Successful delivery after the transfer of twice-vitrified embryos derived from in vitro matured oocytes: a case report

Impact of oxygen tension during in vitro maturation: a sibling-oocyte prospective double-blinded study

OBJECTIVE

To determine whether oxygen (O2) tension (20% vs. 5%) has an impact on oocyte maturation rates and morphology during in vitro maturation (IVM).

DESIGN

A prospective, observational, monocentric, sibling-oocyte study.

SETTING

University Hospital.

PATIENTS

A total of 143 patients who underwent IVM for fertility preservation purposes from November 2016 to April 2021 were analyzed. Patients were included when ≥2 cumulus-oocyte complexes (COCs) were retrieved. The cohort of COCs obtained for each patient was randomly split into two groups: group 20% O2 and group 5% O2.

INTERVENTION

Cumulus-oocyte complexes were incubated for 48 hours either under 5% O2 or 20% O2. After 24 and 48 hours of culture, every oocyte was assessed for maturity and morphology, to estimate oocyte quality. Morphology was evaluated considering six parameters (shape, size, ooplasm, perivitelline space, zona pellucida, and polar body characteristics), giving a total oocyte score ranging from -6 to +6.

MAIN OUTCOME MEASURES

Maturation rates and total oocyte scores were compared using paired-sample analysis between group 20% O2 and group 5% O2.

RESULTS

Patient median age was 31.4 [28.1-35.2] years-old. The mean serum antimüllerian hormone levels and antral follicle count were 3.2 ± 2.3 ng/mL and 27.2 ± 16.0 follicles, respectively. A mean of 10.7 COCs per cycle were retrieved, leading to 6.1 ± 2.4 metaphase II oocytes vitrified (total maturation rate = 57.3%; 991 metaphase II oocytes/1,728 COCs). A total of 864 COCs were included in each group. Oocyte maturation rates were not different between the two groups (group 20% O2: 56.82% vs. group 5% O2: 57.87%, respectively). Regarding oocyte morphology, the mean total oocyte score was significantly higher in group 5% O2 compared with group 20% O2 (3.44 ± 1.26 vs. 3.16 ± 1.32, P=.014).

CONCLUSION

As culture under low O2 tension (5% O2) improves oocyte morphology IVM, our results suggest that culture under hypoxia should be standardized. Additional studies are warranted to assess the impact of O2 tension on oocyte maturation and the benefit of IVM under low O2 tension for embryo culture after utilization of frozen material.

Successful monozygotic triplet pregnancy after a single blastocyst transfer following in vitro maturation of oocytes from a woman with polycystic ovary syndrome: a case report

Background

Although women with polycystic ovarian syndrome (PCOS)-related sub-fertility are high responders to controlled ovarian stimulation, it is difficult to obtain mature oocytes in these women. Therefore, in vitro maturation (IVM), which is the technique of letting the contents of the ovarian follicles and the oocytes inside mature in vitro, has often been proposed in such women. We describe the first successful delivery of monozygotic triplets resulting from transfer of a single blastocyst following IVM of oocytes.

Case presentation

A 32-year-old nulligravida female with PCOS underwent IVM. She underwent vitrified-warmed single blastocyst transfer following IVM, and a dichorionic triamniotic triplet pregnancy was confirmed at 8 weeks. Healthy triplets were delivered by cesarean section at 33 weeks’ gestation. This is the first case of monozygotic triplets derived from IVM oocytes that were successfully delivered. The determination of chorionicity and amnionicity is generally supposed until 3 days after fertilization, and no division or splitting of her embryo was observed on transfer. Interestingly, her embryo might have split after the transfer, resulting in a dichorionic triamniotic triplet pregnancy.

Conclusions

Patients should be informed of a possible increased risk of monozygotic multiple pregnancies after single embryo transfer following IVM.

