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Park JK, Jeon Y, Bang S, Kim JW, Kwak IP, Lee WS. Time-lapse imaging of morula compaction for selecting high-quality blastocysts: a retrospective cohort study. Arch Gynecol Obstet 2024; 309:2897-2906. [PMID: 38649499 DOI: 10.1007/s00404-024-07461-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 03/04/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE Before blastocyst development, embryos undergo morphological and metabolic changes crucial for their subsequent growth. This study aimed to investigate the relationship between morula compaction and blastocyst formation and the subsequent chromosomal status of the embryos. METHODS This retrospective cohort study evaluated embryo development (n = 371) using time-lapse imaging; 94 blastocysts underwent preimplantation genetic testing for aneuploidy (PGT-A). RESULTS The embryos were classified as fully (Group 1, n = 194) or partially (Group 2, n = 177) compacted. Group 1 had significantly higher proportions of good- and average-quality blastocysts than Group 2 (21.6% vs. 3.4%, p = 0.001; 47.9% vs. 26.6%, p = 0.001, respectively). The time from the morula stage to the beginning and completion of compaction and blastocyst formation was significantly shorter in Group 1 than in Group 2 (78.6 vs. 82.4 h, p = 0.001; 87.0 vs. 92.2 h, p = 0.001; 100.2 vs. 103.7 h, p = 0.017, respectively). Group 1 embryos had larger surface areas than Group 2 embryos at various time points following blastocyst formation. Group 1 blastocysts had significantly higher average expansion rates than Group 2 blastocysts (653.6 vs. 499.2 μm2/h, p = 0.001). PGT-A revealed a higher proportion of euploid embryos in Group 1 than in Group 2 (47.2% vs. 36.6%, p = 0.303). CONCLUSION Time-lapse microscopy uncovered a positive relationship between compaction and blastocyst quality and its association with embryo ploidy. Hence, compaction evaluation should be prioritized before blastocyst selection for transfer or cryopreservation.
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Affiliation(s)
- Jae Kyun Park
- Department of Obstetrics and Gynecology, Fertility Center of CHA Gangnam Medical Center, CHA University School of Medicine, 566 Nonhyeon-ro, Gangnam-gu, Seoul, 06135, Korea
| | - Yunmi Jeon
- Department of Obstetrics and Gynecology, Fertility Center of CHA Gangnam Medical Center, CHA University School of Medicine, 566 Nonhyeon-ro, Gangnam-gu, Seoul, 06135, Korea
| | - Soyoung Bang
- Department of Obstetrics and Gynecology, Fertility Center of CHA Gangnam Medical Center, CHA University School of Medicine, 566 Nonhyeon-ro, Gangnam-gu, Seoul, 06135, Korea
| | - Ji Won Kim
- Department of Obstetrics and Gynecology, Fertility Center of CHA Gangnam Medical Center, CHA University School of Medicine, 566 Nonhyeon-ro, Gangnam-gu, Seoul, 06135, Korea.
| | - In Pyung Kwak
- Department of Obstetrics and Gynecology, Fertility Center of CHA Gangnam Medical Center, CHA University School of Medicine, 566 Nonhyeon-ro, Gangnam-gu, Seoul, 06135, Korea
| | - Woo Sik Lee
- Department of Obstetrics and Gynecology, Fertility Center of CHA Gangnam Medical Center, CHA University School of Medicine, 566 Nonhyeon-ro, Gangnam-gu, Seoul, 06135, Korea.
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Yazdani A, Halvaei I, Boniface C, Esfandiari N. Effect of cytoplasmic fragmentation on embryo development, quality, and pregnancy outcome: a systematic review of the literature. Reprod Biol Endocrinol 2024; 22:55. [PMID: 38745305 PMCID: PMC11092204 DOI: 10.1186/s12958-024-01217-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 04/01/2024] [Indexed: 05/16/2024] Open
Abstract
The role of cytoplasmic fragmentation in human embryo development and reproductive potential is widely recognized, albeit without standard definition nor agreed upon implication. While fragmentation is best understood to be a natural process across species, the origin of fragmentation remains incompletely understood and likely multifactorial. Several factors including embryo culture condition, gamete quality, aneuploidy, and abnormal cytokinesis seem to have important role in the etiology of cytoplasmic fragmentation. Fragmentation reduces the volume of cytoplasm and depletes embryo of essential organelles and regulatory proteins, compromising the developmental potential of the embryo. While it has been shown that degree of fragmentation and embryo implantation potential are inversely proportional, the degree, pattern, and distribution of fragmentation as it relates to pregnancy outcome is debated in the literature. This review highlights some of the challenges in analysis of fragmentation, while revealing trends in our evolving knowledge of how fragmentation may relate to functional development of the human embryos, implantation, and pregnancy outcome.
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Affiliation(s)
- Ariella Yazdani
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Vermont Medical Center, The Robert Larner College of Medicine at the University of Vermont, Burlington, VT, 05405, USA
- Present address: Obstetrics and Gynecology Institute, Cleveland Clinic Foundation, Cleveland, OH, 44195, USA
| | - Iman Halvaei
- Department of Anatomical Sciences, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Catherine Boniface
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Vermont Medical Center, The Robert Larner College of Medicine at the University of Vermont, Burlington, VT, 05405, USA
| | - Navid Esfandiari
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Vermont Medical Center, The Robert Larner College of Medicine at the University of Vermont, Burlington, VT, 05405, USA.
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology and Reproductive Sciences, University of Vermont, 111 Colchester Avenue, Burlington, Vermont, 05401, USA.
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3
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Parriego M, Coll L, Carrasco B, Garcia S, Boada M, Polyzos NP, Vidal F, Veiga A. Blastocysts from partial compaction morulae are not defined by their early mistakes. Reprod Biomed Online 2024; 48:103729. [PMID: 38367593 DOI: 10.1016/j.rbmo.2023.103729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 10/23/2023] [Accepted: 11/12/2023] [Indexed: 02/19/2024]
Abstract
RESEARCH QUESTION Is partial compaction during morula formation associated with an embryo's developmental ability and implantation potential? DESIGN Retrospective analysis of data from 196 preimplantation genetic testing for aneuploidy (PGT-A) cycles. Embryos starting compaction were grouped according to the inclusion or not of all the blastomeres in the forming morula (full compaction or partial compaction). The possible effect of maternal age and ovarian response on compaction was analysed. Morphokinetic characteristics, blastocyst formation rate, morphology and cytogenetic constitution of the obtained blastocysts were compared. Comparisons of reproductive outcomes after the transfer of euploid blastocysts from both groups were established. Finally, in a subset of embryos, the chromosomal constitution concordance of the abandoned cells and the corresponding blastocyst through trophectoderm biopsies was assessed. RESULTS A total of 430 embryos failed to include at least one cell during compaction (partial compaction group [49.3%]), whereas the 442 remaining embryos formed a fully compacted morula (full compaction group [50.7%]). Neither female age nor the number of oocytes collected affected the prevalence of partial compaction morulae. Morphokinetic parameters were altered in embryos from partial compaction morulae compared with full compaction. Although an impairment in blastocyst formation rate was observed in partial compaction morulae (57.2% versus 70.8%, P < 0.001), both chromosomal constitution (euploidy rate: partial compaction [38.4%] versus full compaction [34.2%]) and reproductive outcomes (live birth rate: partial compaction [51.9%] versus full compaction [46.2%]) of the obtained blastocysts were equivalent between groups. A high ploidy correlation of excluded cells-trophectoderm duos was observed. CONCLUSIONS Partial compaction morulae show a reduced developmental ability compared with full compaction morulae. Resulting blastocysts from both groups, however, have similar euploidy rates and reproductive outcomes. Cell exclusion might be a consequence of a compromised embryo development regardless of the chromosomal constitution of the excluded cells.
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Affiliation(s)
- Monica Parriego
- Reproductive Medicine Unit, Department of Obstetrics, Gynaecology and Reproduction. Dexeus Mujer. Dexeus University Hospital. Gran Via Carles III, 71-75. 08028 Barcelona, Spain.
| | - Lluc Coll
- Reproductive Medicine Unit, Department of Obstetrics, Gynaecology and Reproduction. Dexeus Mujer. Dexeus University Hospital. Gran Via Carles III, 71-75. 08028 Barcelona, Spain
| | - Beatriz Carrasco
- Reproductive Medicine Unit, Department of Obstetrics, Gynaecology and Reproduction. Dexeus Mujer. Dexeus University Hospital. Gran Via Carles III, 71-75. 08028 Barcelona, Spain
| | - Sandra Garcia
- Reproductive Medicine Unit, Department of Obstetrics, Gynaecology and Reproduction. Dexeus Mujer. Dexeus University Hospital. Gran Via Carles III, 71-75. 08028 Barcelona, Spain
| | - Montserrat Boada
- Reproductive Medicine Unit, Department of Obstetrics, Gynaecology and Reproduction. Dexeus Mujer. Dexeus University Hospital. Gran Via Carles III, 71-75. 08028 Barcelona, Spain
| | - Nikolaos P Polyzos
- Reproductive Medicine Unit, Department of Obstetrics, Gynaecology and Reproduction. Dexeus Mujer. Dexeus University Hospital. Gran Via Carles III, 71-75. 08028 Barcelona, Spain
| | - Francesca Vidal
- Unitat de Biologia Cel·lular, Facultat de Biociències, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
| | - Anna Veiga
- Barcelona Stem Cell Bank, IDIBELL Programme for Regenerative Medicine, 08908 L'Hospitalet de Llobregat, Spain
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Sobkowiak A, Fluks M, Kosyl E, Milewski R, Szpila M, Tamborski S, Szkulmowski M, Ajduk A. The number of nuclei in compacted embryos, assessed by optical coherence microscopy, is a non-invasive and robust marker of mouse embryo quality. Mol Hum Reprod 2024; 30:gaae012. [PMID: 38407286 PMCID: PMC10978378 DOI: 10.1093/molehr/gaae012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 01/15/2024] [Indexed: 02/27/2024] Open
Abstract
Optical coherence microscopy (OCM) visualizes nuclei in live, unlabeled cells. As most cells are uninucleated, the number of nuclei in embryos may serve as a proxy of the cell number, providing important information on developmental status of the embryo. Importantly, no other non-invasive method currently allows for the cell number count in compacted embryos. We addressed the question of whether OCM, by providing the number of nuclei in compacted mouse embryos, may help evaluate embryo quality. We subjected compacted embryonic Day 3 (E3.0: 72 h after onset of insemination) mouse embryos to OCM scanning and correlated nuclei number and developmental potential. Implantation was assessed using an outgrowth assay (in vitro model meant to reflect embryonic ability to implant in vivo). Embryos with more cells at E3.0 (>18 cells) were more likely to reach the blastocyst stage by E4.0 and E5.0 (P ≪ 0.001) and initiate hatching by E5.0 (P < 0.05) than those with fewer cells (<12 cells). Moreover, the number of cells at E3.0 strongly correlated with the total number of cells in E4.0 and E5.0 embryos (ρ = 0.71, P ≪ 0.001 and ρ = 0.61, P ≪ 0.001, respectively), also when only E4.0 and E5.0 blastocysts were considered (ρ = 0.58, P ≪ 0.001 and ρ = 0.56, P ≪ 0.001, respectively). Additionally, we observed a strong correlation between the number of cells at E3.0 and the number of trophectoderm cells in E4.0 and E5.0 blastocysts (ρ = 0.59, P ≪ 0.001 and ρ = 0.57, P ≪ 0.001, respectively). Importantly, embryos that had more cells at E3.0 (>18 cells) were also more likely to implant in vitro than their counterparts with fewer cells (<12 cells; P ≪ 0.001). Finally, we tested the safety of OCM imaging, demonstrating that OCM scanning affected neither the amount of reactive oxygen species nor mitochondrial activity in the embryos. OCM also did not hinder their preimplantation development, ability to implant in vitro, or to develop to term after transfer to recipient females. Our data indicate that OCM imaging provides important information on embryo quality. As the method seems to be safe for embryos, it could be a valuable addition to the current repertoire of embryo evaluation methods. However, our study was conducted only on mouse embryos, so the proposed protocol would require optimization in order to be applied in other species.
