Technique for cellular microsurgery using the 193-nm excimer laser

Advanced tools and methods for single-cell surgery

Highly precise micromanipulation tools that can manipulate and interrogate cell organelles and components must be developed to support the rapid development of new cell-based medical therapies, thereby facilitating in-depth understanding of cell dynamics, cell component functions, and disease mechanisms. This paper presents a literature review on micro/nanomanipulation tools and their control methods for single-cell surgery. Micromanipulation methods specifically based on laser, microneedle, and untethered micro/nanotools are presented in detail. The limitations of these techniques are also discussed. The biological significance and clinical applications of single-cell surgery are also addressed in this paper.

From Zygote to Blastocyst: Application of Ultrashort Lasers in the Field of Assisted Reproduction and Developmental Biology

Although the use of lasers in medical diagnosis and therapies, as well as in fundamental biomedical research is now almost routine, advanced laser sources and new laser-based methods continue to emerge. Due to the unique ability of ultrashort laser pulses to deposit energy into a microscopic volume in the bulk of a transparent material without disrupting the surrounding tissues, the ultrashort laser-based microsurgery of cells and subcellular components within structurally complex and fragile specimens such as embryos is becoming an important tool in developmental biology and reproductive medicine. In this review, we discuss the mechanisms of ultrashort laser pulse interaction with the matter, advantages of their application for oocyte and preimplantation embryo microsurgery (e.g., for oocyte/blastomere enucleation and embryonic cell fusion), as well as for nonlinear optical microscopy for studying the dynamics of embryonic development and embryo quality assessment. Moreover, we focus on ultrashort laser-based approaches and techniques that are increasingly being applied in the fundamental research and have the potential for successful translation into the IVF (in vitro fertilization) clinics, such as laser-mediated individual embryo labelling and controlled laser-assisted hatching.

Trophectoderm biopsy for preimplantation genetic test and technical tips: A review

BACKGROUND

Recently, the Japan Society of Obstetrics and Gynecology initiated a clinical study of preimplantation genetic test for aneuploidy. There will be a great need for a standardized embryo biopsy technique in Japan. However, the gold standard trophectoderm (TE) biopsy procedure has not been established, and this review outlines the clinical use of TE biopsy.

METHODS

Based on literature, the method and associated techniques for TE biopsy, a dissection method of TE cells from blastocysts, were investigated.

MAIN FINDINGS

Two TE biopsy methods are used, namely assisted hatching (herniating) and non-assisted hatching (direct suction); however, it is not clear which of these methods is superior. It is critical to understand whether the flicking or pulling method is beneficial.

CONCLUSION

Non-assisted hatching biopsy method may cause blastocyst collapse with a higher probability, and it may extend the biopsy time. The biopsy procedure should be performed within 3 minutes, and thus direct TE suction may have greater disadvantages. It is a fact that pulling method of TE dissection with laser pulse is simple; however, excess laser shots may induce a higher frequency of mosaicism. It is important to understand that each technique of TE biopsy has benefits and disadvantages.

Revisiting embryo assisted hatching approaches: a systematic review of the current protocols

Zona pellucida (ZP) manipulation, termed "assisted hatching" (AH), has been introduced in order to favor embryo hatching and ultimately improve assisted reproductive technology success but with poor proofs of safety and biological plausibility. We herein provide a systematic review of clinical outcomes following the application of different methods of ZP manipulation on fresh or frozen/thawed embryos at different developmental stages in different groups of patients. Out of the 69 papers that compared the clinical outcomes deriving from hatched versus non-hatched embryos, only 11 considered blastocysts while the rest referred to cleavage stage embryos. The ZP thinning of fresh embryos either by chemical or laser approach was shown to provide very limited benefit in terms of clinical outcomes. Better results were observed with procedures implying a higher degree of zona manipulation, including zona removal. Studies comparing the mechanical or chemical procedures to those laser-mediated consistently reported a superiority of the latter ones over the former. Literature is consistent for a benefit of ZP breaching in thawed blastocysts. This review provides the current knowledge on the AH procedure in order to improve its efficacy in the appropriate context. Embryologists might benefit from the approaches presented herein in order to improve Assisted Reproduction Technologies (ART) outcomes.

