Background: Inter-operator variation in morphology-based embryo assessment is known to be an ongo... more Background: Inter-operator variation in morphology-based embryo assessment is known to be an ongoing issue in in vitro fertilisation (IVF). This includes inconsistent annotation of embryo morphology and disagreement in the predictive weightings amongst different morphological features. Although currently underexplored, subjectivity reduction using statistical tools is considered clinically valuable, and is more affordable than newer approaches such as time-lapse imaging. Aim: This study aims to develop a robust numerical D5 embryo ranking system by incorporating several patient and embryo characteristics arising from routine static D5 assessment. Method: A total of 8866 autologous-oocyte single fresh D5 transfers performed at 14 Monash IVF clinics during 2012-2018 were retrospectively analyzed, with repeat cycles from the same patients excluded to avoid clustering effects. The dataset was randomly split into two subsets at 60:40 ratio, including one (n=5274) used for regression anal...
Background: Recent time-lapse studies have investigated potential live birth prediction by pronuc... more Background: Recent time-lapse studies have investigated potential live birth prediction by pronuclei (PN) associated morphometric and morphokinetic measures. Whether there is gender associated difference in such measures is unknown. Aim: To determine if morphometric and morphokinetic profiles of PN vary between male and female zygotes. Method: This retrospective study included 94 consecutive autologous single day 5 transfers leading to a singleton live birth (43 males and 51 females) at Monash IVF Gold Coast between January 2019 and March 2020. Timing parameters included 2nd polar body extrusion (tPB2), sperm-originated PN (tSPNa) or oocyte-originated PN (tOPNa) appearance (differentiated by proximity to PB2) and PN fading (tPNF). Morphometrics were evaluated at 8 (stage 1), 4 (stage 2) and 0 hour before PNF (stage 3), measuring PN area (um2), PN juxtaposition, and nucleolar precursor bodies (NPB) arrangement. Results: Male zygotes had longer time intervals of tPB2_tSPNa than female...
Reports of the tension-free vaginal tape (TVT) procedure performed in combination with reconstruc... more Reports of the tension-free vaginal tape (TVT) procedure performed in combination with reconstructive vaginal surgery have been published, but none of these has looked specifically at the sub-group of TVT in combination with sacrospinous colpopexy. This report describes a series of 15 cases where TVT was performed in combination with sacrospinous colpopexy. There were no major complications. Five patients (33.3%) had postoperative urine retention for more than 1 week. Mild incontinence was reported in five cases at 12 months. We conclude that the results of TVT in treating stress incontinence when combined with sacrospinous colpopexy are comparable with TVT alone. Patients should be warned of a higher rate of short-term urinary retention of up to 6 months, while the long-term urinary retention rate is comparable with the TVT procedure alone.
An innovative research project launched by CQ Health this week will have wide-reaching benefits f... more An innovative research project launched by CQ Health this week will have wide-reaching benefits for the healthcare of Central Queenslanders. Chief Executive Steve Williamson and Board Chair Paul Bell helped launch CQ Health's Research Ready Grant Program, which will drive research programs in Central Queensland to ultimately improve healthcare services using solid evidence gathered locally. Mr Williamson said support and resources to allow local clinical research was essential in the recruitment and retention of healthcare professionals. "We need to keep our clinicians engaged and enthused and research opportunities are an ideal platform for that. The ultimate benefit of those research programs of course is the improvement of the services we offer our patients and consumers, and that's the reason we all do what we do." Mr Williamson said learning and research was one of the five objectives outlined in CQ Health's strategic plan, Destination 2030: Great Care for...