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Affiliation(s)
- Aleksandra Sobkowiak
- Department of Embryology, Institute of Developmental Biology and Biomedical Sciences, Faculty of Biology, University of Warsaw, Warsaw, Poland
| | - Monika Fluks
- Department of Embryology, Institute of Developmental Biology and Biomedical Sciences, Faculty of Biology, University of Warsaw, Warsaw, Poland
| | - Ewa Kosyl
- Department of Embryology, Institute of Developmental Biology and Biomedical Sciences, Faculty of Biology, University of Warsaw, Warsaw, Poland
| | - Robert Milewski
- Department of Biostatistics and Medical Informatics, Medical University of Bialystok, Białystok, Poland
| | - Marcin Szpila
- Department of Embryology, Institute of Developmental Biology and Biomedical Sciences, Faculty of Biology, University of Warsaw, Warsaw, Poland
| | - Szymon Tamborski
- Department of Biophotonics and Optical Engineering, Institute of Physics, Faculty of Physics, Astronomy, and Informatics, Nicolaus Copernicus University in Torun, Toruń, Poland
| | - Maciej Szkulmowski
- Department of Biophotonics and Optical Engineering, Institute of Physics, Faculty of Physics, Astronomy, and Informatics, Nicolaus Copernicus University in Torun, Toruń, Poland
| | - Anna Ajduk
- Department of Embryology, Institute of Developmental Biology and Biomedical Sciences, Faculty of Biology, University of Warsaw, Warsaw, Poland
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Zou Y, Sui Y, Fu J, Ge N, Sun X, Sun Y. The morphokinetic signature of human blastocysts with mosaicism and the clinical outcomes following transfer of embryos with low-level mosaicism. J Ovarian Res 2024; 17:10. [PMID: 38195558 PMCID: PMC10775590 DOI: 10.1186/s13048-023-01324-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 12/12/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND Genetic mosaicism is commonly observed in human blastocysts. Embryos' morphokinetic feature observed from time-lapse monitoring (TLM) is helpful to predict the embryos' ploidy status in a non-invasive way. However, morphokinetic research on mosaic embryos is extremely limited. Moreover, transfer of mosaic embryos is a new attempt in reproductive medicine, while studies regarding the clinical and neonatal outcomes following transfer of embryos with different levels and types of mosaicism are needed. This study aimed to investigate the morphokinetic characteristics of mosaic blastocysts, uncover clinical outcomes of mosaic embryos, and evaluate the effect of level and type of mosaicism on transfer outcomes. RESULTS A total of 923 blastocysts from 229 preimplantation genetic testing cycles were cultured in TLM incubators in a single fertilization center between July 2016 and July 2021. Multivariate logistic regression models showed mosaic embryos had significantly shorter time to reach morula when compared with euploid (P = 0.002), mosaic with aneuploid (P = 0.005), and aneuploid (P = 0.005) embryos after adjusting the potential confounders. KIDScore is an artificial intelligence scoring program from time lapse incubation system to predict embryo implantation potential. Mosaic with aneuploid embryos had significantly lower KIDScore than euploid (P = 6.47e-4), mosaic (P = 0.005), and aneuploid (P = 0.004) embryos after adjustment. Meanwhile, we compared the clinical outcomes following transfer of low-level (< 50%) mosaic embryos (N = 60) with euploid embryos (N = 1301) matched using propensity scoring collected from September 2020 to January 2023. Mosaic embryos had significantly lower clinical pregnancy rate (41.67% vs. 57.65%, P = 0.015) and live birth rate (38.33% vs. 51.35%, P = 0.048) than the euploid embryos. Subgroup analyses showed the whole, segmental, and complex chromosome mosaic embryos had the similar clinical outcomes. CONCLUSIONS The shortened time to reach morula in mosaic embryos and the low KIDScore in mosaic with aneuploid embryos revealed innovative clues to embryo selection with the non-invasive TLM and provided new insights into biological mechanism of chromosomal abnormality. The analyses of overall and subgroups of mosaic embryo transfer outcomes helped to optimize embryo transfer scheme for in-vitro fertilization procedures. Multi-center prospective studies with large sample sizes are warranted to validate our results in the future.
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Affiliation(s)
- Yaoyu Zou
- Shanghai Ji Ai Genetics & IVF Institute, Obstetrics & Gynecology Hospital, Fudan University, Dalin Road, Shanghai, 200011, China
| | - Yilun Sui
- Shanghai Ji Ai Genetics & IVF Institute, Obstetrics & Gynecology Hospital, Fudan University, Dalin Road, Shanghai, 200011, China
| | - Jing Fu
- Shanghai Ji Ai Genetics & IVF Institute, Obstetrics & Gynecology Hospital, Fudan University, Dalin Road, Shanghai, 200011, China
| | - Naidong Ge
- Shanghai Ji Ai Genetics & IVF Institute, Obstetrics & Gynecology Hospital, Fudan University, Dalin Road, Shanghai, 200011, China
| | - Xiaoxi Sun
- Shanghai Ji Ai Genetics & IVF Institute, Obstetrics & Gynecology Hospital, Fudan University, Dalin Road, Shanghai, 200011, China.
| | - Yijuan Sun
- Shanghai Ji Ai Genetics & IVF Institute, Obstetrics & Gynecology Hospital, Fudan University, Dalin Road, Shanghai, 200011, China.
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Kakulavarapu R, Stensen MH, Jahanlu D, Haugen TB, Delbarre E. Altered morphokinetics and differential reproductive outcomes associated with cell exclusion events in human embryos. Reprod Biomed Online 2023; 47:103285. [PMID: 37573752 DOI: 10.1016/j.rbmo.2023.103285] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 06/19/2023] [Accepted: 07/05/2023] [Indexed: 08/15/2023]
Abstract
RESEARCH QUESTION Can embryos harbouring cell exclusion and their reproductive outcomes be classified based on morphokinetic profiles? DESIGN A total of 469 time-lapse videos of embryos transferred between 2013 and 2019 from a single clinic were analysed. Videos were assessed and grouped according to the presence or absence of one or more excluded cells before compaction. Cell division timings, intervals between subsequent cell divisions and dynamic intervals were analysed to determine the morphokinetic profiles of embryos with cell exclusion (CE+), compared with fully compacted embryos without cell exclusion or extrusion (CE-). RESULTS Transfer of CE+ embryos resulted in lower proportions of fetal heartbeat (FHB) and live birth compared with CE- embryos (both, P < 0.001). CE+ embryos were associated with delays in t2 (P = 0.030), t6 (P = 0.018), t7 (P < 0.001), t8 (P = 0.001), tSC (P < 0.001) and tM (P < 0.001). Earlier timings for t3 (P = 0.014) and t5 (P < 0.001) were positively associated with CE+; CE+ embryos indicated prolonged S2, S3, ECC3, cc2 and cc4. Logistic regression analysis revealed that t5, tM, S2 and ECC3 were the strongest predictive indicators of cell exclusion. Timings for S2 and ECC3 were useful in identifying increased odds of FHB when a cell exclusion event was present. CONCLUSION Embryos harbouring cell exclusion indicated altered morphokinetic profiles. Their overall lower reproductive success was associated with two morphokinetic parameters. Morphokinetic profiles could be used as adjunct indicators for reproductive success during cycles producing few, low-quality embryos. This may allow more objective identification of cell exclusion and refinement of embryo ranking procedures before transfer.
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Affiliation(s)
- Radhika Kakulavarapu
- Department of Life Sciences and Health, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway..
| | | | - David Jahanlu
- Department of Life Sciences and Health, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Trine B Haugen
- Department of Life Sciences and Health, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Erwan Delbarre
- Department of Life Sciences and Health, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway..
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Montgomery K, Montgomery S, Campbell A, Nash DM. A comparison of the morphokinetic profiles of embryos developed from vitrified versus fresh oocytes. Reprod Biomed Online 2023; 47:51-60. [PMID: 37188558 DOI: 10.1016/j.rbmo.2023.02.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 02/13/2023] [Accepted: 02/21/2023] [Indexed: 03/06/2023]
Abstract
RESEARCH QUESTION Do morphokinetic profiles and treatment outcomes differ between embryos developed from vitrified or fresh oocytes? DESIGN Retrospective multicentre analysis using data from eight CARE Fertility clinics across the UK between 2012 and 2019. Patients receiving treatment using embryos developed from vitrified oocytes (n = 118 women, n = 748 oocytes), providing 557 zygotes during this time period, were recruited and matched with patients undergoing treatment with embryos developed from fresh oocytes (n = 123 women, n = 1110 oocytes), providing 539 zygotes in the same time frame. Time-lapse microscopy was used to assess morphokinetic profiles, including early cleavage divisions (2- through to 8-cell), post-cleavage stages including time to start of compaction, time to morula, time to start of blastulation and time to full blastocyst. Duration of key stages such as the compaction stage were also calculated. Treatment outcomes were compared between the two groups (live birth rate, clinical pregnancy rate and implantation rate). RESULTS A significant delay of 2-3 h across all early cleavage divisions (2- through to 8-cell) and time to start of compaction occurred in the vitrified group versus fresh controls (all P ≤ 0.01). The compaction stage was significantly shorter in vitrified oocytes (19.02 ± 0.5 h) compared with fresh controls (22.45 ± 0.6 h, P < 0.001). There was no difference in the time that fresh and vitrified embryos reached the blastocyst stage (108.03 ± 0.7 versus 107.78 ± 0.6 h). There was no significant difference in treatment outcomes between the two groups. CONCLUSION Vitrification is a useful technique for extending female fertility with no effects on IVF treatment outcome.
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Affiliation(s)
- Kathryn Montgomery
- Department of Life Sciences, Aberystwyth University, Penglais, Aberystwyth, Ceredigion, UK
| | - Susan Montgomery
- CARE Fertility Manchester, 108-112 Daisy Bank Road, Victoria Park, Manchester, UK
| | - Alison Campbell
- CARE Fertility Manchester, 108-112 Daisy Bank Road, Victoria Park, Manchester, UK.
| | - Deborah Mary Nash
- Department of Life Sciences, Aberystwyth University, Penglais, Aberystwyth, Ceredigion, UK
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Watanabe S, Yoshikai K, Matsuda Y, Miyai S, Sawada Y, Kurahashi H, Sawada T. The effect of early irregular cell division of human embryos on blastocyst euploidy: considerations from the subsequent development of the blastomeres by direct or reverse cleavage. F&S SCIENCE 2023; 4:21-29. [PMID: 36410651 DOI: 10.1016/j.xfss.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 11/11/2022] [Accepted: 11/15/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To investigate whether blastocysts that divide irregularly reduce subsequent blastocyst euploidy. DESIGN Retrospective study. SETTING Private clinic. PATIENT(S) A total of 122 blastocysts for which consent for disposal and research use was obtained. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Results of next-generation sequencing analysis of the blastocysts and whether blastomeres by normal or irregular divisions subsequently participated in blastocyst formation or not. RESULT(S) The embryos were classified according to their dynamics until the second cleavage. The blastocyst euploidy rates were 33.3% (19/57) in the normal cleavage (NC) group, 38.3% (18/47) in the direct cleavage (embryos with one cell dividing into 3 cells) (DC) group, and 72.2% (13/18) in the reverse cleavage (RC) (embryos with fused cells once divided) group. The rate of the RC group was significantly higher than that of the NC group. The blastocyst participation rate of the blastomeres were 95.6% in the NC group and 56.5% in that derived from DC of the first cleavage, and 91.7% in that of blastomeres derived from normal division of the second cleavage and 53.6% in that derived from DC of the second cleavage, both of which were significantly lower in the latter. In the RC group, the rates of fused and nonfused blastomeres were 62.1% and 87.5%, respectively, with no significant difference. CONCLUSION(S) The blastomeres generated by DC were often excluded from blastocyst formation, and we speculate that this is one reason why their division does not reduce blastocyst euploidy. The association between RC and euploidy of blastocysts merits further study.