Effect of laser optoperforation of the zona pellucida on mouse embryo development in vitro

The effect of laser optical perforation of the zona pellucida on the viability and development of mouse embryos has been studied. Operations of zona pellucida thinning and single or double perforation were carried out on 2-cell embryo, morula, and blastocyst stages with a laser pulse (wavelength 1.48 µm, pulse duration 2 ms). Embryo development up to the blastocyst stage and hatching efficiency were statistically analyzed. It was found that 2-cell or morula stage embryo zona pellucida thinning or single perforation did not affect development to the blastocyst stage and number of hatched embryos, but it accelerated embryo hatching compared to control groups one day earlier in vitro. Double optoperforation on 2-cell embryo or morula stage did not significantly affect development to the blastocyst stage, but it strongly decreased the number of hatched embryos. Also, zona pellucida perforation at the blastocyst stage had a negative effect: hatching did not occur after this manipulation. Blastocyst cell number calculation after single zona pellucida perforation at 2-cell and morula stages showed that cell number of hatching or hatched blastocysts did not differ from the same control groups. This fact points out that the laser single optoperforation method is a useful and safe experimental tool that allows further manipulations within the zona pellucida.

Micromanipulation in assisted reproductive technology

Micromanipulation describes a set of tools and techniques for cellular microsurgery and manipulation. Micromanipulation techniques have played an important role in basic research and the development of clinical techniques in assisted reproductive technology. This work provides a review of the development and current practices involving micromanipulation in the human clinical assisted reproduction laboratory.

Equine Embryo Sexing and Ultrasonographic Foetal Sexing - Interests and Applicability

The ability to choose the sex of the offspring is of upmost economic importance for horse breeders. Unlike other species, horses present several reproductive peculiarities that interfere with assisted reproductive technologies used in other large animals (such as bovine) and make them difficult to apply. Thus, there is a great interest to determine the sex of the offspring as soon as possible. This has led to the development of several technologies to serve this purpose, which can be classified into two categories. One is equine embryo sexing by either non-invasive biotechnological methods, such as monitoring of X-linked enzymes before X chromosome inactivation and detection of sex-specific antigen, or by invasive biotechnological methods, such as cytogenetic analysis and polymerase chain reaction (PCR). The other one is equine foetus sexing using ultrasound scanning in different stages of its development (early, mid or late), by different approaches (transrectally or transabdominally). This can be performed with classic B-mode ultrasound machines or using 3D-mode and Doppler-mode scanners. This review article offers a comprehensive overview of the current status of these procedures as well as an assessment of their interests and applicability.

Assisted hatching in assisted reproduction: a state of the art

The World Health Organization estimates that one in six couples experience some delay in conception and an increasing number require treatment by the assisted conception (AC) procedures of in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI).The implantation rate of embryos resulting from in vitro fertilization cycles is generally less than 20%. The exposure of oocytes and embryos to the artificial conditions of in vitro culture may have negative effects on the embryo's ability to undergo normal hatching, resulting in low rates of implantation following IVF and embryo transfer. Human embryos resulting from superovulation develop more slowly in vitro compared to embryos in vivo, manifest a relatively high degree of cytogenetic abnormalities and undergo cellular fragmentation. Artificially disrupting the zona pellucida is known as assisted hatching (AH) and there is some evidence that embryos that have undergone zona manipulation for assisted hatching tend to implant one day earlier than unhatched embryos. A variety of techniques have since been employed to assist embryo hatching, including partial mechanical zona dissection, zona drilling and zona thinning, making use of acid tyrodes, proteinases, piezon vibrator manipulators and lasers. This review will consider the impact of IVF conditions on zona pellucida physiology, zona hardening, different techniques of assisted hatching, who may benefit from assisted hatching and potential hazards.

Are zona pellucida laser drilling and polar body biopsy safe for in vitro matured oocytes?

INTRODUCTION

Preconception diagnosis requires first polar body biopsy. When the hole in the zona pellucida is made with a laser beam, heat propagation could, like the biopsy itself, be deleterious. Our aim was to evaluate the effect of this technique on human in vitro matured oocyte and embryo development.

METHODS

One hunded fifty five retrieved immature oocytes from 75 women, matured in vitro, were distributed in 3 groups: 50 oocytes in a control group, without laser drilling and first polar body biopsy, 52 oocytes in a group with only laser drilling, and 53 oocytes in a group with both laser drilling and first polar body biopsy. Safety was evaluated using four criteria: [1] oocyte lysis rate, [2] oocyte activation rate, [3] oocyte development after calcium ionophore treatment, [4] and embryo chromosome breakage incidence after Tarkowski preparation.

RESULTS

No difference in the four criteria was observed between the 3 oocyte groups.

