Supplementation of culture media. multiple unsuccessful IVF attempts: a new indication for EmbryoGen?

Transcription

1 Supplementation of culture media with GM-CSF in patients with multiple unsuccessful IVF attempts: a new indication for EmbryoGen? Ioannis Sfontouris, M.Med.Sci., PhD Head of Embryology, Eugonia Assisted Reproduction Unit

2 GM-CSF In humans Promotes morula and blastocyst formation Reduces ICM apoptosis Appears to be beneficial for pregnancy outcome No effect on chromosomal constitution Reduced GM-CSF blood concentrations in women with recurrent miscarriage

3 GM-CSF Commercially available culture medium containing 2 ng/ml rhgm-csf (Embryogen, Origio) Proposed indication for use: Previous miscarriage

4 Ziebe et al. 2013, Large RCT, n=1332 Significant improvement in PRs and IRs using GM-CSF. More pronounced effect in patients with previous miscarriage

5 Systematic review, (Siristatidis et al. 2013): 6 studies Similar implantation and pregnancy rates in general IVF population using GMCSF-supplemented media

6 Other potential indications for Embryogen Multiple failed IVF attempts / RIF? Testicular biopsy cases? Other?

7 Study question Is the inclusion of GM-CSF in embryo culture media (Embryogen) associated with increased clinical pregnancy rates in patients with multiple unsuccessful IVF attempts?

8 Sfontouris et al, ESHRE 2013 Preliminary data 79 patients (n=37 Embryogen versus n=42 Control) Similar pregnancy and implantation rates

9 Study design Prospective observational study patients Inclusion criteria: Patients undergoing fresh IVF cycle At least 2 previous failed IVF attempts (without establishment of clinical pregnancy at week 7) Exclusion criteria: Women >45 years Egg donation Testicular biopsy Frozen oocyte/embryo cycles

10 Methodology Control group N=80 Ovarian stimulation OPU 36hrs following hcg Embryogen group N= 64 Insemination in Universal-IVF Post-ICSI & Embryo culture in ISM1 Embryo transfer on Day 2/3 in UTM (n=67) Insemination in Embryogen Post-ICSI & Embryo culture in Embryogen Embryo transfer on Day 2/3 in Embryogen (n=58)

11 Patient characteristics EmbryoGen N=64 Control N=80 Age (years) 37.9± ±3.3 BMI (kg/m 2 ) 23.6± ±4.2 Number of previous 4.3± ±3.4 IVF attempts Baseline FSH (IU/l) 9.9± ±7.3 AFC 5.9± ±5.9 Number of follicles on day of hcg Oestradiol on day of hcg (pg/ml) Progesterone on day of hcg (ng/ml) 10.8± ± ± ± ± ±0.4 No statistical significance

12 Embryological data EmbryoGen N=64 Control N=80 Number of oocytes 8.2± ±9.4 retrieved Mature oocytes (in 4.0± ±6.1 ICSI patients) Number of 2PN 4.7± ±5.7 Number of good morphology embryos Number of embryos transferred Number of embryos cryopreserved 2.6± ± ± ± ± ±2.6 No statistical significance

13 Pregnancy data Overall population EmbryoGen Control N o patients N o patients undergoing ET Positive test n(%) per 30 (51.7) 33 (49.3) ET Clinical pregnancy 22 (37.9) 30 (44.8) n(%) per ET Ongoing pregnancy 17 (29.3) 24 (35.8) n(%) per ET Implantation rate (%) 35/135 (25.9) 44/149 (29.5) Ongoing IR (%) 30/135 (22.2) 41/149 (27.5) Preclinical miscarriage n(%) Clinical miscarriage n(%) 8 (26.7) 4 (12.1) 5 (22.7) 6 (20) No statistical significance

14 % ,7 49,3 44,8 Embryogen Control 40 37,9 35,8 No statistical significance ,3 29,5 25,9 26,7 22, ,1 10 0

15 Pregnancy data by age 39 years >39 years EmbryoGe n Control EmbryoGen Control N o patients N o patients undergoing ET Positive test per ET 22 (64.7) 25 8 (33.3) 8 (28.6) n(%) (64.1) Clinical pregnancy 18 (52.9) 23 4 (16.7) 7 (25.0) per ET n(%) (59.0) Ongoing pregnancy 14 (41.2) 19 3 (12.5) 5 (17.9) per ET n(%) (48.7) Implantation rate (IR) 29/85 (31.1) 37/90 (41.1) 6/50 (12) 7/59 (11.9) Ongoing IR 25/85 (29.4) 34/90 (37.8) 5/50 (10) 7/59 (11.9) No statistical significance

16 Conclusions Similar PRs and IRs in Embryogen and controls Differences non-statistically significant GM-CSF does not appear to be beneficial in patients with previous failed IVF attempts Number of patients in present study not high enough to obtain statistical significance Sample size calculation for 80% power based on present data: 1570 patients (785 patients per group)

17 Ideally in combination with array-cgh: Exclude Conclusions GM-CSF promising growth factor Limited data regarding effect of GM-CSF on human embryos and pregnancy outcome Technical limitation: ET on Day 2 or 3 only Issue of high chromosome abnormalities: Only 35% of embryos were euploid in patients with idiopathic recurrent pregnancy loss (Hodes-Wertz et al. 2012, Fertil Steril) Larger studies with adequate power and follow-up of children born are required to verify beneficial effect of GM-CSF

18 Thanks to Origio and Life Science Chemilab for subsidy of Embryogen