Blastocyst culture in human IVF: the final destination or a stop along the way?

Clinical outcome analysis of frozen-thawed embryo transfer on Day 7

OBJECTIVE

To investigate the clinical outcomes of Day 7 (D7) frozen-thawed embryo transfer (FET) and to provide a reference value for clinical work.

METHODS

This was a retrospective cohort study. Patients undergoing FET cycles in the Reproductive Medicine Center of the Third Affiliated Hospital of Zhengzhou University between December 2015 and January 2021 were included. According to the developmental stage of the embryos at transfer, the embryos were divided into three groups: Day (D) 5, D6 and D7 blastocysts. Group D7 was compared with Groups D5 and D6. Simultaneously, the preimplantation genetic testing (PGT) and non-PGT cycles in Group D7 were analyzed and compared. The main outcomes were the clinical pregnancy, live birth and miscarriage rates. The secondary outcomes were the implantation and euploidy rates.

RESULTS

In total, 5945, 4094 and 137 FET cycles were included in the D5, D6 and D7 groups, respectively. The clinical pregnancy rate was significantly lower in Group D7 than in Groups D5 (13.9% vs 62.9%, P <0.001) and D6 (13.9% vs 51.4%, P <0.001). Additionally, the live birth rate was significantly lower in Group D7 than in Groups D5 (7.3% vs 50.7%, P <0.001) and D6 (7.3% vs 40.5%, P <0.001). However, the miscarriage rate was significantly higher in Group D7 than in Groups D5 (47.4% vs 18.2%, P =0.001) and D6 (47.4% vs 20.6%, P =0.004). The clinical pregnancy and live birth rates for D7 blastocysts were significantly higher in the PGT group than in the non-PGT group (41.7% vs 13.9%, P=0.012; 33.3% vs 7.3%, P =0.003).

CONCLUSIONS

D7 blastocyst transfer can yield a live birth rate that is lower than that for D5 and D6 blastocysts but has value for transfer. PGT for D7 blastocysts may reduce the number of ineffective transfers and improve the outcome of D7 blastocyst transfer, which can be performed according to a patient's situation.

Raman spectroscopy on live mouse early embryo while it continues to develop into blastocyst in vitro

Laser based spectroscopic methods can be versatile tools in investigating early stage mammalian embryo structure and biochemical processes in live oocytes and embryos. The limiting factor for using the laser methods in embryological studies is the effect of laser irradiation on the ova. The aim of this work is to explore the optimal parameters of the laser exposure in Raman spectroscopic measurements applicable for studying live early embryos in vitro without impacting their developmental capability. Raman spectra from different areas of mouse oocytes and 2-cells embryos were measured and analyzed. The laser power and exposure time were varied and further embryo development was evaluated to select optimal conditions of the measurements. This work demonstrates safe laser irradiation parameters can be selected, which allow acquisition of Raman spectra suitable for further analysis without affecting the early mouse embryo development in vitro up to morphologically normal blastocyst. The estimation of living embryo state is demonstrated via analysis and comparison of the spectra from fertilized embryo with the spectra from unfertilized oocytes or embryos subjected to UV laser irradiation. These results demonstrate the possibility of investigating preimplantation mammalian embryo development and estimating its state/quality. It will have potential in developing prognosis of mammalian embryos in assisted reproductive technologies.

Oviductal secretions: will they be key factors for the future ARTs?

A variety of evolutionary processes has led to the development of different organs to ensure that internal fertilization occur successfully. Fallopian tubes are a particularly interesting example of such organs. Some of the key events during fertilization and early embryo development occur in the oviduct. Knowledge of the different components described in the oviduct is extensive. Oviductal components include hormones, growth factors and their receptors that have important roles in the physiology of the oviduct and embryo development. Other oviductal factors protect the gamete and the embryos against oxidative stress and pathogens. Different proteins and enzymes are present in the oviductal fluid and have the ability to interact with the oocyte and the sperm before the fertilization occurs. Of special interest is the oviduct-specific glycoprotein (OVGP1), a glycoprotein that is conserved in different mammals, and its association with the zona pellucida (ZP). Interaction of the oocyte with oviductal secretions leads us to emphasize the concept of 'ZP maturation' within the oviduct. The ZP changes produced in the oviduct result in an increased efficiency of the in vitro fertilization technique in some animal models, contributing in particular to the control of polyspermy and suggesting that a similar role could be played by oviductal factors in human beings. Finally, attention should be given to the presence in the oviductal fluid of several embryotrophic factors and their importance in relation to the in vivo versus in vitro developmental ability of the embryos.

Culturing in vitro produced blastocysts in sequential media promotes ES cell derivation

Embryonic stem (ES) cell lines are routinely derived from in vivo produced blastocysts. We investigated the efficiency of ES cells derivation from in vitro produced blastocysts either in monoculture or sequential culture. Zygotes from hybrid F1 B6D2 mice were cultured in vitro to the blastocyst stage in Potassium (K(+)) simplex optimised medium (KSOM) throughout or in KSOM and switched to COOK blastocyst medium on day 3 (KSOM-CBM). Blastocysts were explanted on a feeder layer of mitomycin C-inactivated murine embryonic fibroblasts (MEF) in TX-WES medium for ES cell derivation. Sequential KSOM-CBM resulted in improved blastocyst formation compared to KSOM monoculture. ES cells were obtained from 32.1% of explanted blastocsyts cultured in KSOM-CBM versus 18.4% in KSOM alone. ES cell lines were characterized by morphology, expression of SSEA-1, Oct-4 and alkaline phosphatase activity, and normal karyotype. These results indicate that in vitro culture systems to produce blastocysts can influence the efficiency of ES cell line derivation.

The development of fertilized human ova to the blastocyst stage in KSOM(AA) medium: is a two-step protocol necessary?

Current protocols for the culture of human zygotes to blastocysts use two-step sequential media systems. The efficacy of a one-step system involving potassium simplex optimized medium (KSOM(AA)) has been investigated. In study 1, development of zygotes from days 1 to 3 in KSOM(AA) was compared with that for medium P-1. In study 2, embryos were cultured from days 1 to 3 in P-1 followed by culture from days 3 to 5 either in KSOM(AA) or medium CCM. In study 3, the ability of KSOM(AA) to support development of embryos from days 1 to 5, without medium renewal, was compared with the sequential media system P-1-->CCM. The cell numbers and fragmentation scores of day 3 embryos were distributed similarly following culture in KSOM(AA) or P-1. Significantly more KSOM(AA) embryos exhibited cytoplasmic pitting. Blastocyst formation rates were not significantly different whether embryos were cultured in the P-1-->KSOM(AA) or the P-1-->CCM systems, or when cultured from days 1 to 5 in KSOM(AA) without medium renewal or in P-1-->CCM. Five babies have been born from nine blastocysts transferred after extended culture in KSOM(AA). A one-step protocol involving KSOM(AA) can be used successfully to culture human zygotes to the blastocyst stage.