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Affiliation(s)
| | | | | | - Shunsuke Miyai
- Institute for Comprehensive Medical Science, Fujita Health University, Toyoake, Japan
| | - Yuki Sawada
- Sawada Women's Clinic, Nagoya, Japan; Department of Obstetrics and Gynecology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Hiroki Kurahashi
- Institute for Comprehensive Medical Science, Fujita Health University, Toyoake, Japan
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Hur C, Nanavaty V, Yao M, Desai N. The presence of partial compaction patterns is associated with lower rates of blastocyst formation, sub-optimal morphokinetic parameters and poorer morphologic grade. Reprod Biol Endocrinol 2023; 21:12. [PMID: 36709281 PMCID: PMC9883889 DOI: 10.1186/s12958-023-01059-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 01/10/2023] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Compaction is an important marker of embryonic genome activation and marks a critical step in the development to blastocyst. The objective of our study was to determine whether visualization of the embryonic compaction process through time-lapse imaging (TL) can assist in predicting the kinetics of embryo development as well as the likelihood for blastocyst formation, grade, or ploidy. METHODS This study is a retrospective review of prospectively collected datafrom a single academic institution. Couples included were thosewho underwent preimplantation genetic testing for aneuploidy (PGT-A) following in vitro fertilization between Januaryand December 2020. Embryos were cultured in the Embrysocope. Embryo morphokinetic data was prospectively collected and analyzed.TL videos werelater reviewed in detail for compaction pattern. Embryo compaction patterns (CP) were categorized as follows: 1) full compaction (CP-F), 2) partial compaction with cell extrusion (P-ext), 3) partial compactionwith cell exclusion (P-exc) and 4) partial compactionwith both cell extrusion and exclusion (P-both). Assessment of embryo decompaction and re-compaction was evaluated. The association between CP, morphokinetic parameters,blastocyst formation, grade and ploidy were then analyzed. RESULTS A total of 349 embryos were studied. Amongst embryos which progressed to morula (n = 281), the distribution of compaction patterns were: CP-F 45.6%, P-ext12.5%, P-exc29.5% and P-both 12.5%. Embryos exhibiting a CP-F were more likely to proceed to blastocyst compared with those that demonstrated partial compaction patterns (p = 0.006). When compared to CP-F, partial compaction patterns were significantly associated with poorer ICM and TE grades (P < 0.001). Of the 281 morula, 59.8% (n = 168) demonstrated at least one episode of decompaction and re-compaction. Of the 249 blastocysts formed, 200 were cryopreserved for future use after undergoing PGT-A evaluation. Of those, 42.5% were diagnosed as euploid, 39.0% as aneuploid, 9.0% as mosaic and 9.5% had no result. When compared to CP-F, partialCPs exhibited a significantly greater percentage of mosaic embryos (3.6% v. 15.6%, p = 0.032). Additionally, we found that a greater percentage of embryos demonstrating CP-F exhibited morphokinetics that fell into optimal ranges for embryo development when compared to those with partial compaction patterns. CONCLUSION Time-lapse visualization of compaction patterns identified exclusions and/or extrusions as negative indicators of blastocyst formation and blastocyst grade. When compared to full compaction patterns, partial compaction patterns were associated with delayed embryonic development as well as lower rates of optimal kinetic development.
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Affiliation(s)
- Christine Hur
- Department of Obstetrics and Gynecology, Women's Health Institute, Cleveland Clinic, Division of Reproductive Endocrinology and Infertility, 26900 Cedar Road, Beachwood, OH, 44122, USA.
| | - Vaani Nanavaty
- Department of Obstetrics and Gynecology, Women's Health Institute, Cleveland Clinic, Division of Reproductive Endocrinology and Infertility, 26900 Cedar Road, Beachwood, OH, 44122, USA
| | - Meng Yao
- Quantitative Health Sciences, Cleveland Clinic, 9500 Euclid Ave. JJN3, Cleveland, OH, 44195, USA
| | - Nina Desai
- Department of Obstetrics and Gynecology, Women's Health Institute, Cleveland Clinic, Division of Reproductive Endocrinology and Infertility, 26900 Cedar Road, Beachwood, OH, 44122, USA
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10
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Matot R, Kalma Y, Rahav R, Azem F, Amir H, Ben-Yosef D. Cleavage stage at compaction-a good predictor for IVF outcome. Int J Gynaecol Obstet 2022; 161:997-1003. [PMID: 36495286 DOI: 10.1002/ijgo.14619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 11/15/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To analyze whether cleavage stage at compaction, and not only kinetics, can serve as a reliable predictor for clinical outcome. METHODS A retrospective cohort study including 1194 embryos, classified by compaction initiation stage (Group 1: compaction at fewer than eight cells, Group 2: compaction at eight cells, Group 3: compaction at more than eight cells). Of these, 815 embryos were evaluated for morphokinetic preimplantation parameters, and 379 embryos were analyzed for clinical implantation following thawing and transfer of single blastocysts during the same period. RESULTS In total, 1194 embryos were analyzed. Embryos that underwent compaction from more than eight cells (Group 3) exhibited more synchronous cleavage compared with Groups 1 and 2 (at both S2 and S3; P < 0.001), and displayed a significantly lower fragmentation rate. The likelihood of obtaining top-quality blastocysts decreased by 73% and 44% when comparing Group 3 embryos with those of Groups 1 and 2, respectively, (P < 0.03). Clinical validation of the results shows that while compaction from fewer than eight cells barely produced blastocysts for transfer, compaction at eight or more cells is crucial for implantation and birth (birth rates 11.1% and 18.5% for Groups 2 and 3, respectively). CONCLUSION Cleavage stage at compaction has a direct effect on blastocyst quality and subsequent pregnancy, so can be included in newly developed deep learning models for embryo selection.
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Affiliation(s)
- Ran Matot
- Fertility and IVF Institute, Tel-Aviv Sourasky Medical Center, Affiliated to Tel Aviv University, Tel Aviv, Israel
| | - Yael Kalma
- Fertility and IVF Institute, Tel-Aviv Sourasky Medical Center, Affiliated to Tel Aviv University, Tel Aviv, Israel
| | - Roni Rahav
- Fertility and IVF Institute, Tel-Aviv Sourasky Medical Center, Affiliated to Tel Aviv University, Tel Aviv, Israel
| | - Foad Azem
- Fertility and IVF Institute, Tel-Aviv Sourasky Medical Center, Affiliated to Tel Aviv University, Tel Aviv, Israel
| | - Hadar Amir
- Fertility and IVF Institute, Tel-Aviv Sourasky Medical Center, Affiliated to Tel Aviv University, Tel Aviv, Israel
| | - Dalit Ben-Yosef
- Fertility and IVF Institute, Tel-Aviv Sourasky Medical Center, Affiliated to Tel Aviv University, Tel Aviv, Israel.,Department of Cell and Developmental Biology, Sackler Faculty of Medicine, Sagol School of Neuroscience, Tel-Aviv University, Tel Aviv, Israel
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11
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Alexandrova M, Manchorova D, You Y, Mor G, Dimitrova V, Dimova T. Functional HLA-C expressing trophoblast spheroids as a model to study placental-maternal immune interactions during human implantation. Sci Rep 2022; 12:10224. [PMID: 35715452 PMCID: PMC9205925 DOI: 10.1038/s41598-022-12870-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 05/17/2022] [Indexed: 01/04/2023] Open
Abstract
In healthy couples over half of the conceptions result in failed pregnancy and around 30% of them occur during implantation defining it as a rate-limiting step for the success of native and in vitro fertilization. The understanding of the factors regulating each step of implantation and immune recognition is critical for the pregnancy outcome. Creation of 3D-cell culture models, such as spheroids and organoids, is in the focus of placental tissue engineering in attempt to resemble the in vivo complexity of the maternal-fetal interface and to overcome the need of laboratory animals and human embryos. We constructed stable, reliable, and reproducible trophoblast Sw71 spheroids which are functional independently of the serum level in the culture media. These models resemble the hatched human blastocyst in size, shape and function and are useful for in vitro studies of the in vivo concealed human implantation. Since Sw71 spheroids produce HLA-C, the only classical MHC molecule indispensable for establishment of the immune tolerance and proper human implantation, they are applicable for the evaluation not only of implantation itself but also of maternal-trophoblasts immune interactions. In addition, Sw71-blastocyst-like spheroids are manipulable in low-volume platform, easy to monitor and analyze automatically under treatment with favorable/detrimental factors.
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Affiliation(s)
- Marina Alexandrova
- Institute of Biology and Immunology of Reproduction "Acad. K. Bratanov", Bulgarian Academy of Sciences, Sofia, Bulgaria
| | - Diana Manchorova
- Institute of Biology and Immunology of Reproduction "Acad. K. Bratanov", Bulgarian Academy of Sciences, Sofia, Bulgaria
| | - Yuan You
- C.S. Mott Center for Human Growth and Development, Wayne State University, Detroit, USA
| | - Gil Mor
- C.S. Mott Center for Human Growth and Development, Wayne State University, Detroit, USA
| | - Violeta Dimitrova
- Medical University, University Obstetrics and Gynecology Hospital "Maichin Dom", Sofia, Bulgaria
| | - Tanya Dimova
- Institute of Biology and Immunology of Reproduction "Acad. K. Bratanov", Bulgarian Academy of Sciences, Sofia, Bulgaria.
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12
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Aslan Öztürk S, Cincik M, Donmez Cakil Y, Sayan S, Selam B. Early Compaction Might Be a Parameter to Determine Good Quality Embryos and Day of Embryo Transfer in Patients Undergoing Intracytoplasmic Sperm Injection. Cureus 2022; 14:e23593. [PMID: 35494986 PMCID: PMC9046904 DOI: 10.7759/cureus.23593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction: Compaction is the first event in embryo morphogenesis. Blastocyst transfer on day five or six has been widely performed in the last decade. We investigated the clinical value of early compaction on day three for evaluation of the transferred embryo quality and pregnancy. Methods: Four hundred patients with female factor infertility and 776 fresh embryo transfers were included. Two groups were formed: Early compaction group had embryo transfer with at least one day-three embryo exhibiting early compaction. Transferred embryos without early compaction comprised the control group. Embryo transfer was performed on day three or five after the assessment of embryo compaction by a time-lapse technology system. Each patient underwent only a single cycle of embryo transfer. We analyzed fertilization, pregnancy, and live birth rates. Results: We detected significantly higher numbers of the retrieved oocytes, metaphase II (MII) oocytes, and fertilized oocytes in the early compaction group. Moreover, the transfer of the early compacting embryos on day three resulted in higher pregnancy and live birth rates. Conclusion: Our data suggest that early compaction might be a factor to determine good quality embryos and embryo transfer day.
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13
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Cimadomo D, Sosa Fernandez L, Soscia D, Fabozzi G, Benini F, Cesana A, Dal Canto MB, Maggiulli R, Muzzì S, Scarica C, Rienzi L, De Santis L. Inter-centre reliability in embryo grading across several IVF clinics is limited: implications for embryo selection. Reprod Biomed Online 2021; 44:39-48. [PMID: 34819249 DOI: 10.1016/j.rbmo.2021.09.022] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 09/01/2021] [Accepted: 09/26/2021] [Indexed: 12/26/2022]
Abstract
RESEARCH QUESTION What is the intra- and inter-centre reliability in embryo grading performed according to the Istanbul Consensus across several IVF clinics? DESIGN Forty Day 3 embryos and 40 blastocysts were photographed on three focal planes. Senior and junior embryologists from 65 clinics were invited to grade them according to the Istanbul Consensus (Study Phase I). All participants then attended interactive training where a panel of experts graded the same embryos (Study Phase II). Finally, a second set of pictures was sent to both embryologists and experts for a blinded evaluation (Study Phase III). Intra-centre reliability was reported for Study Phase I as Cohen's kappa between senior and junior embryologists; inter-centre reliability was instead calculated between senior/junior embryologists and experts in Study Phase I versus III to outline improvements after training (i.e. upgrade of Cohen's kappa category according to Landis and Koch). RESULTS Thirty-six embryologists from 18 centres participated (28% participation rate). The intra-centre reliability was (i) substantial (0.63) for blastomere symmetry (range -0.02 to 1.0), (ii) substantial (0.72) for fragmentation (range 0.29-1.0), (iii) substantial (0.66) for blastocyst expansion (range 0.19-1.0), (iv) moderate (0.59) for inner cell mass quality (range 0.07-0.92), (v) moderate (0.56) for trophectoderm quality (range 0.01-0.97). The inter-centre reliability showed an overall improvement from Study Phase I to III, from fair (0.21-0.4) to moderate (0.41-0.6) for all parameters under analysis, except for blastomere fragmentation among senior embryologists, which was already moderate before training. CONCLUSIONS Intra-centre reliability was generally moderate/substantial, while inter-centre reliability was just fair. The interactive training improved it to moderate, hence this workflow was deemed helpful. The establishment of external quality assessment services (e.g. UK NEQAS) and the avant-garde of artificial intelligence might further improve the reliability of this key practice for embryo selection.
