Laser scanning confocal imaging of abnormal or arrested human preimplantation embryos

The association between multinucleated blastomeres and poor ovarian response under the Bologna criteria

PURPOSE

To investigate the occurrence of multinucleated blastomeres (MNB) in poor ovarian response (POR) women defined under the Bologna criteria.

METHODS

This observational study was designed in a prospective controlled manner. Among 380 cases evaluated for eligibility, 102 women were found suitable and recruited; 51 with POR in accordance with the Bologna criteria defined as the study group and 51 with normal ovarian response defined as the control group.

RESULTS

Among the 51 women in each group, 8 and 2 did not achieve embryos in the study and control group, respectively (P < 0.05). The percentage of women that had at least one embryo with one MNB was significantly higher in the study as compared to the control group, corresponding to 49 and 29 %, respectively. The total number of embryos evaluated was 416; 167 in the study and 249 in the control groups. Among these embryos, the MNB rate was significantly higher in the study as compared to the control group, corresponding to 19 and 8 %, respectively.

CONCLUSIONS

Blastomere multinuclearity is significantly more common in women and embryos of POR cases, defined under the Bologna criteria. Future studies are warranted to substantiate our observation that has the potential to be clinically implemented in this sub-group of women undergoing assisted reproductive technologies (ART) treatment.

Embryo culture and selection: morphological criteria

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.

Involvement of BCL2 family members in the regulation of human oocyte and early embryo survival and death: gene expression and beyond

In women, up to 99.9% of the oocyte stockpile formed during fetal life is decimated by apoptosis. Apoptotic features are also detected in human preimplantation embryos both in vivo and in vitro. Despite the important consequences of cell death processes to oocyte competence and early embryonic development, little is known about its genetic and molecular control. B cell lymphoma-2 (BCL2) family proteins are major regulators of cell death and survival. Here, we present a literature review on BCL2 family expression and protein distribution in human and animal oocytes and early embryos. Most of the studies focused on the expression of two antagonistic members: the founding and survival family member BCL2 and its proapoptotic homolog BAX. However, recent transcriptomic analyses have identified novel candidate genes related to oocyte and/or early embryonic viability (such as BCL2L10) or commitment to apoptosis (e.g. BIK). Interestingly, some BCL2 proteins appear to be differentially distributed at the subcellular level during oocyte maturation and early embryonic development, a process probably linked to the functional compartmentalization of the ooplasm and blastomere. Assessment of BCL2 family involvement in regulating the survival of human oocytes and embryos may be of particular value for diagnosis and assisted reproductive technology. We suggest that implications of not only aberrant gene expression but also abnormal subcellular protein redistribution should be established in pathological conditions resulting in infertility.

Single embryo transfer in clinical practice

The high incidence of multiple pregnancies is the main reason for adverse treatment outcome in assisted reproduction. A good strategy to avoid multiple pregnancies is elective single embryo transfer and cryopreservation of spare embryos. Important factors in an elective single embryo transfer programme are good counselling of the patients and the selection of embryos with high implantation potential. In the infertility clinic at Helsinki University Central Hospital the elective single embryo transfer programme was started in 1997 and in 2000 the transfer policy turned to single embryo transfer as primary option. In 2003 60% of fresh transfers were elective single embryo transfers and 66% of frozen transfers were single embryo transfers. It has been shown that an elective single embryo transfer programme can be adopted in daily practice and that it decreases the multiple pregnancy rate, in our programme to around 7% with acceptable overall pregnancy and delivery rates. In Finland the increased use of single embryo transfer has reduced the proportion of multiple births. Finally, a good cryopreservation programme is essential to achieve a good cumulative delivery rate without multiple pregnancies.

Insights on blastomere nuclearity

PURPOSE

To analyze the results of our transferred embryos, especially those that "changed" their blastomere nuclearity from Multinucleated (MN) to Mono-nucleated during development.

