (TMS) and selection supported by the use of a multivariable morphokinetic... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
To determine whether incubation in the integrated EmbryoScope time-lapse monitoring system (TMS) and selection supported by the use of a multivariable morphokinetic model improve reproductive outcomes in comparison with incubation in a standard incubator (SI) embryo culture and selection based exclusively on morphology.
DESIGN
Prospective, randomized, double-blinded, controlled study.
SETTING
University-affiliated private in vitro fertilization (IVF) clinic.
PATIENT(S)
Eight hundred forty-three infertile couples undergoing intracytoplasmic sperm injection (ICSI).
INTERVENTION(S)
No patient intervention; embryos cultured in SI with development evaluated only by morphology (control group) and embryos cultured in TMS with embryo selection was based on a multivariable model (study group).
MAIN OUTCOME MEASURE(S)
Rates of embryo implantation, pregnancy, ongoing pregnancy (OPR), and early pregnancy loss.
RESULT(S)
Analyzing per treated cycle, the ongoing pregnancy rate was statistically significantly increased 51.4% (95% CI, 46.7-56.0) for the TMS group compared with 41.7% (95% CI, 36.9-46.5) for the SI group. For pregnancy rate, differences were not statistically significant at 61.6% (95% CI, 56.9-66.0) versus 56.3% (95% CI, 51.4-61.0). The results per transfer were similar: statistically significant differences in ongoing pregnancy rate of 54.5% (95% CI, 49.6-59.2) versus 45.3% (95% CI, 40.3-50.4) and not statistically significant for pregnancy rate at 65.2% (95% CI, 60.6-69.8) versus 61.1% (95% CI, 56.2-66.1). Early pregnancy loss was statistically significantly decreased for the TMS group with 16.6% (95% CI, 12.6-21.4) versus 25.8% (95% CI, 20.6-31.9). The implantation rate was statistically significantly increased at 44.9% (95% CI, 41.4-48.4) versus 37.1% (95% CI, 33.6-40.7).
CONCLUSION(S)
The strategy of culturing and selecting embryos in the integrated EmbryoScope time-lapse monitoring system improves reproductive outcomes.
CLINICAL TRIAL REGISTRATION NUMBER
NCT01549262.
Topics: Adolescent; Adult; Embryo Culture Techniques; Embryo Transfer; Embryo, Mammalian; Equipment Design; Equipment Failure Analysis; Female; Fetoscopes; Humans; Incubators; Infertility, Female; Microscopy, Video; Pregnancy; Pregnancy Outcome; Reproducibility of Results; Sensitivity and Specificity; Time-Lapse Imaging; Young Adult
PubMed: 25217875
DOI: 10.1016/j.fertnstert.2014.07.738 -
FDA Consumer 2006
Topics: Altruism; Device Approval; Equipment Design; Female; Fetofetal Transfusion; Fetoscopes; Humans; Pregnancy
PubMed: 17245825
DOI: No ID Found -
Reproductive Biology and Endocrinology... Aug 2016Previously manual human embryology in many in vitro fertilization (IVF) centers is rapidly being replaced by closed embryo incubation systems with time-lapse imaging.... (Comparative Study)
Comparative Study Randomized Controlled Trial
Different effectiveness of closed embryo culture system with time-lapse imaging (EmbryoScope(TM)) in comparison to standard manual embryology in good and poor prognosis patients: a prospectively randomized pilot study.
BACKGROUND
Previously manual human embryology in many in vitro fertilization (IVF) centers is rapidly being replaced by closed embryo incubation systems with time-lapse imaging. Whether such systems perform comparably to manual embryology in different IVF patient populations has, however, never before been investigated. We, therefore, prospectively compared embryo quality following closed system culture with time-lapse photography (EmbryoScope™) and standard embryology. We performed a two-part prospectively randomized study in IVF (clinical trial # NCT92256309). Part A involved 31 infertile poor prognosis patients prospectively randomized to EmbryoScope™ and standard embryology. Part B involved embryos from 17 egg donor-recipient cycles resulting in large egg/embryo numbers, thus permitting prospectively alternative embryo assignments to EmbryoScope™ and standard embryology. We then compared pregnancy rates and embryo quality on day-3 after fertilization and embryologist time utilized per processed embryo.
RESULTS
Part A revealed in poor prognosis patients no differences in day-3 embryo scores, implantation and clinical pregnancy rates between EmbryoScope™ and standard embryology. The EmbryoScope™, however, more than doubled embryology staff time (P < 0.0001). In Part B, embryos grown in the EmbyoScope™ demonstrated significantly poorer day-3 quality (depending on embryo parameter between P = 0.005 and P = 0.01). Suspicion that conical culture dishes of the EmbryoScope™ (EmbryoSlide™) may be the cause was disproven when standard culture dishes demonstrated no outcome difference in standard incubation.