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Affiliation(s)
| | | | - Daria Soscia
- GeneraLife IVF, Clinica Valle Giulia, Rome, Italy
| | | | | | - Amalia Cesana
- Humanitas Clinical and Research Center-IRCCS, Rozzano, Italy
| | | | | | | | - Catello Scarica
- European Hospital, Center for Reproductive Medicine, Rome, Italy
| | - Laura Rienzi
- GeneraLife IVF, Clinica Valle Giulia, Rome, Italy
| | - Lucia De Santis
- Centro Scienze Natalità, Dept Ob/Gyn, IRCCS San Raffaele Scientific Institute, Milan, Italy
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14
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Coticchio G, Barrie A, Lagalla C, Borini A, Fishel S, Griffin D, Campbell A. Plasticity of the human preimplantation embryo: developmental dogmas, variations on themes and self-correction. Hum Reprod Update 2021; 27:848-865. [PMID: 34131722 DOI: 10.1093/humupd/dmab016] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 03/27/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND IVF for the treatment of infertility offers unique opportunities to observe human preimplantation development. Progress in time-lapse technology (TLT) and preimplantation genetic testing (PGT) has greatly expanded our knowledge of developmental patterns leading to a healthy pregnancy or developmental failure. These technologies have also revealed unsuspected plastic properties of the preimplantation embryo, at macromolecular, cellular and multicellular levels. OBJECTIVE AND RATIONALE This review focuses on the emerging concept of plasticity of the human embryo as revealed by recent evidence derived from TLT and PGT, calling for an updated and more precise redefinition of the boundaries between normal and abnormal development. SEARCH METHODS PubMed was used to search the MEDLINE database for peer-reviewed English-language original articles and reviews concerning human preimplantation development. Cross-searches were performed by adopting 'fertilisation', 'pronucleus', 'cleavage', 'multinucleation', 'compaction', 'embryo', 'preimplantation genetic testing', 'aneuploidy', mosaicism', 'micromanipulation', 'time-lapse microscopy' and 'IVF/assisted reproduction' as main terms. The most relevant publications, i.e. those concerning major phenomena occurring during normal and abnormal development-with a focus on the human species-were assessed and discussed critically. OUTCOMES Advances in TLT and PGT have revealed an astonishing plasticity and self-correction ability of the human preimplantation embryo in vitro. At fertilisation, an abnormal number of pronuclei do not always result in the formation of an aneuploid blastocyst. Animal studies and preliminary human observations indicate that combining of parental genomes may occur at the early cleavage stage, if not at fertilisation. Multinucleation occurs with much higher prevalence than previously thought and may be corrected at later cleavage stages. Irregular cleavage (multichotomous, direct, rapid and reverse cleavages) can generate chromosome segregation abnormalities that often lead to developmental arrest, but that sporadically may be confined to cells excluded from the blastocyst, and may sometimes result in viable pregnancy. Mitotic errors can generate mosaic blastocysts, but alternatively normal embryos may form from selective death or clonal depletion of aneuploid cells. WIDER IMPLICATIONS Deviations from developmental dogmas and the increasing evidence of plasticity of the human embryo challenge current embryological notions and suggest the need to write new rules governing cell cycle, cell determination and chromosome segregation during preimplantation development.
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Affiliation(s)
| | | | | | | | - Simon Fishel
- CARE Fertility Group, Northampton, UK.,School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool, UK
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15
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The freeze-all strategy after IVF: which indications? Reprod Biomed Online 2020; 42:529-545. [PMID: 33384269 DOI: 10.1016/j.rbmo.2020.11.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 10/09/2020] [Accepted: 11/18/2020] [Indexed: 12/21/2022]
Abstract
The freeze-all strategy is gaining popularity worldwide as an alternative to the conventional fresh embryo transfer. It consists of cryopreservation of the entire embryo cohort and the embryo transfer in a subsequent cycle that takes place separately from ovarian stimulation. The freeze-all strategy was initially a 'rescue' strategy for women at high risk of ovarian hyperstimulation syndrome; however, this approach has been extended to other indications as a scheduled strategy to improve implantation rates. This assumes that ovarian stimulation can alter endometrial receptivity in fresh cycles owing to the effect of supraphysiological levels of steroids on endometrial maturation. The procedure, however, has not been associated with increased live birth rates in all infertile couples, and concerns have been raised about the occurrence of several adverse perinatal outcomes. It is, therefore, crucial to identify in which subgroups of patients a freeze-all strategy could be beneficial. The aim of this review is to summarize current scientific research in this field to highlight potential indications for this strategy and to guide clinicians in their daily practice.
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16
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Shebl O, Haslinger C, Kresic S, Enengl S, Reiter E, Oppelt P, Ebner T. The hare and the tortoise: extreme mitotic rates and how these affect live birth. Reprod Biomed Online 2020; 42:332-339. [PMID: 33250413 DOI: 10.1016/j.rbmo.2020.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 09/29/2020] [Accepted: 10/14/2020] [Indexed: 12/17/2022]
Abstract
RESEARCH QUESTION Is live birth of patients with excessive slow (no blastocyst on day 5) and fast mitotic rate (full blastocyst development on day 4) comparable to a matched control standard (blastocyst formation on day 5)? DESIGN In this retrospective matched (age and anti-Müllerian hormone [AMH]) case-control study rates of fertilization, blastulation, implantation, clinical pregnancy and live birth were compared in couples with male factor indication, prolonged embryo culture and fresh single morula and blastocyst transfer. RESULTS The rates of implantation, clinical pregnancy and live birth in the slow-developing group were significantly (P < 0.001) lower (17.6%, 13.7%, and 11.8%, respectively) compared with the fast (58.5%, 52.5%, 47.5%) and normal growing counterparts (51.5%, 42.6%, 39.6%). No differences in neonatal outcome could be observed between the three groups. Sex ratio in the fast-growing group was not different from the other cohorts. CONCLUSIONS Extremely slow development, as assessed by the absence of blastulation on day 5, is a negative predictor of pregnancy and live birth. In contrast, the fear that extremely fast-growing embryos may represent an aneuploid cohort of embryos is unsubstantiated. Day-4 full blastocysts can preferentially be considered for transfer.
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Affiliation(s)
- Omar Shebl
- Kepler University Hospital, Department of Gynecology, Obstetrics, and Gynecological Endocrinology, Altenberger Str. 69, Linz Upper Austria, Austria
| | - Christine Haslinger
- Kepler University Hospital, Department of Gynecology, Obstetrics, and Gynecological Endocrinology, Altenberger Str. 69, Linz Upper Austria, Austria
| | - Sanja Kresic
- Kepler University Hospital, Department of Gynecology, Obstetrics, and Gynecological Endocrinology, Altenberger Str. 69, Linz Upper Austria, Austria
| | - Sabine Enengl
- Kepler University Hospital, Department of Gynecology, Obstetrics, and Gynecological Endocrinology, Altenberger Str. 69, Linz Upper Austria, Austria
| | - Elisabeth Reiter
- Kepler University Hospital, Department of Gynecology, Obstetrics, and Gynecological Endocrinology, Altenberger Str. 69, Linz Upper Austria, Austria
| | - Peter Oppelt
- Kepler University Hospital, Department of Gynecology, Obstetrics, and Gynecological Endocrinology, Altenberger Str. 69, Linz Upper Austria, Austria
| | - Thomas Ebner
- Kepler University Hospital, Department of Gynecology, Obstetrics, and Gynecological Endocrinology, Altenberger Str. 69, Linz Upper Austria, Austria.
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17
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De Croo I, De Sutter P, Tilleman K. A stepwise approach to move from a cleavage-stage to a blastocyst-stage transfer policy for all patients in the IVF clinic. Hum Reprod Open 2020; 2020:hoaa034. [PMID: 32995561 PMCID: PMC7508027 DOI: 10.1093/hropen/hoaa034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/18/2020] [Indexed: 01/11/2023] Open
Abstract
STUDY QUESTION Is a stepwise change management approach an efficacious method to move from a Day 3 transfer policy to a Day 5 transfer policy for all patients in an IVF program? SUMMARY ANSWER A stepwise change from a Day 3 to a Day 5 transfer policy maintained the live birth rates per oocyte collection cycle (OCC) of the IVF program, with increased single embryo transfer (SET) and reduction of twin pregnancies. WHAT IS KNOWN ALREADY Evidence has shown that the probability of a live birth following IVF with a fresh embryo transfer (ET) is significantly higher after blastocyst-stage transfer than after cleavage-stage transfer. Blastocyst culture and transfer are usually performed in cases of good prognosis patients but many centers keep transferring cleavage-stage embryos for most of their patients because of the higher transfer cancelation rate in a blastocyst transfer policy. STUDY DESIGN, SIZE, DURATION In January 2012, a Day 5 embryo culture and blastocyst transfer policy including vitrification of supernumerary Day 5 blastocysts were implemented in a stepwise approach. The retrospective descriptive single-center analysis involving a preintervention phase consisted of Day 3 ETs and Day 3 slow freezing from 2010 until 2012. The postintervention phase involved a 6-year period from 2012 until 2017 in which three consecutive changes in the transfer policy were made, each over a 2-year period, based on the number of zygotes on Day 1. The primary outcome was live birth delivery rate per OCC during the stepwise change. PARTICIPANTS/MATERIALS, SETTING, METHODS All patients with at least one zygote available on Day 1 were scheduled for a fresh transfer, either on Day 3 or 5. Cycles with preimplantation genetic testing, freeze-all and oocyte donation cycles and cycles with a Day 2 transfer in the preintervention period were excluded. In the preintervention group, all cycles were scheduled for Day 3 transfer (n = 671 OCC) and slow freezing of the remaining Day 3 embryos. In the postintervention period, three periods were analyzed: period 1 (n = 1510 OCC; 1–9 zygotes: Day 3 transfer and >9 zygotes: Day 5 transfer); period 2 (n = 1456 OCC; 1–4 zygotes: Day 3 transfer and >4 zygotes: Day 5 transfer) and period 3 (n = 1764 OCC; Day 5 transfer). All remaining embryos underwent extend culture and were vitrified on Day 5, if developed to at least an early blastocyst. Data were analyzed using a mixed regression model with patient as a random factor. MAIN RESULTS AND THE ROLE OF CHANCE In the preintervention group, all OCC were scheduled for a Day 3 transfer. In period 1, period 2 and period 3, 20.9%, 61.5% and 100% of the OCCs were scheduled for a Day 5 transfer, respectively. More transfers per OCC were canceled in the postintervention period 2 and period 3 compared to the preintervention period (5.3% and 18.7% versus 3.4%, respectively; P < 0.0001). The mean number of embryos used per transfer decreased gradually after the introduction of the Day 5 transfer policy, from 1.62 ± 0.65 in the preintervention group to 1.12 ± 0.61 in period 3 (P < 0.0001). The percentage of SET cycles increased from 48.4% in the preintervention group to 54.6%, 73.8% and 87.8% in period 1, period 2 and period 3, respectively (P < 0.0001). The mean number of cryopreserved surplus embryos was significantly lower in period 3 compared to the preintervention group (1.29 ± 1.97 versus 1.78 ± 2.80; P < 0.0001). Pregnancy and live birth delivery rate per fresh transfer, respectively, were significantly lower in the preintervention group (26.7% and 19.1%) as compared to period 3 (39.3% and 24.2%) (P < 0.0001). Twin pregnancy rate decreased gradually from 11.0% to 8.2%, 5.7% and 2.5% in the preintervention group, period 1, period 2 and period 3, respectively (P < 0.0001). Live birth rate and cumulative live birth delivery rates per OCC were significantly higher in group 2 compared to the preintervention period (25.6% and 35.8% versus 18.5% and 25.9%, respectively). Similar live birth and cumulative live birth delivery rates per OCC were achieved between the preintervention period and period 3 (18.5% and 25.6% versus 19.7% and 24.9%; respectively). LIMITATIONS, REASONS FOR CAUTION The primary limitation is the retrospective design of the study. The allocation of the cycles was done by the number of zygotes available without taking into account both embryological and clinical prognostic factors. Furthermore, the analysis was restricted to cycles where the standard transfer policy was followed. Embryos which were in the morula or compaction stage were not vitrified or cultured to Day 6, which could have contributed to the slight, not statistically significant, drop in live birth rate per OCC in group 3. WIDER IMPLICATIONS OF THE FINDINGS Live birth and cumulative live birth delivery rate per OCC in an unselected patient population is maintained in a Day 5 transfer policy compared to a Day 3 transfer policy. Additionally, a significantly reduction in twin pregnancy rate and a significant increase in SET were observed in a Day 5 transfer policy. For centers wanting to make the step from Day 3 to Day 5, this study provides a practical stepwise change management approach. STUDY FUNDING/COMPETING INTEREST(S) None. TRIAL REGISTRATION NUMBER None.