RESEARCH QUESTION Does variation in day 5 assessment timing confound live birth prediction using ... more RESEARCH QUESTION Does variation in day 5 assessment timing confound live birth prediction using snapshot blastocyst morphology and is it possible to develop a numerical prediction algorithm? DESIGN Retrospective multicentre cohort study including 4851 autologous oocyte single day 5 fresh embryo transfers performed at 11 Monash IVF clinics between 2016 and 2020. Repeat cycles of the same patients were excluded to avoid clustering effects in regression analysis. RESULTS Hours post insemination (HPI) at day 5 assessment (115.9 ± 2.6 h) significantly correlated with blastocyst developmental stage (r = 0.118, P < 0.001). Independent association (expressed as adjusted odds ratio [aOR] and 95% confidence interval [CI]) was identified between live birth and HPI (aOR 0.950, 95% CI 0.925-0.976, P < 0.001) after accounting for blastocyst morphology and a range of patient/cycle characteristics. Algorithms were constructed using four significant live birth predictors: HPI at day 5 assessment, blastocyst developmental stage (aOR 1.347, 95% CI 1.217-1.491, P < 0.001), morphological grade (aOR 1.314, 95% 1.197-1.443, P < 0.001) and maternal age (aOR 0.922, 95% CI 0.907-0.936, P < 0.001). Receiver operating characteristic (ROC) analysis showed consistent predicting performance of algorithms via five-fold cross-validation, with similar area under the ROC curve (AUC 0.718, 0.715, 0.720, 0.712, 0.726, P < 0.001, respectively, in development subsets; and AUC 0.718, 0.731, 0.709, 0.741, 0.684, P < 0.001, respectively, in validation subsets). A score (ranging from 0.1 to 4.7) calculator based on the final algorithm was subsequently created. CONCLUSIONS Day 5 assessment timing is a confounding factor for live birth prediction using snapshot blastocyst morphology. A numerical algorithm incorporating day 5 assessment HPI, blastocyst morphology and maternal age can be developed for live birth prediction.
Journal of Assisted Reproduction and Genetics, 2022
To study the morphometric and morphokinetic profiles of pronuclei (PN) between male and female hu... more To study the morphometric and morphokinetic profiles of pronuclei (PN) between male and female human zygotes. This retrospective cohort study included 94 consecutive autologous single day 5 transfer cycles leading to a singleton live birth. All oocytes were placed in the EmbryoScope + incubator post-sperm injection with all annotations performed retrospectively by one embryologist (L-SO). Timing parameters included 2nd polar body extrusion (tPB2), sperm-originated PN (tSPNa) or oocyte-originated PN (tOPNa) appearance, and PN fading (tPNF). Morphometrics were evaluated at 8 (stage 1), 4 (stage 2), and 0 h before PNF (stage 3), measuring PN area (um2), PN juxtaposition, and nucleolar precursor bodies (NPB) arrangement. Male zygotes had longer time intervals of tPB2_tSPNa than female zygotes (4.8 ± 0.2 vs 4.2 ± 0.1 h, OR = 1.442, 95% CI 1.009–2.061, p = 0.044). SPN increased in size from stage 1 through 2 to 3 (435.3 ± 7.2, 506.7 ± 8.0, and 556.3 ± 8.9 um2, p = 0.000) and OPN did similarly (399.0 ± 6.1, 464.3 ± 6.7, and 513.8 ± 6.5 um2, p = 0.000), with SPN being significantly larger than OPN at each stage (p < 0.05 respectively). More male than female zygotes reached central PN juxtaposition at stage 1 (76.7% vs 51.0%, p = 0.010), stage 2 (97.7% vs 86.3%, p = 0.048), and stage 3 (97.7% vs 86.3%, p = 0.048). More OPN showed aligned NPBs than in SPN at stage 1 only (44.7% vs 28.7%, p = 0.023). Embryos with different sexes display different morphokinetic and morphometric features at the zygotic stage. Embryo selection using such parameters may lead to unbalanced sex ratio in resulting offspring.
Data include GDM group and matched control group. For each group data include, demographics, preg... more Data include GDM group and matched control group. For each group data include, demographics, pregnancy outcome measures and neonatal outcome measures.
Clinical Medicine Insights: Reproductive Health, 2017
Introduction: Our study aimed to assess the impact of managed complications of tension-free vagin... more Introduction: Our study aimed to assess the impact of managed complications of tension-free vaginal tape (TVT) on the patients’ assessment of the results as measured by Patient Global Impression of Improvement (PGI-I). Materials and methods: This was a retrospective study, supplemented with a telephone interview, comparing patients who had complications of TVT procedures with those where no complications recorded. The primary outcome was the PGI-I score in the 2 groups. Results: A total of 118 invitations were sent. In all, 60 patients returned the signed consent and completed the telephone interview with one of the authors (response rate = 50.8%). Complications were recorded in 21 patients (group 1) and no complications in 39 patients (group 2). There was no statistically significant difference between PGI-I in both groups. Conclusions: Managed complications of TVT do not seem to affect patients’ assessment of outcome as measured by PGI-I score.
