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Abstract
A time-lapse monitoring system provides a complete picture of the dynamic embryonic development process and simultaneously supplies extensive morphokinetic data. The objective of this study was to investigate whether the use of the morphokinetic parameter of time of starting blastulation (tSB) can improve the implantation rate of day-5 transferred blastocyst selected based on morphological parameters. In this retrospective study we analyzed the morphokinetics of 196 day-5 transferred blastocysts, selected solely based on morphological parameters. The interval time from intracytoplasmic sperm injection (ICSI) to time of starting blastocyst formation (tSB) was calculated for each embryo. The overall implantation rate of transferred blastocyst, selected based only on morphological parameters, was 49.2%. Implantation rate, determined retrospectively, was significantly higher (58.8% versus 42.6%, P = 0.02) for embryos with a short interval time to tSB (78-95.9 h) compared with embryos with a longer timeframe (96-114 h). Time of expanded blastocyst (tEB) post-ICSI was also significantly associated with implantation; however, this parameter was not available for all the embryos at time of transfer. When we tested only high ranked KIDScore day-3 sub-group embryos, the implantation rate was significantly higher in short interval time embryos compared with longer interval time embryos (62.2% vs. 45.5%, respectively, P = 0.02).These observations emphasize the importance of the timing of starting blastulation over blastocyst morphological parameters and may provide a preferable criterion for good morphology day-5 blastocyst selection.
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Liu Y, Ong K, Korman I, Turner R, Shaker D, Zander-Fox D, Rombauts L. The effect of day 5 blastocyst assessment timing on live birth prediction and development of a prediction algorithm. Reprod Biomed Online 2022; 44:609-616. [DOI: 10.1016/j.rbmo.2022.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 12/30/2021] [Accepted: 01/25/2022] [Indexed: 10/19/2022]
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Orevich LS, Watson K, Ong K, Korman I, Turner R, Shaker D, Liu Y. Morphometric and morphokinetic differences in the sperm- and oocyte-originated pronuclei of male and female human zygotes: a time-lapse study. J Assist Reprod Genet 2022; 39:97-106. [PMID: 34993708 PMCID: PMC8866592 DOI: 10.1007/s10815-021-02366-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 11/23/2021] [Indexed: 01/03/2023] Open
Abstract
PURPOSE To study the morphometric and morphokinetic profiles of pronuclei (PN) between male and female human zygotes. METHOD(S) This retrospective cohort study included 94 consecutive autologous single day 5 transfer cycles leading to a singleton live birth. All oocytes were placed in the EmbryoScope + incubator post-sperm injection with all annotations performed retrospectively by one embryologist (L-SO). Timing parameters included 2nd polar body extrusion (tPB2), sperm-originated PN (tSPNa) or oocyte-originated PN (tOPNa) appearance, and PN fading (tPNF). Morphometrics were evaluated at 8 (stage 1), 4 (stage 2), and 0 h before PNF (stage 3), measuring PN area (um2), PN juxtaposition, and nucleolar precursor bodies (NPB) arrangement. RESULTS Male zygotes had longer time intervals of tPB2_tSPNa than female zygotes (4.8 ± 0.2 vs 4.2 ± 0.1 h, OR = 1.442, 95% CI 1.009-2.061, p = 0.044). SPN increased in size from stage 1 through 2 to 3 (435.3 ± 7.2, 506.7 ± 8.0, and 556.3 ± 8.9 um2, p = 0.000) and OPN did similarly (399.0 ± 6.1, 464.3 ± 6.7, and 513.8 ± 6.5 um2, p = 0.000), with SPN being significantly larger than OPN at each stage (p < 0.05 respectively). More male than female zygotes reached central PN juxtaposition at stage 1 (76.7% vs 51.0%, p = 0.010), stage 2 (97.7% vs 86.3%, p = 0.048), and stage 3 (97.7% vs 86.3%, p = 0.048). More OPN showed aligned NPBs than in SPN at stage 1 only (44.7% vs 28.7%, p = 0.023). CONCLUSION(S) Embryos with different sexes display different morphokinetic and morphometric features at the zygotic stage. Embryo selection using such parameters may lead to unbalanced sex ratio in resulting offspring.
