1
|
Castro B, Candelaria JI, Austin MM, Shuster CB, Gifford CA, Denicol AC, Hernandez Gifford JA. Low-dose lipopolysaccharide exposure during oocyte maturation disrupts early bovine embryonic development. Theriogenology 2024; 214:57-65. [PMID: 37857151 PMCID: PMC10841481 DOI: 10.1016/j.theriogenology.2023.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 10/09/2023] [Accepted: 10/10/2023] [Indexed: 10/21/2023]
Abstract
Gram-negative bacteria release of lipopolysaccharide (LPS) endotoxin elicits robust immune responses capable of disrupting normal ovarian function contributing to female infertility. However, effects of subclinical or non-detectable infections on oocyte competence and subsequent embryo development remain to be fully elucidated. The aim of this study was to investigate the effects of exposing bovine oocytes to low LPS doses on oocyte and embryo competence. Bovine oocytes were collected from slaughterhouse-derived ovaries and matured with vehicle-control or increasing doses of LPS (0.01, 0.1, and 1 μg/mL) for 21 h. Oocytes (n = 252) were evaluated for nuclear maturation. A set of embryos from LPS-matured oocytes (n = 300) were cultured for 8 d to evaluate day 3 cleavage rates and day 8 blastocyst rates along with blastocyst cell counts. A subset of oocytes (n = 153) was fertilized and cultured for time-lapse image capture and analysis of embryo development. Results demonstrate no significant treatment differences among treatment groups in percent of oocytes at germinal vesicle (GV; P = 0.90), germinal vesicle breakdown (GVBD; P = 0.13), meiosis I (MI; P = 0.26), or metaphase II (MII; P = 0.44). Likewise, treatment differences were not observed in cleavage rates (P = 0.97), or blastocyst rates (P = 0.88) evaluated via traditional microscopy. Treatment with LPS did not affect total blastocyst cell count (P = 0.68), as indicated by trophectoderm (P = 0.83), and inner cell mass (P = 0.21) cell counts. Time-lapse embryo evaluation demonstrated no differences among control or LPS matured oocytes in number of zygotes that did not cleave after fertilization (P = 0.84), or those that cleaved but arrested at the 2-cell stage (P = 0.50), 4-cell (P = 0.76), prior to morula (P = 0.76). However, embryos derived from oocytes challenged with 0.1 μg/mL LPS tended to have reduced development to the morula stage compared with vehicle-treated controls (P = 0.06). Additionally, the percentage of blastocysts derived from oocytes matured in 0.01 μg/mL LPS tended to decrease compared to vehicle-treated controls (11.38 and 25.45 %, respectively; P = 0.09). Similarly, the proportion of oocytes that developed to the blastocyst stage was greater in vehicle-treated controls (25.45 %) compared with embryos derived from oocytes matured in 0.1 and 1 μg/mL (5.92 and 6.55 %, respectively; P = 0.03) LPS. These data suggest LPS-matured oocytes that subsequently underwent in vitro fertilization, experienced decreased competence to develop to the blastocyst stage.
Collapse
Affiliation(s)
- B Castro
- Department of Animal and Range Sciences, New Mexico State University, Las Cruces, NM, 88003, USA
| | - J I Candelaria
- Department of Animal Science, University of California, Davis, CA, 95616, USA
| | - M M Austin
- Department of Animal and Range Sciences, New Mexico State University, Las Cruces, NM, 88003, USA
| | - C B Shuster
- Department of Biology, New Mexico State University, Las Cruces, NM, 88003, USA
| | - C A Gifford
- Extension Animal Sciences and Natural Resources, New Mexico State University, Las Cruces, NM, 88003, USA
| | - A C Denicol
- Department of Animal Science, University of California, Davis, CA, 95616, USA
| | - J A Hernandez Gifford
- Department of Animal and Range Sciences, New Mexico State University, Las Cruces, NM, 88003, USA.
| |
Collapse
|
2
|
Palmerola KL, Amrane S, De Los Angeles A, Xu S, Wang N, de Pinho J, Zuccaro MV, Taglialatela A, Massey DJ, Turocy J, Robles A, Subbiah A, Prosser B, Lobo R, Ciccia A, Koren A, Baslan T, Egli D. Replication stress impairs chromosome segregation and preimplantation development in human embryos. Cell 2022; 185:2988-3007.e20. [PMID: 35858625 DOI: 10.1016/j.cell.2022.06.028] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 09/03/2021] [Accepted: 06/15/2022] [Indexed: 10/17/2022]
Abstract
Human cleavage-stage embryos frequently acquire chromosomal aneuploidies during mitosis due to unknown mechanisms. Here, we show that S phase at the 1-cell stage shows replication fork stalling, low fork speed, and DNA synthesis extending into G2 phase. DNA damage foci consistent with collapsed replication forks, DSBs, and incomplete replication form in G2 in an ATR- and MRE11-dependent manner, followed by spontaneous chromosome breakage and segmental aneuploidies. Entry into mitosis with incomplete replication results in chromosome breakage, whole and segmental chromosome errors, micronucleation, chromosome fragmentation, and poor embryo quality. Sites of spontaneous chromosome breakage are concordant with sites of DNA synthesis in G2 phase, locating to gene-poor regions with long neural genes, which are transcriptionally silent at this stage of development. Thus, DNA replication stress in mammalian preimplantation embryos predisposes gene-poor regions to fragility, and in particular in the human embryo, to the formation of aneuploidies, impairing developmental potential.
Collapse
Affiliation(s)
- Katherine L Palmerola
- Department of Obstetrics and Gynecology, Columbia University, New York, NY 10032, USA
| | - Selma Amrane
- Department of Obstetrics and Gynecology, Columbia University, New York, NY 10032, USA
| | - Alejandro De Los Angeles
- Department of Pediatrics and Naomi Berrie Diabetes Center, Columbia Stem Cell Initiative, Columbia University, New York, NY 10032, USA
| | - Shuangyi Xu
- Department of Pediatrics and Naomi Berrie Diabetes Center, Columbia Stem Cell Initiative, Columbia University, New York, NY 10032, USA; Masters of Biotechnology Program, Columbia University, New York, NY 10027, USA
| | - Ning Wang
- Department of Pediatrics and Naomi Berrie Diabetes Center, Columbia Stem Cell Initiative, Columbia University, New York, NY 10032, USA
| | - Joao de Pinho
- Department of Obstetrics and Gynecology, Columbia University, New York, NY 10032, USA
| | - Michael V Zuccaro
- Department of Pediatrics and Naomi Berrie Diabetes Center, Columbia Stem Cell Initiative, Columbia University, New York, NY 10032, USA
| | - Angelo Taglialatela
- Department of Genetics and Development, Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY 10032, USA
| | - Dashiell J Massey
- Department of Molecular Biology and Genetics, Cornell University, Ithaca, NY 14853, USA
| | - Jenna Turocy
- Department of Obstetrics and Gynecology, Columbia University, New York, NY 10032, USA
| | - Alex Robles
- Department of Obstetrics and Gynecology, Columbia University, New York, NY 10032, USA
| | - Anisa Subbiah
- Department of Obstetrics and Gynecology, Columbia University, New York, NY 10032, USA
| | - Bob Prosser
- Department of Obstetrics and Gynecology, Columbia University, New York, NY 10032, USA
| | - Rogerio Lobo
- Department of Obstetrics and Gynecology, Columbia University, New York, NY 10032, USA
| | - Alberto Ciccia
- Department of Genetics and Development, Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY 10032, USA
| | - Amnon Koren
- Department of Molecular Biology and Genetics, Cornell University, Ithaca, NY 14853, USA
| | - Timour Baslan
- Cancer Biology and Genetics Program, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Dieter Egli
- Department of Obstetrics and Gynecology, Columbia University, New York, NY 10032, USA; Department of Pediatrics and Naomi Berrie Diabetes Center, Columbia Stem Cell Initiative, Columbia University, New York, NY 10032, USA.
| |
Collapse
|
3
|
Tian L, Xia L, Liu H, Kou Y, Huang Z, Wu X, Fan L, Huang J, Wu Q. Increased blastomere number is associated with higher live birth rate in day 3 embryo transfer. BMC Pregnancy Childbirth 2022; 22:198. [PMID: 35277132 PMCID: PMC8917733 DOI: 10.1186/s12884-022-04521-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 02/25/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Purpose
To study the relationship between blastomere number and pregnancy outcomes of day 3 embryo transfers.
Methods
This retrospective cohort study included 2237 fresh single day 3 embryo transfer cycles from October 2013 to November 2020. Patients were divided into six groups according to the blastomere number on day 3: ≤ 6-cell (n = 100), 7-cell (n = 207), 8-cell (n = 1522), 9-cell (n = 187), 10-cell (n = 91) and ≥ 11-cell (n = 130). Generalized estimating equation analysis based on multivariate logistic regression model was performed to adjust for potential confounders.
Results
The live birth rate (LBR) was 19.0%, 27.1%, 38.9%, 32.1%, 44.0% and 53.8% for the ≤ 6-cell, 7-cell, 8-cell, 9-cell, 10-cell and ≥ 11-cell groups, respectively (P < 0.001). Specifically, the ≤ 6-cell group was associated with reduced LBR compared with the 8-cell group (aOR 0.50, 95% CI 0.29–0.86; P = 0.013). Conversely, the odds of live birth were significantly increased in patients transferred with 10-cell embryos (aOR 1.62, 95% CI 1.03–2.53; P = 0.035) and ≥ 11-cell embryos (aOR 2.14, 95% CI 1.47–3.11; P < 0.001) when using the 8-cell embryo group as reference. Similar trends were also observed in the rates of positive hCG test and clinical pregnancy, while no significant differences were detected in miscarriage risk.
Conclusion
Increased blastomere number was associated with higher LBR in fresh single day 3 embryo transfer cycles. This finding questions the consensus on the reduced developmental potential of fast-cleaving embryos. Further large prospective studies are warranted for confirmation.
Collapse
|
4
|
Gonzalez MB, Robker RL, Rose RD. Obesity and oocyte quality: Significant implications for ART and Emerging mechanistic insights. Biol Reprod 2021; 106:338-350. [PMID: 34918035 DOI: 10.1093/biolre/ioab228] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/22/2021] [Accepted: 12/07/2021] [Indexed: 11/14/2022] Open
Abstract
The prevalence of obesity in adults worldwide, and specifically in women of reproductive age, is concerning given the risks to fertility posed by the increased risk of type 2 diabetes, metabolic syndrome and other non-communicable diseases. Obesity has a multi-systemic impact in female physiology that is characterized by the presence of oxidative stress, lipotoxicity, and the activation of pro-inflammatory pathways, inducing tissue-specific insulin resistance and ultimately conducive to abnormal ovarian function. A higher body mass is linked to Polycystic Ovary Syndrome, dysregulated menstrual cycles, anovulation, and longer time to pregnancy, even in ovulatory women. In the context of ART, compared to women of normal BMI, obese women have worse outcomes in every step of their journey, resulting in reduced success measured as live birth rate. Even after pregnancy is achieved, obese women have a higher chance of miscarriage, gestational diabetes, pregnancy complications, birth defects, and most worryingly, a higher risk of stillbirth and neonatal death. The potential for compounding effects of ART on pregnancy complications and infant morbidities in obese women has not been studied. There is still much debate in the field on whether these poorer outcomes are mainly driven by defects in oocyte quality, abnormal embryo development or an unaccommodating uterine environment, however the clinical evidence to date suggests a combination of all three are responsible. Animal models of maternal obesity shed light on the mechanisms underlaying the effects of obesity on the peri-conception environment, with recent findings pointing to lipotoxicity in the ovarian environment as a key driver of defects in oocytes that have not only reduced developmental competence but long-lasting effects in offspring health.