Background: Inter-operator variation in morphology-based embryo assessment is known to be an ongo... more Background: Inter-operator variation in morphology-based embryo assessment is known to be an ongoing issue in in vitro fertilisation (IVF). This includes inconsistent annotation of embryo morphology and disagreement in the predictive weightings amongst different morphological features. Although currently underexplored, subjectivity reduction using statistical tools is considered clinically valuable, and is more affordable than newer approaches such as time-lapse imaging. Aim: This study aims to develop a robust numerical D5 embryo ranking system by incorporating several patient and embryo characteristics arising from routine static D5 assessment. Method: A total of 8866 autologous-oocyte single fresh D5 transfers performed at 14 Monash IVF clinics during 2012-2018 were retrospectively analyzed, with repeat cycles from the same patients excluded to avoid clustering effects. The dataset was randomly split into two subsets at 60:40 ratio, including one (n=5274) used for regression anal...
Background: Recent time-lapse studies have investigated potential live birth prediction by pronuc... more Background: Recent time-lapse studies have investigated potential live birth prediction by pronuclei (PN) associated morphometric and morphokinetic measures. Whether there is gender associated difference in such measures is unknown. Aim: To determine if morphometric and morphokinetic profiles of PN vary between male and female zygotes. Method: This retrospective study included 94 consecutive autologous single day 5 transfers leading to a singleton live birth (43 males and 51 females) at Monash IVF Gold Coast between January 2019 and March 2020. Timing parameters included 2nd polar body extrusion (tPB2), sperm-originated PN (tSPNa) or oocyte-originated PN (tOPNa) appearance (differentiated by proximity to PB2) and PN fading (tPNF). Morphometrics were evaluated at 8 (stage 1), 4 (stage 2) and 0 hour before PNF (stage 3), measuring PN area (um2), PN juxtaposition, and nucleolar precursor bodies (NPB) arrangement. Results: Male zygotes had longer time intervals of tPB2_tSPNa than female...
Reports of the tension-free vaginal tape (TVT) procedure performed in combination with reconstruc... more Reports of the tension-free vaginal tape (TVT) procedure performed in combination with reconstructive vaginal surgery have been published, but none of these has looked specifically at the sub-group of TVT in combination with sacrospinous colpopexy. This report describes a series of 15 cases where TVT was performed in combination with sacrospinous colpopexy. There were no major complications. Five patients (33.3%) had postoperative urine retention for more than 1 week. Mild incontinence was reported in five cases at 12 months. We conclude that the results of TVT in treating stress incontinence when combined with sacrospinous colpopexy are comparable with TVT alone. Patients should be warned of a higher rate of short-term urinary retention of up to 6 months, while the long-term urinary retention rate is comparable with the TVT procedure alone.
An innovative research project launched by CQ Health this week will have wide-reaching benefits f... more An innovative research project launched by CQ Health this week will have wide-reaching benefits for the healthcare of Central Queenslanders. Chief Executive Steve Williamson and Board Chair Paul Bell helped launch CQ Health's Research Ready Grant Program, which will drive research programs in Central Queensland to ultimately improve healthcare services using solid evidence gathered locally. Mr Williamson said support and resources to allow local clinical research was essential in the recruitment and retention of healthcare professionals. "We need to keep our clinicians engaged and enthused and research opportunities are an ideal platform for that. The ultimate benefit of those research programs of course is the improvement of the services we offer our patients and consumers, and that's the reason we all do what we do." Mr Williamson said learning and research was one of the five objectives outlined in CQ Health's strategic plan, Destination 2030: Great Care for...
