In vitro fertilization: fertilization failure due to toxic catheters

Culture conditions in the IVF laboratory: state of the ART and possible new directions

In the last four decades, the assisted reproductive technology (ART) field has witnessed advances, resulting in improving pregnancy rates and diminishing complications, in particular reduced incidence of multiple births. These improvements are secondary to advanced knowledge on embryonic physiology and metabolism, resulting in the ability to design new and improved culture conditions. Indeed, the incubator represents only a surrogate of the oviduct and uterus, and the culture conditions are only imitating the physiological environment of the female reproductive tract. In vivo, the embryo travels through a dynamic and changing environment from the oviduct to the uterus, while in vitro, the embryo is cultured in a static fashion. Importantly, while culture media play a critical role in optimising embryo development, a large host of additional factors are equally important. Additional potential variables, including but not limited to pH, temperature, osmolality, gas concentrations and light exposure need to be carefully controlled to prevent stress and permit optimal implantation potential. This manuscript will provide an overview of how different current culture conditions may affect oocyte and embryo viability with particular focus on human literature.

Embryotoxicity testing of IVF disposables: how do manufacturers test?

STUDY QUESTION

How do manufacturers perform embryotoxicity testing in their quality control programs when validating IVF consumables?

SUMMARY ANSWER

The Mouse Embryo Assay (MEA) and Human Sperm Survival Assay (HSSA) used for IVF disposables differed from one manufacturer to another.

WHAT IS KNOWN ALREADY

Many components used in IVF laboratories, such as culture media and disposable consumables, may negatively impact human embryonic development.

STUDY DESIGN, SIZE, DURATION

Through a questionnaire-based survey, the main manufacturers of IVF disposable devices were contacted during the period November to December 2018 to compare the methodology of the MEA and HSSA. We focused on catheters for embryo transfer, catheters for insemination, straws, serological pipettes, culture dishes and puncture needles used in the ART procedures.

PARTICIPANTS/MATERIALS, SETTING, METHODS

We approached the manufacturers of IVF disposables and asked for details about methodology of the MEA and HSSA performed for toxicity testing of their IVF disposable devices. All specific parameters like mouse strains, number of embryos used, culture conditions (media, temperature, atmosphere), extraction protocol, subcontracting, and thresholds were registered and compared between companies.

MAIN RESULTS AND THE ROLE OF CHANCE

Twenty-one companies were approached, of which only 11 answered the questionnaire. Significant differences existed in the methodologies and thresholds of the MEA and HSSA used for toxicity testing of IVF disposables. Importantly, some of these parameters could influence the sensitivity of the tests.

LIMITATIONS, REASONS FOR CAUTION

Although we approached the main IVF manufacturers, the response rate was relatively low.

WIDER IMPLICATIONS OF THE FINDINGS

Our study confirms the high degree of heterogeneity of the embryotoxicity tests performed by manufacturers when validating their IVF disposable devices. Currently, no regulations exist on this issue. Professionals should call for and request standardization and a future higher degree of transparency as regards embryotoxicity testing from supplying companies; moreover, companies should be urged to provide the users clear and precise information about the results of their tests and how testing was performed. Future recommendations are urgently awaited to improve the sensitivity and reproducibility of embryotoxicity assays over time.

STUDY FUNDING/COMPETING INTEREST(S)

This study did not receive any funding. L.D. declares a competing interest with Patrick Choay SAS.

TRIAL REGISTRATION NUMBER

N/A.

[Pre-washing catheter dramatically improves the post intrauterine insemination pregnancy rate]

OBJECTIVE

To analyze the effectiveness of pre-washing the intrauterine insemination catheters on IUI outcome.

PATIENTS AND METHODS

Infertile couples (n=322) involved in a IUI program were included in the study. IUI indications were cervical factors, ovulation dysfunction, cryopreserved semen and unexplained infertility. Every other week for two years, IUI catheters were washed with culture medium prior to intrauterine sperm insemination.

RESULT(S)

Only the first IUI for each couple were analyzed. Washing the catheter, prior to use, resulted in a 49.7% increase in clinical pregnancy rate (22.0% vs 14.7% P<0.05). This result is observed with fresh sperm (15.7% vs 11.1%) and frozen-thawed sperm as well (31.1% vs 19.8%). The early pregnancy termination rate was similar in all groups.