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Affiliation(s)
| | - Kate Watson
- Monash IVF Gold Coast, 2 Short Street, Southport, QLD L34215 Australia
| | - Kee Ong
- Monash IVF Gold Coast, 2 Short Street, Southport, QLD L34215 Australia
| | - Irving Korman
- Monash IVF Gold Coast, 2 Short Street, Southport, QLD L34215 Australia
| | - Ross Turner
- Monash IVF Auchenflower, Auchenflower, QLD Australia
| | - David Shaker
- Monash IVF Rockhampton, Rockhampton, QLD Australia ,Rural Clinical School, University of Queensland, Brisbane, QLD Australia
| | - Yanhe Liu
- Monash IVF Gold Coast, 2 Short Street, Southport, QLD L34215 Australia ,Monash IVF Auchenflower, Auchenflower, QLD Australia ,Monash IVF Rockhampton, Rockhampton, QLD Australia ,School of Human Sciences, University of Western Australia, Crawley, WA Australia ,School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA Australia ,School of Health Sciences and Medicine, Bond University, Robina, QLD Australia
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Liao Q, Zhang Q, Feng X, Huang H, Xu H, Tian B, Liu J, Yu Q, Guo N, Liu Q, Huang B, Ma D, Ai J, Xu S, Li K. Development of deep learning algorithms for predicting blastocyst formation and quality by time-lapse monitoring. Commun Biol 2021; 4:415. [PMID: 33772211 PMCID: PMC7998018 DOI: 10.1038/s42003-021-01937-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 02/24/2021] [Indexed: 12/24/2022] Open
Abstract
Approaches to reliably predict the developmental potential of embryos and select suitable embryos for blastocyst culture are needed. The development of time-lapse monitoring (TLM) and artificial intelligence (AI) may help solve this problem. Here, we report deep learning models that can accurately predict blastocyst formation and usable blastocysts using TLM videos of the embryo’s first three days. The DenseNet201 network, focal loss, long short-term memory (LSTM) network and gradient boosting classifier were mainly employed, and video preparation algorithms, spatial stream and temporal stream models were developed into ensemble prediction models called STEM and STEM+. STEM exhibited 78.2% accuracy and 0.82 AUC in predicting blastocyst formation, and STEM+ achieved 71.9% accuracy and 0.79 AUC in predicting usable blastocysts. We believe the models are beneficial for blastocyst formation prediction and embryo selection in clinical practice, and our modeling methods will provide valuable information for analyzing medical videos with continuous appearance variation. Liao et al. propose a deep learning model to predict blastocyst formation using TLM videos following the first three days of embryogenesis. The authors develop an ensemble prediction model, STEM and STEM+, which were found to exhibit 78.2% and 71.9% accuracy at predicting blastocyst formation and useable blastocysts respectively.
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Affiliation(s)
- Qiuyue Liao
- Department of Gynecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Qi Zhang
- Shanghai Institute for Advanced Communication and Data Science, Shanghai University, Shanghai, China
| | - Xue Feng
- Department of Gynecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Haibo Huang
- Shanghai Institute for Advanced Communication and Data Science, Shanghai University, Shanghai, China
| | - Haohao Xu
- Shanghai Institute for Advanced Communication and Data Science, Shanghai University, Shanghai, China
| | - Baoyuan Tian
- Shanghai Institute for Advanced Communication and Data Science, Shanghai University, Shanghai, China
| | - Jihao Liu
- Shanghai Institute for Advanced Communication and Data Science, Shanghai University, Shanghai, China
| | - Qihui Yu
- Shanghai Institute for Advanced Communication and Data Science, Shanghai University, Shanghai, China
| | - Na Guo
- Department of Gynecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Qun Liu
- Department of Gynecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Bo Huang
- Department of Gynecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Ding Ma
- Department of Gynecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jihui Ai
- Department of Gynecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
| | - Shugong Xu
- Shanghai Institute for Advanced Communication and Data Science, Shanghai University, Shanghai, China.
| | - Kezhen Li
- Department of Gynecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
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Sayed S, Reigstad MM, Petersen BM, Schwennicke A, Wegner Hausken J, Storeng R. Time-lapse imaging derived morphokinetic variables reveal association with implantation and live birth following in vitro fertilization: A retrospective study using data from transferred human embryos. PLoS One 2020; 15:e0242377. [PMID: 33211770 PMCID: PMC7676704 DOI: 10.1371/journal.pone.0242377] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 11/01/2020] [Indexed: 01/03/2023] Open
Abstract
The purpose of this retrospective time-lapse data analysis from transferred preimplantation human embryos was to identify early morphokinetic cleavage variables that are related to implantation and live birth following in vitro fertilization (IVF). All embryos were monitored from fertilization check until embryo transfer for a minimum of 44 hours. The study was designed to assess the association between day 2 embryo morphokinetic variables with implantation and live birth based on Known Implantation Data (KID). The kinetic variables were subjected to quartile-based analysis. The predictive ability for implantation and live birth was studied using receiver operator characteristic (ROC) curves. Three morphokinetic variables, time to 2-cells (t2), duration of second cell cycle (cc2) below one threshold and cc2 above another threshold had the highest predictive value with regards to implantation and live birth following IVF treatment. The predictive pre-transfer information has little divergence between fetal heartbeat and live birth data and therefore, at least for early morphokinetic variables up to the four-cell stage (t4), conclusions and models based on fetal heartbeat data can be expected to be valid for live birth datasets as well. The three above mentioned variables (t2, cc2 below one threshold and cc2 above another threshold) may supplement morphological evaluation in embryo selection and thereby improve the outcome of in vitro fertilization treatments.
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Affiliation(s)
- Shabana Sayed
- Klinikk Hausken, IVF and Gynecology, Haugesund, Norway
| | - Marte Myhre Reigstad
- Norwegian National Advisory Unit on Women's Health, Oslo University Hospital, Oslo, Norway
| | | | | | | | - Ritsa Storeng
- Norwegian National Advisory Unit on Women's Health, Oslo University Hospital, Oslo, Norway
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Influence of Different Quality Sperm on Early Embryo Morphokinetic Parameters and Cleavage Patterns: A Retrospective Time-lapse Study. Curr Med Sci 2020; 40:960-967. [PMID: 33123909 DOI: 10.1007/s11596-020-2272-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 05/28/2020] [Indexed: 10/23/2022]
Abstract
To investigate whether sperm with low concentration and motility can impact preimplantation embryos and to analyze how the effects present under a time-lapse incubation system, 2905 oocytes were collected from 219 couples between January 2014 and December 2015. Patients were divided into three groups according to sperm quality. Morphokinetic parameters and six cleavage patterns in the initial three cleavages were evaluated using the Primo Vision system. Embryo quality and clinic outcomes such as implantation rate, pregnancy rate and live birth rate were measured. The results showed that the concentration and motility of sperm correlated strongly with the rate of 2PN embryos, good-quality embryos on D3, blastocysts on D5/6 and good-quality embryos on D5/6. The time-lapse system recordings showed that compromised sperm quality could result in a significant delay in cc1 and a decrease in cc2, and impact embryo developmental potential mainly through large fragments or/and blastomere fragmentation in the initial three cleavages. In conclusion, sperm with low concentration and motility can have paternal effects on preimplantation embryos. These paternal effects present both as changes in morphokinetic parameters and cleavage patterns, which occur as early as fertilization and may cause severe damage to the preimplantation embryos.