CONCLUSIONS

We did not find evidence of deleterious effect of laser drilling and first polar body biopsy on in vitro matured oocytes, according to our criteria.

Engineering Approaches to Biomanipulation

This article presents a review on the existing techniques for manipulating biological cells. Because biomanipulation involves a wide range of disciplines, from biology to engineering, we concentrate on some of the key methodologies that would result in an efficient biomanipulation system. Some of the key methodologies discussed in this article for cell manipulation relate to the use of magnetics, microelectromechanical systems (MEMS)-based approaches, optics, electric field, and mechanical techniques. Recent advances in engineering have allowed researchers worldwide to address the problems arising from conventional manipulation techniques. This paper assimilates significance and limitations of biomanipulation techniques described in the literature.

Screening oocytes by polar body biopsy

Preimplantation genetic aneuploidy screening performed by polar body biopsy has become a frequently used method, especially as in several countries only preconceptional genetic diagnosis is allowed. To penetrate the zona pellucida, mechanical, chemical and laser-assisted techniques have been introduced. In this paper, the advantages, disadvantages, efficacy and safety of these techniques are elucidated.

Assisted hatching using a 1.48-µm diode laser: Evaluation of zona opening and zona thinning techniques in human embryos

Aim:  We assessed the effectiveness of assisted hatching using a 1.48-µm diode laser in human embryos, comparing zona opening and zona thinning techniques. Methods:  A total of 56 day 3 embryos were assigned randomly to a zona opening group, a zona thinning group, or a control group. We then carried out assisted hatching using the OCTAX Laser Shot system (MTG Medical Technology, Altdorf, Germany) in the first two groups. In the zona opening group, the inner membrane of the zona pellucida was broken to create a full-thickness opening. In the zona thinning group, the inner membrane of the zona pellucida was not breached. After the laser procedure, embryos were cultured to the hatched blastocyst stage. Results:  Blastocyst development rates did not differ significantly between the three groups. In the zona opening group, blastocysts were significantly more likely to hatch than those in the control group (P ≤ 0.05) and no arrested hatching of blastocysts was observed. Conclusions:  Assisted hatching using a 1.48-µm diode laser in the zona opening technique increases the likelihood of blastocyst hatching in human embryos and does not adversely effect subsequent embryo development. (Reprod Med Biol 2006; 5: 221-226).

Possible applications of a non-contact 1.48 μm wavelength diode laser in assisted reproduction technologies

Recently, one laser system has been introduced in IVF fulfilling all safety requirements, while achieving a high standard of reproducibility in terms of ablation diameter. This 1.48 microm wavelength indium-gallium-arsenic-phosphorus (InGaAsP) semiconductor laser offers a variety of laser applications to the embryologist. On the one hand, zona pellucida of oocytes or embryos can be manipulated in order to facilitate ICSI or biopsy and assist hatching, and on the other, spermatozoa may be paralysed or immobilized prior to usage. To conclude, the 1.48 microm diode laser provides a promising tool for the microdissection of subcellular targets. The diode laser stands out due to the rapidity, the simplicity and the safety of the procedure which is supported by healthy offspring after laser application.

Comparison of effects of zona drilling by non-contact infrared laser or acid Tyrode's on the development of human biopsied embryos as revealed by blastomere viability, cytoskeletal analysis and molecular cytogenetics

Use of a non-contact infrared laser (IRL) or acid Tyrode's for zona drilling before embryo biopsy was compared by assessing blastomere viability using various fluorescent markers or culture of the single biopsied blastomere, and, by cytoskeletal and molecular cytogenetic analysis of the biopsied embryos following culture to the blastocyst stage. There was no significant difference in the proportion of biopsied embryos that showed no damage in both the biopsied blastomere and in the remaining embryo (acid Tyrode's: 75% versus IRL: 68%), or in the proportion of single biopsied blastomeres that divided in culture (P > 0.05). However, single biopsied blastomeres from laser drilled embryos showed a greater tendency to form miniblastocysts. The proportion of laser or acid Tyrode's biopsied embryos that reached the blastocyst stage by day 6 was similar, although evident earlier (day 5) in the laser biopsied embryos. Spindle abnormalities at the blastocyst stage included tripolar and tetrapolar spindles, but their incidence was not significantly different from controls. In addition, no significant difference was observed in the incidence of chromosomal abnormalities and mosaicism between the two groups. It is concluded that using an IRL at a safe working distance does not cause adverse immediate or longer term effects on the development of human biopsied embryos, although damage can occur if drilling within this distance is unavoidable. Acid Tyrode's drilling can also cause damage, and tended to retard blastocyst development.