Collapse
Affiliation(s)
- Macarena B Gonzalez
- Robinson Research Institute, School of Biomedicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Rebecca L Robker
- Robinson Research Institute, School of Biomedicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Ryan D Rose
- Robinson Research Institute, School of Biomedicine, University of Adelaide, Adelaide, South Australia, Australia.,Fertility SA, St. Andrews Hospital, Adelaide, South Australia, Australia
| |
Collapse
|
5
|
Wu J, Zhang J, Kuang Y, Chen Q, Wang Y. The effect of Day 3 cell number on pregnancy outcomes in vitrified-thawed single blastocyst transfer cycles. Hum Reprod 2021; 35:2478-2487. [PMID: 32944763 DOI: 10.1093/humrep/deaa209] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 07/18/2020] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION Does cell number on Day 3 have an impact on pregnancy outcomes in vitrified-thawed single blastocyst transfer cycles? SUMMARY ANSWER A low Day 3 cell number (≤5 cells) was independently associated with decreased live birth rate (LBR) during single blastocyst transfer cycles in young women. WHAT IS KNOWN ALREADY Day 3 cell number is an effective predictor of IVF success rates when transferring cleavage stage embryos. However, the association between Day 3 blastomere number and pregnancy outcomes after blastocyst transfer is still unknown. STUDY DESIGN, SIZE, DURATION A retrospective cohort study of 3543 patients who underwent frozen-thawed single blastocyst transfers from January 2013 to June 2018 at a tertiary-care academic medical center. PARTICIPANTS/MATERIALS, SETTING, METHODS Patients were grouped into six groups according to the Day 3 cell number: ≤4 cells, 5 cells, 6 cells, 7 cells, 8 cells and >8 cells. The primary outcome measure was LBR. A logistic regression analysis was performed to explore the independent association between Day 3 blastomere number and LBR after adjustment for some potential confounders. MAIN RESULTS AND THE ROLE OF CHANCE In women <35 years old, the LBR varied significantly according to Day 3 cell number, with the rate of 31.2%, 34.4%, 41.9%, 45.1%, 48.1% and 48.2% for the ≤4-cell, 5-cell, 6-cell, 7-cell, 8-cell and >8-cell groups, respectively (P < 0.001). This significant difference was also observed in the high- and low-quality blastocyst subgroups of young women. However, for women ≥35 years old, the rate of live birth was similar between groups. Furthermore, after accounting for confounding factors, the LBR was significantly decreased in the ≤4-cell (adjusted odds ratio (aOR): 0.62, 95% CI: 0.48-0.80, P < 0.001) and 5-cell (aOR: 0.73, 95% CI: 0.57-0.92, P = 0.009) groups as compared to the 8-cell group. Likewise, the blastocysts arising from ≤4-cell (aOR: 0.73, 95% CI: 0.57-0.93, P = 0.010) or 5-cell (aOR: 0.77, 95% CI: 0.61-0.97, P = 0.024) embryos were associated with lower clinical pregnancy rate than those from 8-cell embryos. No significant differences were observed in biochemical pregnancy rate and miscarriage rate. LIMITATIONS, REASONS FOR CAUTION A limitation of the current study was its retrospective design. Future prospective studies are needed to confirm our findings. WIDER IMPLICATIONS OF THE FINDINGS Our observations suggested that a low Day 3 cell number was related to decreased LBR after blastocyst transfer in young women, which provided vital information for clinicians in selecting blastocyst during IVF treatment. STUDY FUNDING/COMPETING INTEREST(S) This study was supported by the National Natural Science Foundation of China (NSFC) (31770989 to Y.W.; 81671520 to Q.C.) and the Shanghai Ninth People's Hospital Foundation of China (JYLJ030 to Y.W.). The authors have no conflicts of interest to declare. TRIAL REGISTRATION NUMBER N/A.
Collapse
|
6
|
Masuda Y, Hasebe R, Kuromi Y, Kobayashi M, Urataki K, Hishinuma M, Ohbayashi T, Nishimura R. Three-Dimensional Live Imaging of Bovine Preimplantation Embryos: A New Method for IVF Embryo Evaluation. Front Vet Sci 2021; 8:639249. [PMID: 33981741 PMCID: PMC8107228 DOI: 10.3389/fvets.2021.639249] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 03/11/2021] [Indexed: 12/21/2022] Open
Abstract
Conception rates for transferred bovine embryos are lower than those for artificial insemination. Embryo transfer (ET) is widely used in cattle but many of the transferred embryos fail to develop, thus, a more effective method for selecting bovine embryos suitable for ET is required. To evaluate the developmental potential of bovine preimplantation embryos (2-cell stage embryos and blastocysts), we have used the non-invasive method of optical coherence tomography (OCT) to obtain live images. The images were used to evaluate 22 parameters of blastocysts, such as the volume of the inner cell mass and the thicknesses of the trophectoderm (TE). Bovine embryos were obtained by in vitro fertilization (IVF) of the cumulus-oocyte complexes aspirated by ovum pick-up from Japanese Black cattle. The quality of the blastocysts was examined under an inverted microscope and all were confirmed to be Code1 according to the International Embryo Transfer Society standards for embryo evaluation. The OCT images of embryos were taken at the 2-cell and blastocyst stages prior to the transfer. In OCT, the embryos were irradiated with near-infrared light for a few minutes to capture three-dimensional images. Nuclei of the 2-cell stage embryos were clearly observed by OCT, and polynuclear cells at the 2-cell stage were also clearly found. With OCT, we were able to observe embryos at the blastocyst stage and evaluate their parameters. The conception rate following OCT (15/30; 50%) is typical for ETs and no newborn calves showed neonatal overgrowth or died, indicating that the OCT did not adversely affect the ET. A principal components analysis was unable to identify the parameters associated with successful pregnancy, while by using hierarchical clustering analysis, TE volume has been suggested to be one of the parameters for the evaluation of bovine embryo. The present results show that OCT imaging can be used to investigate time-dependent changes of IVF embryos. With further improvements, it should be useful for selecting high-quality embryos for transfer.
Collapse
Affiliation(s)
- Yasumitsu Masuda
- Department of Animal Science, Tottori Livestock Research Center, Tottori, Japan
| | | | | | | | - Kanako Urataki
- Laboratory of Theriogenology, Joint Department of Veterinary Medicine, Faculty of Agriculture, Tottori University, Tottori, Japan
| | - Mitsugu Hishinuma
- Laboratory of Theriogenology, Joint Department of Veterinary Medicine, Faculty of Agriculture, Tottori University, Tottori, Japan
| | - Tetsuya Ohbayashi
- Organization for Research Initiative and Promotion, Tottori University, Tottori, Japan
| | - Ryo Nishimura
- Laboratory of Theriogenology, Joint Department of Veterinary Medicine, Faculty of Agriculture, Tottori University, Tottori, Japan
| |
Collapse
|
7
|
Cleavage vs blastocyst stage embryos: how are they interrelating? Arch Gynecol Obstet 2021; 304:1083-1088. [PMID: 33620556 DOI: 10.1007/s00404-021-06003-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 02/11/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE To assess the variables that may predict which cleavage-stage embryo may develop into a blastocyst, and vice versa, to determine whether the cleavage-stage embryo morphology should be taken into consideration when transferring the embryo at the blastocyst stage. METHODS A single center, retrospective cohort study. The study cohort included 3072 patients undergoing 3607 retrieval cycles and 23,124 embryos at the cleavage stage. We assessed the blastulation rate and evaluated which variables impact the ongoing pregnancy rate. RESULTS High blastulation rate correlates with higher embryos' grading (I > II > III > IV > V) and higher number of blastomeres (8 > 7 > 6 > 5 > 4). 949 patients had fresh single blastocyst transfers. The ongoing pregnancy rate was 28.9% per transfer. Patients with ongoing pregnancies were significantly younger (34.3 vs. 36 years, p < 0.001), had higher number of oocyte yield (9.8 vs. 9, p = 0.02), and an increased rate of good-quality embryos transferred (70.7% vs. 47.7%, p = 0.001). When evaluating embryos progression, we found that whenever embryo developed to a good-quality blastocyst, its appearance at the cleavage stage did not affect ongoing pregnancy rate. CONCLUSION Higher the number of blastomeres and better embryo grading were found to correlate with a higher blastulation rate. Nevertheless, if the embryo has already developed to a top-quality blastocyst, its morphology at the cleavage stage did not impact ongoing pregnancy rate.
Collapse
|
8
|
Lin PY, Lin CY, Tsai NC, Huang FJ, Chiang HJ, Lin YJ, Su YT, Lan KC. Disposition of embryos from women who only produced morphologically poor embryos on day three. Biomed J 2021; 45:190-199. [PMID: 35148259 PMCID: PMC9133239 DOI: 10.1016/j.bj.2021.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 11/17/2020] [Accepted: 01/11/2021] [Indexed: 11/25/2022] Open
Abstract
Background The presence of only morphologically poor embryos (MPEs) on day3 is common in autologous in vitro fertilization (IVF), particularly among p Tel: 886-7-7317123 Ext. 8916. Fax: 886-7-7322915.atients who have advanced maternal age or are poor responders. However, there are limited data regarding the disposition of embryos from patients who only produced MPEs on day3. The present study was designed to investigate the possible benefits of extended culturing MPEs. Try to detect whether the extended culture (day4 or day5 culture) can improve the live birth rate per cycle? Methods This retrospective, observational, single-center, cohort study examined 224 IVF/intracytoplasmic sperm injection (ICSI) cycles between January 2010 and June 2015, in which women only produced MPEs on day3. A total of 544 MPEs were analyzed. The defines a day3 embryo as an MPE if it fails to develop to eight cells, blastomeres of equal size, and less than 20% cytoplasmic fragments. Of the 224 cycles, 89 (39.7%) underwent fresh embryo transfer on day3, and 135 (60.3%) underwent extended culture. Of the 135 extended cultures, 54 cycles (40.0%) experienced day4, or day5 embryo transfer, 16 cycles (11.9%) had all embryos frozen, and 65 cycles (48.1%) had total embryo arrest. Results Analysis of patient baseline demographic data, cycle characteristics, and cycle outcomes for day3 transfer group and extended culture group indicated that a higher body mass index in the day3 transfer group was the only significant difference (p = 0.006). Both fresh transfer groups had low live birth rates (LBRs) (4.5% vs. 7.4% p = 0.46). After extended culture, 65 cycles (48.1%) were cancelled because the embryos exhibited developmental arrest and 70 cycles (51.9%) grew to day4 or day5. Thirteen frozen embryo transfer (FET) cycles and 22 frozen blastocysts derived from MPEs were thawed. There were more high-quality embryos (p < 0.001), higher implantation rates (IRs) (p = 0.038), and higher LBRs (p = 0.042) for embryos that underwent FET cycles. MPES in extended culture transfer have favorable survival than MPES in day3 transfer. Conclusion The extended culture of MPEs in fresh transfer cycles did not increase the LBR. However, younger females with the extended culture of MPEs followed by FET resulted in significantly higher LBRs and may be a feasible strategy to improve outcomes for patients with poor embryo quality. However, day3 embryo transfer may be a better choice if a fresh transfer is unrestricted and avoid the cycle cancellation. Extended culture may decrease to the transfer of developmental potential arrest embryos to patients.
Collapse
Affiliation(s)
- Pin-Yao Lin
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; Lee Womens' Hospital, Taichung, Taiwan
| | - Chia-Yun Lin
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ni-Chin Tsai
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Fu-Jen Huang
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hsin-Ju Chiang
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yu-Ju Lin
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yu-Ting Su
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Kuo-Chung Lan
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; Center for Menopause and Reproductive Medicine Research, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
| |
Collapse
|
9
|
Li B, Huang J, Li L, He X, Wang M, Zhang H, He Y, Kang B, Shi Y, Chen S, Wang X. Improving the clinical outcomes by extended culture of day 3 embryos with low blastomere number to blastocyst stage following frozen-thawed embryo transfer. Arch Gynecol Obstet 2020; 303:573-580. [PMID: 33033867 PMCID: PMC7858202 DOI: 10.1007/s00404-020-05774-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 08/26/2020] [Indexed: 11/25/2022]
Abstract
Purpose This study aimed to investigate whether the extended culture of day 3 (D3) embryos with low blastomere number to blastocyst following frozen–thawed embryo transfer improved the clinical outcomes. Methods This was a retrospective study of clinical data of women undergoing in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) cycles in the Tangdu Hospital. The patients were divided into groups with 4–5, 6, 7–9 and > 9 cells based on the blastomere number of D3 embryos. The clinical outcomes were compared. Results In fresh transfer cycles, the implantation and clinical pregnancy rates significantly decreased, while the abortion rate significantly increased in the groups with 4–5 and 6 cells compared with those with 7–9 and > 9 cells. In frozen–thawed transfer cycles, the clinical pregnancy and implantation rates for a single blastocyst transfer cycle showed no significant differences in the groups with 4–5 and 6 cells compared with those with 7–9 and > 9 cells. However, the abortion rate was significantly higher in the group with 4–5 cells than in that with 7–9 and > 9 cells. In the double blastocyst transfer cycle, the clinical pregnancy rate showed no significant differences among the groups with 4–5, 6, and 7–9 cells. Conclusion The implantation and clinical pregnancy rates of D3 embryos with 6 cells significantly decreased; these embryos were not considered as high-quality embryos. Extended culture of D3 embryos with ≤ 6 blastomeres to blastocysts, particularly 6-cell embryos, resulted in a similar clinical pregnancy rate as that of blastocysts derived from D3 embryos with ≥ 7 blastomeres.