Live birth in a woman with recurrent implantation failure and adenomyosis following transfer of refrozen-warmed embryos

The aim was to report a healthy live birth using re-vitrified-warmed cleavage-stage embryos derived from supernumerary warmed embryos after frozen embryo transfer (ET) in a patient with recurrent implantation failure (RIF). The case was a 39-year-old female with a history of polycystic ovarian syndrome and adenomyosis, along with RIF. After ovarian hyperstimulation, 33 cumulus-oocyte complexes were retrieved and fertilized with conventional in vitro fertilization and intracytoplasmic sperm injection. Because of the risk of ovarian hyperstimulation syndrome, 16 grade B and C embryos were vitrified. After 3 and 6 months, 3 and 4 B–C warmed embryos were transferred to the uterus, respectively. However, implantation did not take place. Ten months later, four embryos were warmed, two grade B 8-cell embryos were transferred, and two embryos were re-vitrified. One year later, the two re-vitrified cleavage-stage embryos were warmed, which resulted in a successful live birth. This finding showed that following first warming, it is feasible to refreeze supernumerary warmed embryos for subsequent ET in patients with a history of RIF.

A closed system supports the developmental competence of human embryos after vitrification : Closed vitrification of human embryos

PURPOSE

Closed-system vitrification may enable the risk of contamination to be minimised. We performed three studies to compare the developmental competence of human embryos vitrified using either a closed vitrification system (CVS; Rapid-i®) or an open vitrification system (OVS; Cryo-top®).

METHODS

The first study was performed in vitro using 66 zygotes previously vitrified at pronuclear stage. These were warmed and randomised 1:1 to revitrification using either the OVS or the CVS. After re-warming, embryo development and blastocyst cell number were assessed. For the second study, also performed in vitro, 60 vitrified-warmed blastocysts were randomised 1:1:1 into three groups (OVS or CVS revitrification, or no revitrification). The proportion of dead cells was assessed by staining. The third study was performed in vivo, using 263 high-grade blastocysts randomly assigned to vitrification using either the CVS (n = 100) or the OVS (n = 163). After warming, single blastocyst transfer was performed.

RESULTS

There were no differences between the CVS and the OVS in survival rate (100 % vs. 97 %), blastulation rate (96 h: 50 % vs. 50 %; 120 h: 68 % vs. 56 %), proportion of good blastocysts (96 h: 32 % vs. 22 %, 120 h: 47 % vs. 41 %), or mean number of cells (137 vs. 138). The proportion of dead cells in blastocysts re-vitrified by CVS (31 %) was similar to that for OVS (38 %) and non-revitrification (32 %). In vivo, the implantation rate for blastocysts vitrified using the CVS (54 %) was similar to that with the OVS (53 %).

CONCLUSION

Our studies consistently indicate that human embryos may be vitrified using a CVS without impairment of developmental competence.

Effect of polyvinylpyrrolidone on sperm function and early embryonic development following intracytoplasmic sperm injection in human assisted reproduction

The objective here was to review the effects of polyvinylpyrrolidone (PVP) upon sperm function and embryonic development in humans. PVP has been used successfully in intracytoplasmic sperm injection (ICSI) to facilitate the handling and immobilization of sperm for both domestic animals and humans. In our previous reports, PVP solution exists locally in embryos injected during the early developmental period, and also exerts influence over the developmental capacity of such embryos. In other reports, PVP causes significant damage to sperm membranes that can be detected by transmission electron microscopy, and has been associated with chromosomal abnormalities in pregnancy derived from ICSI embryos. In some Japanese clinics, PVP-free media has been used for sperm immobilization in order to optimise safety. Consequently, it is strongly suggested that the success rate of fertilization and clinical pregnancy could be improved by using PVP-free solution for human ICSI. In conclusion, our interpretation of the available data is to perform ICSI without PVP or select a lower concentration of PVP solution in order to reduce safety for pregnancy and children born via ICSI.

