Human embryos from induced pluripotent stem cell-derived gametes: ethical and quality considerations

Protocols for successful differentiation of male and female gametes from induced pluripotent stem cells have been published. Although culture of precursor cells in a natural microenvironment remains necessary to achieve terminal differentiation, the creation of human preimplantation embryos from induced pluripotent stem cell-derived gametes is technically feasible. Such embryos could provide a solution to the scarcity of human cleavage-stage embryos donated for research. Here, we discuss current technology, major research-related ethical concerns and propose the norms that would assure the quality and reliability of such embryos.

Effect of oocyte vitrification on embryo quality: time-lapse analysis and morphokinetic evaluation

OBJECTIVE

To analyze whether oocyte vitrification may affect subsequent embryo development from a morphokinetic standpoint by means of time-lapse imaging.

DESIGN

Observational cohort study.

SETTING

University-affiliated private IVF center.

PATIENT(S)

Ovum donation cycles conducted with the use of vitrified (n = 631 cycles; n = 3,794 embryos) or fresh oocytes (n = 1,359 cycles; n = 9,935 embryos) over 2 years.

INTERVENTIONS(S)

None.

MAIN OUTCOME MEASURE(S)

Embryo development was analyzed in a time-lapse imaging incubator. The studied variables included time to 2 cells (t2), 3 cells (t3), 4 cells (t4), 5 cells (t5), morula (tM), and cavitated, early, and hatching blastocyst (tB, tEB, tHB) as well as 2nd cell cycle duration (cc2 = t3 - t2). All of the embryos were classified according to the hierarchic tree model currently used for embryo selection. The analyzed variables were compared with the use of analysis of variance or chi-square and included 95% confidence intervals (CIs).

RESULT(S)

The embryos that originated from vitrified oocytes showed a delay of ∼1 hour from the first division to 2 cells (t2) to the time of blastulation (tB). The embryos that originated from vitrified oocytes showed a delay of ∼1 hour from the 1st division to 2 cells (t2) to the time of blastulation (tB) (P<.05). The proportions of embryos allocated to categories A-E in the hierarchical tree were similar between groups. No differences in implantation rates between the fresh (51.3% [95% CI 47.1%-55.7%]) and vitrified (46.4% [95% CI 38.4%-54.4%]) groups were found.

CONCLUSION(S)

The embryo quality of vitrified oocytes was not impaired: cc2, quality according to our hierarchic morphokinetic model, and implantation rates were similar between fresh and vitrified oocytes. However, morphokinetic differences were observed from t2 to tB. Our main study limitation was the retrospective nature of the analysis, although a large database was studied.

The impact of male age on embryo quality: a retrospective study using time-lapse imaging

OBJECTIVE

This study aimed to correlate male age with embryo morphokinetic parameters on D3 considering the timing and the exact moment of embryo cleavage.

METHODS

Time-lapse imaging was used to produce an ideal cleavage curve for the embryos analyzed. The percentage of embryos under the curve was analyzed and correlated with male age.

RESULTS

32.6% of the embryos from patients aged 28-33 years were under the curve; 36.2% of the embryos from patients aged 34-39 years were under the curve; 41.3% of the embryos from patients aged 40-45 years were under the curve; and 26.3% of the embryos fro patients aged 46-57 years were under the curve.

CONCLUSIONS

a statistically non-significant decrease was observed in the percentage of embryos under the optimal cleavage curve on D3 in the group of men aged between 40 and 45 years. Further studies looking into embryos in the blastocyst stage (D5 or D6) are required.

Morphokinetic behavior of euploid and aneuploid embryos analyzed by time-lapse in embryoscope

BACKGROUND:

Embryonic aneuploidy may result in miscarriage, implantation failure, or birth defects. Thus, it is clinically necessary to avoid the selection of aneuploid embryos during in vitro fertilization treatment.

AIM:

The aim of this study was to identify the morphokinetic differences by analyzing the development of euploid and aneuploid embryos using a time-lapse technology. We also checked the accuracy of a previously described model for selection of euploid embryos based on morphokinetics in our study population.

MATERIALS AND METHODS:

It is a retrospective study of 29 cycles undergoing preimplantation genetic screening from October 2013 to April 2015 at our center. Of 253 embryos, 167 suitable for biopsy embryos were analyzed for their chromosomal status using array-comparative genome hybridization (CGH). The morphokinetic behavior of these embryos was further analyzed in embryoscope using time-lapse technology.

RESULTS:

Among the analyzed embryos, 41 had normal and 126 had abnormal chromosome content. No significant difference in morphokinetics was found between euploid and aneuploid embryos. The percentage of embryos with blastulation was similar in the euploid (65.85%, 27/41) and aneuploid (60.31%, 76/126) embryos (P = 0.76). Although hard to define, majority of the chromosomal defects might be due to meiotic errors. On applying embryo selection model from Basile et al., embryos falling within optimal ranges for time to division to 5 cells (t5), time period of the third cell cycle (CC3), and time from 2 cell division to 5 cell division (t5-t2) exhibited greater proportion of normal embryos than those falling outside the optimal ranges (28.6%, 25.9%, and 26.7% vs. 17.5%, 20.8%, and 14.3%).