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Doron-Lalehzari A, Wainstock T, Szaingurten-Solodkin I, Richter D, Zeadna A, Harlev A, Lunenfeld E, Levitas E, Har-Vardi I. Are morphokinetic parameters of embryo development associated with adverse perinatal outcomes following fresh blastocyst transfer? Reprod Biomed Online 2020; 42:207-216. [PMID: 33168490 DOI: 10.1016/j.rbmo.2020.09.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 09/22/2020] [Accepted: 09/30/2020] [Indexed: 11/17/2022]
Abstract
RESEARCH QUESTION Are obstetric and perinatal complications associated with morphokinetic parameters of embryo development? DESIGN This proof-of-concept pilot study included a retrospective analysis of embryo morphokinetic parameters of 85 live births following day 5 single blastocyst transfer. Kinetic variables included time interval (hours) from time of pronuclei fading (tPNf) to: time of 2 cells (tPNf-t2), 9 cells (tPNf-t9), morula (tPNf-tM), start of blastulation (tPNf-tSB), full blastocyst (tPNf-tB) and expanded blastocyst (tPNf-tEB). Multivariable logistic models were used to calculate the risk of perinatal complications after adjustment for confounders. RESULTS The mean interval of tPNf-tSB was significantly longer for newborns with congenital anomalies compared with healthy newborns (79.49 ± 5.78 versus 71.7 ± 6.3, respectively, P = 0.01) and for embryos of women who had gestational diabetes mellitus compared with normoglycemic women (76.56 ± 7.55 versus 71.5 ± 6.13, respectively, P = 0.015). The mean interval of tPNf-t9 was significantly longer for low-birthweight newborns compared with normal weight (49.25 ± 5.54 versus 45.47 ± 4.77, respectively, P = 0.01). Preterm delivery was associated with several longer intervals of cell divisions compared with delivery at term (tPNf-t5: 28.76 ± 3.13 versus 26.64 ± 2.40, respectively, P = 0.01; tPNf-t6: 30.10 ± 3.05 versus 27.68 ± 2.30, respectively, P < 0.001; tPNf-t7: 32.08 ± 4.11 versus 28.70 ± 2.67, respectively, P < 0.001; tPNf-t8: 34.75 ± 4.95 versus 30.70 ± 4.10, respectively, P < 0.001; tPNf-t9: 50.23 ± 5.87 versus 45.44 ± 4.67, respectively, P < 0.001). For each of the outcomes, the association remained significant after adjusting for confounders. CONCLUSION This study indicates that there may be a possible association between adverse perinatal outcomes and morphokinetic parameters. Larger studies are needed to establish this association.
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Affiliation(s)
| | - Tamar Wainstock
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; School of Public Health, Beer-Sheva, Israel
| | - Irit Szaingurten-Solodkin
- Soroka University Medical Center, Fertility and IVF Unit, Department of Obstetrics and Gynecology, Beer-Sheva, Israel
| | - Dganit Richter
- Soroka University Medical Center, Fertility and IVF Unit, Department of Obstetrics and Gynecology, Beer-Sheva, Israel
| | - Atif Zeadna
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Soroka University Medical Center, Fertility and IVF Unit, Department of Obstetrics and Gynecology, Beer-Sheva, Israel
| | - Avi Harlev
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Barzilai Medical Center, Fertility and IVF Unit, Department of Obstetrics and Gynecology, Ashkelon, Israel
| | - Eitan Lunenfeld
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Soroka University Medical Center, Fertility and IVF Unit, Department of Obstetrics and Gynecology, Beer-Sheva, Israel
| | - Eliahu Levitas
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Soroka University Medical Center, Fertility and IVF Unit, Department of Obstetrics and Gynecology, Beer-Sheva, Israel
| | - Iris Har-Vardi
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Soroka University Medical Center, Fertility and IVF Unit, Department of Obstetrics and Gynecology, Beer-Sheva, Israel.
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Gallego RD, Remohí J, Meseguer M. Time-lapse imaging: the state of the art†. Biol Reprod 2020; 101:1146-1154. [PMID: 30810735 DOI: 10.1093/biolre/ioz035] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 02/12/2019] [Accepted: 02/26/2019] [Indexed: 12/12/2022] Open
Abstract
The introduction of time-lapse imaging to clinical in vitro fertilization practice enabled the undisturbed monitoring of embryos throughout the entire culture period. Initially, the main objective was to achieve a better embryo development. However, this technology also provided an insight into the novel concept of morphokinetics, parameters regarding embryo cell dynamics. The vast amount of data obtained defined the optimal ranges in the cell-cycle lengths at different stages of embryo development. This added valuable information to embryo assessment prior to transfer. Kinetic markers became part of embryo evaluation strategies with the potential to increase the chances of clinical success. However, none of them has been established as an international standard. The present work aims at describing new approaches into time-lapse: progress to date, challenges, and possible future directions.