Low oxygen tension during IVM improves bovine oocyte competence and enhances anaerobic glycolysis

This study evaluated the effect of two oxygen concentrations (20 and 5%) on bovine embryo development (kinetics of first cleavage and blastocyst development) during maturation (M) and fertilization (F) and analysed differences in gene expression between cumulus-oocyte complexes (COC) matured at 5 or 20% oxygen and the resulting blastocysts. A total of 1179 COC were divided into four groups according to the oxygen tension used (M5F5, M5F20, M20F5 and M20F20). Relative poly(A) mRNA abundance of GLUT1, GAPDH, LDHA, G6PD, MNSOD, GPX1, IGFR2, BAX, CCNB1, PTGS2 and GREM1 was analysed in COC, whereas 10 quality-related genes were analysed in blastocysts. M20F5 group developmental rates were significantly lower than all other groups (one-way ANOVA, P < or = 0.05). Two-way ANOVA showed a beneficial effect of low oxygen tension during in-vitro maturation on developmental rates, whereas the opposite situation was obtained in fertilization (P < or = 0.05). GAPDH, IGFR2, CCNB1, and GREM1 were up-regulated in the oocytes matured in low oxygen, whereas GLUT1, GAPDH, LDHA and GREM1 were up-regulated and PTGS2 down-regulated in the cumulus cells from the M5 group (P < or = 0.05). No differences were observed in blastocysts. Low oxygen tension during maturation alters the expression of genes related to oocyte competence and glucose metabolism and significantly (P < or = 0.05) improves embryo development, but not blastocyst quality.

Effects of in vitro maturation and age on oocyte quality in the rhesus macaque Macaca mulatta

OBJECTIVE

To evaluate oocyte quality in a primate model.

DESIGN

Analysis of oocyte karyotype by chromosome spreading and oocyte spindles by confocal microscopy.

SETTING

Research laboratory, Caribbean Primate Research Center.

ANIMAL(S)

Rhesus macaques aged 6-22 years.

INTERVENTION(S)

Fourteen females underwent both Regimen A (FSH + hCG) and Regimen B (FSH only) stimulation cycles to facilitate collection of mature and immature oocytes. Immature oocytes from Regimens A and B underwent in vitro maturation (IVM) to produce metaphase II oocytes. All metaphase II oocytes underwent gradual fixation to spread chromosomes or were fixed and stained with probes specific to alpha-tubulin, actin, and DNA for visualization of the meiotic spindle using confocal microscopy.

MAIN OUTCOME MEASURE(S)

Karyotype and meiotic spindle architecture differences among in vivo matured (IVO) and IVM oocytes from young and old rhesus macaques.

RESULT(S)

In all, 4.7% of IVO oocytes (Regimen A) from young females were hyperhaploid versus 25.0% of IVM oocytes (Regimen B) from old females; 4.5% of IVO oocytes (Regimen A) from young females versus 51.5% of IVM oocytes (Regimen B) from old females displayed abnormal chromosome alignment on the metaphase spindle.

CONCLUSION(S)

IVM can induce meiotic anomalies in macaque oocytes, especially those obtained from older females. Results from this study provide possible explanations for the reported reduction in developmental competence of IVM primate oocytes.

A case of oocyte and embryo vitrification resulting in clinical pregnancy

OBJECTIVE

To examine a case of clinical pregnancy following oocyte and day 3 embryo vitrification.

DESIGN

Case report.

SETTING

Huntington Centro de Medicina Reprodutiva, a private infertility clinic, in São Paolo, Brazil.

PATIENT(S)

A 31-year-old woman, gravida 1, para 1, with polycystic ovary syndrome.

INTERVENTION(S)

In vitro fertilization with oocyte and embryo vitrification.

MAIN OUTCOME MEASURE(S)

Clinical pregnancy defined as fetal cardiac activity on ultrasound examination.

RESULT(S)

Transvaginal ultrasound examination, at 7 6/7 weeks, revealed a single live intrauterine pregnancy with positive cardiac activity.

CONCLUSION(S)

Although further research is needed, this case suggests that repeat vitrification and warming of oocytes and embryos not only are possible but can result in pregnancy.