CONCLUSION:

Keeping a track of time interval between two stages can help us recognize aneuploid embryos at an earlier stage and prevent their selection of transfer. However, it cannot be used as a substitute for array CGH to select euploid embryos for transfer.

Morphokinetic Evaluation of Embryo Development in a Mouse Model: Functional and Molecular Correlates

Although time-lapse analysis of early embryo cleavage parameters (morphokinetics) predicts blastocyst development, it has not been definitively linked to establishing pregnancy and live birth. For example, a direct comparison of the developmental potential of embryos with optimal kinetic parameters compared to suboptimal kinetics has not been performed with human embryos. To ascertain whether such a linkage exists, we developed a mouse model of morphokinetic analysis of early embryo cleavage using time-lapse microscopy to predict blastocyst formation and tested whether cleavage parameters predict pregnancy outcome by transferring morphokinetically optimal and suboptimal embryos into a single host. Using classification and regression trees, we established that the timing of the second and third mitotic divisions (division from two to three and three to four cells, respectively) predicts blastocyst development in the mouse. Using this prediction model, we found that the incidence of sustained implantation at mid-gestation was significantly higher for the optimal compared to suboptimal embryos. In addition, the incidence of resorption among implanted embryos was significantly higher in the suboptimal compared to the optimal group. Transcript profiling of optimal and suboptimal embryos revealed minimal differences between the two groups, suggesting that time-lapse imaging of early embryo cleavage events provides additional information regarding developmental competence apart from gene expression.

Developmental clock compromises human twin model created by embryo splitting

STUDY QUESTION

Is the quality of the human embryos generated by twinning in vitro comparable to the quality of the embryos created by fertilization?

SUMMARY ANSWER

Our data suggest that the human twin embryos created in vitro are unsuitable not only for clinical use but also for research purposes.

WHAT IS KNOWN ALREADY

Pregnancy from in vitro generated monozygotic twins by embryo splitting or twinning leads to live birth of healthy animals. Similar strategies, however, have been less successful in primates. Recent reports suggest that the splitting of human embryos might result in viable, morphologically adequate blastocysts, although the qualitative analyses of the embryos created in such a way have been very limited.

STUDY DESIGN, SIZE, DURATION

This study was a comparative analysis of embryos generated by twinning in vitro and the embryos created by in vitro fertilization.

PARTICIPANTS/MATERIALS, SETTING, METHODS

We analysed morphokinetics and developmental competence of 176 twin embryos created by splitting of 88 human embryos from either early (2-5 blastomeres, n = 43) or late (6-10 blastomeres, n = 45) cleavage stages. We compared the data with morphometrics of embryos created by in vitro fertilization and resulting in pregnancy and live birth upon single blastocyst transfer (n = 42).

MAIN RESULTS AND THE ROLE OF CHANCE

The morphokinetic data suggested that the human preimplantation development is subjected to a strict temporal control. Due to a 'developmental clock', the size of twin embryos was proportionate to the number of cells used for their creation. Furthermore, the first fate decision was somewhat delayed; the inner cell mass (ICM) became distinguishable later in the twin than in the normal blastocysts obtained through fertilization. If an ICM was present at all, it was small and of poor quality. The majority of the cells in the twin embryos expressed ICM and trophectoderm markers simultaneously.

LIMITATIONS, REASONS FOR CAUTION

We created monozygotic twins by blastomere separation from cleavage stage embryos. Embryo twinning by blastocyst bisection may circumvent limitations set by the developmental clock.

WIDER IMPLICATIONS OF THE FINDINGS

Taken together, our data suggest that the human twin embryos created in vitro are unsuitable not only for clinical use but also for research purposes.

Analysis of factors influencing morphokinetic characteristics of embryos in ART cycles

In this article, some factors were evaluated for their impact on embryo morphokinetics during assisted reproductive technology (ART) cycles. We detected significant differences in the fourth cell division time (t5) of embryos obtained after controlled ovarian stimulation in long GnRH agonists and GnRH antagonist protocols. We also found that higher gonadotropin dose may slow down the development of embryos. However, both male and female age, the number of oocytes and number of normal forms of sperm in the ejaculate did not affect the kinetic parameters of embryo development. Further research is needed to identify all the spectrum of factors, which can affect the rate of embryo development.

Could time-lapse embryo imaging reduce the need for biopsy and PGS?

PURPOSE

To review relevant studies examining the relationship between embryo morpho-kinetics and aneuploidy.

METHODS

Search of Pubmed and Medline using relevant keywords pertaining to morphology, morphokinetics and embryonic aneuploidy, as well as examination of various reference lists and conference proceedings.