Collapse
Affiliation(s)
- Bo Li
- Department of Obstetrics and Gynecology, Tangdu Hospital, The Air Force Military Medical University, Xi’an, 710038 China
| | - Jianlei Huang
- Department of Obstetrics and Gynecology, Tangdu Hospital, The Air Force Military Medical University, Xi’an, 710038 China
| | - Li Li
- Department of Obstetrics and Gynecology, Tangdu Hospital, The Air Force Military Medical University, Xi’an, 710038 China
| | - Xiao He
- Department of Obstetrics and Gynecology, Tangdu Hospital, The Air Force Military Medical University, Xi’an, 710038 China
| | - Ming Wang
- Department of Obstetrics and Gynecology, Tangdu Hospital, The Air Force Military Medical University, Xi’an, 710038 China
| | - Hengde Zhang
- Department of Obstetrics and Gynecology, Tangdu Hospital, The Air Force Military Medical University, Xi’an, 710038 China
| | - Yuping He
- Department of Obstetrics and Gynecology, Tangdu Hospital, The Air Force Military Medical University, Xi’an, 710038 China
| | - Bin Kang
- Department of Obstetrics and Gynecology, Tangdu Hospital, The Air Force Military Medical University, Xi’an, 710038 China
| | - Yongqian Shi
- Department of Obstetrics and Gynecology, Tangdu Hospital, The Air Force Military Medical University, Xi’an, 710038 China
| | - Shuqiang Chen
- Department of Obstetrics and Gynecology, Tangdu Hospital, The Air Force Military Medical University, Xi’an, 710038 China
| | - Xiaohong Wang
- Department of Obstetrics and Gynecology, Tangdu Hospital, The Air Force Military Medical University, Xi’an, 710038 China
| |
Collapse
|
10
|
Bori L, Paya E, Alegre L, Viloria TA, Remohi JA, Naranjo V, Meseguer M. Novel and conventional embryo parameters as input data for artificial neural networks: an artificial intelligence model applied for prediction of the implantation potential. Fertil Steril 2020; 114:1232-1241. [PMID: 32917380 DOI: 10.1016/j.fertnstert.2020.08.023] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 08/14/2020] [Accepted: 08/19/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To describe novel embryo features capable of predicting implantation potential as input data for an artificial neural network (ANN) model. DESIGN Retrospective cohort study. SETTING University-affiliated private IVF center. PATIENT(S) This study included 637 patients from the oocyte donation program who underwent single-blastocyst transfer during two consecutive years. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) The research was divided into two phases. Phase 1 consisted of the description and analysis of the following embryo features in implanted and nonimplanted embryos: distance and speed of pronuclear migration, blastocyst expanded diameter, inner cell mass area, and trophectoderm cell cycle length. Phase 2 consisted of the development of an ANN algorithm for implantation prediction. Results were obtained for four models fed with different input data. The predictive power was measured with the use of the area under the receiver operating characteristic curve (AUC). RESULT(S) Out of the five novel described parameters, blastocyst expanded diameter and trophectoderm cell cycle length had statistically different values in implanted and nonimplanted embryos. After the ANN models were trained and validated using fivefold cross-validation, they were capable of predicting implantation on testing data with AUCs of 0.64 for ANN1 (conventional morphokinetics), 0.73 for ANN2 (novel morphodynamics), 0.77 for ANN3 (conventional morphokinetics + novel morphodynamics), and 0.68 for ANN4 (discriminatory variables from statistical test). CONCLUSION(S) The novel proposed embryo features affect the implantation potential, and their combination with conventional morphokinetic parameters is effective as input data for a predictive model based on artificial intelligence.
Collapse
Affiliation(s)
| | - Elena Paya
- IVI-RMA Valencia, Valencia, Spain; Instituto de Investigación e Innovación en Bioingeniería, Universitat Politécnica de Valencia, Valencia, Spain
| | | | | | | | - Valery Naranjo
- Instituto de Investigación e Innovación en Bioingeniería, Universitat Politécnica de Valencia, Valencia, Spain
| | - Marcos Meseguer
- IVI-RMA Valencia, Valencia, Spain; Health Research Institute la Fe, Valencia, Spain
| |
Collapse
|
11
|
Blank C, DeCroo I, Weyers B, van Avermaet L, Tilleman K, van Rumste M, de Sutter P, Mischi M, Schoot BC. Improvement instead of stability in embryo quality between day 3-5: A possible extra predictor for blastocyst selection. Eur J Obstet Gynecol Reprod Biol 2020; 253:198-205. [PMID: 32877773 DOI: 10.1016/j.ejogrb.2020.08.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 08/20/2020] [Accepted: 08/21/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the predictive value of the dynamic morphological development process between cleavage-stage and blastocyst-stage embryos. STUDY DESIGN A retrospective study was executed between 2015 and 2017 at Ghent University Hospital. A total of 996 first fresh IVF/ICSI cycles resulting in a single embryo transfer on day 5 were included. Embryos were scored on day 3 and day 5 as excellent, good, moderate or poor based on Alpha/ESHRE guidelines and Gardner and Schoolcraft scoring-system. If embryos changed category between day 3 and 5, the number of steps (between excellent; good; moderate; poor) in positive and negative direction was expressed. RESULTS On day 5, the ongoing pregnancy rate (OPR) of excellent embryos was 37.4 %. Univariate analyses showed that on day 5, both a higher cell stage, better inner cell mass and better trophectoderm were significantly associated with an ongoing pregnancy. In case of deterioration in quality of individual embryos between day 3 and day 5, the OPR was significantly lower. Conversely, improvement of embryo quality between day 3 and day 5 showed higher ongoing pregnancy rates (overall OPR of good day-3 embryos improving to excellent day-5 embryos: 30 %; moderate day 3 to excellent day 5: 50 %; poor day 3 to excellent day 5: 42 %; poor day 3 to good day 5: 20 %; poor day 3 to moderate day 5: 16 %). When embryos improved from poor on day 3 to excellent day 5 the OPR was significantly higher in comparison with embryos that did not change in quality scoring during development (steady embryos) (OR: 1.785, p < 0.05). CONCLUSION Our results suggest that it is more likely to achieve an ongoing pregnancy when transferring an embryo that has improved in quality between days 3 and 5 as opposed to one that has remained stable.
Collapse
Affiliation(s)
- C Blank
- Department of Electrical Engineering (Signal Processing Systems), Eindhoven University of Technology, Groene loper 19, Flux, Postbus 513, Eindhoven, 5600, MB, the Netherlands; Department of Reproductive Medicine, Ghent University Hospital, De Pintelaan 185, Ghent, 9000, Belgium.
| | - I DeCroo
- Department of Reproductive Medicine, Ghent University Hospital, De Pintelaan 185, Ghent, 9000, Belgium
| | - B Weyers
- Department of Reproductive Medicine, Ghent University Hospital, De Pintelaan 185, Ghent, 9000, Belgium
| | - L van Avermaet
- Department of Reproductive Medicine, Ghent University Hospital, De Pintelaan 185, Ghent, 9000, Belgium
| | - K Tilleman
- Department of Reproductive Medicine, Ghent University Hospital, De Pintelaan 185, Ghent, 9000, Belgium
| | - M van Rumste
- Department of Obstetrics and Gynaecology, Catharina Hospital, Michelangelolaan 2, Eindhoven, 5623 EJ, the Netherlands
| | - P de Sutter
- Department of Reproductive Medicine, Ghent University Hospital, De Pintelaan 185, Ghent, 9000, Belgium
| | - M Mischi
- Department of Electrical Engineering (Signal Processing Systems), Eindhoven University of Technology, Groene loper 19, Flux, Postbus 513, Eindhoven, 5600, MB, the Netherlands
| | - B C Schoot
- Department of Electrical Engineering (Signal Processing Systems), Eindhoven University of Technology, Groene loper 19, Flux, Postbus 513, Eindhoven, 5600, MB, the Netherlands; Department of Reproductive Medicine, Ghent University Hospital, De Pintelaan 185, Ghent, 9000, Belgium; Department of Obstetrics and Gynaecology, Catharina Hospital, Michelangelolaan 2, Eindhoven, 5623 EJ, the Netherlands
| |
Collapse
|
12
|
Zhao H, Liu H, Li M, Wu K. Clinical outcomes following frozen-thawed blastocyst transfers with blastocysts derived from different cell numbers on day 3: a retrospective cohort study. J Assist Reprod Genet 2020; 37:641-648. [PMID: 31902101 DOI: 10.1007/s10815-019-01664-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 12/12/2019] [Indexed: 10/25/2022] Open
Abstract
PURPOSE To evaluate clinical outcomes after frozen-thawed blastocyst transfer (TBT) with blastocysts which were derived from different cell numbers on day 3. METHODS The study included 1444 patients undergoing single autologous frozen-thawed blastocyst transfer cycles, which were allocated to five groups according to the cell numbers on day 3 of the transferred blastocysts: ≤ 6-cell (n = 109), 7-cell (n = 169), 8-cell (n = 811), 9-cell (n = 136), and ≥ 10-cell (n = 219). RESULTS The LBR of the ≤ 6-cell group was found to be statistically lower than that of the 8-cell group in single TBT cycles which had been transferred with fair quality blastocysts (defined as 4BB according to Gardner's grading scale) (41.28% vs 55.73%, P = 0.004), while the miscarriage rate was significantly higher for the ≤ 6-cell group compared with the 8-cell group (25.00% vs 13.74%, P = 0.02). No differences were found between the two groups in terms of cPR (P = 0.06). However, for blastocysts categorized as high quality according to Gardner's classification (defined as 4AA/4AB/4BA), cPR, LBR, and early miscarriage rates did not differ between the two groups (P = 0.76, P = 0.44, P = 0.40, respectively). CONCLUSIONS When transferring blastocysts, an evaluation of the cleavage stage should be performed along with blastocyst morphology to shorten the time of conceiving.