Assisted reproductive research: laser assisted hatching and spindle detection (spindle view technique)

Animal experiments are very important for the development of new assisted reproductive techniques (ART) for use in human and animal reproductive medicine. Most technical aspects of reproductive manipulation of humans and animals are very similar, and many components of successful human ART used nowadays have been derived from animal studies. In this study we examined (1) the use of 'non-contact' laser for assisted hatching, (2) whether spindles in living mouse oocytes could safely be imaged/examined by polarisation microscope (polscope) and (3) the influence of environment (e.g. temperature, in vitro culture, etc.) on spindle detection/visualisation. The data of the study presented here show that (1) laser assisted hatching (AH) is a fast, very accurate and safe procedure without any harmful effect on embryo development and it can support very effectively the implantation of embryos, (2) the use of polscope facilitates the evaluation of oocyte quality and the selection of oocytes with spindle, (3) by monitoring the spindle position during intracytoplasmic sperm injection (ICSI), we can reduce spindle damage and increase the chance of fertilisation. Further studies are underway to test the hypothesised connection between spindle birefringence and developmental capacity of oocytes/embryos.

A follow-up study of children born after diode laser assisted hatching

This follow-up study of children born after laser assisted hatching (LAH) with a non-contact laser aims to compile data on karyotypes, deliveries, congenital malformations and growth parameters to evaluate the safety of this new technique. The study design consisted of karyotyping and completion of a standardized questionnaire. Data were analyzed for the first 134 children born after LAH. Indication for LAH were the age (over 35 years) (group I), previously minimum three unsuccessful IVF-ET treatment cycles (group II) and age >35 years with at least three unsuccessful IVF cycles (group III). In our study group of 134 babies we found no increase in the major congenital malformation rate (2.2%) which is comparable with the major congenital malformation rate (3%) among all deliveries at our hospital. No increase in chromosomal aberrations could be observed. Neither could we observe a difference in minor congenital malformations between the LAH treated group and all deliveries at our hospital (10.4% versus 11.1%). On this limited number of children born after LAH there was neither evidence of an increased incidence of chromosomal aberrations nor of congenital malformations.

Zona dissection by infrared laser: developmental consequences in the mouse, technical considerations, and controlled clinical trial

Infrared laser systems are currently being marketed for application in clinical zona pellucida dissection. However, these systems have undergone only limited animal testing and minor clinical trials that lacked proper controls. Two of these systems have been evaluated in protocols that addressed potential detrimental effects on embryonic development in the mouse. Exaggerated large openings were made in the zona pellucida of 8-16 cell mouse embryos. Embryonic development and subsequent implantation and viability were assessed. A definite negative effect on these parameters was observed following the use of one of these systems. Following this animal trial, the second system was evaluated in a clinical trial for assisted hatching and embryo biopsy. Laser dissection was directly compared with the standard zona drilling using acidified Tyrode's solution. While no significant difference was evident between the two protocols, it was felt that laser dissection presented some problems in both consistency between operators and in the efficacy of subsequent manipulations such as blastomere biopsy and fragment removal. These results argue that laser zona dissection is far from a simple technique and should be carefully evaluated before any clinical application is made.

Noncontact, laser-mediated extraction of polar bodies for prefertilization genetic diagnosis

PURPOSE

We tested an entirely noncontact polar body-extraction method using an ultraviolet laser beam for laser zona drilling and a near infrared laser beam for polar body (PB) trapping and extraction.

METHODS

A hole was drilled into the zona pellucida of an oocyte. Then, the PB was trapped with optical tweezers and dragged through the drilled hole.

RESULTS

Bovine first PBs could be extracted in 49 out of 63 oocytes (78%) using this method. In human oocytes, PB extraction was successfully demonstrated, which however was more time consuming. A number of extracted PBs were dried on a special membrane, circumcised with the laser microbeam, and successfully catapulted into the lid of a microfuge tube (laser pressure catapulting).

CONCLUSIONS

This solely laser-mediated extraction method allows convenient procurement of PBs without the danger of contamination and is a promising approach that might replace standard micromanipulation methods in the future.