RESULTS

An abundance of publications, both preliminary and peer-reviewed, have emerged regarding the usefulness of time-lapse imaging in tracking embryo development and improving embryo selection. Recently, these publications have explored ability to not only predict blastocyst formation and implantation, but also the ability to detect embryonic chromosomal aneuploidy. Of the two peer-reviewed retrospective studies on morpho-kinetics and embryonic aneuploidy, one demonstrates that early cleavage timings can indicate chromosomal complement, while the other demonstrates that key events following the maternal-zygotic transition can be markers of aneuploidy. A recent paper also demonstrates improved outcomes following IVF using a selection algorithm to identify embryos at "low risk" of chromosomal abnormalities. However, the predictive nature of these events and timings is far from ideal. Additionally, results may be dependent upon the day of biopsy and method utilized for chromosomal assessment.

CONCLUSION

With continued effort, the combination of multiple morphologic endpoint assessments and developmental timings and refinement of modeling systems may improve the predictive ability to determine embryonic aneuploidy. This may help select a subset of embryos that are less likely to carry chromosomal abnormalities and improve assisted reproductive outcomes. However, embryo biopsy, followed by preimplantation genetic screening/comprehensive chromosomal screening still remains the most reliable method to assess chromosomal complement of preimplantation embryos.

New approaches to embryo selection

Embryo selection has been an important topic since the introduction of assisted reproduction, with embryo morphology being the most obvious criterion. Although morphology serves as indicator for overall IVF laboratory quality, its statistical assessment limits the possibility to identify the most implantation-competent embryos. In order to reach a direct picture of the developing embryo, invasive procedures such as preimplantation genetic screening or transcriptome and proteome analysis of biopsied embryonic tissue were initially prioritized and are still under investigation. More recently, focus has shifted towards noninvasive techniques that maintain the integrity of the embryo. Metabolomic profiling of culture medium from growing embryos attracted much research. Although successful in a pilot study, that approach failed in a randomized controlled trial. Other metabolomics studies are on their way but not yet available for routine clinical use. The most promising strategy at present is the combined evaluation of morphology and developmental kinetics using time-lapse imaging. This has brought new insights into certain characteristics that enable deselection of embryos at an early stage of development and to identify others with high potential for successful implantation. However, there is still considerable room for improvement. Further strategies will most likely involve the combination of several different approaches.

Advances in quality control: mouse embryo morphokinetics are sensitive markers of in vitro stress

STUDY QUESTION

Can time-lapse analysis of cell division timings [morphokinetics (MK)] in mouse embryos detect toxins at concentrations that do not affect blastocyst formation?

SUMMARY ANSWER

An MK algorithm enhances assay sensitivity while providing results 24–48 h sooner than the traditional mouse embryo assay (MEA).

WHAT IS KNOWN ALREADY

Current quality control testing methodology is sensitive but further improvements are needed to assure optimal culture conditions. MKs of embryo development may detect small variations in culture conditions.

STUDY DESIGN

Cross sectional—control versus treatment. Mouse embryo development kinetics of 466 embryos were analyzed according to exposure to various concentrations of toxins and toxic mineral oil.

MATERIALS, SETTING, METHODS

Cryopreserved 1-cell embryos from F1 hybrid mice were cultured with cumene hydroperoxide (CH) (0, 2, 4, 6 and 8 µM) and Triton X-100 (TX-100; 0, 0.0008, 0.0012, 0.0016 and 0.002%). Using the Embryoscope, time-lapse images were obtained every 20 min for 120 h in seven focal planes. End-points were timing and pattern of cell division and embryo development. The blastocyst rate (BR) was defined as the percentage of embryos that developed to the expanded blastocyst stage within 96 h.

MAIN RESULTS AND THE ROLE OF CHANCE

BR was not affected for embryos cultured in the three lowest concentrations of CH and the four lowest concentrations of TX-100. In contrast, a unique MK model detected all concentrations tested (P < 0.05). The MK model identified toxicity in two lots of toxic mineral oil that did not affect BR (P < 0.05).

LIMITATIONS, REASONS FOR CAUTION

A limited number of toxins were used so that the results may not apply to all potential embryo toxins. A larger sample size may also demonstrate other statistically significant developmental kinetic parameters.

WIDER IMPLICATIONS OF THE FINDINGS

MKs in mouse embryos are a sensitive and efficient method for quality control testing of in vitro culture conditions. BR, the end-point of traditional quality control assays, did not detect sublethal concentrations of toxins in the culture milieu in our study. This study demonstrates that temporal variation at key developmental stages reflects the quality of the culture environment. An MEA that incorporates MK will provide enhanced sensitivity and faster turn-around times.

STUDY FUNDING/COMPETING INTEREST(S)

The study was supported by Mayo Clinic Department of Obstetrics and Gynecology Small Grant Program. The authors have no competing interests to declare.