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Apter S, Ebner T, Freour T, Guns Y, Kovacic B, Le Clef N, Marques M, Meseguer M, Montjean D, Sfontouris I, Sturmey R, Coticchio G. Good practice recommendations for the use of time-lapse technology †. Hum Reprod Open 2020; 2020:hoaa008. [PMID: 32206731 PMCID: PMC7081060 DOI: 10.1093/hropen/hoaa008] [Citation(s) in RCA: 88] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 12/05/2019] [Accepted: 01/29/2020] [Indexed: 12/26/2022] Open
Affiliation(s)
| | | | - Thomas Ebner
- Department of Gynecology, Obstetrics, and Gynecological Endocrinology, Kepler Universitätsklinikum, Linz, Austria
| | - Thomas Freour
- Médecine de la Reproduction, CHU de Nantes, Nantes, France
| | - Yves Guns
- Center for Reproductive Medicine, UZ Brussel, Brussels, Belgium
| | - Borut Kovacic
- Department of Reproductive Medicine and Gynecologic Endocrinology, Univerzitetni klinicni center Maribor, Maribor, Slovenia
| | - Nathalie Le Clef
- European Society of Human Reproduction and Embryology, Grimbergen, Belgium
| | | | - Marcos Meseguer
- IVF Laboratory, Instituto Valenciano de Infertilidad, Valencia, Spain
| | - Debbie Montjean
- Médecine et Biologie de la Reproduction, Hopital Saint Joseph, Marseille, France
| | | | - Roger Sturmey
- Centre for Atherothrombosis and Metabolic Disease, Hull York Medical School, University of Hull, Hull, UK
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Sacha CR, Dimitriadis I, Christou G, James K, Brock ML, Rice ST, Bhowmick P, Bormann CL, Souter I. The impact of male factor infertility on early and late morphokinetic parameters: a retrospective analysis of 4126 time-lapse monitored embryos. Hum Reprod 2020; 35:24-31. [DOI: 10.1093/humrep/dez251] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 09/19/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
STUDY QUESTION
Is there an effect of male factor infertility (MFI) on either early or late morphokinetic parameters obtained during embryonic culture to blastocyst stage in a time-lapse imaging (TLI) incubator?
SUMMARY ANSWER
Neither mild nor severe MFI had an impact on overall time to blastocyst or duration of individual cleavage stages in the total embryo population.
WHAT IS KNOWN ALREADY
Prior studies have suggested that paternal DNA and sperm quality affect embryo morphokinetic parameters, but the impact of MFI is not fully understood.
STUDY DESIGN, SIZE, DURATION
This retrospective cohort study, at a major academic fertility centre, included 536 couples (women, ≤44 years of age) undergoing IVF between September 2013 and September 2016.
PARTICIPANTS/MATERIALS, SETTING, METHODS
Data from 4126 embryos cultured to the blastocyst stage in a TLI-monitored incubator were retrospectively reviewed. Embryos derived from the sperm of men with MFI were compared with those derived from patients with other infertility diagnoses. Generalized fixed and random effects models, t-test and χ2 were used as appropriate.
MAIN RESULTS AND THE ROLE OF CHANCE
Couples with MFI had a higher rate of ICSI utilization and fewer usable embryos on average, and the men were older compared with couples with other diagnoses. Additionally, the women in MFI couples were younger and had higher antral follicle counts (AFCs) and higher anti-Müllerian hormone (AMH) levels compared with the other women undergoing IVF. When controlling for maternal and paternal ages, AMH and fertilization method (conventional IVF versus ICSI), neither mild nor severe MFI affected duration of individual cleavage stages or overall time to the blastocyst stage, when all or only usable embryos were examined (coefficient 0.44 hours in all embryos, P = 0.57; coefficient 0.39 hours in usable embryos, P = 0.60). Whether the sperm was surgically extracted similarly had no significant effect on embryo morphokinetic parameters. When the fertilization method was assessed independently, ICSI lengthened the overall time to blastocyst stage by 1.66 hours (P = 0.03) on average, primarily due to an increase in duration of the time from 5-cell embryo stage to early blastulation (P5SB).
LIMITATIONS, REASONS FOR CAUTION
This large cohort study avoided embryo selection bias due to random assignment of embryos to the TLI incubators. However, our findings may not be generalizable to groups under-represented in our clinic population. Future studies should also evaluate the impact of male hormonal status and detailed sperm morphology, such as head versus flagellum defects, on embryo morphokinetic development.
WIDER IMPLICATIONS OF THE FINDINGS
Our findings suggest that the fertilization method rather than MFI per se impacts time to early blastulation. The clinical implications of this effect on embryo development warrant further investigation.
STUDY FUNDING/COMPETING INTEREST(S)
There were no sources of funding for this study. There are no competing interests.