DISCUSSION AND CONCLUSION

Pre-washing the catheter before IUI should be recommended in Good Laboratory Practice Guidelines as it is already the case for embryo transfer catheters. This raises the problem of washing all single-use devices, in contact with gametes or embryos during IVF.

Quality Management Issues in the Assisted Reproduction Laboratory

In the United States, the Clinical Laboratory Improvement Act (CLIA) of 1988 describes requirements and guidelines for implementing a quality control/quality assurance (QC/QA) program for moderate and high complexity laboratories. These requirements and guidelines apply to Assisted Reproductive Technology (ART) laboratories as well. The general topic of QC and QA as it pertains to in vitro fertilization (IVF) and embryo transfer (ET) is extensively reviewed. This review summarizes many of the QC and QA events that contribute to the advancement of knowledge in this biotechnological field. These events include control of the culture environment inside and outside of the incubator, as well as factors that affect culture media. This review also discusses, in considerable detail, the QC and the QA that pertain to equipment used within the laboratory and how to control for potential contaminants, which reside within the laboratory. This review provides evidence to indicate the need for laboratory personnel to monitor quality improvement issues on a continuous basis. Personnel must be willing to change as improvements in technology occur in order to meet the ever-evolving demands of a more difficult patient population. Suggestions for meeting these demands are offered.

Optimizing sensitivity of the human sperm motility assay for embryo toxicity testing

The human sperm motility assay was used as a measure of quality control in the IVF laboratory. The effects of albumin supplementation and incubation time on the sensitivity of the human sperm motility assay were investigated. The assay was also compared with mouse embryo development. The human sperm motility assay and mouse embryo development assays were performed on 25 items commonly used in IVF laboratories. Sperm motility assay was conducted after 2, 4, 6, 8, 24 and 48 h incubation intervals under standard embryology conditions. A calculated sperm motility index value <0.75 was used to indicate sperm toxicity. It was found that optimum sensitivity (P < 0.01) of the human sperm motility assay was attained in the absence of albumin after 4, 8 and 48 h incubation periods. Items identified to be sperm toxic within 8 h by the human sperm motility assay were considered to be of clinical significance due to the close concordance of these results with mouse embryo development.

Cytotoxicity of orthodontic elastics

The neon-colored orthodontic rubber bands have recently become remarkably popular to wear among the young patients. In this study we examined if the dyes used in the manufacture of these elastics might exhibit any toxic effects. Gingival fibroblasts were exposed to extracts of colored and plain elastics in vitro. Cytotoxicity was examined by cellular proliferation rate and viability. Results showed that both the plain and the colored elastics display identical toxic effects. This ex vivo cytotoxicity, however, could not be observed in orthodontic patients: gingival fibroblast viability is no different in patients with and without rubber band wear. We conclude that in in vitro conditions, all orthodontic rubber bands are cytotoxic. Clinically, however, this effect is not demonstrable.

Human sperm motility is affected by plasticizers and diesel particle extracts

In order to test various drugs and possibly hazardous compounds on living cells in vitro a system with human spermatozoa was employed. A population of human spermatozoa was transferred into a defined medium by a swim-up procedure or by separation on a Percoll gradient. Such a population is rather homogenous with respect to motility characteristics and was found to be useful for this purpose. Different modes of response were recorded, indicating various effect mechanisms. Effects of various phthalates used as plastic softeners in the production of medical equipment, and extracts from diesel particulate material were recorded. All these compounds interfered with sperm motility in a dose-response fashion. Immediate effects of phthalates were modest, but upon prolonged exposure effects became more evident. Sperm motility was more affected by diethyl-hexyl and dibutyl phthalates. Significant effects were noted for the different phthalates with regard both to percent motility and to some of the various qualities of motility, such as velocity, linearity and amplitude of the track. Thus, the pattern of response considering the motion variables was not the same with the different phthalates. With regard to the effects on sperm motion di-n-octyl phthalate seemed to be the least toxic, followed by dibutyl phthalate. The initial effects of diesel particulate extracts were moderate and mainly restricted to percent motile sperm but upon exposure for 18 hr the effects became more pronounced for all the movement variables.