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Don’t forget to always comment on the thread of the question! #ESHREjc

Juanjo Fraire-Zamora George Liperis Munevver Serdarogullari Zoya Ali Kashish Sharma Bassel Wattar Alessandra Alteri Debbie Montjean Andrew the Embryologist For this particular paper, variations in SOPs and all IVF cycle details within each study analyzed could actually influence results. I think a multi center RCT with a strict protocol would be very beneficial! #ESHREjc

Juanjo Fraire-Zamora cimsit George Liperis Omar Ammar Munevver Serdarogullari Zoya Ali Kashish Sharma Bassel Wattar Alessandra Alteri Debbie Montjean Andrew the Embryologist I think large cohort studies are needed to study the relationship between miscarriages following double biopsy+double vitrification

Juanjo Fraire-Zamora George Liperis Omar Ammar Munevver Serdarogullari Zoya Ali Kashish Sharma Bassel Wattar Alessandra Alteri Debbie Montjean Andrew the Embryologist 1. Limitations of Retrospective datasets: introduction of potential bias. 2. Variability in biopsy/vitri protocols. 3. Maybe neonatal outcomes underreported?

#ESHREjc Q2. Authors have found an effect on clinical outcomes when double biopsy 🧬🧬 and double ❄️❄️ was performed. 🌀What are the sources of amplification failure from a genetics🧬/embryological background❓️❓️ ESHRE

Q2 of the #ESHREjc is underway! What are the sources of amplification failure?

George Liperis 🎯In this paper, it is very detailed #eshrejc academic.oup.com/molehr/article…

Juanjo Fraire-Zamora George Liperis Omar Ammar Munevver Serdarogullari Zoya Ali Kashish Sharma Bassel Wattar Alessandra Alteri Debbie Montjean Andrew the Embryologist Future: Difficult as standarizarion of protocols across clinics is necessary and they currently rely on manual techniques and operation skills. However... automation and the use of AI/robotics in the IVF lab could offer some solutions for heterogeneity in the future. #ESHREjc

Whilst we can standardise protocols, we cannot standardise the actual biopsy. How many times does your method change depending on how difficult the blastocyst is to biopsy? #eshrejc

Kashish Sharma ESHRE 2. Each episode of pipetting between receptacles, or observation (outside the controlled incubation environment), can introduce mechanical or environmental stresses and increase risk of incident or accident, albeit small. DOI: 10.1017/S2040174417000368 #ESHREjc

Alessandra Alteri George Liperis Omar Ammar Munevver Serdarogullari Zoya Ali Kashish Sharma Bassel Wattar Debbie Montjean Andrew the Embryologist Definetly! It is important to note that meta-analyses are capped by the quality of retrospective studies and outcomes 😖 #ESHREjc

Kashish Sharma ESHRE Embryological and lab factors including insufficient cell number (<5 TE cells), excessive laser use or mechanical damage, contamination, poor quality blastocysts #ESHREjc

Kashish Sharma ESHRE I would also add quality of the cells obtained from the biopsy. Excluded cells from the blastocyst that tend to degenerate might not get a signal. The ‘sight’ of zona opening can make a difference #ESHREjc

Kashish Sharma ESHRE Loading volume during tubing can also make a difference when it comes to amplification failure #ESHREjc

Andrea Brackner George Liperis Omar Ammar Munevver Serdarogullari Zoya Ali Kashish Sharma Bassel Wattar Alessandra Alteri Debbie Montjean Andrew the Embryologist True! But we (as a community) have to decide which protocols should be automated 😅 there might be some patients/embryos that might not benefit from a one-size fits all approach 😖 and might need the hand of skillful embryologists 🤓💪🏼 #ESHREjc

Embryo quality here is a key one. Two biopsies of a C grade trophectoderm biopsy is a much bigger proportion of an embryo than 2 of grade A! #eshrejc

Q3 of the #ESHREjc is underway on double vitrification and biopsy 👇🏻