TRIAL REGISTRATION NUMBER
N/A
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Affiliation(s)
- C R Sacha
- Department of Reproductive Endocrinology and Infertility, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - I Dimitriadis
- Department of Reproductive Endocrinology and Infertility, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - G Christou
- Department of Reproductive Endocrinology and Infertility, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - K James
- Deborah Kelly Center for Outcomes Research, Department of OB/GYN, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - M L Brock
- Department of Reproductive Endocrinology and Infertility, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - S T Rice
- Department of Reproductive Endocrinology and Infertility, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - P Bhowmick
- Department of Reproductive Endocrinology and Infertility, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - C L Bormann
- Department of Reproductive Endocrinology and Infertility, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - I Souter
- Department of Reproductive Endocrinology and Infertility, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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11
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Reignier A, Girard JM, Lammers J, Chtourou S, Lefebvre T, Barriere P, Freour T. Performance of Day 5 KIDScore™ morphokinetic prediction models of implantation and live birth after single blastocyst transfer. J Assist Reprod Genet 2019; 36:2279-2285. [PMID: 31444634 DOI: 10.1007/s10815-019-01567-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 08/15/2019] [Indexed: 11/25/2022] Open
Abstract
PURPOSE While several studies reported the association between morphokinetic parameters and implantation, few predictive models were developed to predict implantation after day 5 embryo transfer, generally without external validation. The objective of this study was to evaluate the respective performance of 2 commercially available morphokinetic-based models (KIDScore™ Day 5 versions 1 and 2) for the prediction of implantation and live birth after day 5 single blastocyst transfer. METHODS This monocentric retrospective study was conducted on 210 ICSI cycles with single day 5 embryo transfer performed with a time-lapse imaging (TLI) system between 2013 and 2016. The association between both KIDScore™ and the observed implantation and live birth rates was calculated, as well as the agreement between embryologist's choice for transfer and embryo ranking by the models. RESULTS Implantation and live birth rate were both 35.7%. A significant positive correlation was found between both models and implantation rate (r = 0.96 and r = 0.90, p = 0.01) respectively. Both models had statistically significant but limited predictive power for implantation (AUC 0.60). There was a fair agreement between the embryologists' choice and both models (78% and 61% respectively), with minor differences in case of discrepancies. CONCLUSIONS KIDScore™ Day 5 predictive models are significantly associated with implantation rates after day 5 single blastocyst transfer. However, their predictive performance remains perfectible. The use of these predictive models holds promises as decision-making tools to help the embryologist select the best embryo, ultimately facilitating the implementation of SET policy. However, embryologists' expertise remains absolutely necessary to make the final decision.
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Affiliation(s)
- Arnaud Reignier
- Service de biologie et médecine de la reproduction, CHU Nantes, 38 boulevard Jean Monnet, 44093, Nantes, France.,Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, Nantes, France.,Faculté de médecine, Université de Nantes, Nantes, France
| | | | - Jenna Lammers
- Service de biologie et médecine de la reproduction, CHU Nantes, 38 boulevard Jean Monnet, 44093, Nantes, France
| | - Sana Chtourou
- Service de biologie et médecine de la reproduction, CHU Nantes, 38 boulevard Jean Monnet, 44093, Nantes, France.,Laboratoire de biologie de la reproduction et de cytogénétique, Hôpital Aziza Othmana, Tunis, Tunisia
| | - Tiphaine Lefebvre
- Service de biologie et médecine de la reproduction, CHU Nantes, 38 boulevard Jean Monnet, 44093, Nantes, France.,Faculté de médecine, Université de Nantes, Nantes, France
| | - Paul Barriere
- Service de biologie et médecine de la reproduction, CHU Nantes, 38 boulevard Jean Monnet, 44093, Nantes, France.,Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, Nantes, France.,Faculté de médecine, Université de Nantes, Nantes, France
| | - Thomas Freour
- Service de biologie et médecine de la reproduction, CHU Nantes, 38 boulevard Jean Monnet, 44093, Nantes, France. .,Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, Nantes, France. .,Faculté de médecine, Université de Nantes, Nantes, France.
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12
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Liu Y, Sakkas D, Afnan M, Matson P. Time-lapse videography for embryo selection/de-selection: a bright future or fading star? HUM FERTIL 2019; 23:76-82. [PMID: 30963781 DOI: 10.1080/14647273.2019.1598586] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
The recent clinical introduction of time-lapse videography into in vitro fertilization laboratories has offered a novel opportunity for embryologists to explore improved methods for embryo selection. While the concept of uninterrupted culture of embryos provided by such systems is welcomed, the current evidence does not support its full application in routine clinical practice. The issue of whether or not algorithms for embryo selection can be extrapolated between laboratories, which may represent a major hurdle to its wide application, is currently gaining increasing attention amongst embryologists worldwide. In this commentary issues identified in time-lapse embryo selection/de-selection algorithms, such as quantitative versus qualitative parameters, are discussed alongside the reference start point for the timing system, and types of datasets used for developing and validating time-lapse algorithms. Considering these factors, alternative future research directions which could potentially solve current issues are proposed.