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Affiliation(s)
- I De Croo
- Department of Reproductive Medicine, Universitair Ziekenhuis Gent (UZ Gent), Ghent, Belgium
| | - P De Sutter
- Department of Reproductive Medicine, Universitair Ziekenhuis Gent (UZ Gent), Ghent, Belgium
| | - K Tilleman
- Department of Reproductive Medicine, Universitair Ziekenhuis Gent (UZ Gent), Ghent, Belgium
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18
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Hernandez-Nieto C, Lee JA, Slifkin R, Sandler B, Copperman AB, Flisser E. What is the reproductive potential of day 7 euploid embryos? Hum Reprod 2020; 34:1697-1706. [PMID: 31398251 DOI: 10.1093/humrep/dez129] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 06/14/2019] [Indexed: 12/15/2022] Open
Abstract
STUDY QUESTION What is the rate of euploidy and the reproductive potential of embryos biopsied after 6 days of development? SUMMARY ANSWER Embryos biopsied after 6 days of development have higher rates of aneuploidy; however, day 7 euploid embryos selected at transfer can achieve acceptable pregnancy rates and live birth (LB) outcomes. WHAT IS KNOWN ALREADY Recent publications have shown promising treatment results after euploid day 7 embryo transfers (ETs), albeit these studies were limited by small sample sizes. Whereas the current clinical standard has been to discard embryos that do not reach expansion by day 6 of development, the lack of robust data surrounding the clinical utility of day 7 embryos warrants further evaluation. STUDY DESIGN, SIZE, DURATION Retrospective cohort analysis in a single, academic in vitro fertilization (IVF) center from January 2012 to March 2018. A total of 25 775 embryos underwent trophectoderm (TE) biopsy and preimplantation genetic testing for aneuploidy (PGT-A). Additionally, the clinical IVF outcomes of 3824 single, euploid frozen embryo transfer (FET) cycles were evaluated. PARTICIPANTS/MATERIALS, SETTING, METHODS Cohorts were segregated by day of TE biopsy following oocyte retrieval (day 5, day 6 or day 7). PGT-A was performed to identify embryonic ploidy rates. Secondly, IVF and LB outcomes after single, euploid FET were evaluated for each cohort. MAIN RESULTS AND THE ROLE OF CHANCE A total of day 5 (n = 12 535), day 6 (n = 11 939) and day 7 (n = 1298) embryos were included in the study analysis. The rate of embryo euploidy was significantly lower in day 7 blastocysts compared to day 5 or day 6 cohorts (day 7 = 40.5%; day 5 = 54.7%; day 6 = 52.9%; (P < 0.0001)). After adjusting for age, anti-Müllerian hormone, BMI, embryo quality and number of embryos biopsied, there was a significant association between aneuploidy and embryos biopsied on day 7 when compared to day 5 biopsied embryos (OR = 1.34, CI 95% 1.09-1.45, P = 0.001) and day 6 biopsied embryos (OR = 1.26, CI95% 1.07-1.16, P < 0.001).A sub-analysis of subsequent 3824 single, euploid FET cycles (day 5: n = 2321 cycles; day 6: n = 1381 cycles; and day 7: n = 116 cycles) showed significant differences among cohorts in implantation, clinical pregnancy, LB and clinical loss rates. There was a significant decrease in the odds of implantation, clinical pregnancy and LB, but no association with clinical loss or multiple pregnancy rates in patients who utilized day 7-biopsied embryos during treatment. LIMITATIONS, REASONS FOR CAUTION The retrospective nature of the study and potential variability in the study center's laboratory protocol(s) compared to other reproductive treatment centers may limit the external validity of our findings. Additionally, patients who transferred euploid embryos, biopsied on day 7 of development due to an absence of day 5 or day 6 counterparts, may have introduced selection bias in this study. WIDER IMPLICATIONS OF THE FINDINGS Embryonic developmental stage, morphological grade and ploidy status are paramount factors affecting ET selection and implantation potential. This study reveals that embryos ineligible for TE biopsy on day 5 or day 6 of development may benefit from extended culture to day 7. Our study demonstrates patient benefit when extended culture to day 7 of development is routinely performed for embryos failing to meet biopsy criteria by day 5 or 6. STUDY FUNDING/COMPETING INTEREST(S) No funding was received for the realization of this manuscript. Dr Alan Copperman is Advisor or Board Member of Sema 4 (Stake holder in Data), Progyny and Celmatix. TRIAL REGISTRATION NUMBER This retrospective analysis was approved by an Institutional Review Board (WIRB PRO NUM: 20161791; Study Number: 1167398).
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Affiliation(s)
| | - Joseph A Lee
- Reproductive Medicine Associates of New York, New York, NY, USA
| | - Richard Slifkin
- Reproductive Medicine Associates of New York, New York, NY, USA
| | - Benjamin Sandler
- Reproductive Medicine Associates of New York, New York, NY, USA.,Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alan B Copperman
- Reproductive Medicine Associates of New York, New York, NY, USA.,Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Eric Flisser
- Reproductive Medicine Associates of New York, New York, NY, USA.,Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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19
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Tocci A. The unknown human trophectoderm: implication for biopsy at the blastocyst stage. J Assist Reprod Genet 2020; 37:2699-2711. [PMID: 32892265 DOI: 10.1007/s10815-020-01925-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 08/11/2020] [Indexed: 11/30/2022] Open
Abstract
Trophectoderm biopsy is increasingly performed for pre-implantation genetic testing of aneuploidies and considered a safe procedure on short-term clinical outcome, without strong assessment of long-term consequences. Poor biological information on human trophectoderm is available due to ethical restrictions. Therefore, most studies have been conducted in vitro (choriocarcinoma cell lines, embryonic and pluripotent stem cells) and on murine models that nevertheless poorly reflect the human counterpart. Polarization, compaction, and blastomere differentiation (e.g., the basis to ascertain trophectoderm origin) are poorly known in humans. In addition, the trophectoderm function is poorly known from a biological point of view, although a panoply of questionable and controversial microarray studies suggest that important genes overexpressed in trophectoderm are involved in pluripotency, metabolism, cell cycle, endocrine function, and implantation. The intercellular communication system between the trophectoderm cells and the inner cell mass, modulated by cell junctions and filopodia in the murine model, is obscure in humans. For the purpose of this paper, data mainly on primary cells from human and murine embryos has been reviewed. This review suggests that the trophectoderm origin and functions have been insufficiently ascertained in humans so far. Therefore, trophectoderm biopsy should be considered an experimental procedure to be undertaken only under approved rigorous experimental protocols in academic contexts.
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Affiliation(s)
- Angelo Tocci
- Reproductive Medicine Unit, Gruppo Donnamed, Via Giuseppe Silla 12, Rome, Italy.
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20
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Abstract
Gene regulatory networks and tissue morphogenetic events drive the emergence of shape and function: the pillars of embryo development. Although model systems offer a window into the molecular biology of cell fate and tissue shape, mechanistic studies of our own development have so far been technically and ethically challenging. However, recent technical developments provide the tools to describe, manipulate and mimic human embryos in a dish, thus opening a new avenue to exploring human development. Here, I discuss the evidence that supports a role for the crosstalk between cell fate and tissue shape during early human embryogenesis. This is a critical developmental period, when the body plan is laid out and many pregnancies fail. Dissecting the basic mechanisms that coordinate cell fate and tissue shape will generate an integrated understanding of early embryogenesis and new strategies for therapeutic intervention in early pregnancy loss.
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Affiliation(s)
- Marta N Shahbazi
- MRC Laboratory of Molecular Biology, Francis Crick Avenue, Cambridge Biomedical Campus, Cambridge CB2 0QH, UK
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21
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Bourdon M, Ferreux L, Maignien C, Patrat C, Marcellin L, Pocate-Cheriet K, Chapron C, Santulli P. Tobacco consumption is associated with slow-growing day-6 blastocysts. F S Rep 2020; 1:30-36. [PMID: 34223209 PMCID: PMC8244283 DOI: 10.1016/j.xfre.2020.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 04/28/2020] [Accepted: 04/28/2020] [Indexed: 12/16/2022] Open
Abstract
Objective To investigate if there are any obvious clinical factors associated with delayed blastulation at day 6 (D6) compared with day 5 (D5). Design Monocentric observational cohort study from November 2012 to December 2018. Setting Tertiary-care academic medical center. Patient(s) A total of 941 women with an entire cohort of exclusively D5 blastocysts compared with 162 patients with a cohort of exclusively D6 blastocysts. Intervention(s) None. Main Outcome Measure(s) Clinical characteristics and data related to the ovarian stimulation protocols. Result(s) After univariate analysis, a significantly higher proportion of women who were active smokers was found in the D6 group compared with the D5 group (n = 22/162 [13.6%] vs. n = 82/941 [8.7%]). In addition, the women in the D6 group had a higher rank number of assisted reproductive technology (ART; total no. of ART cycles performed: 2.1 ± 1.4 vs. 1.6 ± 1.1) and a lower antral follicle count (AFC; 18.7 ± 11.3 vs. 22.2 ± 12.8). Moreover, fertilization with the use of intracytoplasmic sperm injection was used more frequently in the D6 group compared with the D5 group. Logistic regression analysis adjusted for confounders highlighted several independent predictors for reaching blastocyst stage at D6 rather than D5: being an active smoker, previous ART cycles, and a lower AFC. Conclusion(s) Obtaining an exclusively D6 blastocyst cohort is independently associated with women who are active smokers, previous ART cycles, and a lower AFC. These findings provide evidence, to be confirmed by further studies, that women who are active smokers could greatly benefit from smoking cessation before undergoing ART.
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Affiliation(s)
- Mathilde Bourdon
- Service de Gynécologie-Obstétrique II et de Médecine de la Reproduction, Faculté de Médecine, Sorbonne Paris Cité, Université de Paris, Assistance Publique-Hôpitaux de Paris Centre, Cochin, Paris.,Institut Cochin, Institut National de la Santé et de la Recherche Médicale U1016, Sorbonne Paris Cité, Université de Paris, Paris
| | - Lucile Ferreux
- Service d'Histologie-Embryologie-Biologie de la Reproduction, Faculté de Médecine, Sorbonne Paris Cité, Université de Paris, Assistance Publique-Hôpitaux de Paris Centre, Cochin, Paris, France
| | - Chloé Maignien
- Service de Gynécologie-Obstétrique II et de Médecine de la Reproduction, Faculté de Médecine, Sorbonne Paris Cité, Université de Paris, Assistance Publique-Hôpitaux de Paris Centre, Cochin, Paris
| | - Catherine Patrat
- Service d'Histologie-Embryologie-Biologie de la Reproduction, Faculté de Médecine, Sorbonne Paris Cité, Université de Paris, Assistance Publique-Hôpitaux de Paris Centre, Cochin, Paris, France
| | - Louis Marcellin
- Service de Gynécologie-Obstétrique II et de Médecine de la Reproduction, Faculté de Médecine, Sorbonne Paris Cité, Université de Paris, Assistance Publique-Hôpitaux de Paris Centre, Cochin, Paris.,Institut Cochin, Institut National de la Santé et de la Recherche Médicale U1016, Sorbonne Paris Cité, Université de Paris, Paris
| | - Khaled Pocate-Cheriet
- Service d'Histologie-Embryologie-Biologie de la Reproduction, Faculté de Médecine, Sorbonne Paris Cité, Université de Paris, Assistance Publique-Hôpitaux de Paris Centre, Cochin, Paris, France
| | - Charles Chapron
- Service de Gynécologie-Obstétrique II et de Médecine de la Reproduction, Faculté de Médecine, Sorbonne Paris Cité, Université de Paris, Assistance Publique-Hôpitaux de Paris Centre, Cochin, Paris.,Institut Cochin, Institut National de la Santé et de la Recherche Médicale U1016, Sorbonne Paris Cité, Université de Paris, Paris
| | - Pietro Santulli
- Service de Gynécologie-Obstétrique II et de Médecine de la Reproduction, Faculté de Médecine, Sorbonne Paris Cité, Université de Paris, Assistance Publique-Hôpitaux de Paris Centre, Cochin, Paris.,Institut Cochin, Institut National de la Santé et de la Recherche Médicale U1016, Sorbonne Paris Cité, Université de Paris, Paris
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22
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Time of morulation and trophectoderm quality are predictors of a live birth after euploid blastocyst transfer: a multicenter study. Fertil Steril 2020; 112:1080-1093.e1. [PMID: 31843084 DOI: 10.1016/j.fertnstert.2019.07.1322] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 07/11/2019] [Accepted: 07/22/2019] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To investigate whether the morphodynamic characterization of a euploid blastocyst's development allows a higher prediction of a live birth after single-embryo-transfer (SET). DESIGN Observational cohort study conducted in two phases: training and validation. SETTING Private in vitro fertilization centers. PATIENT(S) Euploid blastocysts: 511 and 319 first vitrified-warmed SETs from 868 and 546 patients undergoing preimplantation genetic testing for aneuploidies (PGT-A) in the training and validation phase, respectively. INTERVENTION(S) Data collected from time of polar body extrusion to time of starting blastulation, and trophectoderm and inner-cell-mass static morphology in all embryos cultured in a specific time-lapse incubator with a continuous medium. Logistic regressions conducted to outline the variables showing a statistically significant association with live birth. In the validation phase, these variables were tested in an independent data set. MAIN OUTCOME MEASURE(S) Live births per SET. RESULT(S) The average live birth rate (LBR) in the training set was 40% (N = 207/511). Only time of morulation (tM) and trophectoderm quality were outlined as putative predictors of live birth at two IVF centers. In the validation set, the euploid blastocysts characterized by tM <80 hours and high-quality trophectoderm resulted in a LBR of 55.2% (n = 37/67), while those with tM ≥ 80 hours and a low-quality trophectoderm resulted in a LBR of 25.5% (N = 13/51). CONCLUSION(S) Time of morulation and trophectoderm quality are better predictors of a euploid blastocyst's reproductive competence. Our evidence was reproducible across different centers under specific culture conditions. These data support the crucial role of morulation for embryo development, a stage that involves massive morphologic, cellular, and molecular changes and deserves more investigation.