Single cell analysis of CAG repeat in brains of dentatorubral-pallidoluysian atrophy (DRPLA)

Somatic mosaicism of an expanded repeat is present in tissues of patients with triplet repeat diseases. Of the spinocerebellar ataxias associated with triplet repeat expansion, the most prominent heterogeneity of the expanded repeat is seen in dentatorubral-pallidoluysian atrophy (DRPLA). The common feature of this somatic mosaicism is the difference in the repeat numbers found in the cerebellum as compared to other tissues. The expanded allele in the cerebellum shows a smaller degree of expansion. We previously showed by microdissection analysis that the expanded allele in the granular layer in DRPLA cerebellum has less expansion than expanded alleles in the molecular layer and white matter. Whether this feature of lesser expansion in granule cells is common to other types of neurons is yet to be clarified. We used a newly developed excimer laser microdissection system to analyze somatic mosaicism in the brains of two patients, one with early- and another with late-onset DRPLA, and used single cell PCR to observe the cell-to-cell differences in repeat numbers. In the late onset patient, repeat expansion was more prominent in Purkinje cells than in granule cells, but less than that in the glial cells. In the early onset patient, repeat expansion in Purkinje cells was greater than in granule cells but did not differ from that in glial cells. These findings suggest that there is a difference in repeat expansion among neuronal subgroups and that the number of cell division cycles is not the only determinant of somatic mosaicism.

Aspects of biopsy procedures prior to preimplantation genetic diagnosis

Today, preimplantation genetic diagnosis (PGD) is offered in over 40 centres worldwide for an expanded range of genetic defects causing disease. This very early form of prenatal diagnosis involves the detection of affected embryos by fluorescent in situ hybridization (FISH) (sex determination or chromosomal defects) or by polymerase chain reaction (PCR) (monogenic diseases) prior to implantation. Genetic analysis of the embryos involves the removal of some cellular mass from the embryos (one or two blastomeres at cleavage-stage or some extra-embryonic trophectoderm cells at the blastocyst stage) by means of an embryo biopsy procedure. Genetic analysis can also be performed preconceptionally by removal of the first polar body. However, additional information is then often gained by removal of the second polar body and/or a blastomere from the embryo. Removal of polar bodies or cellular material from embryos requires an opening in the zona pellucida, which can be created in a mechanical way (partial zona dissection) or chemical way (acidic Tyrode's solution). However, the more recent introduction of laser technology has facilitated this step enormously. Different biopsy procedures at different preimplantation stages are reviewed here, including their pros and cons and their clinical applications. The following aspects will also be discussed: safety of zona drilling by laser, use of Ca2+/Mg2+-free medium for decompaction, and removal of one or two cells from cleavage-stage embryos.

Enhanced hatching rate of bovine IVM/IVF/IVC blastocysts using a 1.48-micron diode laser beam

PURPOSE

Our purpose was to test whether zona pellucida (ZP) drilling using a 1.48-micron diode laser beam on bovine IVM/IVF/IVC blastocysts is effective for embryo hatching.

METHODS

Blastocysts produced in vitro at day 7 after IVF were divided into control and laser-drilled groups, respectively.

RESULTS

When the rates of in vitro development of bovine embryos were examined, the average cleavage rate (> or = two-cell) was 82.3% and the blastocyst rate at day 7 after IVF was 32.5%. Using these blastocysts, when the laser drilling effect was investigated at 48 hr after treatment, the total hatching rate in the laser-drilled group (98.0%) was significantly higher than that in the control group (60.0%) (P < 0.001). Especially, the hatched rate of the laser-drilled group (68.0%) was significantly enhanced compared with that of the control group (30.0%) (P < 0.001).

CONCLUSIONS

These results demonstrated that laser ZP drilling on bovine IVM/IVF/IVC blastocysts can significantly increase the hatching rate.

Laser scissors and tweezers

In summary, we described the use of laser scissors and tweezers from three perspectives: (a) the historical background from which these two techniques evolved, (b) an understanding and lack of understanding of the mechanisms of interaction with the biological systems, and (c) the applications of the scissors and tweezers alone and in combination. As the technology improves and we gain a better understanding of how these two tools operate they will become even more useful in probing cell structure and function, as well as practically manipulating cells in genetics, oncology, and developmental biology.