Collapse
Affiliation(s)
- Haibin Zhao
- Center for Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong University, National Research Center for Assisted Reproductive Technology and Reproductive Genetics, No.157 Jingliu Road, Jinan, 250001, People's Republic of China.,The Key laboratory for Reproductive Endocrinology of Ministry of Education, Jinan, China.,Shandong Provincial Key Laboratory of Reproductive Medicine, NO. 157 Jingliu Road, Jinan, 250001, China
| | - Hui Liu
- Center for Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong University, National Research Center for Assisted Reproductive Technology and Reproductive Genetics, No.157 Jingliu Road, Jinan, 250001, People's Republic of China.,The Key laboratory for Reproductive Endocrinology of Ministry of Education, Jinan, China.,Shandong Provincial Key Laboratory of Reproductive Medicine, NO. 157 Jingliu Road, Jinan, 250001, China
| | - Mei Li
- Center for Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong University, National Research Center for Assisted Reproductive Technology and Reproductive Genetics, No.157 Jingliu Road, Jinan, 250001, People's Republic of China.,The Key laboratory for Reproductive Endocrinology of Ministry of Education, Jinan, China.,Shandong Provincial Key Laboratory of Reproductive Medicine, NO. 157 Jingliu Road, Jinan, 250001, China
| | - Keliang Wu
- Center for Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong University, National Research Center for Assisted Reproductive Technology and Reproductive Genetics, No.157 Jingliu Road, Jinan, 250001, People's Republic of China. .,The Key laboratory for Reproductive Endocrinology of Ministry of Education, Jinan, China. .,Shandong Provincial Key Laboratory of Reproductive Medicine, NO. 157 Jingliu Road, Jinan, 250001, China.
| |
Collapse
|
13
|
Pons MC, Carrasco B, Parriego M, Boada M, González-Foruria I, Garcia S, Coroleu B, Barri PN, Veiga A. Deconstructing the myth of poor prognosis for fast-cleaving embryos on day 3. Is it time to change the consensus? J Assist Reprod Genet 2019. [PMID: 31478159 PMCID: PMC6885468 DOI: 10.1007/s10815-019-01574-y,] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023] Open
Abstract
PURPOSE To determine the developmental competence of fast-cleaving D3 embryos. METHODS Retrospective study including 4028 embryos from 513 PGT-A cycles performed between July 2014 and June 2017. Embryos were cultured in time-lapse incubators and biopsied at blastocyst stage. Embryos were classified in groups according to the number of cells on D3 (from 2-cell to ≥13 -cell and compacted). A generalized linear mixed model adjusted for confounding factors was performed to assess the chance to give rise to an euploid blastocyst in each group compared with the chance of 8-cell embryos. Implantation and live birth rates were also analyzed. RESULTS The statistical analysis showed that embryos with 9 to 11 cells had a slightly lower euploid blastocyst rate than 8-cell embryos (OR (95% CI) 0.77 (0.61-0.96)) while embryos with more than 11 cells were found to be just as likely to give rise to an euploid blastocyst as the 8-cell embryos (OR (95% CI) 1.20 (0.92-1.56)). Conversely, slow-cleaving embryos had a significantly lower euploid blastocyst rate than 8-cell embryos (OR (95% CI) 0.31 (0.24-0.39)). Moreover, euploid blastocysts derived from fast-cleaving embryos and from 8-cell embryos exhibit similar live birth rates. No significant differences were found in the chance to give rise a live birth between 8-cell and 9- to 11-cell embryos (OR (95% CI) 1.23 (0.70-2.15)) and > 11-cell embryos (OR (95% CI) 1.09 (0.57-2.09)). CONCLUSIONS Embryos with more than 11 cells exhibit similar developmental competence to 8-cell embryos. Their poor prognosis should be reconsidered.
Collapse
Affiliation(s)
- Maria Carme Pons
- Reproductive Medicine Service, Dexeus Mujer, Hospital Universitari Dexeus, Gran Via Carles III, 71-75, 08028, Barcelona, Spain.
| | - Beatriz Carrasco
- Reproductive Medicine Service, Dexeus Mujer, Hospital Universitari Dexeus, Gran Via Carles III, 71-75, 08028, Barcelona, Spain
| | - Mònica Parriego
- Reproductive Medicine Service, Dexeus Mujer, Hospital Universitari Dexeus, Gran Via Carles III, 71-75, 08028, Barcelona, Spain
| | - Montserrat Boada
- Reproductive Medicine Service, Dexeus Mujer, Hospital Universitari Dexeus, Gran Via Carles III, 71-75, 08028, Barcelona, Spain
| | - Iñaki González-Foruria
- Reproductive Medicine Service, Dexeus Mujer, Hospital Universitari Dexeus, Gran Via Carles III, 71-75, 08028, Barcelona, Spain
| | - Sandra Garcia
- Reproductive Medicine Service, Dexeus Mujer, Hospital Universitari Dexeus, Gran Via Carles III, 71-75, 08028, Barcelona, Spain
| | - Buenaventura Coroleu
- Reproductive Medicine Service, Dexeus Mujer, Hospital Universitari Dexeus, Gran Via Carles III, 71-75, 08028, Barcelona, Spain
| | - Pedro N Barri
- Reproductive Medicine Service, Dexeus Mujer, Hospital Universitari Dexeus, Gran Via Carles III, 71-75, 08028, Barcelona, Spain
| | - Anna Veiga
- Reproductive Medicine Service, Dexeus Mujer, Hospital Universitari Dexeus, Gran Via Carles III, 71-75, 08028, Barcelona, Spain.,Barcelona Stem Cell Bank, Centre of Regenerative Medicine in Barcelona, Hospital Duran i Reynals, Gran Via de l' Hospitalet 199, 08908, Hospitalet de Llobregat, Spain
| |
Collapse
|
14
|
Storr A, Bilir E, Cooke S, Garrett D, Venetis CA. Fine-tuning blastocyst selection based on morphology: a multicentre analysis of 2461 single blastocyst transfers. Reprod Biomed Online 2019; 39:588-598. [PMID: 31515169 DOI: 10.1016/j.rbmo.2019.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 05/16/2019] [Accepted: 06/18/2019] [Indexed: 11/25/2022]
Abstract
RESEARCH QUESTION Which blastocyst morphology parameter is associated with live birth after controlling for female age and endometrial receptivity? DESIGN Retrospective study including fresh single blastocyst transfers (n = 2461) where the value of serum progesterone on day of human chorionic gonadotrophin trigger (PdHCG) was available. Generalized estimating equation regression models evaluated the independent effects of developmental stage (DevSt), inner cell mass (ICM) and trophectoderm grade on live birth rates while controlling for the confounding effects of female age and PdHCG. RESULTS DevSt was strongly associated with the probability of live birth (P < 0.0001) independently of female age (odds ratio [OR] 0.89, 95% confidence interval [CI] 0.87-0.91) and PdHCG (OR 0.80, 95% CI 0.74-0.87). For full blastocysts, expanded blastocysts and hatching blastocysts, addition of ICM and trophectoderm grading in the multivariable analysis suggested that besides female age (OR 0.92, 95% CI 0.90-0.94) and PdHCG (OR 0.80, 95% CI 0.73-0.87), only DevSt (P = 0.001) and trophectoderm quality (P = 0.004) were independent predictors of live birth, while the predictive capacity of ICM was no longer significant. The mean probability of live birth was highest for AA blastocysts (35.0%), followed by BA blastocysts (31.2%) and AB blastocysts (27.7%). CONCLUSION This large study analyses for the first time the independent role of blastocyst morphology in predicting live birth while controlling for female age and PdHCG. Its findings suggest that DevSt and then trophectoderm grade are stronger predictors of live birth over ICM grade when selecting a single blastocyst for transfer.
Collapse
Affiliation(s)
- Ashleigh Storr
- School of Women's and Children's Health, UNSW Medicine, UNSW NSW, Australia; Flinders Fertility, Adelaide SA, Australia.
| | - Esra Bilir
- Koç University, School of Medicine Istanbul, Turkey
| | | | | | - Christos A Venetis
- IVF Australia, Sydney NSW, Australia; Centre for Big Data Research in Health and School of Women's and Children's Health, UNSW NSW, Australia
| |
Collapse
|
15
|
Pons MC, Carrasco B, Parriego M, Boada M, González-Foruria I, Garcia S, Coroleu B, Barri PN, Veiga A. Deconstructing the myth of poor prognosis for fast-cleaving embryos on day 3. Is it time to change the consensus? J Assist Reprod Genet 2019; 36:2299-2305. [PMID: 31478159 DOI: 10.1007/s10815-019-01574-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 08/26/2019] [Indexed: 12/01/2022] Open
Abstract
PURPOSE To determine the developmental competence of fast-cleaving D3 embryos. METHODS Retrospective study including 4028 embryos from 513 PGT-A cycles performed between July 2014 and June 2017. Embryos were cultured in time-lapse incubators and biopsied at blastocyst stage. Embryos were classified in groups according to the number of cells on D3 (from 2-cell to ≥13 -cell and compacted). A generalized linear mixed model adjusted for confounding factors was performed to assess the chance to give rise to an euploid blastocyst in each group compared with the chance of 8-cell embryos. Implantation and live birth rates were also analyzed. RESULTS The statistical analysis showed that embryos with 9 to 11 cells had a slightly lower euploid blastocyst rate than 8-cell embryos (OR (95% CI) 0.77 (0.61-0.96)) while embryos with more than 11 cells were found to be just as likely to give rise to an euploid blastocyst as the 8-cell embryos (OR (95% CI) 1.20 (0.92-1.56)). Conversely, slow-cleaving embryos had a significantly lower euploid blastocyst rate than 8-cell embryos (OR (95% CI) 0.31 (0.24-0.39)). Moreover, euploid blastocysts derived from fast-cleaving embryos and from 8-cell embryos exhibit similar live birth rates. No significant differences were found in the chance to give rise a live birth between 8-cell and 9- to 11-cell embryos (OR (95% CI) 1.23 (0.70-2.15)) and > 11-cell embryos (OR (95% CI) 1.09 (0.57-2.09)). CONCLUSIONS Embryos with more than 11 cells exhibit similar developmental competence to 8-cell embryos. Their poor prognosis should be reconsidered.
Collapse
Affiliation(s)
- Maria Carme Pons
- Reproductive Medicine Service, Dexeus Mujer, Hospital Universitari Dexeus, Gran Via Carles III, 71-75, 08028, Barcelona, Spain.
| | - Beatriz Carrasco
- Reproductive Medicine Service, Dexeus Mujer, Hospital Universitari Dexeus, Gran Via Carles III, 71-75, 08028, Barcelona, Spain
| | - Mònica Parriego
- Reproductive Medicine Service, Dexeus Mujer, Hospital Universitari Dexeus, Gran Via Carles III, 71-75, 08028, Barcelona, Spain
| | - Montserrat Boada
- Reproductive Medicine Service, Dexeus Mujer, Hospital Universitari Dexeus, Gran Via Carles III, 71-75, 08028, Barcelona, Spain
| | - Iñaki González-Foruria
- Reproductive Medicine Service, Dexeus Mujer, Hospital Universitari Dexeus, Gran Via Carles III, 71-75, 08028, Barcelona, Spain
| | - Sandra Garcia
- Reproductive Medicine Service, Dexeus Mujer, Hospital Universitari Dexeus, Gran Via Carles III, 71-75, 08028, Barcelona, Spain
| | - Buenaventura Coroleu
- Reproductive Medicine Service, Dexeus Mujer, Hospital Universitari Dexeus, Gran Via Carles III, 71-75, 08028, Barcelona, Spain
| | - Pedro N Barri
- Reproductive Medicine Service, Dexeus Mujer, Hospital Universitari Dexeus, Gran Via Carles III, 71-75, 08028, Barcelona, Spain
| | - Anna Veiga
- Reproductive Medicine Service, Dexeus Mujer, Hospital Universitari Dexeus, Gran Via Carles III, 71-75, 08028, Barcelona, Spain.,Barcelona Stem Cell Bank, Centre of Regenerative Medicine in Barcelona, Hospital Duran i Reynals, Gran Via de l' Hospitalet 199, 08908, Hospitalet de Llobregat, Spain
| |
Collapse
|
16
|
Huang TT, Huang DH, Ahn HJ, Arnett C, Huang CT. Early blastocyst expansion in euploid and aneuploid human embryos: evidence for a non-invasive and quantitative marker for embryo selection. Reprod Biomed Online 2019; 39:27-39. [PMID: 31130402 DOI: 10.1016/j.rbmo.2019.01.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 12/14/2018] [Accepted: 01/17/2019] [Indexed: 12/27/2022]
Abstract
RESEARCH QUESTION How can the kinetics of human blastocyst expansion be used to evaluate an embryo's ploidy identified using preimplantation genetic testing for aneuploidy (PGT-A)? DESIGN This was a retrospective observational study of 188 autologous blastocysts from 34 sequential treatment cycles using PGT-A and blastocyst biopsy. Using time-lapse imaging, blastocyst expansion was evaluated using a quantitative standardized expansion assay (qSEA). Trophectoderm cell division was examined in selected, unbiopsied embryos (n = 7) to evaluate the contribution of mitosis to the expansion rate. RESULTS The averaged euploid blastocyst expansion rate was significantly (52.8%) faster than in aneuploid blastocysts (P = 0.0041). Scatterplots, representing 'expansion maps', revealed that both populations showed a similarly overlapping distribution of blastocyst formation times at 80-140 h from fertilization. Euploidy and aneuploidy were better distinguished in regions of higher and lower expansion, respectively, in expansion maps. Based upon the expansion slopes, rank-ordering of individual embryos within cohorts resulted in more than 90% euploid embryos in the first two ranks in patients less than 35 years of age. Additional detailed time-lapse image analysis provided evidence that rapid expansion was associated with robust, integrative cellular mitosis in trophectoderm cells. CONCLUSIONS The kinetics of human blastocyst expansion are related to an embryo's ploidy. These preliminary observations describe a new quantitative, non-invasive approach to embryo assessment that may be useful to identify single blastocysts for transfer, particularly in younger patient groups. However, this approach may also be useful for euploid embryo selection after PGT-A. The results support the hypothesis that aneuploidy universally impairs general cellular processes, including cell division, in differentiated cells.