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23
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Coticchio G, Lagalla C, Sturmey R, Pennetta F, Borini A. The enigmatic morula: mechanisms of development, cell fate determination, self-correction and implications for ART. Hum Reprod Update 2020; 25:422-438. [PMID: 30855681 DOI: 10.1093/humupd/dmz008] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 01/20/2019] [Accepted: 02/11/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Assisted reproduction technology offers the opportunity to observe the very early stages of human development. However, due to practical constraints, for decades morphological examination of embryo development has been undertaken at a few isolated time points at the stages of fertilisation (Day 1), cleavage (Day 2-3) and blastocyst (Day 5-6). Rather surprisingly, the morula stage (Day 3-4) has been so far neglected, despite its involvement in crucial cellular processes and developmental decisions. OBJECTIVE AND RATIONALE The objective of this review is to collate novel and unsuspected insights into developmental processes occurring during formation of the morula, highlighting the key importance of this stage for a better understanding of preimplantation development and an improvement of ART. SEARCH METHODS PubMed was used to search the MEDLINE database for peer-reviewed English-language original articles and reviews concerning the morula stage in mammals. Searches were performed by adopting 'embryo', 'morula', 'compaction', 'cell fate' and 'IVF/assisted reproduction' as main terms, in association with other keywords expressing concepts relevant to the subject (e.g. cell polarity). The most relevant publications, i.e. those concerning major phenomena occurring during formation of the morula in established experimental models and the human species, were assessed and discussed critically. OUTCOMES Novel live cell imaging technologies and cell biology studies have extended our understanding of morula formation as a key stage for the development of the blastocyst and determination of the inner cell mass (ICM) and the trophectoderm (TE). Cellular processes, such as dynamic formation of filopodia and cytoskeleton-mediated zippering cell-to-cell interactions, intervene to allow cell compaction (a geometrical requisite essential for development) and formation of the blastocoel, respectively. At the same time, differential orientation of cleavage planes, cell polarity and cortical tensile forces interact and cooperate to position blastomeres either internally or externally, thereby influencing their cellular fate. Recent time lapse microscopy (TLM) observations also suggest that in the human the process of compaction may represent an important checkpoint for embryo viability, through which chromosomally abnormal blastomeres are sensed and eliminated by the embryo. WIDER IMPLICATIONS In clinical embryology, the morula stage has been always perceived as a 'black box' in the continuum of preimplantation development. This has dictated its virtual exclusion from mainstream ART procedures. Recent findings described in this review indicate that the morula, and the associated process of compaction, as a crucial stage not only for the formation of the blastocyst, but also for the health of the conceptus. This understanding may open new avenues for innovative approaches to embryo manipulation, assessment and treatment.
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Affiliation(s)
| | - Cristina Lagalla
- 9.Baby, Family and Fertility Center, Via Dante 15, Bologna, Italy
| | - Roger Sturmey
- Centre for Cardiovascular Metabolic Research, Hull York Medical School, University of Hull, Hull, United Kingdom
| | | | - Andrea Borini
- 9.Baby, Family and Fertility Center, Via Dante 15, Bologna, Italy
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24
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Alternative patterns of partial embryo compaction: prevalence, morphokinetic history and possible implications. Reprod Biomed Online 2020; 40:347-354. [DOI: 10.1016/j.rbmo.2019.11.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 11/18/2019] [Accepted: 11/21/2019] [Indexed: 12/11/2022]
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25
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Harada Y, Maeda T, Fukunaga E, Shiba R, Okano S, Kinutani M, Horiuchi T. Selection of high-quality and viable blastocysts based on timing of morula compaction and blastocyst formation. Reprod Med Biol 2020; 19:58-64. [PMID: 31956286 PMCID: PMC6955590 DOI: 10.1002/rmb2.12302] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 08/30/2019] [Accepted: 09/17/2019] [Indexed: 11/08/2022] Open
Abstract
PURPOSE The time-lapse system is a device that allows continuous monitoring without removing embryos from the incubator. Using a time-lapse system, we retrospectively investigated cleavage speed time points as potential indicators for selecting high-quality viable blastocysts. METHODS This study included 963 zygotes of two pronuclei retrieved from 196 patients between January 2015 and December 2016. All embryos in culture were monitored by time-lapse after intracytoplasmic sperm injection. Of 492 blastocysts developed in vitro, 128 vitrified-warmed single blastocyst transfers were classified into pregnancy and non-pregnancy groups, and the parameters were compared. RESULTS In the pregnancy group, timing of both morula compaction and regular blastocyst formation was significantly faster than in the non-pregnancy group. Furthermore, the optimal cutoff values for compacted morula (94.9 hours) and regular blastocyst (113.9 hours) were determined using the receiver operator characteristic curve analysis. Embryos that formed compacted morulae within 94.9 hours and developed into regular blastocysts within 113.9 hours were associated with a significantly higher pregnancy rate than those that did not (44.4% vs 16.0%). CONCLUSION The timing of morula compaction and regular blastocyst formation is important as an indicator of high-quality blastocysts to increase odds for pregnancy after embryo transfer.
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Affiliation(s)
- Yoshihisa Harada
- Kinutani Women’s ClinicHiroshimaJapan
- Graduate School of Comprehensive Scientific ResearchPrefectural University of HiroshimaHiroshimaJapan
| | | | | | | | | | | | - Toshitaka Horiuchi
- Graduate School of Comprehensive Scientific ResearchPrefectural University of HiroshimaHiroshimaJapan
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26
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Tsai NC, Su YT, Lin YJ, Chiang HJ, Huang FJ, Kung FT, Lan KC. Developmental potential of surplus morulas with delayed and/or incomplete compaction after freezing-thawing procedures. Reprod Biol Endocrinol 2019; 17:87. [PMID: 31666062 PMCID: PMC6821030 DOI: 10.1186/s12958-019-0535-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 10/15/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Morulas with delayed growth sometimes coexist with blastocysts. There is still limited evidence regarding the optimal disposal of surplus morulas. With the advancement of vitrification, the freezing-thawing technique has been widely applied to zygotes with 2 pronuclei, as well as embryos at the cleavage and blastocyst stages. The freezing of morulas, however, has rarely been discussed. The purpose of this study was to investigate whether these poor-quality and slow-growing morulas are worthy of cryopreservation. METHODS This is a retrospective, observational, proof-of-concept study. A total of 1033 day 5/6 surplus morulas were cryopreserved from January 2015 to December 2018. The study included 167 women undergoing 180 frozen embryo transfer cycles. After the morulas underwent freezing-thawing procedures, their development was monitored for an additional day. The primary outcome was the blastocyst formation rate. Secondary outcomes were clinical pregnancy rate, live birth rate and abortion rate. RESULTS A total of 347 surplus morulas were thawed. All studied morulas showed delayed compaction (day 5, n = 329; day 6, n = 18) and were graded as having low (M1, n = 54), medium (M2, n = 138) or high (M3, n = 155) fragmentation. The post-thaw survival rate was 79.3%. After 1 day in extended culture, the blastocyst formation rate was 66.6%, and the top-quality blastocyst formation rate was 23.6%. The day 5 morulas graded as M1, M2, and M3 had blastocyst formation rates of 88.9, 74.0, and 52.8% (p < 0.001), respectively, and the top-quality blastocyst formation rates were 64.8, 25.2, and 9.0% (p < 0.001), respectively. The clinical pregnancy rate was 33.6%. CONCLUSIONS The post-thaw blastocyst formation rate was satisfactory, with approximately one-half of heavily fragmented morulas (M3) developing into blastocysts. Most of the poor-quality morulas were worth to freeze, with the reasonable goal of obtaining pregnancy and live birth. This alternative strategy may be a feasible approach for coping with poor-quality surplus morulas in non-PGS (preimplantation genetic screening) cycles.
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Affiliation(s)
- Ni-Chin Tsai
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung District, Kaohsiung city, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yu-Ting Su
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung District, Kaohsiung city, Taiwan
| | - Yu-Ju Lin
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung District, Kaohsiung city, Taiwan
| | - Hsin-Ju Chiang
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung District, Kaohsiung city, Taiwan
| | - Fu-Jen Huang
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung District, Kaohsiung city, Taiwan
| | - Fu-Tsai Kung
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung District, Kaohsiung city, Taiwan
- Department of Obstetrics and Gynecology, Xiamen Chang Gung Hospital, Xiamen, Fujian, China
| | - Kuo-Chung Lan
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung District, Kaohsiung city, Taiwan.
- Center for Menopause and Reproductive Medicine Research, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
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27
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Abstract
The complexity of predicting embryo development potential at the cleavage stages and the emergence of epigenetic risks during prolonged in vitro culture of pre-implantation embryos made it more advantageous to transfer embryos at the morula stage to the uterine cavity. The criteria for estimating embryos at this stage that allow prediction of cryopreservation outcomes have been poorly described. All day 4 embryos (n = 224) were graded 1, 2, 3, 4 or 5 according to blastomere compaction degree (BCD = 100, 75, 50, 25 or 0%, respectively) and the survival and blastocyst formation rate of these morulae were studied after cryopreservation. An inverse dependence was found between survival rate and BCD. Excluded fragments were characterized by low osmotic reaction during exposure to cryoprotective medium and, after freeze-thawing, they were destroyed. As damaged necrotic areas of the embryo can affect their further development rate we proposed blastomeres and biopsy fragments of incomplete compacted morula be removed before embryo cryopreservation. This step led to significant increase in the post-thawing survival rate up to 93.1 ± 4.1%, 75 ± 8.8% and blastocyst formation rate up to 85.2 ± 10.4%, 59.4 ± 5.2% in grade 2 and grade 3 embryos, respectively. There was no significant difference in grade 4 embryos. Therefore the removal of blastomeres and biopsy fragments in incomplete compacted morulae can improve cryopreservation outcomes of grade 2 and grade 3 embryos with BCD.
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28
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Hammond ER, Cree LM, Morbeck DE. Should extended blastocyst culture include Day 7? Hum Reprod 2019; 33:991-997. [PMID: 29648640 DOI: 10.1093/humrep/dey091] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 03/27/2018] [Indexed: 11/12/2022] Open
Abstract
Extended culture to the blastocyst stage is widely practised, improving embryo selection and promoting single embryo transfer. Selection of useable blastocysts typically occurs on Days 5 and 6 of embryo culture. Embryos not suitable for transfer, biopsy or cryopreservation after Day 6 are routinely discarded. Some embryos develop at a slower rate, however, forming blastocysts on Day 7 of culture. Day 7 blastocysts can be viable, they can be of top morphological grade, euploid and result in a healthy live birth. Since ending culture on Day 6 is current practice in most clinics, viable Day 7 blastocysts may be prematurely discarded. Although Day 7 blastocysts make up only 5% of useable blastocysts, those which are suitable for cryopreservation or biopsy are clinically significant. Overall, culturing embryos an additional day increases the number of useable embryos per IVF cycle and provides further opportunity for pregnancy for patients, especially those who have only a few or low-quality blastocysts.
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Affiliation(s)
- Elizabeth R Hammond
- Fertility Associates, 7 Ellerslie Racecourse Drive, Remuera, Auckland 1051, New Zealand
| | - Lynsey M Cree
- Fertility Associates, 7 Ellerslie Racecourse Drive, Remuera, Auckland 1051, New Zealand.,Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Rd, Grafton, Auckland 1023, New Zealand
| | - Dean E Morbeck
- Fertility Associates, 7 Ellerslie Racecourse Drive, Remuera, Auckland 1051, New Zealand.,Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Rd, Grafton, Auckland 1023, New Zealand
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29
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Haas J, Meriano J, Bassil R, Barzilay E, Zilberberg E, Casper RF. Developmental potential of slow-developing embryos: day-5 morulae compared with day-5 cavitating morulae. Fertil Steril 2019; 111:105-111. [DOI: 10.1016/j.fertnstert.2018.08.053] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 08/24/2018] [Accepted: 08/28/2018] [Indexed: 10/27/2022]
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30
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Using time-lapse technology to explore vacuolization in embryos on Day 3 and Day 4. Arch Gynecol Obstet 2018; 299:857-862. [PMID: 30569342 DOI: 10.1007/s00404-018-5008-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 12/07/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE To investigate the occurrence and development state of embryo vacuoles between the 8-cell and morula stages, and to explore how vacuoles affected the development of embryos. METHODS A retrospective study of a cohort of 422 patients undergoing conventional in vitro fertilization or intracytoplasmic sperm injection. With the help of time-lapse imaging, the development processes and outcomes of good quality embryos with or without vacuoles were analyzed. RESULTS Vacuole positive embryos had significantly lower blastulation rate and good quality blastulation rate than vacuole negative embryos, p < 0.05. Compared to vacuole negative embryos, the number of best and good quality blastocysts was significantly reduced, while the number of fair and discarded ones was significantly increased, p < 0.05. The average starting time of vacuolization was 73.7 ± 9.3 h after insemination. The proportion of blastomeres affected by vacuoles was associated with embryonic developmental potential. CONCLUSIONS Vacuolization on Day 3 and Day 4 was frequently observed and was detrimental to embryo development. The proportion of blastomeres affected by vacuoles may be an indicator of embryo developmental potential.