Targeted gene transfer in eucaryotic cells by dye-assisted laser optoporation

The blue beam of an Argon laser (488 nm) has been focused on the cell membrane in the presence of phenol-red, an usual component of cell culture media, through a 100 x objective. At the site of the beam impact, due probably to local temperature changes, the cell membrane modifies its permeability. As a consequence of the hit, circular areas, whose radius may be apparently regulated by changing the irradiation time and/or the radiation intensity (energy), appear on the wall, last for a short time and fade spontaneously within 1-2 minutes. No evident sings of cell injury or hurt have been observed afterward. Plasmid DNA, purposely added to culture fluid, easily slips in the cytoplasm; utilizing such approach, thereafter indicated as "optoporation', we have successfully transfected two genes, namely beta-galactosidase and chloramphenicol-acetyl-transferase in murine NIH3T3 fibroblasts. Therefore optoporation represents an additional procedure for gene transfer with several advantages over already available methods: (1) it only takes advantage of the presence of phenol-red, a normal cell medium component, with no need of addition of extraneous substances; (2) it is a very mild treatment virtually suitable for any cell type and (3) it allows transfection of selected cells even in the presence of cells of different type (providing that they are morphologically distinguishable).

Non-contact microdrilling of mouse zona pellucida with an objective-delivered 1.48-microns diode laser

BACKGROUND AND OBJECTIVE

A non-touch laser-induced microdrilling procedure is studied on mouse zona pellucida (ZP).

STUDY DESIGN/MATERIALS AND METHODS

A 1.48-microns diode laser beam is focused in a 8-microns spot through a 45x objective of an inverted microscope. Mouse zygotes, suspended in a culture medium, are microdrilled by exposing their ZP to a short laser irradiation and allowed to develop in vitro.

RESULTS

Various sharp-edged holes can be generated in the ZP with a single laser irradiation. Sizes can be varied by changing irradiation time (3-100 ms) or laser power (22-55 mW). Drilled zygotes present no signs of thermal damage under light and scanning electron microscopy and develop as expected in vitro, except for a distinct eight-shaped hatching behavior.

CONCLUSION

The microdrilling procedure can generate standardized holes in mouse ZP, without any visible side effects. The hole formation can be explained by a local photothermolysis of the protein matrix.

Microdissection of mouse and human zona pellucida using a 1.48-microns diode laser beam: efficacy and safety of the procedure

OBJECTIVE

To investigate the efficacy and safety of a small and affordable 1.48-microns continuous wave diode laser for zona pellucida (ZP) microdissection.

DESIGN

Mouse and human oocytes and zygotes were submitted to ZP drilling. The hole characteristics and possible laser-induced structural alterations of the neighboring cytoplasm were investigated with scanning and transmission electron microscopy. The safety of the procedure was checked on control and drilled zygotes by determining their ability to develop in vitro and in vivo.

SETTING

Collaborative study between three Swiss academic centers.

INTERVENTIONS

The collimated diode laser beam was delivered through a 45x objective of an inverted microscope and focused through the culture dish and culture medium in 1- to 3-microns spots.

MAIN OUTCOME MEASURE

Safety assessment of the laser drilling procedure.

RESULTS

The 1.48-microns radiation achieves a rapid, precise, and easily controlled lysis of the ZP without any micromanipulative handling of the eggs. Different shapes of holes can be produced by varying the laser beam intersection site on the ZP, laser power, and irradiation time. The energy needed to drill holes of a given diameter is greater for zygotes than for oocytes. Safety of the drilling procedure is confirmed by the lack of damage at the ultrastructural and biologic levels.

CONCLUSIONS

The low-cost 1.48-microns diode laser allows an easy, objective-driven, nontouch microdissection of the ZP. The procedure is safe, as drilled embryos give rise to normal and fertile offspring.

Assisted hatching in mouse embryos using a noncontact Ho:YSGG laser system

PURPOSE

A noncontact holmium:yttrium scandium gallium garnet (Ho:YSGG) laser system has been designed and tested for the micromanipulation of mammalian embryos. The purpose of this preliminary investigation was to determine the effectiveness of this laser for assisted hatching and evaluate its impact on embryo viability. The Ho:YSGG system, utilizing 250-microsecond pulses at a wavelength of 2.1 microns and 4 Hz, was used to remove a portion of the zona pellucida (ZP) of two- to four-cell FVB mouse embryos.

RESULTS

In the first experiment there was no difference in blastocyst production or hatching rates following laser or conventional assisted hatching (LAH or AH, respectively) in contrast to control embryos cultured in a 5% CO2 humidified air incubator at 37 degrees C. In the second experiment a blastocyst antihatching culture model was employed and LAH-treated embryos were cultured in a serum-free HTF medium (HTF-o). Blastocyst formation was not influenced by LAH treatment and hatching was increased (P < 0.01) from 4 to 60% compared to HTF-o control group.