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Affiliation(s)
- Yanhe Liu
- Reproductive Medicine Center, Tianjin United Family Hospital, Tianjin, China.,School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
| | | | - Masoud Afnan
- Reproductive Medicine Center, Tianjin United Family Hospital, Tianjin, China
| | - Phillip Matson
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia.,Joondalup Private Hospital, Fertility North, Joondalup, Australia
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Predicting live birth by combining cleavage and blastocyst-stage time-lapse variables using a hierarchical and a data mining-based statistical model. Reprod Biol 2018; 18:355-360. [DOI: 10.1016/j.repbio.2018.10.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 10/17/2018] [Accepted: 10/19/2018] [Indexed: 10/28/2022]
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14
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Huang B, Ren X, Zhu L, Wu L, Tan H, Guo N, Wei Y, Hu J, Liu Q, Chen W, Liu J, Li D, Liao S, Jin L. Is differences in embryo morphokinetic development significantly associated with human embryo sex?†. Biol Reprod 2018; 100:618-623. [PMID: 30371742 DOI: 10.1093/biolre/ioy229] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 09/21/2018] [Accepted: 10/25/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- Bo Huang
- Reproductive Medical Center, Tongji Hospital, Tongji College of Medicine, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Xinling Ren
- Reproductive Medical Center, Tongji Hospital, Tongji College of Medicine, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Lixia Zhu
- Reproductive Medical Center, Tongji Hospital, Tongji College of Medicine, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Li Wu
- Reproductive Medical Center, Tongji Hospital, Tongji College of Medicine, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Huiping Tan
- Reproductive Medical Center, Tongji Hospital, Tongji College of Medicine, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Na Guo
- Reproductive Medical Center, Tongji Hospital, Tongji College of Medicine, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Yulan Wei
- Reproductive Medical Center, Tongji Hospital, Tongji College of Medicine, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Juan Hu
- Reproductive Medical Center, Tongji Hospital, Tongji College of Medicine, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Qun Liu
- Reproductive Medical Center, Tongji Hospital, Tongji College of Medicine, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Wen Chen
- Reproductive Medical Center, Tongji Hospital, Tongji College of Medicine, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Jing Liu
- Reproductive Medical Center, Tongji Hospital, Tongji College of Medicine, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Dan Li
- Reproductive Medical Center, Tongji Hospital, Tongji College of Medicine, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Shujie Liao
- Reproductive Medical Center, Tongji Hospital, Tongji College of Medicine, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Lei Jin
- Reproductive Medical Center, Tongji Hospital, Tongji College of Medicine, Huazhong University of Science and Technology, Wuhan, People's Republic of China
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15
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Yang SH, Wu CH, Chen YC, Yang CK, Wu TH, Chen PC, Tsai HD. Effect of morphokinetics and morphological dynamics of cleavage stage on embryo developmental potential: A time-lapse study. Taiwan J Obstet Gynecol 2018; 57:76-82. [PMID: 29458909 DOI: 10.1016/j.tjog.2017.12.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2017] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Using a non-invasive method to select the most competent embryo is essential in in vitro fertilization (IVF). Since the beginning of clinical application of time-lapse technology, several studies have proposed models using the time-lapse imaging system for predicting the IVF outcome. This study used both morphokinetic and morphological dynamic parameters to select embryos with the highest developmental potential. MATERIALS AND METHODS A total of 23 intracytoplasmic sperm injection treatment cycles with 138 fertilized oocytes were included in this study. All embryos were cultured to the blastocyst stage, and embryo development was recorded every 10 min by using a time-lapse imaging system. Morphokinetic parameters and eight major abnormal division behaviors were studied to determine their effects on blastocyst formation. The most influential variables were used in hierarchical classification for blastocyst formation prediction. RESULTS Several parameters were significantly related to the developmental potential. Embryos with the timing of pronuclear fading (tPNF) of >26.4 h post insemination (hpi), the timing of division to two cells (t2) of >29.1 hpi, and the timing of division to four cells (t4) of >41.3 hpi showed the lowest blastocyst formation rate. The abnormal division behaviors of fragmentation >50%, direct cleavage, reverse cleavage, and delayed division or developmental arrest were found to be detrimental to blastocyst formation. On the basis of these results, we propose a hierarchical model classification, in which embryos are classified into groups A-D according to their developmental potential. The blastocyst formation rates of groups A, B, C, and D were 80.0%, 77.8%, 53.7%, and 22.2% (p < 0.001). The good blastocyst rates of groups A, B, C, and D were 60.0%, 44.4%, 14.6%, and 11.1% (p = 0.007). CONCLUSION We propose a hierarchical classification system for blastocyst formation prediction, which provides information for embryo selection by using a time-lapse imaging system.
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Affiliation(s)
- Shiao-Hsuan Yang
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, Changhua Christian Hospital, Changhua, Taiwan, R.O.C
| | - Cheng-Hsuan Wu
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, Changhua Christian Hospital, Changhua, Taiwan, R.O.C
| | - Yu-Ching Chen
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, Changhua Christian Hospital, Changhua, Taiwan, R.O.C
| | - Chueh-Ko Yang
- Reproductive Medicine Laboratory, Department of Medical Research, Changhua Christian Hospital, Changhua, Taiwan, R.O.C
| | - Tsui-Huang Wu
- In Vitro Fertilization Laboratory, Department of Obstetrics and Gynecology, Changhua Christian Hospital, Changhua, Taiwan, R.O.C
| | - Pei-Chi Chen
- In Vitro Fertilization Laboratory, Department of Obstetrics and Gynecology, Changhua Christian Hospital, Changhua, Taiwan, R.O.C
| | - Horng-Der Tsai
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, Changhua Christian Hospital, Changhua, Taiwan, R.O.C.
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16
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Adolfsson E, Porath S, Andershed AN. External validation of a time-lapse model; a retrospective study comparing embryo evaluation using a morphokinetic model to standard morphology with live birth as endpoint. JBRA Assist Reprod 2018; 22:205-214. [PMID: 29932617 PMCID: PMC6106632 DOI: 10.5935/1518-0557.20180041] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objective To validate a morphokinetic implantation model developed for EmbryoScope on
embryos with known outcome, compared to standard morphology in a
retrospective single center study. Methods Morphokinetic annotation of 768 embryos with known outcome between 2013
-2015; corresponding to 116 D3 fresh embryos, 80 D6 frozen blastocysts, and
572 D5 blastocysts, fresh or frozen. The embryos were ranked by the KIDScore
into five classes, KID1-5, and grouped into four classes based on standard
morphology. Pregnancy rates, clinical pregnancy rates and live birth rates
were compared. Combinations of morphology and morphokinetics were evaluated
for implantation rates and live births. Results Live birth rate increased with increasing KIDScore, from 19% for KID1 to 42%
for KID5. Of all live births, KID5 contributed with 71%, KID4 with 20%, KID3
with 4%, KID2 with 4%, and KID1 with 2%. For morphology, the corresponding
figure was 43% for Top Quality, 47% for Good Quality, 4% for Poor Quality,
and 5% for Slow embryos. For day 3 embryos, KID5 embryos had the highest
live birth rates, and contributed to 83% of the live births; whereas the
second best morphological class had the highest live birth rate and
contributed to most of the live births. For blastocysts, the KIDScore and
morphology performed equally well. Combining morphology and morphokinetics
indicated stronger predictive power for morphokinetics. Conclusions Overall, the KIDScore correlates with both implantation and live birth in our
clinical setting. Compared to morphology, the KIDScore was superior for day
3 embryos, and equally good for blastocysts at predicting live births.
