Evidence map›Paper›PMID 42436531›Full record

ArticleJournal of translational medicine2026

Nonlinear effects of post-denudation timing on day 3 embryo outcomes in ICSI and evidence for a translatable optimization window.

Yongfang Xu, Yunxiu Li, Yonggang Li, Lifeng Xiang, Haishan Zheng, Mengying Gao, Lian Deng, Mingying Li, Peng Zeng, Xiaorong Wu and 4 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of translational medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

14 authors.

Yongfang Xu *Department of Reproductive Medicine, NHC Key Laboratory of Healthy Birth and Birth Defect Prevention in Western China, The First People's Hospital of Yunnan Province, Kunming, 650032, China.
Yunxiu Li *Department of Reproductive Medicine, NHC Key Laboratory of Healthy Birth and Birth Defect Prevention in Western China, The First People's Hospital of Yunnan Province, Kunming, 650032, China.
Yonggang Li *Department of Reproductive Medicine, NHC Key Laboratory of Healthy Birth and Birth Defect Prevention in Western China, The First People's Hospital of Yunnan Province, Kunming, 650032, China.
Lifeng Xiang *Department of Reproductive Medicine, NHC Key Laboratory of Healthy Birth and Birth Defect Prevention in Western China, The First People's Hospital of Yunnan Province, Kunming, 650032, China.
Haishan ZhengDepartment of Reproductive Medicine, NHC Key Laboratory of Healthy Birth and Birth Defect Prevention in Western China, The First People's Hospital of Yunnan Province, Kunming, 650032, China.
Mengying GaoDepartment of Reproductive Medicine, NHC Key Laboratory of Healthy Birth and Birth Defect Prevention in Western China, The First People's Hospital of Yunnan Province, Kunming, 650032, China.
Lian DengDepartment of Reproductive Medicine, NHC Key Laboratory of Healthy Birth and Birth Defect Prevention in Western China, The First People's Hospital of Yunnan Province, Kunming, 650032, China.
Mingying LiDepartment of Reproductive Medicine, NHC Key Laboratory of Healthy Birth and Birth Defect Prevention in Western China, The First People's Hospital of Yunnan Province, Kunming, 650032, China.
Peng ZengDepartment of Reproductive Medicine, NHC Key Laboratory of Healthy Birth and Birth Defect Prevention in Western China, The First People's Hospital of Yunnan Province, Kunming, 650032, China.
Xiaorong WuDepartment of Reproductive Medicine, NHC Key Laboratory of Healthy Birth and Birth Defect Prevention in Western China, The First People's Hospital of Yunnan Province, Kunming, 650032, China.
Manqin ZhangDepartment of Reproductive Medicine, NHC Key Laboratory of Healthy Birth and Birth Defect Prevention in Western China, The First People's Hospital of Yunnan Province, Kunming, 650032, China.
Lei DingDepartment of Reproductive Medicine, NHC Key Laboratory of Healthy Birth and Birth Defect Prevention in Western China, The First People's Hospital of Yunnan Province, Kunming, 650032, China.
Ze WuDepartment of Reproductive Medicine, NHC Key Laboratory of Healthy Birth and Birth Defect Prevention in Western China, The First People's Hospital of Yunnan Province, Kunming, 650032, China. wuzes2010@163.com.
Xi LuoDepartment of Reproductive Medicine, NHC Key Laboratory of Healthy Birth and Birth Defect Prevention in Western China, The First People's Hospital of Yunnan Province, Kunming, 650032, China. luoxi@kust.edu.cn.ORCID 0000-0002-9779-3697

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundIntracytoplasmic sperm injection (ICSI) is performed in over half of assisted reproductive technology cycles globally; however, the optimal interval between oocyte denudation and sperm injection remains undefined in clinical guidelines. This knowledge gap hinders the standardization of laboratory workflows and may compromise embryo developmental potential due to suboptimal timing practices. It necessitates a comprehensive investigation to formulate evidence-based recommendations.

methodsThis retrospective cohort study examined 1,152 consecutive fresh ICSI cycles performed at an academic reproductive center between January 2024 and April 2025 to establish quantitative timing guidance. The denudation-to-ICSI interval (DTI) was defined as the primary exposure, and the day-3 embryo utilization rate, calculated as the number of usable embryos divided by the number of retrieved oocytes, was designated as the primary outcome. Nonlinear dose-response relationships were evaluated using generalized additive models and restricted cubic spline analyses, with multivariable adjustment for demographic characteristics, ovarian reserve parameters, and treatment-related factors. Effect heterogeneity was examined across 19 predefined patient subgroups, and robustness of the findings was validated through bootstrap resampling and cross-validation.

resultsA significant inverted U-shaped relationship was identified between DTI and day 3 embryo utilization rate. In the final parsimonious model adjusted for basal FSH and E2 per MII (p = 0.017), predicted utilization rates spanned 12.2 percentage points across the observed DTI range, peaking at 2.75 h post-denudation and defining an optimal window of 1.75-3.75 h. This association was robust to progressive covariate adjustment (24% coefficient attenuation from univariate to fully adjusted model, p = 0.036) and consistent across all 19 patient subgroups (no significant interactions; I

conclusionsThis study identified an optimal window of 1.75-3.75 h for ICSI after oocyte denudation, with consistent associations observed across diverse patient subgroups within the studied population. The identified window represents a workflow-level optimization achievable through procedural standardization alone, with the potential to increase embryo availability for a substantial proportion of cycles currently outside this timeframe. Future trials are warranted to confirm causality and measure improvements in clinical pregnancy outcomes. CLINICAL TRIAL NUMBER: Not applicable.

Indexed as

Embryo, MammalianNonlinear DynamicsSperm Injections, IntracytoplasmicAdultFemaleHumansOocytesPregnancyTime FactorsTreatment OutcomeAssisted reproductive technologyEmbryo developmentIntracytoplasmic sperm injectionOocyte denudationRestricted cubic spline analysis

Identifiers

PMID42436531
PMCPMC13366850

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.