Collapse
Affiliation(s)
- Thomas Tf Huang
- Department of Obstetrics and Gynecology and Women's Health, John A. Burns School of Medicine, Honolulu Hawaii, USA; Pacific In Vitro Fertilization Institute, Honolulu Hawaii, USA.
| | - David H Huang
- Pacific In Vitro Fertilization Institute, Honolulu Hawaii, USA
| | - Hyeong J Ahn
- Department of Complementary and Integrative Medicine, University of Hawaii John A. Burns School of Medicine, Honolulu Hawaii, USA
| | - Christina Arnett
- Advanced Reproductive Center of Hawaii, Kapiolani Medical Center for Women and Children, Honolulu Hawaii, USA
| | - Christopher Tf Huang
- Advanced Reproductive Center of Hawaii, Kapiolani Medical Center for Women and Children, Honolulu Hawaii, USA
| |
Collapse
|
17
|
Somoskői B, Kovács M, Cseh S. Effects of T-2 and Fumonisin B1 combined treatment on in vitro mouse embryo development and blastocyst quality. Toxicol Ind Health 2018; 34:353-360. [DOI: 10.1177/0748233718764039] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
In the temperate region, most common mycotoxins are members of fusariotoxins. It often happens that food and forage are contaminated with two or more fusariotoxins at the same time. Effects of co-contamination are poorly documented, especially in the field of reproduction. The aim of our study was to assess the combined effect of the two common fusariotoxins, T-2 toxin (T-2) and Fumonisin B1 on early mouse embryo development in vitro. Embryo culture media contained either (1) 0.5 ng/ml T-2; 1, 2, or 10 ng/ml FB1 (group A, B, and C, respectively); or (2) 0.5 ng/ml T-2 and 1, 2, or 10 ng/ml FB1 (group TA, TB, and TC, respectively). Developmental rate, blastocoel expansion, cell number, and micronucleus rate were measured following 96 h culture. Although the developmental rate was similar to the control group (86.43% vs. 83.33, 78.79, 85.98, and 86.67%, respectively) in the case of single toxin treatments, the combined treatments induced significant decreases (14.5, 33.6, and 22.8% in TA, TB, and TC, respectively). The proportion of late blastocysts was lower in all treatments compared to control (83.6% vs. 0–83.6%). Combined treatment resulted in a significantly lower proportion of late blastocysts (25% in TA and 0% in TB and TC). Cell numbers decreased in all toxin-treated groups with a higher rate after combined treatments. No differences were detected in the micronucleus rate in the single or combined treatments compared to control. Our study shows that T-2 and FB1 toxins do not necessarily decrease the developmental rate, but co-contamination results in a significantly lower blastocyst rate and disturbs the blastocoel expansion as well. One possible explanation of this observation could be that the presence of two mycotoxins in the culture media intensifies their negative effects. All toxin treatments decreased the cell number in the blastocysts and this negative effect was more expressed after combined treatment.
Collapse
Affiliation(s)
- Bence Somoskői
- Department and Clinic of Obstetrics and Reproduction, University of Veterinary Medicine, Budapest, Hungary
| | - Melinda Kovács
- MTA-KE Mycotoxins in the Food Chain Research Team, Kaposvár, Hungary
| | - Sándor Cseh
- Department and Clinic of Obstetrics and Reproduction, University of Veterinary Medicine, Budapest, Hungary
| |
Collapse
|
18
|
Laskowski D, Båge R, Humblot P, Andersson G, Sirard MA, Sjunnesson Y. Insulin during in vitro oocyte maturation has an impact on development, mitochondria, and cytoskeleton in bovine day 8 blastocysts. Theriogenology 2017; 101:15-25. [DOI: 10.1016/j.theriogenology.2017.06.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Revised: 05/30/2017] [Accepted: 06/04/2017] [Indexed: 01/07/2023]
|
19
|
Barrie A, Homburg R, McDowell G, Brown J, Kingsland C, Troup S. Examining the efficacy of six published time-lapse imaging embryo selection algorithms to predict implantation to demonstrate the need for the development of specific, in-house morphokinetic selection algorithms. Fertil Steril 2017; 107:613-621. [DOI: 10.1016/j.fertnstert.2016.11.014] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 11/04/2016] [Accepted: 11/07/2016] [Indexed: 11/17/2022]
|
20
|
Subira J, Craig J, Turner K, Bevan A, Ohuma E, McVeigh E, Child T, Fatum M. Grade of the inner cell mass, but not trophectoderm, predicts live birth in fresh blastocyst single transfers. HUM FERTIL 2016; 19:254-261. [PMID: 27624529 DOI: 10.1080/14647273.2016.1223357] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Debate continues over which morphological parameter is most important in selecting blastocysts for transfer. We aimed to investigate which parameter more accurately predicts the occurrence of a live birth by designing a retrospective cohort study of 1084 fresh elective single blastocyst transfers. Primary outcome was live birth rate (LBR) and secondary outcomes were implantation, clinical pregnancy and early pregnancy loss rates. Blastocyst expansion and inner cell mass (ICM), but not trophoectoderm, were associated with LBR in the definitive multivariable regression analysis. When ICM grade dropped from A to C the likelihood of achieving a live birth was reduced by 55% (OR= 0.45, 95% CI 0.26-0.79, p = .005). These results were similar for clinical pregnancy rates. Early pregnancy loss rates of embryos with ICM grade C were more than double (38.0%) compared to those of grades A (15.95%) and B (17.17%, p = .002). The transfer of an embryo with an optimal inner cell mass reduces early pregnancy loss and increases the likelihood of a live birth. We did not find any significant association between trophectoderm and LBR in the multivariable analysis in contrast with recent studies.
Collapse
Affiliation(s)
- Jessica Subira
- a Nuffield Department Obstetrics and Gynaecology, Oxford Fertility Unit , Institute of Reproductive Sciences, University of Oxford , Oxford , UK
| | - Jo Craig
- a Nuffield Department Obstetrics and Gynaecology, Oxford Fertility Unit , Institute of Reproductive Sciences, University of Oxford , Oxford , UK
| | - Karen Turner
- a Nuffield Department Obstetrics and Gynaecology, Oxford Fertility Unit , Institute of Reproductive Sciences, University of Oxford , Oxford , UK
| | - Aysha Bevan
- a Nuffield Department Obstetrics and Gynaecology, Oxford Fertility Unit , Institute of Reproductive Sciences, University of Oxford , Oxford , UK
| | - Eric Ohuma
- b Nuffield Department Obstetrics and Gynaecology , University of Oxford , Oxford , UK
| | - Enda McVeigh
- a Nuffield Department Obstetrics and Gynaecology, Oxford Fertility Unit , Institute of Reproductive Sciences, University of Oxford , Oxford , UK
| | - Tim Child
- a Nuffield Department Obstetrics and Gynaecology, Oxford Fertility Unit , Institute of Reproductive Sciences, University of Oxford , Oxford , UK
| | - Muhammad Fatum
- a Nuffield Department Obstetrics and Gynaecology, Oxford Fertility Unit , Institute of Reproductive Sciences, University of Oxford , Oxford , UK
| |
Collapse
|
21
|
Gardner DK, Balaban B. Assessment of human embryo development using morphological criteria in an era of time-lapse, algorithms and 'OMICS': is looking good still important? Mol Hum Reprod 2016; 22:704-718. [PMID: 27578774 DOI: 10.1093/molehr/gaw057] [Citation(s) in RCA: 108] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 08/24/2016] [Indexed: 02/07/2023] Open
Abstract
With the worldwide move towards single embryo transfer there has been a renewed focus on the requirement for reliable means of assessing embryo viability. In an era of 'OMICS' technologies, and algorithms created through the use of time-lapse microscopy, the actual appearance of the human embryo as it progresses through each successive developmental stage to the blastocyst appears to have been somewhat neglected in recent years. Here we review the key features of the human preimplantation embryo and consider the relationship between morphological characteristics and developmental potential. Further, the impact of the culture environment on morphological traits, how key morphological qualities reflect aspects of embryo physiology, and how computer-assisted analysis of embryo morphology may facilitate a more quantitative approach to selection are discussed. The clinical introduction of time-lapse systems has reopened our eyes and given us a new vantage point from which to view the beauty of the initial stages of human life. Rather than a future in which the morphology of the embryo is deemed irrelevant, we propose that key features, such as multinucleation, cell size and blastocyst differentiation should be included in future iterations of selection/deselection algorithms.
Collapse
Affiliation(s)
- David K Gardner
- School of BioSciences, University of Melbourne, Victoria 3010, Australia
| | - Basak Balaban
- VKF American Hospital Assisted Reproduction Unit, Guzelbahce St. No. 20, Istanbul, Turkey
| |
Collapse
|
22
|
Du QY, Wang EY, Huang Y, Guo XY, Xiong YJ, Yu YP, Yao GD, Shi SL, Sun YP. Blastocoele expansion degree predicts live birth after single blastocyst transfer for fresh and vitrified/warmed single blastocyst transfer cycles. Fertil Steril 2016; 105:910-919.e1. [DOI: 10.1016/j.fertnstert.2015.12.014] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 11/24/2015] [Accepted: 12/08/2015] [Indexed: 11/26/2022]
|
23
|
Li G, He N, Jin H, Liu Y, Guo Y, Su Y, Sun Y. The Influence of Single Nucleotide Polymorphism Microarray-Based Molecular Karyotype on Preimplantation Embryonic Development Potential. PLoS One 2015; 10:e0138234. [PMID: 26381524 PMCID: PMC4575173 DOI: 10.1371/journal.pone.0138234] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 08/27/2015] [Indexed: 11/19/2022] Open
Abstract
In order to investigate the influence of the molecular karyotype based on single nucleotide polymorphism (SNP) microarray on embryonic development potential in preimplantation genetic diagnosis (PGD), we retrospectively analyzed the clinical data generated by PGD using embryos retrieved from parents with chromosome rearrangements in our center. In total, 929 embryos from 119 couples had exact diagnosis and development status. The blastocyst formation rate of balanced molecular karyotype embryos was 56.6% (276/488), which was significantly higher than that of genetic imbalanced embryos 24.5% (108/441) (P<0.001). No significant difference was detected in blastocyst formation rates in the groups of maternal age <30, 30-35 and >35 respectively. Blastocyst formation rates of male and female embryos were 44.5% (183/411) and 38.8% (201/518) respectively, with no significant difference between them (P>0.05). The rates of balanced molecular karyotype embryos vary from groups of embryos with different cell numbers at 68 hours after insemination. The blastocyst formation rate of embryos with 6-8 cells (48.1%) was significantly higher than that of embryos with <6 cells (23.9%) and with >8 cells (42.9%) (P<0.05). As for the unbalanced embryos, there was no significant difference of the distribution of abnormal molecular karyotypes in the subgroup of the arrest, morula and blastocyst. Thus, we conclude that embryos with balanced molecular karyotype have significant higher development potential than those with imbalanced molecular karyotype whilst maternal age, embryo gender and types of abnormal molecular karyotype have no significant influence on blastocyst formation. Compared with embryos with <6 and >8 cells, embryos with 6-8 blastomeres have higher rate of balanced molecular karyotype and blastocyst formation.
Collapse
Affiliation(s)
- Gang Li
- Reproductive Medical Center, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Nannan He
- Reproductive Medical Center, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Haixia Jin
- Reproductive Medical Center, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yan Liu
- Reproductive Medical Center, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yihong Guo
- Reproductive Medical Center, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yingchun Su
- Reproductive Medical Center, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yingpu Sun
- Reproductive Medical Center, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- * E-mail:
| |
Collapse
|
24
|
Increased blastomere number in cleavage-stage embryos is associated with higher aneuploidy. Fertil Steril 2014; 103:694-8. [PMID: 25557243 DOI: 10.1016/j.fertnstert.2014.12.090] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2014] [Revised: 11/18/2014] [Accepted: 12/01/2014] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To evaluate the relationship between blastomere number and aneuploidy. DESIGN Historical cohort study. SETTING In vitro fertilization clinic. PATIENT(S) Two hundred fifty-nine patients undergoing in vitro fertilization (IVF) in combination with comprehensive chromosomal screening of embryos. INTERVENTION(S) A total of 1,915 embryos were biopsied on day 3 and underwent comprehensive chromosomal screening with microarray-based comparative genomic hybridization. MAIN OUTCOME MEASURE(S) Relationship between day 3 blastomere number, aneuploidy rate, and progression to the blastocyst stage. RESULT(S) A number of day 3 blastomeres >9 was associated with significantly increased aneuploidy rates. Rapidly developing embryos were significantly more likely to blastulate regardless of their chromosomal status. Number of embryos per patient greater than 13 was independently associated with lower aneuploidy rates after controlling for maternal age. This trend was not significant with the use of a more clinically relevant threshold of greater than six embryos per patient. CONCLUSION(S) Embryos with 6-9 cells at the cleavage stage should be considered for transfer over embryos with >9 cells. Day 3 blastomere number may be used in conjunction with extended culture to improve selection of euploid embryos, especially when supernumerary embryos are available. Further studies are needed to show if these selection criteria improve clinical outcomes.
