Baris Ata

Dean@KocUniversity School of Medicine, President @Turkish Sos Rep Med. Curious physician🤓

[Koç Üniversitesi @kocuniversity]

Gelecekteki doktorlarımız için unutulmaz bir an! 👩‍⚕️👨‍⚕️🩺
Birinci sınıf tıp öğrencilerimiz, profesyonel yolculuklarının başlangıcını simgeleyen beyaz önlüklerini giydiler. Tıp dünyasına ilk adımlarını atarken kendilerine başarılarla dolu bir yolculuk diliyoruz.

Bu anlamlı günün en özel anlarını izlemek için tıklayın: https://t.co/9uRtEyD58m

A milestone moment for our future doctors! 👩‍⚕️👨‍⚕️🩺
Our first-year medical students put on their white coats, marking the beginning of their professional journey. As they take their first steps into the world of medicine, we wish them a journey filled with success.

Click to watch the most memorable moments of this meaningful day: https://t.co/9uRtEyD58m

[Baris Ata @drbarisata]

@juanjo_fraire @NoemiSalme30386 In these studies, the answer is not in the final cumulative live birth rate achieved. It is in the difference between increments with each subsequent transfer. If there is a uterine factor, you are supposed to observe a gradual decline with each transfer, which is not visible.

[Baris Ata @drbarisata]

@zoyaalii_ @MicahJHillDO @PirteaP @Genera_pma @GLiperis @juanjo_fraire @LaurCraciunas @ESHRE @PaolaVigano3 @kashish__ @SCobanMune @NMacklon @JuanchoGVelasco An ambiguous term such as RIF wouldn’t help the patient’s well being. They already feel lost as they did “even IVF”, the most sophisticated treatment, and it failed several times. Assuring them that each new embryo still has a descent chance would help. #ESHREjc

[Baris Ata @drbarisata]

@LaurCraciunas @GLiperis @PaolaVigano3 @PirteaP @MicahJHillDO @juanjo_fraire @SCobanMune @kashish__ Agree. Euploidy is not everything. Even though current PGT-A is capable of detecting subchromosomal anomalies still the resolution is not 100%. There are more than 20.000 genes and PGT-A is only about copy numbers. Genetics is much more than that. #ESHREjc

[Baris Ata @drbarisata]

@Genera_pma @juanjo_fraire @GLiperis @LaurCraciunas @SCobanMune @MicahJHillDO @PaolaVigano3 Managing patient expectations and preventing dropouts is also very relevant even for one child as you always highlight. Counseling about possible need for multiple cycles is crucial for poor prognosis patients. This may be the next frontier. #ESHREjc

[Baris Ata @drbarisata]

@juanjo_fraire @Genera_pma @GLiperis @LaurCraciunas @SCobanMune @MicahJHillDO @PaolaVigano3 The study does not suggest everyone will need 5 euploids for a live birth. It shows live birth rate remains stable across up to 5 transfers when obvious uterine pathology is ruled out. Majority will deliver earlier. #ESHREjc

[Baris Ata @drbarisata]

@PirteaP @Genera_pma @GLiperis @juanjo_fraire @LaurCraciunas @ESHRE @PaolaVigano3 @MicahJHillDO @kashish__ @SCobanMune @NMacklon @JuanchoGVelasco Yes, absolutely. Every transfer requires proper assessment in advance, we don’t need a number of failures to cover relevant bases. On the other hand, we shouldn’t panic and delve into controversial practices after a failure. #ESHREjc

[Baris Ata @drbarisata]

@LaurCraciunas @SCobanMune @MicahJHillDO @PaolaVigano3 @Genera_pma While we did not address the morphologic quality issue, it is associated with live birth. It is a subjective choice since euploid low grade embryos also have a descent chance of live birth E.g., day 5 5AA 62.5% vs D5 5CC 24% based on our data from UAE #ESHREjc

[Baris Ata @drbarisata]

