Department of Obstetrics and Gynaecology

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Browsing Department of Obstetrics and Gynaecology by browse.metadata.advisor "De Beer, Marie-Lena"

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    The effects of co-culturing human embryos in one-step continuous culture media on blastulation and assisted reproductive technology outcomes
    (Stellenbosch : Stellenbosch University, 2021-03) Mc Lachlan, Taryn Grace; Hanekom, Gerhardus; De Beer, Marie-Lena; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Obstetrics and Gynaecology.
    ENGLISH SUMMARY : Background: The embryo culture system plays a vital role in optimizing human embryos' growth and development in vitro. At present, studies determining these conditions are often limited and contradictory, especially when considering the best culture media (sequential vs. continuous) and method of embryo culture (individual vs. co-culture) to use. As such, each laboratory is recommended to perform their own internal studies to determine which culture conditions give them the best clinical outcomes based upon their patient population and laboratory settings. Aim: This study aims to investigate the effects of changing the embryo culture method from individually culturing embryos in Sequential SeriesTM embryo culture medium (ORIGIO®, Embryo Culture Method A) to co-culturing embryos in SAGETM 1-StepTM with Human Albumin Solution (ORIGIO®, Embryo Culture Method B) at Drs. Aevitas Fertility Clinic. Objectives: Primary objective: To evaluate the effects of changing the embryo culture method on the blastulation outcomes. Secondary objective: To evaluate the effects of changing the embryo culture method on the ART outcomes. Tertiary objective: To determine whether the findings from this study support the continued use of Embryo Culture Method B at Drs. Aevitas Fertility Clinic for future ART cycles. Methods and Materials: This was a retrospective study, utilizing the data obtained from the medical and laboratory records of Drs. Aevitas Fertility Clinic between January 2016 to December 2018. 479 cycles were included and separated into two sub-groups (Group A with 184 cycles and Group B with 295 cycles). All data were analysed and assessed for statistical significances (p<0.05) based on the difference in the means ± 95% confidence intervals. Results: This study concluded that Group B attained statistically better blastulation outcomes than Group A, resulting in significantly higher blastocyst development rates [total blastocysts (53.96% vs. 40.70%), good-quality (11.97% vs. 4.45%), and fair-quality blastocysts (11.97% vs. 4.45%)], a significantly higher proportion of better-quality blastocysts [significantly more good-quality blastocysts (18.92% vs. 7.61%) and fewer poor-quality blastocysts (39.77% vs. 51.03%)], and a significantly higher day 5 embryo transfer rate (95.76% vs. 88.04%). Furthermore, Group B attained a significantly better blastocyst attribution profile, resulting in significantly more and better good-quality blastocysts obtained, utilized, and available for cryopreservation. This suggested a potential advantage of attaining better cumulative pregnancy rates than Group A. Group B further attained slightly better ART outcomes, resulting in higher implantation rates (38.36% vs. 36.23%), higher clinical pregnancy rates (54.91% vs. 46.74%), lower miscarriage rates (9.15% vs. 10.33%), and higher live birth rates (47.12% vs. 41.85%). Although, no statistical significance was reported. Conclusion: This study supports the continued use of Embryo Culture Method B at Drs. Aevitas Fertility Clinic in future ART cycles.
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    Human oocyte and ovarian tissue vitrification in fertility preservation for women: an audit and prospective study
    (Stellenbosch : Stellenbosch University, 2022-04) Janke, Camilla Edwina; De Beer, Marie-Lena; Siebert, Thomas Ignatius; Whittaker, Judith; Hanekom, Gerhardus; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Obstetrics and Gynaecology
    ENGLISH SUMMARY: Introduction: Female fertility preservation [FP] is of interest, due to the advancement in cancer therapy and the resultant increased survival rate. Methods of FP include embryo vitrification, oocyte vitrification [OV] and ovarian tissue cryopreservation [OTC]. Research on FP techniques, their success rates and new developments are encouraged. Relevant information is important for accurate patient counselling on indications for FP. This study investigated two of the FP methods: ovarian tissue vitrification [OTV] and OV. Aims & Objectives: Two separate studies were performed: Study A (prospective) and Study B (retrospective audit). Study A investigated OTV, and aimed to observe the survival rates of vitrified-thawed ovarian tissue using a commercial vitrification kit [Kitazato], to determine the effectiveness of the method, as an option for FP. Study B was an audit of OV programmes at Drs Aevitas Fertility Clinic (and a participating clinic) that was done to determine the success of this treatment as a form of FP. Materials & Methods: Study population A: consenting, oophorectomy surgery patients, from whom an ovary/ovaries were removed, prepared, vitrified, thawed, and tested for survival using a H&E histological evaluation and a Ki-67 proliferation test. The sample size was N = 2 patients [from ethical approval (8th October 2018) to November 202]. Fifty follicles from each group (fresh ovarian tissue [FOT] and vitrified-thawed ovarian tissue [VTOT]) were evaluated. Study population B: consenting patients with vitrified-thawed oocyte treatment (own and donor oocytes)] at Drs Aevitas Fertility Clinic and a participating clinic. The sample size for study B was N = 196 patients (January 2015-December 2019) and used medical records only. Results: Study A - the overall percentage of H&E morphologically normal follicles were not significantly different between the 2 sample groups [FOT (36.0%) vs. VTOT (22.0%)]. Most follicles showed detachment of the oocyte from the granulosa cell layer. The Ki-67 proliferation index was 68.0% for both groups. Study B - the overall oocyte survival rate [SR] was 76.63%, fertilization rate [FR] 77.54%, and the blastulation rate [BR] 43.45%. The CPR and LBR outcomes were 37.68% and 28.26%, respectively. Sub-analysis results showed that Group A (own vitrified-thawed oocytes), had significantly poorer outcomes compared to Group B (donor vitrified-thawed oocytes at Drs Aevitas Fertility Clinic) and Group C (vitrified oocytes thawed at a participating clinic) respectively - SR: 65.25%, 76.62% and 83.52%, FR: 69.91%, 76.81% and 83.4%. BR: 16.27%, 49.49% and 37.53%, CPR: 15.00%, 37.78% and 53.57%, LBR: 15.00%, 33.33% and 30.0% [p<0.05]. The only confounding factor that had a significant effect was the recipient age – older patients had a significantly higher CPR [p<0.05]. Conclusion: Study A – Based on results of histological evaluations and immunochemistry staining, ovarian tissue survival was achieved after vitrification and thawing of the ovarian tissue. Study B - The clinical outcomes observed (SR, FR, BR, CPR and LBR) in patients making use of OV programmes at Drs Aevitas Fertility Clinic and a participating clinic, were comparable to the results found in the literature and can be considered an effective treatment option for FP in female patients.