CONCLUSIONS

These preliminary data demonstrate the utility and nontoxic properties of the Ho:YSGG laser system for quick and precise ZP drilling.

Rescue of human embryos by micromanipulation

This chapter evaluates clinical micromanipulation techniques aimed at rescuing abnormally developing zygotes and cleaved embryos. First, the possibility of reversing dispermic zygotes to a normal biparental diploid state was evaluated by extracting the distal pronucleus (that furthest from the polar body). The ratio of X:Y was determined in both groups of embryos by assessing a minimum of two blastomeres using duplex PCR or multiple colour FISH. The ratio of embryos containing only an X chromosome and those with X as well as Y chromosomes in the intact dispermic zygotes was 1.0:2.6, which is similar to the theoretical ratio of 1:3. This ratio was 1.0:1.5 in dispermic zygotes from which the distal pronuclei were removed. Although the ratio of X:Y was altered following removal of distal pronuclei, suggesting frequent targeting of male pronuclei, accidental removal of the female pronucleus could not be excluded. In a second set of mouse experiments, it was shown that the hatching process of embryos that develop with excessive amounts of degenerate material is adversely affected. It was shown that removal of such extracellular material by micromanipulation potentially reverted the hatching process. It was also indicated that immediate removal of the degenerate tissue was more beneficial than that following prolonged co-culture. Assisted hatching is probably the most frequently applied clinical embryo micromanipulation procedure. The outcome of assisted hatching is dependent largely on the mode by which the zona pellucida is breached, the size of the artificial gap and the thickness of the zona pellucida. Embryos with zonae thicker than 17 microns rarely implant. Zona drilling could be detrimental in embryos with thin zonae (< 12 microns). Superficial zona thinning has not enhanced implantation. These observations led to a routine procedure called selective assisted hatching, which involves measuring the zonae before zona drilling and replacement on day 3 of development. This appears to be most successful in older women and those with elevated basal FSH levels. Selective assisted hatching is routinely applied in consenting patients whose embryos have thick zonae, slow development or excessive fragmentation (> 20%). Zona drilling of all embryos, regardless of zona thickness, is being performed in patients aged over 40 years and in those with repeated failures or elevated basal FSH levels. Results in the first group of more than 900 patients indicate that nearly one-quarter of human embryos have the ability to implant.

308 nm excimer laser ablation of cartilage

This article reports the investigation of the XeCl excimer laser as a cutting-ablating tool for human fibrocartilage and hyaline cartilage. Quantitative measurements were made of tissue ablation rates as a function of fluence in meniscal fibrocartilage and articular hyaline cartilage. A force of 1.47 Newtons was applied to an 800-microns fiber with the laser delivering a range of fluences (40-190 mJ/mm2) firing at a frequency of 5 Hz. To assess the effect of repetition rate on depth per pulse, a set of measurements was made at a constant fluence of 60 mJ/mm2, with the repetition rate varying from 10 to 40 Hz. Histologic and morphometric analysis of preserved specimens was performed using light microscopy. The results of these studies revealed that the ablation rate was directly proportional to fluence over the range tested. Fibrocartilage was ablated at a rate 2.56 times faster than hyaline cartilage. Repetition rate had no effect on the penetration per pulse. Adjacent tissue damage was noted to be minimal (10-70 microns). The excimer laser achieved ablation rates adequate for arthroscopic applications.

Interaction between human sperm cells and hamster oocytes after argon fluoride excimer laser drilling of the zona pellucida

OBJECTIVES

To provide conclusive evidence that sperm cells gain access to the perivitelline space exclusively through a laser-drilled opening. To assess the optimal size of the hole and to evaluate the efficacy of laser drilling in comparison with that of mechanical zona dissection.

DESIGN

An interspecies model of human sperm cell that interacts with a laser-drilled or partially zona-dissected hamster oocytes.

MAIN OUTCOME MEASURES

Penetration rate into the perivitelline space as related to the size of the opening (group A [5 microns], group B [10 microns], and group C [15 microns]) and to the sperm cell concentrations (1 x 10(6), 5 x 10(6), and 10 x 10(6) cells/mL) used for insemination.