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Affiliation(s)
- Emma Adolfsson
- Örebro University Hospital. Department of Laboratory Medicine. Örebro, Sweden
| | - Sandra Porath
- Örebro University Hospital. Department of Laboratory Medicine. Örebro, Sweden
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Liu Y, Feenan K, Chapple V, Matson P. Assessing efficacy of day 3 embryo time-lapse algorithms retrospectively: impacts of dataset type and confounding factors. HUM FERTIL 2018; 22:182-190. [PMID: 29338469 DOI: 10.1080/14647273.2018.1425919] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
This study investigated the efficacy of four published day 3 embryo time-lapse algorithms based on different types of datasets (known implantation data [KID] and single embryo transfer [SET]), and the confounding effect of female age and conventional embryo morphology. Four algorithms were retrospectively applied to three types of datasets generated at Fertility North between February 2013 and December 2014: (a) KID dataset (n = 270), (b) a subset of SET (n = 144, end-point = implantation), and (c) SET (n = 144, end-point = live birth), respectively. All four algorithms showed progressively reduced predictive power (expressed as area under the receiver operating characteristics curve and 95% confidence interval [CI]) after application to the three datasets (a-c): Liu (0.762 [0.701-0.824] vs. 0.724 [0.641-0.807] vs. 0.707 [0.620-0.793]), KIDScore (0.614 [0.539-0.688] vs. 0.548 [0.451-0.645] vs. 0.536 [0.434-0.637]), Meseguer (0.585 [0.508-0.663] vs. 0.56 [0.462-0.658] vs. 0.549 [0.445-0.652]), and Basile (0.582 [0.505-0.659] vs. 0.519 [0.421-0.618] vs. 0.509 [0.406-0.612]). Furthermore, using KID dataset, the association (expressed as odds ratio and 95% CI) between time-lapse algorithms and implantation outcomes lost statistical significance after adjusting for conventional embryo morphology and female age in 3 of the 4 algorithms (KIDScore 1.832 [1.118-3.004] vs. 1.063 [0.659-1.715], Meseguer 1.150 [1.021-1.295] vs. 1.122 [0.981-1.284] and Basile 1.122 [1.008-1.249] vs. 1.038 [0.919-1.172]). In conclusion, SET is a preferred dataset to KID when developing or validating time-lapse algorithms, and day 3 conventional embryo morphology and female age should be considered as confounding factors.
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Affiliation(s)
- Yanhe Liu
- a Fertility North , Joondalup , Australia.,b School of Medical and Health Sciences, Edith Cowan University , Joondalup , Australia
| | | | | | - Phillip Matson
- a Fertility North , Joondalup , Australia.,b School of Medical and Health Sciences, Edith Cowan University , Joondalup , Australia
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18
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Delayed APC/C activation extends the first mitosis of mouse embryos. Sci Rep 2017; 7:9682. [PMID: 28851945 PMCID: PMC5575289 DOI: 10.1038/s41598-017-09526-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 06/29/2017] [Indexed: 02/02/2023] Open
Abstract
The correct temporal regulation of mitosis underpins genomic stability because it ensures the alignment of chromosomes on the mitotic spindle that is required for their proper segregation to the two daughter cells. Crucially, sister chromatid separation must be delayed until all the chromosomes have attached to the spindle; this is achieved by the Spindle Assembly Checkpoint (SAC) that inhibits the Anaphase Promoting Complex/Cyclosome (APC/C) ubiquitin ligase. In many species the first embryonic M-phase is significantly prolonged compared to the subsequent divisions, but the reason behind this has remained unclear. Here, we show that the first M-phase in the mouse embryo is significantly extended due to a delay in APC/C activation. Unlike in somatic cells, where the APC/C first targets cyclin A2 for degradation at nuclear envelope breakdown (NEBD), we find that in zygotes cyclin A2 remains stable for a significant period of time after NEBD. Our findings that the SAC prevents cyclin A2 degradation, whereas over-expressed Plk1 stimulates it, support our conclusion that the delay in cyclin A2 degradation is caused by low APC/C activity. As a consequence of delayed APC/C activation cyclin B1 stability in the first mitosis is also prolonged, leading to the unusual length of the first M-phase.
