Samenvatting

Introduction: Subfertility is a growing problem in The Netherlands. Assisted reproductive techniques (ART) are applied to aid subfertile couples conceiving. The EmbryoScope is a novel incubator, used in ART, to cultivate embryos under optimal conditions. The EmbryoScope provides time lapse images, which enable close monitoring of early embryo development. Time lapse images generated by the EmbryoScope are used to select the embryos with the highest implantation potential and to design the KIDscore; a score predicting embryonic implantation potential. Embryo development during the periconceptional period is vital because in this period most reproductive failures originate. In this period, poor nutrition and lifestyle can have a negative impact on the development and health of an embryo, both immediate and later in life. SmarterPregnancy is an online application, supporting couples trying to conceive. SmarterPregnancy aims to improve chances of conceiving and contribute to healthy development of the embryo by modifying nutrition and lifestyle behavior.
Aim: The aim of the present study is to examine the relation between the five SmarterPregnancy characteristics (intake of fruits, intake of vegetables, folic acid supplementation, smoking and use of alcohol) and the implantation potential of a pre-implantation embryo cultured in the EmbryoScope, defined by the KIDscore. Methods: The study population of this cross-sectional study consists of 79 participants that underwent ART treatment in the Erasmus Medical Center and subscribed to SmarterPregnancy between October 2014 and November 2016. Participant’s embryos were placed in the EmbryoScope for cultivation. Data registered by the EmbryoScope was used to calculate the KIDScore. Baseline data from SmarterPregnancy were used to define the 5 nutrition and lifestyle characteristics. This data was translated in risk scores. After randomly selecting one embryo per participant, logistic regression was conducted to analyze the association between nutrition, lifestyle and the implantation potential.
Results: Results show a significant negative relation between the nutrition risk score (NRS) and the KIDScore (OR 0.76, CI 0.58-0.98, p-value 0.04). Lifestyle behaviors (inadequate intake of folic acid, smoking and the use of alcohol) were insufficient present in the measurements to be analyzed.
Conclusion and discussion: The relation found in this study indicates that women with a higher NRS have a lower chance to develop a high-quality pre-implantation embryo. The association between nutrition and embryo development is supported by recent research. Detrimental lifestyle behavior showed to be negatively associated with embryo development. Limitations are that the present subfertile population, with predominant male subfertility causes, is not representative for the general population. The KIDScore was not assigned to all embryos and the risk scores used are not yet validated. Strengths are the high quality innovative data used and the unique research population. Future research should aim at more knowledge about factors impacting embryo development and behavioral change.
Recommendations: Couples undergoing ART should receive nutrition and lifestyle advice. Preconception care should receive more attention and made easily available for all couples with a desire to have a child.