The neglected human blastocyst

Comparative study on the pregnancy outcomes of in vitro fertilization-embryo transfer between patients with different ovarian responses (a STROBE-compliant article)

There have been few studies on large-sample data of cleavage-stage embryo and blastocyst transfers. We compared the pregnancy outcomes of patients with different ovarian responses after the transfer of different numbers of embryos in different developmental stages.Patients were divided into 3 groups including low response group, medium response group, and high response group according to different ovarian responses. Patients in each group were further divided into 4 subgroups including group A: transfer of 1 D3 embryo, group B: transfer of 2 D3 embryos; group C: transfer of 1 D5 blastocyst; and group D: transfer of 2 D5 blastocysts.In low ovarian responders, the implantation rate, clinical pregnancy rate and live birth rate were significantly lower in the group A than in the groups B and C. In medium ovarian responders, the implantation rate was significantly higher, but the multiple pregnancy rate was significantly lower in the group C than in the group B. The multiple pregnancy rate was significantly higher in the group D than in the group C. In high ovarian responders, the implantation rate was significantly lower, but the multiple pregnancy rate was significantly higher in the group B than in group C.Based on the above results, the single blastocyst transfer is preferable for the patients with different ovarian responses.

Embryo transfer after 2 or 5 days of IVF culture: a retrospective comparison

BACKGROUND

To determine whether prolongation of embryo culture in vitro from day 2 to day 5 after ovum pick-up (OPU) and fertilization can improve the results of in vitro fertilization (IVF), and the morphology of the spare embryos on day 2 can predict the developmental capacity during prolonged culture. We also wanted to consider this as a strategy to avoid twin pregnancies if it could be possible to transfer only one blastocyst at a time in the future.

METHODS

A retrospective analysis with embryo transfer timed according to the weekday of OPU. Embryo transfer was performed on day 2 in 103 cases and on day 5 in 120 cases. Only one cycle per couple was included.

RESULTS

The pregnancy rates per embryo transfer on day 2 (27/103, 26%) and day 5 (36/120, 30%) were similar. There were significantly more miscarriages in the day 5 (50%) than in the day 2 group (22%, p = 0.02), but there was no significant difference in the baby take home rate (20% in day 2 group, 15% in day 5 group). The morphological appearance of the embryos on day 2 was poorly correlated to the developmental potential during prolonged culture in vitro. On day 5, transfer of one or two blastocysts resulted in a pregnancy rate that tended to be higher than that after transfer of morulae only.

CONCLUSION

Prolongation of embryo culture from day 2 to day 5 did not improve the clinical outcome of the IVF treatment when measured as baby take home rate. Therefore, for the time being, this strategy does not increase our chances to move towards single embryo transfer.

Blastocyst culture and transfer: analysis of results and parameters affecting outcome in two in vitro fertilization programs

OBJECTIVE

To determine whether previously described advanced blastocyst development and high implantation rates are confirmed in an expanded multicenter trial.

DESIGN

Retrospective review.

SETTING

Two private assisted reproductive technology units.

PATIENT(S)

One hundred seventy-four patients who underwent blastocyst culture and transfer.

INTERVENTION(S)

Culture of all pronucleate embryos in sequential media to the blastocyst stage (day 5) followed by ET.

MAIN OUTCOME MEASURE(S)

The number and percentage of blastocysts developed, implantation rates, pregnancy rates, and parameters that affected outcome were analyzed.

RESULT(S)

Only 3 of 174 patients failed to achieve blastocyst-stage ET. The mean blastocyst development rate was 48%. The ongoing pregnancy rate was 66.3% per oocyte retrieval, with a mean (+/-SE) of 2.2 +/- 0.05 blastocysts transferred and an implantation rate of 48% per blastocyst transferred.

CONCLUSION(S)

Blastocyst culture and transfer is an effective means of treating patients who respond well to gonadotropins. High pregnancy rates can be accomplished with low numbers of embryos transferred. Patients who failed to achieve ET were rare.

Improved human zygote development in a modified Ham's F10 medium in vitro

PURPOSE

Our purpose was to determine the effect of modified Ham's F10 media with and without glucose, hypoxanthine, phosphate, and transition metals (MM) on human embryo development.

METHODS

Patients with at least one zygote were randomized by alternate assignment to one of the treatment groups. The treatment groups were as follows: normal Hams F10, MM, and MM with 0.5 mM glucose (LGMM). Patients were undergoing in vitro fertilization and embryo transfer or frozen-thawed embryo transfer. Zygotes (fresh and frozen-thawed) were incubated in one of three media for 24 hr before transfer. The groups were compared with respect to embryo quality, number of embryos transferred, age of the patients, clinical pregnancy rate, and implantation rate.