Collapse
|
25
|
Stone BA, March CM, Ringler GE, Baek KJ, Marrs RP. Casting for determinants of blastocyst yield and of rates of implantation and of pregnancy after blastocyst transfers. Fertil Steril 2014; 102:1055-64. [DOI: 10.1016/j.fertnstert.2014.06.049] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Revised: 06/30/2014] [Accepted: 06/30/2014] [Indexed: 10/24/2022]
|
26
|
Embryo culture and selection: morphological criteria. Methods Mol Biol 2014; 1154:501-32. [PMID: 24782025 DOI: 10.1007/978-1-4939-0659-8_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
In this chapter, we have outlined the various morphological criteria for selection of the best embryo at each important milestone encountered in the progress from the oocyte to the blastocyst. As Gerris et al. stated, a combination of one, two, or even three selection points should lead to a more accurate selection of the best embryo, as no one criterion is better than the other. An embryo that fails to meet the entire set of selection criteria must be avoided as culture cannot correct an impaired embryo.
Collapse
|
27
|
Is it acceptable to destroy or include human embryos before day 5 in research programmes? Reprod Biomed Online 2014; 28:522-9. [PMID: 24581988 DOI: 10.1016/j.rbmo.2013.12.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 12/13/2013] [Accepted: 12/17/2013] [Indexed: 11/21/2022]
Abstract
Day-3 poor-quality embryos (PQE) from IVF-embryo transfer cycles are usually destroyed or are included in research programmes. Knowing that these embryos have the ability to evolve to the blastocyst stage and yield embryonic stem cell lines, this study postulated that they could also give rise to live births. This is a prospective study including 186 IVF-embryo transfer candidates who had obtained at least one supernumerary PQE on day 3. PQE were kept for extended culture and high-quality blastocysts were frozen. A total of 620 PQE were eligible for the study, 217 (35.0%) reached the blastocyst stage and 73 (33.6%) were frozen. Blastulation rates were 7-fold higher (OR 7.29, 95% CI 5.01-10.61) in embryos compacted on day 4. Of the frozen blastocysts, 40 were thawed during 33 thawed blastocyst transfer cycles, which led to 10 clinical pregnancies. These pregnancies resulted in five miscarriages and five healthy live births at full term. PQE may achieve their development to the blastocyst stage, be frozen-thawed and harbour reasonable implantation potential. These results, thereby, raise an ethical issue regarding the fate reserved to PQE.
Collapse
|
28
|
Le Cruguel S, Ferré-L'Hôtellier V, Morinière C, Lemerle S, Reynier P, Descamps P, May-Panloup P. Early compaction at day 3 may be a useful additional criterion for embryo transfer. J Assist Reprod Genet 2013; 30:683-90. [PMID: 23563915 DOI: 10.1007/s10815-013-9983-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2012] [Accepted: 03/15/2013] [Indexed: 11/30/2022] Open
Abstract
PURPOSE The reduction of the number of embryos transferred while maintaining a satisfactory rate of pregnancy (PR) with in vitro fertilization calls for a refined technique of embryonic selection. This prospective study investigates the significance of early embryonic compaction at day 3 as a marker of the chances of implantation. METHODS We examined 317 transfers and their outcome involving 509 embryos including 91 compacted embryos. RESULTS Early compaction seems linked with the ovarian response to stimulation and embryonic quality. The PR is significantly increased when the embryonic cohort contains at least one compacted embryo (44% versus 29.5%, p = 0.01), and when at least one compacted embryo is transferred (44% versus 31%, p < 0.05). The analysis of our single embryo transfers shows that the implantation rates are significantly better for compacted embryos (50% versus 30%, p < 0.05) (OR 2.98; CI 1.02-5.28). CONCLUSION Thus, early compaction, sometimes observed at day 3, may serve as a useful additional criterion for selecting the embryos transferred.
Collapse
Affiliation(s)
- Sébastien Le Cruguel
- Laboratoire de Biologie de la Reproduction, Centre Hospitalier Universitaire d'Angers, Angers, France
| | | | | | | | | | | | | |
Collapse
|
29
|
Clinical factors associated with live birth after single embryo transfer. Fertil Steril 2012; 98:1152-6. [PMID: 22959461 DOI: 10.1016/j.fertnstert.2012.07.1141] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Revised: 07/19/2012] [Accepted: 07/31/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To identify patient, cycle, and retrieval characteristics associated with embryo implantation and live birth in patients undergoing single embryo transfer (SET). DESIGN Analysis of prospectively collected IVF database. SETTING Academic IVF program. PATIENT(S) All patient cycles meeting criteria for SET between June 2004 and September 2010. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Clinical pregnancy and live birth. RESULT(S) Single embryo transfer was performed in 438 cycles, resulting in a clinical pregnancy rate of 76.2% and a live birth rate of 66.8% per transfer. Clinical pregnancy was associated with younger female age, ≥ 58% mature (metaphase II) oocytes at the time of retrieval, and increasing blastocyst expansion. Ongoing pregnancy was associated with younger female age and more advanced blastocysts. A diagnosis of uterine factor was negatively associated with live birth. CONCLUSION(S) Even in a favorable prognosis population, younger female age is associated with clinical pregnancy and live birth. Although all patients underwent blastocyst transfer, expanded and hatching blastocysts were strongly associated with pregnancy and live birth. A diagnosis of uterine factor was the only infertility diagnosis found to affect live birth after SET. Obesity did not negatively affect SET outcome. These findings may assist physicians in determining the best candidates for SET.
Collapse
|
30
|
Prediction of human blastocyst development from morulas with delayed and/or incomplete compaction. Fertil Steril 2011; 96:1473-1478.e2. [DOI: 10.1016/j.fertnstert.2011.09.015] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2011] [Revised: 09/06/2011] [Accepted: 09/06/2011] [Indexed: 11/23/2022]
|
31
|
Ahlstrom A, Westin C, Reismer E, Wikland M, Hardarson T. Trophectoderm morphology: an important parameter for predicting live birth after single blastocyst transfer. Hum Reprod 2011; 26:3289-96. [DOI: 10.1093/humrep/der325] [Citation(s) in RCA: 182] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
32
|
Effect of the new legislation and single-embryo transfer policy in Turkey on assisted reproduction outcomes: preliminary results. Reprod Biomed Online 2011; 22:208-14. [DOI: 10.1016/j.rbmo.2010.10.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2010] [Revised: 10/15/2010] [Accepted: 10/19/2010] [Indexed: 11/19/2022]
|
33
|
Guerif F, Lemseffer M, Leger J, Bidault R, Cadoret V, Chavez C, Gasnier O, Saussereau M, Royere D. Does early morphology provide additional selection power to blastocyst selection for transfer? Reprod Biomed Online 2010; 21:510-9. [DOI: 10.1016/j.rbmo.2010.06.043] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2009] [Revised: 06/26/2010] [Accepted: 06/29/2010] [Indexed: 12/01/2022]
|
34
|
Kader AA, Choi A, Orief Y, Agarwal A. Factors affecting the outcome of human blastocyst vitrification. Reprod Biol Endocrinol 2009; 7:99. [PMID: 19758458 PMCID: PMC2757025 DOI: 10.1186/1477-7827-7-99] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2009] [Accepted: 09/16/2009] [Indexed: 11/10/2022] Open
Abstract
With single blastocyst transfer practice becoming more common in ART, there is a greater demand for a convenient and reliable cryostorage of surplus blastocysts. Vitrification has emerged in the last decade as an alternative promising substitute for slow freezing. Blastocysts represent a unique challenge in cryostorage due to their size, multicellular structure and presence of blastocoele. The continuous acquisition of experience and introduction of many different technological developments has led to the improvement of vitrification as a technology and improved the results of its application in blastocyst cryostorage. The current information concerning safety and efficacy of the vitrification of blastocysts will be reviewed along with the variables that can impact the outcome of the procedure.
Collapse
Affiliation(s)
- Amr A Kader
- Center for Reproductive Medicine, Glickman Urological and Kidney Institute, Ob/Gyn and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Department of Obstetrics and Gynecology, University of Alexandria, Alexandria, Egypt
- Center of Surgical Innovation, Technology and Education, Cleveland Clinic, Cleveland, Ohio, USA
| | - Audrey Choi
- Center for Reproductive Medicine, Glickman Urological and Kidney Institute, Ob/Gyn and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Yasser Orief
- Center for Reproductive Medicine, Glickman Urological and Kidney Institute, Ob/Gyn and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Center of Surgical Innovation, Technology and Education, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ashok Agarwal
- Center for Reproductive Medicine, Glickman Urological and Kidney Institute, Ob/Gyn and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio, USA
| |
Collapse
|
35
|
Weissman A, Biran G, Nahum H, Glezerman M, Levran D. Blastocyst culture and transfer: lessons from an unselected, difficult IVF population. Reprod Biomed Online 2008; 17:220-8. [PMID: 18681996 DOI: 10.1016/s1472-6483(10)60198-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Blastocyst-stage transfer has yielded excellent results in good prognosis IVF patients, but its efficacy in the general IVF population has not been clearly demonstrated. The objective of this study was to compare cleavage-stage and blastocyst-stage transfer in a mixed, general IVF population. In a prospective, quasi-randomized study, 152 patients underwent 164 treatment cycles. Patients were allocated to cleavage-stage (group 1; n = 94) or blastocyst-stage (group 2; n = 70) transfer. Main outcome measures included implantation, clinical pregnancy and live birth rates. Implantation (11.2% versus 15.5%), clinical pregnancy (34% versus 21%) and live birth rates per transfer (21.3% versus 13.8%) and per started cycle (21.3% versus 11.4%) were all comparable for groups 1 and 2, respectively. Logistic regression analysis revealed that blastocyst culture and transfer reduced the odds for pregnancy in the general IVF population and defined a good prognosis group for blastocyst transfer. Introducing blastocyst culture and transfer to all IVF patients is not advantageous. Blastocyst transfer should be offered primarily to good prognosis patients, and this group should be specifically defined in each clinical set-up.
Collapse
Affiliation(s)
- Ariel Weissman
- Department of Obstetrics and Gynecology, IVF Unit, Wolfson Medical Centre, Holon, Israel.
| | | | | | | | | |
Collapse
|
36
|
Shapiro BS, Daneshmand ST, Garner FC, Aguirre M, Thomas S. Large blastocyst diameter, early blastulation, and low preovulatory serum progesterone are dominant predictors of clinical pregnancy in fresh autologous cycles. Fertil Steril 2008; 90:302-9. [PMID: 17905239 DOI: 10.1016/j.fertnstert.2007.06.062] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2007] [Revised: 06/20/2007] [Accepted: 06/20/2007] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To identify dominant predictors of clinical pregnancy in IVF cycles. DESIGN Retrospective study. SETTING Private fertility center. PATIENT(S) The study included 580 fresh autologous IVF cycles with blastocyst transfer. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Clinical pregnancy rate. RESULT(S) A set of 25 suspected predictors was used to develop predictive models of clinical pregnancy in a set of 361 blastocyst transfer cycles. Initial bivariate analysis identified 14 of these variables that were significant enough to be candidate variables for multiple logistic regression. Similar sets of significant variables were identified by using alternative approaches for model construction. The final model included blastocyst diameter, day of blastulation, and preovulatory serum P level as significant predictors of clinical pregnancy. Specifically, clinical pregnancy was predicted by preovulatory serum P of <1.0 ng/mL, blastulation on day 5, and large blastocyst diameter. Of these variables, blastocyst diameter was the most significant predictor of clinical pregnancy in the multivariate models. The final model was validated against a separate set of 219 subsequent blastocyst transfer cycles. CONCLUSION(S) Pre-ovulatory serum P level, blastulation day, and embryo diameter are simultaneously predictive of clinical pregnancy, and their relationships with clinical pregnancy are consistent with an effect of embryo-endometrium synchrony.