@juanjo_fraire @ESHRE @LaurCraciunas @PirteaP @NMacklon @Genera_pma @maclaudiaa @PaolaVigano3 Unlikely as we or others did not observe an increasing probability of live birth with consecutive euploid or untested transfers. What we have shown is that each euploid transfer had similar chance of live birth when obvious uterine anomaly was excluded. #ESHREjc

[Baris Ata @drbarisata]

@GLiperis @juanjo_fraire @LaurCraciunas @ESHRE @PirteaP @PaolaVigano3 @MicahJHillDO @Genera_pma @kashish__ @SCobanMune @NMacklon @JuanchoGVelasco Another important point we are trying to make is that all relevant investigations should be complete before any transfer, the “RIF” concept has little relevance. We tried to explain this here https://t.co/uNUmdGvr0G #ESHREjc

[Baris Ata @drbarisata]

@juanjo_fraire @LaurCraciunas @ESHRE @PirteaP @PaolaVigano3 @MicahJHillDO @Genera_pma @GLiperis @kashish__ @SCobanMune @NMacklon @JuanchoGVelasco We have recently published on the role of PGT-A in management of RPL. It is a different discussion but here is the link https://t.co/beE0JKlCyA It is important to do proper evaluation in advance and maybe genetic analysis of products of conception may help too. #ESHREjc

[Baris Ata @drbarisata]

@LaurCraciunas @juanjo_fraire @ESHRE @PirteaP @PaolaVigano3 @MicahJHillDO @Genera_pma @GLiperis @kashish__ @SCobanMune @NMacklon @JuanchoGVelasco @Genera_pma can answer this in more detail. With euploid transfers even number of previous pregnancy losses may not be that relevant #ESHREjc

[Baris Ata @drbarisata]

@juanjo_fraire Thanks for reposting @juanjo_fraire I seem to forget adding #eshrejc 🙈

[Baris Ata @drbarisata]

@Genera_pma @SCobanMune @GLiperis @juanjo_fraire @ESHRE @PirteaP @PaolaVigano3 @LaurCraciunas @MicahJHillDO @kashish__ @NMacklon I have been doing SET for everyone for over 10 yrs now. I think risk of multiple gestation is even more relevant for patients with poor prognosis. They may not have a second chance😬

[Baris Ata @drbarisata]

@juanjo_fraire @LaurCraciunas @ESHRE @PirteaP @PaolaVigano3 @MicahJHillDO @Genera_pma @GLiperis @kashish__ @SCobanMune @NMacklon @JuanchoGVelasco so even if one assumes that embryos could have impacted each others chances of implantation, which is controversial, this does not seem to affect the conclusions of the study

[Baris Ata @drbarisata]

@juanjo_fraire @LaurCraciunas @ESHRE @PirteaP @PaolaVigano3 @MicahJHillDO @Genera_pma @GLiperis @kashish__ @SCobanMune @NMacklon @JuanchoGVelasco BTW only 16 of the 305 transfer cycles that led to the failure of three euploid blasts to qualify for inclusion in the study were DETs

[Baris Ata @drbarisata]

@juanjo_fraire @LaurCraciunas @ESHRE @PirteaP @PaolaVigano3 @MicahJHillDO @Genera_pma @GLiperis @kashish__ @SCobanMune @NMacklon @JuanchoGVelasco Right. Sensitivity analysis limited to patients who exclusively underwent single euploid transfers included 92 patients and yielded similar results with the overall analysis, i.e., the 4th and 5th euploid blastocysts had similar live birth rate 40% vs 50% RR 1.24 (0.81-1.91).

[Juanjo Fraire-Zamora @juanjo_fraire]

Now your turn to ask questions! Join the discussion on September 27 at 17:00 CET! You’ll have 24 hours to ask and interact with authors @drbarisata @JuanchoGVelasco @fubaldi @Genera_pma and experts @PirteaP @PaolaVigano3 @LaurCraciunas @MicahJHillDO and the #ESHREjc team! @ESHRE