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31
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Mizobe Y, Ezono Y, Tokunaga M, Oya N, Iwakiri R, Yoshida N, Sato Y, Onoue N, Miyoshi K. Selection of human blastocysts with a high implantation potential based on timely compaction. J Assist Reprod Genet 2017; 34:991-997. [PMID: 28573523 DOI: 10.1007/s10815-017-0962-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 05/22/2017] [Indexed: 12/21/2022] Open
Abstract
PURPOSE Recently, we established a noninvasive system for selecting human blastocysts with a high pre-transfer implantation potential based on first and second division patterns. The present study was carried out to improve the selection system. METHODS Embryos that completed first and second divisions within 25.90 and 37.88 h after culture, respectively, were selected using a time-lapse incubator. We examined the effects of compaction and blastocyst formation times on pregnancy rates after transferring these embryos at the blastocyst stage. RESULTS The completion of compaction and blastocyst formation times (79.93 and 97.47 h after culture, respectively) of embryos resulting in pregnancies after transfer were significantly (P < 0.01) shorter than those (86.46 and 100.34 h after culture, respectively) of embryos that failed to induce pregnancies. Embryo selection based on completion of compaction time improved pregnancy rates (40.9 vs. 74.6%, P < 0.01). CONCLUSIONS Of the embryos that formed two cells during the first division within 25.90 h after culture and four cells during the second division within 37.88 h after culture, those that completed compaction within 79.93 h after culture before reaching the blastocyst stage had a high implantation potential.
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Affiliation(s)
- Yamato Mizobe
- Aiiku Ladies Clinic, 1-40-2 Komatsubara, Kagoshima, 891-0114, Japan. .,The United Graduate School of Agricultural Sciences, Kagoshima University, 1-21-24 Korimoto, Kagoshima, 890-0065, Japan.
| | - Yuji Ezono
- Aiiku Ladies Clinic, 1-40-2 Komatsubara, Kagoshima, 891-0114, Japan
| | - Makoto Tokunaga
- Aiiku Ladies Clinic, 1-40-2 Komatsubara, Kagoshima, 891-0114, Japan
| | - Naoto Oya
- Aiiku Ladies Clinic, 1-40-2 Komatsubara, Kagoshima, 891-0114, Japan
| | - Reiko Iwakiri
- Aiiku Ladies Clinic, 1-40-2 Komatsubara, Kagoshima, 891-0114, Japan
| | - Naomi Yoshida
- Aiiku Ladies Clinic, 1-40-2 Komatsubara, Kagoshima, 891-0114, Japan
| | - Yumi Sato
- Aiiku Ladies Clinic, 1-40-2 Komatsubara, Kagoshima, 891-0114, Japan
| | - Nanase Onoue
- Aiiku Ladies Clinic, 1-40-2 Komatsubara, Kagoshima, 891-0114, Japan
| | - Kazuchika Miyoshi
- The United Graduate School of Agricultural Sciences, Kagoshima University, 1-21-24 Korimoto, Kagoshima, 890-0065, Japan
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32
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In vitro developmental ability of ovine oocytes following intracytoplasmic injection with freeze-dried spermatozoa. Sci Rep 2017; 7:1096. [PMID: 28439073 PMCID: PMC5430622 DOI: 10.1038/s41598-017-00583-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 03/03/2017] [Indexed: 12/11/2022] Open
Abstract
Freeze-drying (FD) is a new and alternative method to preserve spermatozoa in refrigeration or at room temperature. Suitable protection is required to maintain the sperm DNA integrity during the whole process and storage. The aim of this study was to examine the effect of rosmarinic acid and storage temperature on the DNA integrity of freeze-dried ram sperm. In addition, we evaluated the in vitro developmental ability to the blastocyst stage of oocytes injected with freeze-dried sperm. Ram sperm was freeze-dried in basic medium and in this medium supplemented with 105 µM rosmarinic acid. The vials were stored for 1 year at 4 °C and at room temperature. Frozen sperm was used as control. After rehydration, sperm DNA damage was evaluated, observing that the percentage of spermatozoa with DNA damage decreased significantly in the presence of rosmarinic acid, without differences between the two storage temperatures. Moreover, no differences were observed between the freeze-dried group and the frozen-thawed group in terms of blastocyst formation rate. We proved for the first time that ovine spermatozoa can be lyophilized effectively, stored at room temperature for long term, reconstituted and further injected into oocytes with initial embryo development.
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33
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Lagalla C, Tarozzi N, Sciajno R, Wells D, Di Santo M, Nadalini M, Distratis V, Borini A. Embryos with morphokinetic abnormalities may develop into euploid blastocysts. Reprod Biomed Online 2017; 34:137-146. [DOI: 10.1016/j.rbmo.2016.11.008] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 11/08/2016] [Accepted: 11/15/2016] [Indexed: 12/11/2022]
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Gardner DK, Balaban B. Assessment of human embryo development using morphological criteria in an era of time-lapse, algorithms and 'OMICS': is looking good still important? Mol Hum Reprod 2016; 22:704-718. [PMID: 27578774 DOI: 10.1093/molehr/gaw057] [Citation(s) in RCA: 108] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 08/24/2016] [Indexed: 02/07/2023] Open
Abstract
With the worldwide move towards single embryo transfer there has been a renewed focus on the requirement for reliable means of assessing embryo viability. In an era of 'OMICS' technologies, and algorithms created through the use of time-lapse microscopy, the actual appearance of the human embryo as it progresses through each successive developmental stage to the blastocyst appears to have been somewhat neglected in recent years. Here we review the key features of the human preimplantation embryo and consider the relationship between morphological characteristics and developmental potential. Further, the impact of the culture environment on morphological traits, how key morphological qualities reflect aspects of embryo physiology, and how computer-assisted analysis of embryo morphology may facilitate a more quantitative approach to selection are discussed. The clinical introduction of time-lapse systems has reopened our eyes and given us a new vantage point from which to view the beauty of the initial stages of human life. Rather than a future in which the morphology of the embryo is deemed irrelevant, we propose that key features, such as multinucleation, cell size and blastocyst differentiation should be included in future iterations of selection/deselection algorithms.
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Affiliation(s)
- David K Gardner
- School of BioSciences, University of Melbourne, Victoria 3010, Australia
| | - Basak Balaban
- VKF American Hospital Assisted Reproduction Unit, Guzelbahce St. No. 20, Istanbul, Turkey
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Wirleitner B, Schuff M, Stecher A, Murtinger M, Vanderzwalmen P. Pregnancy and birth outcomes following fresh or vitrified embryo transfer according to blastocyst morphology and expansion stage, and culturing strategy for delayed development. Hum Reprod 2016; 31:1685-95. [DOI: 10.1093/humrep/dew127] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 05/10/2016] [Indexed: 11/13/2022] Open
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Mallol A, Piqué L, Santaló J, Ibáñez E. Morphokinetics of cloned mouse embryos treated with epigenetic drugs and blastocyst prediction. Reproduction 2015; 151:203-14. [PMID: 26621919 DOI: 10.1530/rep-15-0354] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 11/30/2015] [Indexed: 12/31/2022]
Abstract
Time-lapse monitoring of somatic cell nuclear transfer (SCNT) embryos may help to predict developmental success and increase birth and embryonic stem cells (ESC) derivation rates. Here, the development of ICSI fertilized embryos and of SCNT embryos, non-treated or treated with either psammaplin A (PsA) or vitamin C (VitC), was monitored, and the ESC derivation rates from the resulting blastocysts were determined. Blastocyst rates were similar among PsA-treated and VitC-treated SCNT embryos and ICSI embryos, but lower for non-treated SCNT embryos. ESC derivation rates were higher in treated SCNT embryos than in non-treated or ICSI embryos. Time-lapse microscopy analysis showed that non-treated SCNT embryos had a delayed development from the second division until compaction, lower number of blastomeres at compaction and longer compaction and cavitation durations compared with ICSI ones. Treatment of SCNT embryos with PsA further increased this delay whereas treatment with VitC slightly reduced it, suggesting that both treatments act through different mechanisms, not necessarily related to their epigenetic effects. Despite these differences, the time of completion of the third division, alone or combined with the duration of compaction and/or the presence of fragmentation, had a strong predictive value for blastocyst formation in all groups. In contrast, we failed to predict ESC derivation success from embryo morphokinetics. Time-lapse technology allows the selection of SCNT embryos with higher developmental potential and could help to increase cloning outcomes. Nonetheless, further studies are needed to find reliable markers for full-term development and ESC derivation success.
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Affiliation(s)
- Anna Mallol
- Unitat de Biologia Cel.lularDepartament de Biologia Cel.lular, Fisiologia i Immunologia, Facultat de Biociències, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
| | - Laia Piqué
- Unitat de Biologia Cel.lularDepartament de Biologia Cel.lular, Fisiologia i Immunologia, Facultat de Biociències, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
| | - Josep Santaló
- Unitat de Biologia Cel.lularDepartament de Biologia Cel.lular, Fisiologia i Immunologia, Facultat de Biociències, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
| | - Elena Ibáñez
- Unitat de Biologia Cel.lularDepartament de Biologia Cel.lular, Fisiologia i Immunologia, Facultat de Biociències, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
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Bakri NM, Ibrahim SF, Osman NA, Hasan N, Jaffar FHF, Rahman ZA, Osman K. Embryo apoptosis identification: Oocyte grade or cleavage stage? Saudi J Biol Sci 2015; 23:S50-5. [PMID: 26858565 PMCID: PMC4705312 DOI: 10.1016/j.sjbs.2015.10.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Revised: 10/29/2015] [Accepted: 10/29/2015] [Indexed: 11/25/2022] Open
Abstract
Apoptosis is a programed cell death that is vital for tissue homeostasis. However, embryo apoptosis had been known to be related to embryo fragmentation which should be avoided in in vitro fertilization (IVF). The purpose of this study was to evaluate the relationship of embryo apoptosis with the grade of immature oocytes and cleavage stage of in vitro produced (IVP) cattle embryos. This study consisted of 345 oocytes collected through ovary slicing. Immature oocytes were graded as A, B and C. This grading was based on cumulus cell thickness and compactness. All oocytes then underwent an in vitro maturation (IVM) procedure. An IVF was done 24 h after IVM culture. Prior to staining, stage of cleaved embryos was determined and classified as either 2, 4, 8 or >8-cell embryo stage. Apoptosis status of cleaved IVP embryos was determined by using annexin V-FITC staining technique at 48 and 72 h post insemination (hpi). Apoptosis status for each embryo was classified as either early or late. The result showed that there was no significant difference (p > 0.05) of apoptosis status among grade A, B and C embryos. All grades of oocytes showed embryo apoptosis where 1.5% late apoptosis for grade A, 4.5% and 10.4% of early and late apoptosis for grade B and grade C. Early apoptosis was not seen in grade A embryo. We also noted no significant difference (p > 0.05) of apoptosis status between 2, 4, 8 and >8-cell embryo stage. Early apoptosis was also not seen in >8-cell stage. Even though there were no differences in apoptosis expression between the three classes, the cleavage rate of grade A oocytes was significantly higher (p < 0.01) than grade B and grade C. In conclusion, the apoptosis expression in the embryo can occur regardless of the oocyte quality and the cleavage stage of the embryo produced.
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Key Words
- ART, assisted reproductive technologies
- Apoptosis
- BO, Brackett and Oliphant
- BSA, bovine serum albumin
- CC, cumulus cells
- CO2, carbon dioxide
- COC, cumulus–oocyte complex
- CR1aa, Charles Rosenkran’s 1 amino acid
- CaI, calcium ionophore
- Cleavage stage
- DNA, deoxyribonucleic acid
- DO, denuded oocyte
- EA, early apoptosis
- FBS, fetal bovine serum
- FITC, fluorescein isothiocyanate
- FSH, follicle stimulating hormone
- GSH, glutathione
- IVC, in vitro culture
- IVF, in vitro fertilization
- IVM, in vitro maturation
- IVP, in vitro produced
- LA, late apoptosis
- LH, luteinizing hormone
- Oocyte grading
- PBS, phosphate buffered saline
- PI, propidium iodide
- PS, phosphatidylserine
- TUNEL, terminal deoxynucleotidyl transfer-mediated dUTP nick end-labeling.