METHODS

Pregnancies where at least one MN embryo was transferred were retrospectively evaluated and categorized in order to record and follow-up on the ones that were implanted. Embryos were classified as normal (when all blastomeres were mono-nucleated on day one and two of development), corrected (multinucleated embryos on day one that became mono-nucleated on day two) and non-corrected (multinucleated either on day one, on day two or both days).

RESULTS

There were 633 transfer cycles analyzed. Thirty-three percent (206) had at least one embryo with a MN blastomere at a given stage of development. Pregnancy and implantation rates were 29.0% and 19.0% for the group of exclusively mono-nucleated embryo transfers, and 28.6% and 15.8% for the group with at least one MN embryo transferred. The pregnancy outcome for "corrected" and "non-corrected" embryos could be corroborated unequivocally in only 9 cases, with an outcome of 8 and 4 normal babies, respectively.

CONCLUSIONS

Because the amount of data analyzed is not satisfactorily large, differences were not significantly different; however, a trend may exist showing that normal at term pregnancies obtained from corrected embryos are more likely to occur than those from non-corrected embryos. Nuclear observation on a daily basis should be one of the strategies used to select the best embryos for transferring, to improve implantation rates and avoid multiple pregnancies.

Genetic regulation of preimplantation embryo survival

Mammalian embryonic death is the most common outcome of fertilization. This review focuses on the recent advances concerning genetic regulation of preimplantation embryo survival. The predominant role of the Ped(preimplantation embryo development) gene, which regulates fast or slow cleavage of preimplantation mouse embryos, and its implication on embryo survival are discussed. Recent morphological and biochemical observations suggested that programmed cell death was an essential mechanism in preimplantation embryo fragmentation and survival, thus leading to original investigations on apoptosis and apoptosis-related genes. Other genes, transcripts, or proteins seem to be involved in embryo development and control of survival. In particular, the role of heat shock proteins (HSP), telomerase activity (human telomerase catalytic subunit hTCS), and the developmental significance of regulatory protein polarization (leptin, STAT 3) in preimplantation embryos are discussed.

Ploidy of Bovine Nuclear Transfer Blastocysts Reconstructed Using In Vitro Produced Blastomere Donors

The higher rate of embryonic loss in nuclear transfer compared to in vitro produced embryos may be due to chromosome abnormalities that occur during preimplantation in vitro development. Because little is known about ploidy errors in nuclear transfer embryos, this was examined using embryos reconstructed from in vitro produced embryo donors. In vitro matured oocytes were enucleated and then activated using calcium ionophore A23187 followed by 6-dimethylaminopurine (6-DMAP). Subsequently, embryos were reconstructed using blastomeres from day 4-5 in vitro produced donors. The embryos were cultured until day 7 at which time blastocyst nuclei were extracted and chromosome abnormalities were evaluated by fluorescent in situ hybridization using two probes that bind to the subcentromeric regions on chromosomes 6 and 7. In 16 nuclear transfer blastocysts generated from 5 donor embryos, 53.8 +/- 20.2 (mean % +/- SD) nuclei/embryo were examined. Of these 16, 7 embryos (43.8%) were potentially abnormal because in these, 1.1%, 1.4%, 5.3%, 7.5%, 26.3%, 30.4%, and 66.2% % of the nuclei had a chromosome composition deviating from the diploid condition, indicating a wide degree of variation between embryos. These errors comprised mainly triploid (8.2 +/- 10.3 [0-26.3]: % +/- SD [range]) and tetraploid (10.6 +/- 19.9 [0-54.9]) nuclei with other ploidy combinations accounting for only 0.9 +/- 2.1 [0-2.1]% of deviant nuclei. The proportion of completely normal nuclear transfer embryos was no less than those produced by in vitro fertilization but the distribution of chromosome abnormalities was different (p = 0.0002). In conclusion, nuclear transfer embryos reconstructed using blastomere cells can produce over 50% blastocysts with a diploid chromosome complement. However, the contribution of chromosome abnormalities to embryonic loss in the remaining embryos deserves further investigation.