RESULTS

For each sperm cell concentration, the penetration rate into the perivitelline space was lowest for group A followed by group C and highest for group B. When penetration was compared for each hole size, it was found that sperm concentration had no effect on the rate of penetration in groups A and C but significantly affected this rate in group B. The highest penetration rate of 73% was observed with a concentration of 10 x 10(6) cell/mL and declined to 58% and 23% at 5 x 10(6) cell/mL and 1 x 10(6) cell/mL, respectively. Oocytes drilled by laser (10-microns hole) demonstrated a significantly higher penetration rate when compared with those treated by partial zona dissection (73% versus 20% and 58% versus 21% for sperm densities of 10 x 10(6) cells/mL and 5 x 10(6) cells/mL, respectively).

CONCLUSION

Human sperm cells gain access into the perivitelline space of hamster oocytes exclusively through a hole drilled by an argon fluoride excimer laser. An opening of 10 microns was found to yield optimal results. Laser drilling of the zona pellucida seems to be superior to that of mechanical slitting in terms of sperm oolema interaction.

Pre-embryo: therapeutic approaches

There are potential interventions in the pre-embryo stage in order to improve the clinical results of assisted reproductive technology, live-birth per cycle of treatment, and to prevent the birth of offspring with genetic aberrations. The following therapeutic measures can be potentially applied to the pre-embryo: improvement of culture conditions, pre-embryo cryopreservation, assisted hatching, genetic diagnosis and gene therapy. In order to discuss the parents' rights and duties in applying therapeutic measures to the pre-embryo, it is essential to clarify the ethical and legal dilemmas concerning the status of the pre-embryo.

The efficacy and safety of zona pellucida drilling by a 193-nm excimer laser

OBJECTIVE

To examine the efficiency of argon fluoride excimer laser drilling of the zona pellucida of mouse oocytes in improving in vitro fertilization (IVF) at low sperm concentrations and to assess its safety.

DESIGN

Oocytes obtained from (Balb/c x C57BL6)CB6F1 female mice were drilled by laser and divided into two groups: group I (89 oocytes) were inseminated with 10(5) sperm cells/mL, and group II (94 oocytes) were inseminated with 10(6) sperm cells/mL. Both groups' fertilization rate and development in vitro was compared with control oocytes that underwent the same preparation steps but no drilling (94 and 88 oocytes for group I and group II, respectively).

MAIN OUTCOME MEASURES

The fertilization rate and the development in vitro of the laser-drilled groups is compared with that of the control. In addition, in vivo development of embryos generated from laser-drilled oocytes after transfer to pseudopregnant recipients is assessed.

RESULTS

For both sperm concentrations, laser drilling significantly enhanced fertilization over control (67% versus 31% at 10(5) sperm cells/mL and 90% versus 54% at 10(6) sperm cells/mL). The development into the blastocyst stage after 96 hours of incubation was similar for both the laser-drilled and control groups at any sperm cell concentration. However, complete hatching at this point was significantly enhanced by the drilling procedure. Normal litters were obtained from the transfer of embryos developed from zona-drilled oocytes into pseudopregnant recipients.

CONCLUSIONS

Excimer laser drilling enhanced IVF at low sperm cell concentration. The procedure is safe and did not interfere with embryo development in vitro or in vivo.

Microinjection of FITC-dextran into mouse blastomeres to assess topical effects of zona photoablation

The objective of the current experiments was to investigate whether all or only some blastomeres from precompacted mouse embryos were affected by zona photoablation. The microbeam of xenon chloride excimer laser (308 nm) was guided through an inverted microscope (non-contact system). Topical effects of lasing were determined by microinjection of a vital fluorescent dye of high molecular weight (fluorescein isothiocyanate [FITC] dextran) into the cell immediately adjacent to the site of zona photoablation. This dye is only passed onto daughter blastomeres and therefore allows study of specific cell lines. Embryonic growth was assessed following cell separation at the morula and blastocyst stage. Four-cell embryos treated with the laser had significantly fewer cells 12 h after zona photoablation than control embryos. A similar effect was noted after 24 h between dye injected embryos and those injected and lased simultaneously, indicating potential toxic effects of the laser treatment on the embryo. Effects on the blastomere closest to the site of ablation were evaluated by calculating the ratio of dyed cells to the total number of cells at specific time intervals. The ratios were similar in the dye and laser+dye groups of treated 4-cell embryos 36 h after treatment (0.22 and 0.23, respectively), indicating that the dye was still present in approximately 25% of the cells and that the negative effect of photoablation was evenly distributed among the blastomeres. It is concluded that zona photoablation may have long-term detrimental effects of a non-topical nature on precompacted mouse embryos in spite of the apparent precision of the laser spot size.