Collapse
Affiliation(s)
- Bruce S Shapiro
- Fertility Center of Las Vegas, Las Vegas, Nevada 89117, USA.
| | | | | | | | | |
Collapse
|
37
|
Yamamoto S, Umeki M, Hamano T, Matsusita F, Kuwahara K. Elective cryopreservation of all day 5 blastocysts is more effective than using day 6 blastocysts for improving pregnancy outcome in stimulated cycles. Reprod Med Biol 2008; 7:75-83. [PMID: 29662418 DOI: 10.1111/j.1447-0578.2008.00203.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Aim: To evaluate the efficacy of cryopreservation of all blastocysts for future transfers in stimulated cycles. Methods: We carried out fresh blastocyst transfer cycles on day 5 (n = 290) or day 6 (n = 119) and thawed blastocyst transfer cycles that were frozen on day 5 (n = 136), day 6 (n = 71) or day 6 electively (n = 21). We retrospectively compared the clinical outcome of fresh blastocyst transfers with thawed blastocyst transfers according to the day of blastocyst transfer or freezing. Results: The clinical implantation rates in women with stimulated cycles were significantly higher after the transfer of thawed blastocysts compared with the transfer of fresh blastocysts (day 5, P < 0.0005; day 6, P < 0.00005). Although the implantation rate of fresh day 6 transfer cycles was lower than that of elective day 6 frozen-thawed cycles, this difference was not statistically significant (P = 0.17). Conclusions: Thawed blastocysts demonstrated a better potential for implantation when compared with fresh blastocysts in stimulated cycles. We concluded that elective cryopreservation of all blastocysts on day 5 is an effective option to improve the clinical outcome in stimulated cycles. Additionally, with cryopreservation of all day 6 blastocysts, the implantation rates of first embryo transfers may increase by allowing the best-quality blastocysts to be transferred in thawed cycles. (Reprod Med Biol 2008; 7: 75-83).
Collapse
|
38
|
Luna M, Copperman AB, Duke M, Ezcurra D, Sandler B, Barritt J. Human blastocyst morphological quality is significantly improved in embryos classified as fast on day 3 (≥10 cells), bringing into question current embryological dogma. Fertil Steril 2008; 89:358-63. [PMID: 17531231 DOI: 10.1016/j.fertnstert.2007.03.030] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2006] [Revised: 03/05/2007] [Accepted: 03/07/2007] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate developmental potential of fast cleaving day 3 embryos. DESIGN Retrospective analysis. SETTING Academic reproductive center. PATIENT(S) Three thousand five hundred twenty-nine embryos. INTERVENTION(S) Day 3 embryos were classified according to cell number: slow cleaving: <or=6 cells, intermediate cleaving: 7-9 cells, and fast cleaving: >or=10 cells, and further evaluated on day 5. The preimplantation genetic diagnosis (PGD) results of 43 fast cleaving embryos were correlated to blastocyst formation. Clinical outcomes of transfers involving only fast cleaving embryos (n = 4) were evaluated. MAIN OUTCOME MEASURE(S) Blastocyst morphology correlated to day 3 blastomere number. Relationship between euploidy and blastocyst formation of fast cleaving embryos. Implantation, pregnancy (PR), and birth rates resulting from fast embryo transfers. RESULT(S) Blastocyst formation rate was significantly greater in the intermediate cleaving (72.7%) and fast cleaving (54.2%) groups when compared to the slow cleaving group (38%). Highest quality blastocysts were formed significantly more often in the fast cleaving group. Twenty fast cleaving embryos that underwent PGD, formed blastocysts, of which 45% (9/20) were diagnosed as euploid. Aneuploidy was diagnosed in 82.6% (19/23) of arrested embryos. A 50% implantation and 100% PR and birth rate were achieved with embryo transfers involving fast cleaving embryos. CONCLUSION(S) Fast cleaving embryos not only reach the blastocyst stage at a similar rate to intermediate cleaving embryos, but also exceed morphological quality criteria on day 5. Fast cleaving embryo transfers demonstrated a high clinical potential.
Collapse
Affiliation(s)
- Martha Luna
- Mount Sinai School of Medicine, Department of Obstetrics and Gynecology, New York, New York 10022, USA
| | | | | | | | | | | |
Collapse
|
39
|
Levens ED, Whitcomb BW, Hennessy S, James AN, Yauger BJ, Larsen FW. Blastocyst development rate impacts outcome in cryopreserved blastocyst transfer cycles. Fertil Steril 2008; 90:2138-43. [PMID: 18178191 DOI: 10.1016/j.fertnstert.2007.10.029] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2007] [Revised: 10/24/2007] [Accepted: 10/24/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To assess cycle outcome among day 5 and day 6 cryopreserved frozen-thawed blastocyst embryo transfers (FBET). DESIGN Retrospective cohort study. SETTING Military-based assisted reproduction technology (ART) center. PATIENT(S) One hundred seventy-two nondonor, programmed cryopreserved embryo cycles. INTERVENTION(S) Fully expanded blastocysts on day 5 were cryopreserved on day 5, and those achieving this state on day 6 were cryopreserved on day 6. Leuprolide acetate was given for ovulation inhibition, and endometrial supplementation was by oral and vaginal estradiol. Progesterone in oil was administered, and blastocyst transfer occurred in the morning of the sixth day of progesterone. MAIN OUTCOME MEASURE(S) Implantation, pregnancy, and live-birth rates. RESULT(S) Fresh and frozen cycle characteristics were similar between groups. Day-5 FBET had statistically significantly higher implantation rates (32.2% vs. 19.2%), which remained significant even when adjusting for covariates (odds ratio: 1.91; 95% confidence interval, 1.00, 3.67). Live-birth rates trended toward improvement after adjusting for covariates (odds ratio: 1.18; 95% confidence interval, 0.61, 2.30). CONCLUSION(S) Cryopreserved day-5 blastocysts have higher implantation rates and trend toward improved pregnancy outcomes compared with cryopreserved day-6 blastocysts. This suggests that embryo development rate may, in part, predict implantation and subsequent FBET outcomes, although embryos not achieving the blastocyst stage until day 6 still demonstrate acceptable outcomes.
Collapse
Affiliation(s)
- Eric D Levens
- Walter Reed Army Medical Center ART Program, Washington, DC, USA.
| | | | | | | | | | | |
Collapse
|
40
|
Bongso A, Tan S. Human blastocyst culture and derivation of embryonic stem cell lines. ACTA ACUST UNITED AC 2007; 1:87-98. [PMID: 17142843 DOI: 10.1385/scr:1:2:087] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Human embryonic stem cell (hESC) biology is expected to revolutionize the future of medicine by the provision of cell-based therapies for the treatment of a variety of deliberatig diseases. The tremendous versatility of hESCs has reinforced this hope. To understand the biology of these mysterious cells and attempt to differentiate them into desirable tissues, bona fide hESCs that maintain their stability with time are required for research and clinical application. This review discusses the various protocols to derive and propagate hESCs from high quality embryos. The nature and properties of hESCs are also described together with unanswered questions that need to be addressed if this science is to be taken to the bedside.
Collapse
Affiliation(s)
- Ariff Bongso
- Department of Obstetrics and Gynaecology, National University of Singapore, Kent Ridge, Singapore 119074.
| | | |
Collapse
|
41
|
The rate at which serum total beta-subunit human chorionic gonadotropin increases after embryo transfer is a predictor of the viability of pregnancy and an identifier of determinants of pregnancy. Fertil Steril 2006; 86:1626-33. [PMID: 17081527 DOI: 10.1016/j.fertnstert.2006.04.048] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2005] [Revised: 04/28/2006] [Accepted: 04/28/2006] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine whether elements of treatment associated with faster doubling times of total beta-hCG in serum (beta-t2) in pregnant patients are also associated with a higher likelihood of pregnancy in all patients. DESIGN Retrospective analysis of beta-t2 values, elements of ovarian stimulation (COH), and outcomes. SETTING Private assisted reproductive technology (ART) center. PATIENT(S) Initial analysis of data from 432 cycles in which conception occurred after COH and embryo transfer, followed by analysis of pregnancy outcomes after 1,287 cycles of COH/ embryo transfer. INTERVENTION(S) No interventions. MAIN OUTCOME MEASURES The beta-t2 values initially computed from consecutive serum beta-hCG levels in ongoing pregnancies were correlated with multiple properties of the patients and their treatment cycles. RESULT(S) The beta-t2 values during early pregnancy increased exponentially from about 1.6 days at 12 days to about 3.0 days at 24 days after embryo transfer. In those pregnancies which spontaneously aborted, early average beta-t2 values were higher than those for ongoing pregnancies; absolute beta-hCG levels did not differ. Positive correlations were established between beta-t2 values, the number of days of stimulation, and the number of ampules of drug administered per oocyte retrieved. The beta-t2 values were inversely related to average numbers of blastomeres in transferred embryos. Ongoing pregnancy rates (PR) were higher for cycles with lower gonadotropin dosages per oocyte retrieved, and when the average number of blastomeres in transferred embryos was higher. CONCLUSION(S) Steeper beta-hCG doubling times in early pregnancy were associated with lower gonadotropin dosages during ovarian stimulation and with higher numbers of blastomeres in transferred embryos. The latter variables were, in turn, associated with a higher likelihood of pregnancy after embryo transfer.
Collapse
|
42
|
Munné S. Chromosome abnormalities and their relationship to morphology and development of human embryos. Reprod Biomed Online 2006; 12:234-53. [PMID: 16478592 DOI: 10.1016/s1472-6483(10)60866-8] [Citation(s) in RCA: 185] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This review covers the relationship between chromosome abnormalities, morphological abnormalities and embryonic development. The baseline of chromosome abnormalities in human embryos produced by assisted reproduction is higher than 50%, regardless of maternal age. While aneuploidy increases with maternal age, abnormalities arising post-meiotically, such as mosaicism, chaoticism, polyploidy and haploidy, have similar incidence in all age groups (about 33%). Post-meiotic abnormalities do increase with dysmorphism. The most common dysmorphisms found in cleavage-stage embryos are multinucleation, fragmentation and uneven cells, among others. All dysmorphisms are associated with an increase in post-meiotic chromosome abnormalities and a decreased implantation potential. Similarly, embryos developing slowly or with arrested development have higher incidence of post-meiotic abnormalities than normally developing ones. Chromosome studies in blastocysts indicate that mosaicism is the most common abnormality but that the load of abnormal cells decreases with increasing blastocyst quality. Regardless of blastocyst quality, more than 40% of mosaics are still chromosomally abnormal and will not implant or will spontaneously abort. Because aneuploidy is not related to cleavage stage dysmorphism and trisomies can reach blastocyst stage and beyond, morphological analysis is not enough to select against chromosome abnormalities, and thus preimplantation genetic diagnosis should be recommended in patients 35 and older.
Collapse
|
43
|
Montag M, van der Ven K, Dorn C, van der Ven H. Extended embryo culture reduces the implantation rate on day 4 and day 5 when only a maximum of three embryos are cultured beyond the pronuclear stage. Eur J Obstet Gynecol Reprod Biol 2006; 124:65-9. [PMID: 16188376 DOI: 10.1016/j.ejogrb.2005.08.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2004] [Revised: 07/27/2005] [Accepted: 08/12/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To study the potential of embryo transfer after 3, 4 or 5 days of embryo culture under the German embryo protection law according to which only a maximum of three zygotes are allowed to be cultured for embryo transfer. STUDY DESIGN In a prospective study, 273 patients with assisted reproductive treatment were randomly allocated for transfer on days 3, 4 or 5. Pregnancy and implantation rates were evaluated in regard to day of transfer and results were compared by Chi-square or ANOVA test. RESULTS Out of 234 transfer cycles, 79 were performed on day 3, 76 on day 4 and 79 on day 5. Pregnancy and implantation rates were 41.8%/27.1% for transfer on day 3, 27.6%/14.1% for day 4 transfer and 16.5%/8.8% for transfer on day 5. These results were significantly different for pregnancy rates on day 3 versus day 5 (P < 0.001) and for implantation rates on day 3 versus day 4 (P < 0.005) and day 3 versus day 5 (P < 0.001). CONCLUSIONS These findings suggest that extended embryo culture is not beneficial when the option for embryo selection at later stages of development is not available.