RESULTS

The clinical pregnancy rate and the implantation rate were significantly higher in the group of patients whose zygotes were cultured in MM. LGMM did not appear to improve the pregnancy outcome compared to normal Ham's F10. However, the quality of the embryos cultured in MM or LGMM appears to be superior to the normal Ham's F10 with respect to the number of excellent and good-quality embryos and embryos without fragments.

CONCLUSION

A modified Ham's F10 medium (MM) without added glucose appears to be superior to normal Ham's F10 for culture of human zygotes for embryo transfer.

Clinical experience with synthetic serum substitute as a protein supplement in IVF culture media: a retrospective study

OBJECTIVE

Our objective was to evaluate the efficacy of Synthetic Serum Substitute (Irvine Scientific--Materials Section, Santa Ana, CA), a globulin-enriched protein preparation containing human serum albumin for supplementation of IVF culture media.

DESIGN

We retrospectively analyzed IVF cycles performed at MacDonald Womens Hospital between January 1992 and November 1994. IVF cycles were reviewed and classified according to the nature of protein supplementation used in the embryo culture medium. Three protein supplements utilized during this time period were compared: Synthetic Serum Substitute (SSS), Plasmanate (PL), and maternal serum (MS).

RESULTS

Although clinical pregnancy rates among the three treatment groups were not statistically different, there was a definite trend toward a higher pregnancy rate with SSS supplementation (SSS, 38.2%; MS, 28.0%; and PL, 24.9%). Embryos grown in SSS-supplemented culture media had a significantly higher implantation rate (17.8 vs 10.4 and 10.3%, respectively, for MS and PL). Preliminary data also suggest that human embryo development and blastulation in vitro were enhanced by this protein supplement.

CONCLUSIONS

The higher implantation rate with SSS suggests that it may be superior to both maternal serum and Plasmanate in supporting human embryo development in vitro. Whether blastocysts derived from PL- and SSS-supplemented media are able to implant and give rise to clinical pregnancies remains to be seen.

Beneficial effects of coculture with cumulus cells on blastocyst formation in a prospective trial with supernumerary human embryos

PURPOSE

We reported previously on the use of coculture with cumulus cells in insemination medium for the development of human embryos in vitro. Here we describe a prospective trial to determine if this procedure has a significant beneficial effect.

METHODS

On the day after insemination, zygotes were randomized for culture in either a fresh drop of medium without (- cum) or were left in their insemination drop with (+ cum) cumulus cells. Embryos with the best morphological quality were replaced on the third day of development at the eight-cell stage. The remaining embryos were cultured for a further 3 days and cryopreserved if they reached the fully expanded blastocyst (FEB) stage. Three different culture media were used over the period of this study.

RESULTS

In 11 patients, supernumerary embryos were available only for continued culture in +cum and three patients had embryos cultured in only -cum. Thirty-nine other patients had embryos assigned to both +cum and -cum treatments. In the +cum group, 98 blastocysts developed from 216 embryos cultured for 6 days (45%), and this was significantly greater (P < 0.01) than the 48 blastocysts from 156 embryos (31%) developing in the absence of cumulus cells. In basal HTF medium (HTF medium with EDTA and glutamine) and basal XI HTF medium (similar to basal HTF but devoid of glucose and phosphate), culture of embryos with cumulus cells produced significantly more FEBs than in the absence of cumulus cells. There was no significant difference between the two culture treatments when regular HTF medium was used. Preliminary results indicate that pronectin-coated dishes provide a good substratum for cumulus cell attachment and embryo development.

CONCLUSIONS

The culture of human embryos with their cumulus cells in insemination drops of medium produces a significantly greater proportion of FEBs than when the zygotes are transferred to fresh culture drops devoid of cumulus cells. This is the first report of a significantly higher blastocyst rate with coculture in which a real comparison has been made between two culture treatments which differ only in the presence or absence of homologous cumulus cells in insemination drops.

Use of coculture with cumulus cells in insemination medium in human in vitro fertilization (IVF)

PURPOSE

In an initial trial, 16 of 33 (48%) bipronuclear human zygotes left in culture in the insemination drop from which they had originated developed to fully expanded blastocysts.

RESULTS

This method was subsequently used for all supernumerary embryos judged unsuitable for replacement or cryopreservation on Day 1, 2, or 3 of development. Over a 4-year period, embryos reaching the fully expanded blastocyst stage were cryopreserved. Of 113 such blastocysts thawed, 81 survived (72%), and upon transfer to 52 patients, 8 clinical pregnancies were established (15%), of which 6 were live births. Subsequently, following modification of some culture parameters, 60 patients had 296 supernumerary embryos cultured for 6 days; 43 of these patients (72%) had 148 embryos (50%) that cavitated and 134 (45%) of these cavitating embryos were judged to be fully expanded blastocycts; 125 (42%) of these embryos were cryopreserved.

CONCLUSION

The blastocyst formation rate is similar to that reported by others using conventional culture procedures or coculture on Vero or other cell types. I conclude that cumulus cells are a ready source of feeder cells for the coculture of human embryos.