RESEARCH QUESTION Does variation in day 5 assessment timing confound live birth prediction using ... more RESEARCH QUESTION Does variation in day 5 assessment timing confound live birth prediction using snapshot blastocyst morphology and is it possible to develop a numerical prediction algorithm? DESIGN Retrospective multicentre cohort study including 4851 autologous oocyte single day 5 fresh embryo transfers performed at 11 Monash IVF clinics between 2016 and 2020. Repeat cycles of the same patients were excluded to avoid clustering effects in regression analysis. RESULTS Hours post insemination (HPI) at day 5 assessment (115.9 ± 2.6 h) significantly correlated with blastocyst developmental stage (r = 0.118, P < 0.001). Independent association (expressed as adjusted odds ratio [aOR] and 95% confidence interval [CI]) was identified between live birth and HPI (aOR 0.950, 95% CI 0.925-0.976, P < 0.001) after accounting for blastocyst morphology and a range of patient/cycle characteristics. Algorithms were constructed using four significant live birth predictors: HPI at day 5 assessment, blastocyst developmental stage (aOR 1.347, 95% CI 1.217-1.491, P < 0.001), morphological grade (aOR 1.314, 95% 1.197-1.443, P < 0.001) and maternal age (aOR 0.922, 95% CI 0.907-0.936, P < 0.001). Receiver operating characteristic (ROC) analysis showed consistent predicting performance of algorithms via five-fold cross-validation, with similar area under the ROC curve (AUC 0.718, 0.715, 0.720, 0.712, 0.726, P < 0.001, respectively, in development subsets; and AUC 0.718, 0.731, 0.709, 0.741, 0.684, P < 0.001, respectively, in validation subsets). A score (ranging from 0.1 to 4.7) calculator based on the final algorithm was subsequently created. CONCLUSIONS Day 5 assessment timing is a confounding factor for live birth prediction using snapshot blastocyst morphology. A numerical algorithm incorporating day 5 assessment HPI, blastocyst morphology and maternal age can be developed for live birth prediction.
Journal of Assisted Reproduction and Genetics, 2022
To study the morphometric and morphokinetic profiles of pronuclei (PN) between male and female hu... more To study the morphometric and morphokinetic profiles of pronuclei (PN) between male and female human zygotes. This retrospective cohort study included 94 consecutive autologous single day 5 transfer cycles leading to a singleton live birth. All oocytes were placed in the EmbryoScope + incubator post-sperm injection with all annotations performed retrospectively by one embryologist (L-SO). Timing parameters included 2nd polar body extrusion (tPB2), sperm-originated PN (tSPNa) or oocyte-originated PN (tOPNa) appearance, and PN fading (tPNF). Morphometrics were evaluated at 8 (stage 1), 4 (stage 2), and 0 h before PNF (stage 3), measuring PN area (um2), PN juxtaposition, and nucleolar precursor bodies (NPB) arrangement. Male zygotes had longer time intervals of tPB2_tSPNa than female zygotes (4.8 ± 0.2 vs 4.2 ± 0.1 h, OR = 1.442, 95% CI 1.009–2.061, p = 0.044). SPN increased in size from stage 1 through 2 to 3 (435.3 ± 7.2, 506.7 ± 8.0, and 556.3 ± 8.9 um2, p = 0.000) and OPN did similarly (399.0 ± 6.1, 464.3 ± 6.7, and 513.8 ± 6.5 um2, p = 0.000), with SPN being significantly larger than OPN at each stage (p < 0.05 respectively). More male than female zygotes reached central PN juxtaposition at stage 1 (76.7% vs 51.0%, p = 0.010), stage 2 (97.7% vs 86.3%, p = 0.048), and stage 3 (97.7% vs 86.3%, p = 0.048). More OPN showed aligned NPBs than in SPN at stage 1 only (44.7% vs 28.7%, p = 0.023). Embryos with different sexes display different morphokinetic and morphometric features at the zygotic stage. Embryo selection using such parameters may lead to unbalanced sex ratio in resulting offspring.
Data include GDM group and matched control group. For each group data include, demographics, preg... more Data include GDM group and matched control group. For each group data include, demographics, pregnancy outcome measures and neonatal outcome measures.
Clinical Medicine Insights: Reproductive Health, 2017
Introduction: Our study aimed to assess the impact of managed complications of tension-free vagin... more Introduction: Our study aimed to assess the impact of managed complications of tension-free vaginal tape (TVT) on the patients’ assessment of the results as measured by Patient Global Impression of Improvement (PGI-I). Materials and methods: This was a retrospective study, supplemented with a telephone interview, comparing patients who had complications of TVT procedures with those where no complications recorded. The primary outcome was the PGI-I score in the 2 groups. Results: A total of 118 invitations were sent. In all, 60 patients returned the signed consent and completed the telephone interview with one of the authors (response rate = 50.8%). Complications were recorded in 21 patients (group 1) and no complications in 39 patients (group 2). There was no statistically significant difference between PGI-I in both groups. Conclusions: Managed complications of TVT do not seem to affect patients’ assessment of outcome as measured by PGI-I score.
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