Collapse
Affiliation(s)
- Markus Montag
- Department of Gynecological Endocrinology and Reproductive Medicine, University Clinics Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany.
| | | | | | | |
Collapse
|
44
|
Borges E, Rossi LM, Farah LMS, Guilherme P, Rocha CC, Ortiz V, Iaconelli A. The impact of pronuclear orientation to select chromosomally normal embryos. J Assist Reprod Genet 2005; 22:107-14. [PMID: 16018240 PMCID: PMC3455178 DOI: 10.1007/s10815-005-4874-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
PURPOSE To find an effective method to select embryos from ICSI with better chromosomal status when preimplantation-genetic-diagnosis (PGD) is not applied. METHODS Several morpholological evaluations were done in same embryos. Embryos from ICSI were classified on day 1 according to pronuclear-nucleoli arrangement. On day 3, classification was done according to number, fragmentation, size and shape of cells. In some patients, embryos exhibiting good quality on day 3 (at least six regular blastomeres with cell fragmentation lower than 20%) were also submitted to PGD, irrespective to pronuclear-nucleoli morphology. RESULTS Forty-two per cent of normally fertilized embryos showed pronuclear-nucleoli-good-morphology; from those, 86% were also classified as good quality on day 3. Good-quality embryos submitted to PGD have shown lower chromosomal abnormality rates when also classified as pronuclear-nucleoli-good-morphology. CONCLUSIONS Pronuclear-nucleoli morphology seems to be correlated with PGD results. This criterion may prove useful for pre-select embryos with normal chromosomal package when PGD is not applied.
Collapse
Affiliation(s)
- Edson Borges
- Fertility–Centro de Fertilização Assistida, São Paulo, Brazil
| | - Lia Mara Rossi
- Fertility–Centro de Fertilização Assistida, São Paulo, Brazil
- Fertility Center, Medical School at Jundiaí, S.P., Brazil
- Fertility - Centro de Fertilização Assistida, Avenida Brigadeiro Luís Antônio, 4.251, São Paulo/SP, 01402-002 Brazil
| | - Leila M. S. Farah
- Fertility–Centro de Fertilização Assistida, São Paulo, Brazil
- Genetics Laboratory, São Paulo, S.P., Brazil
| | | | | | - Valdemar Ortiz
- Fertility–Centro de Fertilização Assistida, São Paulo, Brazil
- Federal University of São Paulo, S.P., Brazil
| | | |
Collapse
|
45
|
Rienzi L, Ubaldi F, Iacobelli M, Romano S, Minasi MG, Ferrero S, Sapienza F, Baroni E, Greco E. Significance of morphological attributes of the early embryo. Reprod Biomed Online 2005; 10:669-81. [PMID: 15949228 DOI: 10.1016/s1472-6483(10)61676-8] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
There are many morphological transformations during development of human embryos that mainly involve phenomena that can be easily assessed in living embryos by simple non-invasive microscopical observation. A clear correlation between pronuclear morphology and the ability of the resulting embryo to continue developing and to implant has been described. There is also general agreement that a positive relationship exists between early embryo morphology and implantation rate. The parameters classically involved in embryo evaluation are: cleavage rate, blastomere symmetry, cytoplasmic appearance, extent of fragmentation and blastomere nuclear status. In this paper, morphological features that have been related to embryo developmental potential are described. Furthermore, the ability of a cumulative classification scheme developed in the laboratory to predict blastocyst formation and implantation is analysed.
Collapse
Affiliation(s)
- Laura Rienzi
- Centre for Reproductive Medicine, European Hospital, Via Portuense 700, 00149 Rome, Italy.
| | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Stone BA, Greene J, Vargyas JM, Ringler GE, Marrs RP. Embryo fragmentation as a determinant of blastocyst development in vitro and pregnancy outcomes following embryo transfer. Am J Obstet Gynecol 2005; 192:2014-9; discussion 2019-20. [PMID: 15970880 DOI: 10.1016/j.ajog.2005.02.048] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE(S) To determine how the type of embryo fragmentation on day 3 affects progression of human embryos to blastocyst and pregnancy rates following embryo transfer. STUDY DESIGN Retrospective analysis of all in vitro fertilization cycles in patients < or =40 years of age or younger from January 2002 through December 2003, during which time surplus day 3 embryos were transferred to blastocyst medium for extended culture. All embryos (4 cells or more) not suitable for transfer or freezing 72 hours following in vitro fertilization were placed into microdroplets (60 microL) of blastocyst medium and cultured for an additional 48 hours to assess blastocyst formation. Normal blastocyst development required blastulation, a visible inner-cell mass, trophectoderm cells covering 60% of the inner zona surface and thinning of the zona. The rate of blastocyst formation was then analyzed (chi 2 and analysis of variance) against the type of fragmentation 72 hours after insemination. Pregnancy outcomes were analyzed with respect to the pattern of fragmentation in cleaving embryos transferred after 3 days of culture. RESULTS A total of 1566 embryos were cultured beyond day 3 of development of which 229 (14.6%) reached the blastocyst stage and were frozen. Embryos exhibiting no fragmentation or type I fragmentation had significantly higher blastocyst development rates (27.9% and 19.9%) than embryos with type 2 or 3 fragmentation (13.9 and 8.8, respectively; P < .001). No embryos with type 4 or 5 fragmentation progressed to blastocyst. The average type of fragmentation in transferred embryos correlated with pregnancy outcome and embryo age. CONCLUSION(S) More pervasive embryo fragmentation was associated with a decreasing rate of blastocyst development with day 3 embryos. To the extent that blastocyst development rates of day 3 embryos is an index of embryo viability, our findings establish that careful classification of the type of embryo fragmentation is important in selection of day 3 embryos for transfer. Recent reports of associations among embryo fragmentation, aneuploidy, apoptosis, and patient age support these conclusions.
Collapse
Affiliation(s)
- Bronte A Stone
- California Fertility Partners and Institute for Fertility Research, Los Angeles, USA
| | | | | | | | | |
Collapse
|
47
|
Hammitt DG, Sattler CA, Manes ML, Singh AP. Selection of embryos for day-3 transfer at the pronuclear-stage and pronuclear-stage cryopreservation results in high delivery rates in fresh and frozen cycles. J Assist Reprod Genet 2004; 21:271-8. [PMID: 15526985 PMCID: PMC3455180 DOI: 10.1023/b:jarg.0000042013.62311.b2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Evaluate IVF-ET outcome data for a unique culture and cryopreservation strategy. METHODS Retrospective study of 92 patients. Embryos for day-3 transfer were selected at pronuclear-stage; all extra zygotes were cryopreserved at pronuclear-stage. RESULTS Delivery rates for Anonymous Oocyte Donation (Group I), patients <35 years (Group II), and 35-38 years (Group III) were 52.9%, 61.5%, and 51.7% for fresh and 38.5%, 33.3%, and 40.0% for frozen transfer. Deliveries per retrieval were 82.3%, 71.8%, and 58.6%. Only 0.88, 0.80, and 0.61 more zygotes were cultured than what were used for fresh transfer. Singleton, twin, and triplet rates were 64.6%, 31.2%, and 4.2% for fresh and 69.2%, 30.8%, and 0% for frozen. CONCLUSIONS Selection of day-3 transfer embryos at the pronuclear-stage and cryopreservation of extra zygotes results in high delivery rates in fresh and frozen cycles. This approach optimizes deliveries per retrieval and provides many patients with more than one pregnancy per retrieval.
Collapse
Affiliation(s)
- Diane G Hammitt
- Center for Reproductive Medicine, Mayo Clinic Scottsdale, Thunderbird Women's Health Center, 13737 North 92nd Street, Scottsdale, Arizona 85260, USA.
| | | | | | | |
Collapse
|
48
|
Abstract
This review considers the value of single embryo transfer (SET) to prevent multiple pregnancies (MP) after IVF/ICSI. The incidence of MP (twins and higher order pregnancies) after IVF/ICSI is much higher (approximately 30%) than after natural conception (approximately 1%). Approximately half of all the neonates are multiples. The obstetric, neonatal and long-term consequences for the health of these children are enormous and costs incurred extremely high. Judicious SET is the only method to decrease this epidemic of iatrogenic multiple gestations. Clinical trials have shown that programmes with >50% of SET maintain high overall ongoing pregnancy rates ( approximately 30% per started cycle) while reducing the MP rate to <10%. Experience with SET remains largely European although the need to reduce MP is accepted worldwide. An important issue is how to select patients suitable for SET and embryos with a high putative implantation potential. The typical patient suitable for SET is young (aged <36 years) and in her first or second IVF/ICSI trial. Embryo selection is performed using one or a combination of embryo characteristics. Available evidence suggests that, for the overall population, day 3 and day 5 selection yield similar results but better than zygote selection results. Prospective studies correlating embryo characteristics with documented implantation potential, utilizing databases of individual embryos, are needed. The application of SET should be supported by other measures: reimbursement of IVF/ICSI (earned back by reducing costs), optimized cryopreservation to augment cumulative pregnancy rates per oocyte harvest and a standardized format for reporting results. To make SET the standard of care in the appropriate target group, there is a need for more clinical studies, for intensive counselling of patients, and for an increased sense of responsibility in patients, health care providers and health insurers.
Collapse
Affiliation(s)
- Jan M R Gerris
- Centre for Reproductive Medicine, Middelheim Hospital, Lindendreef 1, Antwerp, Belgium.
| |
Collapse
|
49
|
Lahav-Baratz S, Koifman M, Shiloh H, Ishai D, Wiener-Megnazi Z, Dirnfeld M. Analyzing factors affecting the success rate of frozen-thawed embryos. J Assist Reprod Genet 2004; 20:444-8. [PMID: 14714822 PMCID: PMC3455644 DOI: 10.1023/b:jarg.0000006705.46147.a2] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE In recent years the infertile population applying for IVF treatments was changed and so the indications for performing intracellular sperm injection (ICSI). The aim of this study was to analyze predicting factors of our thawing cycles. METHODS From December 1998 to July 2001, 440 consecutive thawing cycles were performed. Patient characteristics were examined. The number of cryopreserved embryos, number of transferred embryos, the timing of cryopreservation (48 h vs. 72 h), and embryo survival rate were analyzed as a possible predictor for pregnancies achievement. RESULTS Conventional IVF patient's characteristic was significantly different from ICSI population and analysis has been performed for every population separately. In the IVF population the women age, the number of transferred embryos, and timing of cryopreservation were factors significantly influencing the pregnancy rate. Interestingly, in the ICSI population only the number of transferred embryos was found to be a predictive factor. CONCLUSION ICSI and IVF cycles should be analyzed separately. Not all the factors influencing the success rate in the conventional IVF population are valid in the ICSI population.
Collapse
Affiliation(s)
- S Lahav-Baratz
- Department of Obstetric and Gynecology, IVF unit, Carmel Medical Center, Haifa, Israel.
| | | | | | | | | | | |
Collapse
|
50
|
Abstract
One of the negative aspects of in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) is the increased risk of multiple pregnancies. There is an epidemic of twin pregnancies with a higher risk of obstetric, perinatal and neonatal complications than singleton pregnancies and with an important psychosocial, economic and financial impact for the parents to be. A reduction in the number of twins can only be obtained by the transfer of one embryo. Single embryo transfer with an acceptable pregnancy rate might be considered if a top quality embryo is available. The need to characterize embryos with optimal implantation potential is obvious. A top quality embryo is characterized by the presence of 4 or 5 blastomeres at day 2 and at least 7 blastomeres on day 3 after insemination, the absence of multinucleated blastomeres and<20% cellular fragments on day 2 and day 3 after fertilization. Others prognostic factors of implantation are discussed in this review. Judicious application of eSET can halve the twinning rate while maintaining the overall pregnancy rate.
Collapse
Affiliation(s)
- D de Neubourg
- Fertility Clinic, Department of Obstetrics-Gynaecology-Fertility, Middelheim Hospital, Antwerp, Belgique
| |
Collapse
|