- hpi, hours post insemination
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Affiliation(s)
- Noraina Mohd Bakri
- Physiology Department, Preclinical Building, Faculty of Medicine, Canselor Tuanku Muhriz Hospital, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Wilayah Persekutuan, Kuala Lumpur, Malaysia
| | - Siti Fatimah Ibrahim
- Physiology Department, Preclinical Building, Faculty of Medicine, Canselor Tuanku Muhriz Hospital, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Wilayah Persekutuan, Kuala Lumpur, Malaysia
| | - Nurul Atikah Osman
- Physiology Department, Preclinical Building, Faculty of Medicine, Canselor Tuanku Muhriz Hospital, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Wilayah Persekutuan, Kuala Lumpur, Malaysia
| | - Nurhaslina Hasan
- Faculty of Dentistry, Universiti Teknologi MARA, 40450 Shah Alam, Selangor, Malaysia
| | - Farah Hanan Fathihah Jaffar
- Physiology Department, Preclinical Building, Faculty of Medicine, Canselor Tuanku Muhriz Hospital, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Wilayah Persekutuan, Kuala Lumpur, Malaysia
| | - Zulaiha Abdul Rahman
- Faculty of Dentistry, Universiti Sains Islam Malaysia, Level 15, Tower B, Persiaran MPAJ, Jalan Pandan Utama, 55100 Kuala Lumpur, Malaysia
| | - Khairul Osman
- Department of Forensic Sciences, School of Diagnostic and Applied Health Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia
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Morphological assessment on day 4 and its prognostic power in selecting viable embryos for transfer. ZYGOTE 2015; 24:477-84. [DOI: 10.1017/s0967199415000404] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
SummaryThe aim of this study was to describe a system for embryo morphology scoring at the morula stage and to determine the efficiency of this model in selecting viable embryos for transfer. In total, 519 embryos from 122 patients undergoing intracytoplasmic sperm injection (ICSI) were scored retrospectively on day 4 according to the grading system proposed in this article. Two separate quality scores were assigned to each embryo in relation to the grade of compaction and fragmentation and their developmental fate was then observed on days 5 and 6. Secondly, the prediction value of this scoring system was compared with the prediction value of the traditional scoring system adopted on day 3. Morulas classified as grade A showed a significant higher blastocyst formation rate (87.2%) compared with grades B, C and D (63.8, 41.3 and 15.0%, respectively), (P < 0.001). Furthermore, the ability to form top quality blastocysts was significantly higher for grade A morulas with respect to grades B, and C and D (37.8% vs. 22.4% vs. 11.1%), (P < 0.001). Finally, the morula scoring system showed more prediction power with respect to the embryo scoring a value of 1 [Akaike information criterion (AIC) index 16.4 vs. 635.3 and Bayesian information criterion (BIC) index −68.8 vs. −30.0 for morulas and embryos respectively]. In conclusion, results demonstrated that the presented scoring system allows for the evaluation of eligible embryos for transfer as a significant correlation between the grade of morula, blastulation rate and blastocyst quality was observed. Furthermore, the morula scoring system was shown to be the best predictive model when compared with the traditional scoring system performed on day 3.
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Ciray HN, Campbell A, Agerholm IE, Aguilar J, Chamayou S, Esbert M, Sayed S. Proposed guidelines on the nomenclature and annotation of dynamic human embryo monitoring by a time-lapse user group. Hum Reprod 2014; 29:2650-60. [DOI: 10.1093/humrep/deu278] [Citation(s) in RCA: 156] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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Simon L, Murphy K, Shamsi MB, Liu L, Emery B, Aston KI, Hotaling J, Carrell DT. Paternal influence of sperm DNA integrity on early embryonic development. Hum Reprod 2014; 29:2402-12. [PMID: 25205757 DOI: 10.1093/humrep/deu228] [Citation(s) in RCA: 174] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
STUDY QUESTION Does sperm DNA damage affect early embryonic development? SUMMARY ANSWER Increased sperm DNA damage adversely affects embryo quality starting at Day 2 of early embryonic development and continuing after embryo transfer, resulting in reduced implantation rates and pregnancy outcomes. WHAT IS KNOWN ALREADY Abnormalities in the sperm DNA in the form of single and double strand breaks can be assessed by an alkaline Comet assay. Some prior studies have shown a strong paternal effect of sperm DNA damage on IVF outcome, including reduced fertilization, reduced embryo quality and cleavage rates, reduced numbers of embryos developing into blastocysts, increased percentage of embryos undergoing developmental arrest, and reduced implantation and pregnancy rates. STUDY DESIGN, SIZE, DURATION A cross-sectional study of 215 men from infertile couples undergoing assisted reproduction techniques at the University of Utah Center for Reproductive Medicine. PARTICIPANTS/MATERIALS, SETTING, METHODS Sperm from men undergoing ART were analyzed for DNA damage using an alkaline Comet assay and classified into three groups: 'low damage' (0-30%), 'intermediate damage' (31-70%) and 'high damage' (71-100%). The cause of couples' infertility was categorized into one of the three types (male, female or unexplained). Each embryo was categorized as 'good', 'fair' or 'poor' quality, based on the number and grade of blastomeres. The influence of sperm DNA damage on early embryonic development was observed and classified into four stages: peri-fertilization effect (fertilization rate), early paternal effect (embryonic days 1-2), late paternal effect (embryonic days 3-5) and implantation stage effect. MAIN RESULTS AND THE ROLE OF CHANCE The paternal effect of sperm DNA damage was observed at each stage of early embryonic development. The peri-fertilization effect was higher in oocytes from patients with female infertility (20.85%) compared with male (8.22%; P < 0.001) and unexplained (7.30%; P < 0.001) infertility factors. In both the early and late paternal effect stages, the low DNA damage group had a higher percentage of good quality embryos (P < 0.05) and lower percentage of poor quality embryos (P < 0.05) compared with the high DNA damage group. Implantation was lower in the high DNA damage (33.33%) compared with intermediate DNA damage (55.26%; P < 0.001) and low DNA damage (65.00%; P < 0.001) groups. The implantation rate was higher following blastocyst transfer (58.33%), when compared with early stage blastocyst (53.85%; P = 0.554) and cavitating morula transfers (34.40%; P < 0.001). Implantation was higher when the female partner age was ≤35 years when compared with >35 year age group (52.75 versus 35.44%; P = 0.008). LIMITATIONS, REASONS FOR CAUTION A potential limitation of this study is that it is cross-sectional. Generally in such studies more than one variable could affect the outcome. Analyzing sperm is one part of the equation but a number of environmental and female factors also have the potential to influence embryo development and implantation. Furthermore, the selection of morphologically normal and physiologically motile sperm may result in isolation of sperm with reduced DNA damage. Therefore, selecting the best available sperm for ICSI may lead to experimental bias, as the selected sperm do not represent the overall sperm population in which the DNA damage is measured. Similar studies on selected sperm and with a larger sample size are now required. WIDER IMPLICATIONS OF THE FINDINGS The paternal influence of damaged chromatin is more prominent after zygotic transcriptional activation. A prolonged paternal effect on the developing embryo may be due to the active repair mechanism present in oocytes that tends to overcome the damaged paternal chromatin. The probability of eliminating an embryo fertilized by a sperm with damaged DNA is higher at the blastocyst stage than the cleavage stage; therefore blastocyst transfer could be recommended for better implantation success. Finally, we recommend ICSI treatment for patients with a higher percentage of sperm with DNA damage as well as additional studies with a larger sample size aimed at assessing DNA damage analysis as a diagnostic tool for IVF. STUDY FUNDING/COMPETING INTERESTS This work was supported by the University of Utah internal funds. The authors declare no competing interests. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- L Simon
- Andrology and IVF Laboratory, Department of Surgery (Urology), University of Utah, Salt Lake City, UT 84108, USA
| | - K Murphy
- Andrology and IVF Laboratory, Department of Surgery (Urology), University of Utah, Salt Lake City, UT 84108, USA
| | - M B Shamsi
- Andrology and IVF Laboratory, Department of Surgery (Urology), University of Utah, Salt Lake City, UT 84108, USA
| | - L Liu
- Andrology and IVF Laboratory, Department of Surgery (Urology), University of Utah, Salt Lake City, UT 84108, USA
| | - B Emery
- Andrology and IVF Laboratory, Department of Surgery (Urology), University of Utah, Salt Lake City, UT 84108, USA
| | - K I Aston
- Andrology and IVF Laboratory, Department of Surgery (Urology), University of Utah, Salt Lake City, UT 84108, USA
| | - J Hotaling
- Andrology and IVF Laboratory, Department of Surgery (Urology), University of Utah, Salt Lake City, UT 84108, USA
| | - D T Carrell
- Andrology and IVF Laboratory, Department of Surgery (Urology), University of Utah, Salt Lake City, UT 84108, USA Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT 84108, USA Department of Human Genetics, University of Utah, Salt Lake City, UT 84108, USA
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Orozco-Lucero E, Dufort I, Robert C, Sirard MA. Rapidly cleaving bovine two-cell embryos have better developmental potential and a distinctive mRNA pattern. Mol Reprod Dev 2013; 81:31-41. [PMID: 24285591 DOI: 10.1002/mrd.22278] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Accepted: 10/31/2013] [Indexed: 12/28/2022]
Abstract
Mammalian embryos that rapidly reach the two-cell stage in culture have a higher probability of becoming viable blastocysts. Our goal was to separate two-cell bovine embryos based on their zygotic cleavage timing, and to assess their global mRNA levels. Following in vitro fertilization, all embryos that cleaved by 29.5 hpi (early) were cultured separately from those that divided at 46 hpi (late). The blastocyst rates were 46.1 ± 3.7% and 6.1 ± 3.4% for early- and late-cleavers, respectively (P < 0.01). Seven replicates of selected two-cell embryos were collected at each time point for microarray characterization (n = 4) and quantitative reverse-transcriptase PCR (n = 3); the rest were left in culture for blastocyst evaluation. A total of 774 and 594 probes were preferentially present in early- and late-cleaving embryos, respectively (fold change ± 1.5, P < 0.05), with important contrasts related to cell cycle, gene expression, RNA processing, and protein degradation functions. A total of 12 transcripts were assessed by quantitative PCR, of which ATM, ATR, CTNNB1, MSH6, MRE11A, PCNA, APC, CENPE, and GRB2 were in agreement with the hybridization results. Since most of these molecules are directly or indirectly associated with cell-cycle regulation, DNA damage response, and transcription control, our results strongly suggest key roles for those biological functions in mammalian preimplantation development.
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Affiliation(s)
- Ernesto Orozco-Lucero
- Faculté des Sciences de l'Agriculture et de l'Alimentation, Département des Sciences Animales, Pavillon INAF, Centre de Recherche en Biologie de la Reproduction (CRBR), Université Laval, Québec, Canada
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Le Cruguel S, Ferré-L'Hôtellier V, Morinière C, Lemerle S, Reynier P, Descamps P, May-Panloup P. Early compaction at day 3 may be a useful additional criterion for embryo transfer. J Assist Reprod Genet 2013; 30:683-90. [PMID: 23563915 DOI: 10.1007/s10815-013-9983-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2012] [Accepted: 03/15/2013] [Indexed: 11/30/2022] Open
Abstract
PURPOSE The reduction of the number of embryos transferred while maintaining a satisfactory rate of pregnancy (PR) with in vitro fertilization calls for a refined technique of embryonic selection. This prospective study investigates the significance of early embryonic compaction at day 3 as a marker of the chances of implantation. METHODS We examined 317 transfers and their outcome involving 509 embryos including 91 compacted embryos. RESULTS Early compaction seems linked with the ovarian response to stimulation and embryonic quality. The PR is significantly increased when the embryonic cohort contains at least one compacted embryo (44% versus 29.5%, p = 0.01), and when at least one compacted embryo is transferred (44% versus 31%, p < 0.05). The analysis of our single embryo transfers shows that the implantation rates are significantly better for compacted embryos (50% versus 30%, p < 0.05) (OR 2.98; CI 1.02-5.28). CONCLUSION Thus, early compaction, sometimes observed at day 3, may serve as a useful additional criterion for selecting the embryos transferred.
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Affiliation(s)
- Sébastien Le Cruguel
- Laboratoire de Biologie de la Reproduction, Centre Hospitalier Universitaire d'Angers, Angers, France
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