CONCLUSIONS
Though due to small patient numbers preliminary, this study raises concerns about the mostly uncontrolled introduction of closed incubation systems with time lapse imaging into routine clinical embryology. Appropriately designed and powered prospectively randomized studies appear urgently needed in well-defined patient populations before the uncontrolled utilization of these instruments further expands.
TRIAL REGISTRATION
NCT02246309 Registered September 18, 2014.
Topics: Adult; Embryo Culture Techniques; Embryo Implantation; Embryo Transfer; Female; Fertilization in Vitro; Fetoscopes; Fetoscopy; Follow-Up Studies; Humans; Infertility, Female; Pilot Projects; Pregnancy; Prognosis; Prospective Studies; Time-Lapse Imaging; Treatment Outcome
PubMed: 27553622
DOI: 10.1186/s12958-016-0181-x -
Journal of Obstetrics and Gynaecology... Dec 2012To study the feasibility, learning curve, and safety of fetoscopy, so that fetal surgery can be confidently performed in ongoing pregnancies.
PURPOSE
To study the feasibility, learning curve, and safety of fetoscopy, so that fetal surgery can be confidently performed in ongoing pregnancies.
METHODS
Fetoscopy was performed at 12-20 weeks of gestation, in 12 women with fetal congenital malformations and/or for termination of pregnancy, under local anesthesia using fine fetoscopes ranging from 1 to 2-mm diameter. The fetal parts and placenta were examined for clarity of vision, identification, and anomalies.
RESULTS
Fetoscopy required great skill, patience, and extensive use of ultrasound for correct orientation. Visualization was better with endoscope of 2-mm diameter. Laser coagulation of placental vessels using diode laser system was possible in the last two cases. There were no major complications.
CONCLUSIONS
Fetal endoscopy is a feasible procedure, safe in experienced hands but has an appreciable learning curve.
PubMed: 24293843
DOI: 10.1007/s13224-012-0232-y -
Journal of the National Medical... Mar 1984Velamentous insertion of the umbilical cord is a high-risk obstetrical condition that is rarely diagnosed before delivery of the placenta. The fetal mortality rate from...
Velamentous insertion of the umbilical cord is a high-risk obstetrical condition that is rarely diagnosed before delivery of the placenta. The fetal mortality rate from this condition has been estimated to be as high as 70 percent. Criteria used to aid in the diagnosis of this condition include (1) vaginal bleeding accompanied by fetal heart irregularities, (2) vaginal blood determined to be of fetal origin, (3) palpation of vasoprevia through a dilated cervix, (4) visualization of vasoprevia through the amnioscope, and (5) marked fetal bradycardia when the membranes are unruptured and there is no evidence of vaginal bleeding.
Topics: Adult; Female; Fetal Heart; Fetal Monitoring; Heart Rate; Humans; Labor, Induced; Pregnancy; Umbilical Cord
PubMed: 6716505
DOI: No ID Found -
Medical Image Computing and... Oct 2015Image guidance plays a central role in minimally invasive fetal surgery such as photocoagulation of inter-twin placental anastomosing vessels to treat twin-to-twin...
Image guidance plays a central role in minimally invasive fetal surgery such as photocoagulation of inter-twin placental anastomosing vessels to treat twin-to-twin transfusion syndrome (TTTS). Fetoscopic guidance provides insufficient sensitivity for imaging the vasculature that lies beneath the fetal placental surface due to strong light scattering in biological tissues. Incomplete photocoagulation of anastamoses is associated with postoperative complications and higher perinatal mortality. In this study, we investigated the use of multi-spectral photoacoustic (PA) imaging for better visualization of the placental vasculature. Excitation light was delivered with an optical fiber with dimensions that are compatible with the working channel of a fetoscope. Imaging was performed on an normal term human placenta collected at Caesarean section birth. The photoacoustically-generated ultrasound signals were received by an external clinical linear array ultrasound imaging probe. A vein under illumination on the fetal placenta surface was visualized with PA imaging, and good correspondence was obtained between the measured PA spectrum and the optical absorption spectrum of deoxygenated blood. The delivery fiber had an attached fiber optic ultrasound sensor positioned directly adjacent to it, so that its spatial position could be tracked by receiving transmissions from the ultrasound imaging probe. This study provides strong indications that PA imaging in combination with ultrasonic tracking could be useful for detecting the human placental vasculature during minimally invasive fetal surgery.
Topics: Algorithms; Female; Fetoscopes; Fetoscopy; Humans; Photoacoustic Techniques; Placenta; Pregnancy; Reproducibility of Results; Sensitivity and Specificity; Ultrasonography, Prenatal
PubMed: 28101537
DOI: 10.1007/978-3-319-24553-9_46