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Fertility technologies and how to optimize laboratory performance to support the shortening of time to birth of a healthy singleton: a Delphi consensus

  • Assisted Reproduction Technologies
  • Published:
Journal of Assisted Reproduction and Genetics Aims and scope Submit manuscript

Abstract

Purpose

To explore how the assisted reproductive technology (ART) laboratories can be optimized and standardized to enhance embryo culture and selection, to bridge the gap between standard practice and the new concept of shortening time to healthy singleton birth.

Methods

A Delphi consensus was conducted (January to July 2018) to assess how the ART laboratory could be optimized, in conjunction with existing guidelines, to reduce the time to a healthy singleton birth. Eight experts plus the coordinator discussed and refined statements proposed by the coordinator. The statements were distributed via an online survey to 29 participants (including the eight experts from step 1), who voted on their agreement/disagreement with each statement. Consensus was reached if ≥ 66% of participants agreed/disagreed with a statement. If consensus was not achieved for any statement, that statement was revised and the process repeated until consensus was achieved. Details of statements achieving consensus were communicated to the participants.

Results

Consensus was achieved for all 13 statements, which underlined the need for professional guidelines and standardization of lab processes to increase laboratory competency and quality. The most important points identified were the improvement of embryo culture and embryo assessment to shorten time to live birth through the availability of more high-quality embryos, priority selection of the most viable embryos and improved cryosurvival.

Conclusion

The efficiency of the ART laboratory can be improved through professional guidelines on standardized practices and optimized embryo culture environment, assessment, selection and cryopreservation methodologies, thereby reducing the time to a healthy singleton delivery.

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Materials availability

Any requests for data by qualified scientific and medical researchers for legitimate research purposes will be subject to Merck KGaA’s Data Sharing Policy. All requests should be submitted in writing to Merck KGaA’s data sharing portal https://www.merckgroup.com/en/research/our-approach-to-research-and-development/healthcare/clinical-trials/commitment-responsible-data-sharing.html. When Merck KGaA has a co-research, co-development, or co-marketing or co-promotion agreement, or when the product has been out-licensed, the responsibility for disclosure might be dependent on the agreement between parties. Under these circumstances, Merck KGaA will endeavour to gain agreement to share data in response to requests.

Code availability

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Acknowledgments

Medical writing support was provided by Evelina Matekonyte and Steven Goodrick, inScience Communications, Springer Healthcare Ltd, UK, and funded by Merck Healthcare KGaA, an affiliate of Merck KGaA, Darmstadt, Germany. The Delphi consensus process was coordinated by Sanitanova Srl.

Funding

The work was funded by Merck KGaA, Darmstadt, Germany.

Author information

Authors and Affiliations

  1. 9.baby Family and Fertility Center, Via Dante, 15, 40125, Bologna, Italy

    Giovanni Coticchio

  2. Division of Reproductive Endocrinology and Infertility, Department of Obstetrics & Gynecology, Stanford University School of Medicine, Stanford, CA, USA

    Barry Behr

  3. CARE Fertility Group, John Webster House, Nottingham, UK

    Alison Campbell

  4. IVI-RMA Global, Valencia, Spain

    Marcos Meseguer

  5. Fertility Associates, Auckland, New Zealand

    Dean E Morbeck

  6. Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand

    Dean E Morbeck

  7. Reproductive Medicine Department, International Evangelical Hospital, Genoa, Italy

    Valerio Pisaturo

  8. Inst. Histologia e Biologia do Desenvolvimento, Faculdade de Medicina, Universidade de Lisboa and CEMEARE, Lisbon, Portugal

    Carlos E Plancha

  9. Boston IVF, Waltham, MA, USA

    Denny Sakkas

  10. Department of Obstetrics and Gynecology, Yale University, New Haven, CT, USA

    Denny Sakkas & Thomas D’Hooghe

  11. Reproductive Medicine Center, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China

    Yanwen Xu

  12. Global Medical Affairs Fertility, R&D Biopharma, Merck KGaA, Darmstadt, Germany

    Thomas D’Hooghe & Evelyn Cottell

  13. Department of Development and Regeneration, Biomedical Sciences Group, KU Leuven (University of Leuven), Leuven, Belgium

    Thomas D’Hooghe

  14. Reproductive Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden

    Kersti Lundin

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  1. Giovanni Coticchio
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  2. Barry Behr
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  3. Alison Campbell
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  7. Carlos E Plancha
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Contributions

GC contributed to project direction and coordination and provided the final approval of the version to be published. BB contributed to the consensus design and data analysis, assisted with drafting the article and revising it critically for important intellectual content, and provided the final approval of the version to be published. AC was an expert panel member and survey participant and assisted with editing and reviewing the manuscript and provided the final approval of the version to be published. MM was an expert panel member and survey participant and provided the final approval of the version to be published. DEM was an expert panel member and survey participant and edited and reviewed the manuscript. VP contributed to project coordination and assisted with editing and reviewing the manuscript and provided the final approval of the version to be published. CEP participated in all stages of manuscript preparation and provided final approval of the version to be published. DS participated in the construction of the consensus statements, survey and manuscript preparation and provided the final approval of the version to be published. YX was a survey participant and reviewed the manuscript and provided approval of the final version to be published. TDH contributed to overall concept and design, assisted with manuscript drafting and revision and provided the final approval of the version to be published. EC contributed to overall concept and design, assisted with manuscript drafting and revision and provided the final approval of the version to be published. KL was an expert panel member and survey participant and edited and reviewed the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Giovanni Coticchio.

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Conflict of interest

VP, BB and YX have nothing to disclose.

EC and TDH are employees of Merck KGaA, Darmstadt, Germany.

AC has received consultancy fees from Merck KGaA, Darmstadt, Germany, and is a minor shareholder in the CARE Fertility Group, a private company offering fertility treatment.

DM is a consultant to Cook Medical, Irvine Scientific and Cooper Surgical and received personal fees from Sanitanova during the conduct of this study.

GC reports personal fees from Merck KGaA, Darmstadt, Germany, during the conduct of this study, and personal fees from IBSA and Excemed outside of this submitted work.

MM reports speaker fees from Merck KGaA, Darmstadt, Germany, during the conduct of this study, and personal fees from MSD and Ferring outside of this work.

KL reports personal fees from Sanitanova during the conduct of the study.

DS has nothing to disclose in relation to the submitted work.

CP reports personal fees from Sanitanova during the course of the study.

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Coticchio, G., Behr, B., Campbell, A. et al. Fertility technologies and how to optimize laboratory performance to support the shortening of time to birth of a healthy singleton: a Delphi consensus. J Assist Reprod Genet 38, 1021–1043 (2021). https://doi.org/10.1007/s10815-021-02077-5

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