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19
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Eastick J, Venetis C, Cooke S, Storr A, Susetio D, Chapman M. Is early embryo development as observed by time-lapse microscopy dependent on whether fresh or frozen sperm was used for ICSI? A cohort study. J Assist Reprod Genet 2017; 34:733-740. [PMID: 28455755 DOI: 10.1007/s10815-017-0928-0] [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: 01/17/2017] [Accepted: 04/18/2017] [Indexed: 11/30/2022] Open
Abstract
PURPOSE The aim of this study was to compare timings of key events of embryo development from those originating from either fresh or cryopreserved ejaculate sperm using time-lapse technology. METHODS In this retrospective observational cohort study, time-lapse technology was used to monitor 1927 embryos from 234 women undergoing intracytoplasmic sperm injection (ICSI) and utilizing either fresh (n = 172 cycles) or cryopreserved ejaculate sperm (n = 62 cycles) for insemination were included in the study. Key developmental events as described in time-lapse were compared with the use of generalized estimating equations (GEE) to adjust for any auto-correlation between the observations. In addition, multivariable logit regression models were used to account for any known baseline differences between the two groups. RESULTS There were no differences in conventional embryo development such as number of 8-cell embryos by 72 h (p = 0.359), the number of blastocysts by 120 h (p = 0.417), and the number of top quality blastocysts (p = 0.956) between the two groups compared. There were no statistical differences in the timings of any of the key embryo developmental events (PN_t1, NEBD, cytokinesis, t2, t3, t4, t5, t6, t7, t8, tM, tSB, tEB, tHB, s1, s2, s3, cc2, and cc3) when either fresh or cryopreserved ejaculate sperm was used for ICSI. This was also confirmed with conventional morphological assessment. CONCLUSIONS This observational cohort study has shown that there are no differences in the morphokinetic parameters of early embryo development when either fresh or frozen ejaculate sperm are used for ICSI insemination.
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Affiliation(s)
- Jessica Eastick
- Hunter IVF, IVF Australia, PO Box 417, New Lambton, New South Wales, 2305, Australia. .,University of New South Wales, Sydney, New South Wales, Australia.
| | - Christos Venetis
- Hunter IVF, IVF Australia, PO Box 417, New Lambton, New South Wales, 2305, Australia.,University of New South Wales, Sydney, New South Wales, Australia
| | - Simon Cooke
- Hunter IVF, IVF Australia, PO Box 417, New Lambton, New South Wales, 2305, Australia
| | - Ashleigh Storr
- Hunter IVF, IVF Australia, PO Box 417, New Lambton, New South Wales, 2305, Australia.,University of New South Wales, Sydney, New South Wales, Australia
| | - Daisy Susetio
- Hunter IVF, IVF Australia, PO Box 417, New Lambton, New South Wales, 2305, Australia
| | - Michael Chapman
- Hunter IVF, IVF Australia, PO Box 417, New Lambton, New South Wales, 2305, Australia.,University of New South Wales, Sydney, New South Wales, Australia
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20
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Milewski R, Ajduk A. Time-lapse imaging of cleavage divisions in embryo quality assessment. Reproduction 2017; 154:R37-R53. [PMID: 28408705 DOI: 10.1530/rep-17-0004] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 04/04/2017] [Accepted: 04/13/2017] [Indexed: 11/08/2022]
Abstract
In vitro fertilization (IVF) is one of the most important procedures for treating infertility. As several embryos are usually produced in a single IVF cycle, it is crucial to select only the most viable ones for transfer to the patient. Morphokinetics, i.e. analysis of the dynamics of cleavage divisions and processes such as compaction and cavitation, has provided both biologists and clinicians with a new set of data regarding embryonic behaviour during preimplantation development and its association with embryo quality. In the current review, we focus on biological significance of morphokinetic parameters and show how they can be used to predict a reproductive outcome. We also explain the statistics behind the predictive algorithms and discuss the future perspectives of morphokinetics.
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Affiliation(s)
- Robert Milewski
- Department of Statistics and Medical InformaticsMedical University of Bialystok, Bialystok, Poland
| | - Anna Ajduk
- Department of EmbryologyFaculty of Biology, University of Warsaw, Warsaw, Poland
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21
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Barrie A, Homburg R, McDowell G, Brown J, Kingsland C, Troup S. Examining the efficacy of six published time-lapse imaging embryo selection algorithms to predict implantation to demonstrate the need for the development of specific, in-house morphokinetic selection algorithms. Fertil Steril 2017; 107:613-621. [DOI: 10.1016/j.fertnstert.2016.11.014] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 11/04/2016] [Accepted: 11/07/2016] [Indexed: 11/17/2022]
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22
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Munevver S, Findikli N, Bahceci M. New Horizons/Developments in Time-Lapse Morphokinetic Analysis of Mammalian Embryos. Hum Reprod 2016. [DOI: 10.1002/9781118849613.ch8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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23
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Bodri D, Sugimoto T, Yao Serna J, Kawachiya S, Kato R, Matsumoto T. Blastocyst collapse is not an independent predictor of reduced live birth: a time-lapse study. Fertil Steril 2016; 105:1476-1483.e3. [DOI: 10.1016/j.fertnstert.2016.02.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 02/04/2016] [Accepted: 02/04/2016] [Indexed: 12/25/2022]
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Time-lapse variables and embryo gender: a retrospective analysis of 81 live births obtained following minimal stimulation and single embryo transfer. J Assist Reprod Genet 2016; 33:589-596. [PMID: 26931440 DOI: 10.1007/s10815-016-0678-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Accepted: 02/15/2016] [Indexed: 01/02/2023] Open
Abstract
PURPOSE The purpose of this study was to determine which morphokinetic variables are related to embryo gender in a cohort of consecutive live births obtained through single blastocyst transfer following mild ovarian stimulation. METHODS Eighty-one live births (49 % of them females) from successfully treated, consecutive infertile patients (maternal age 36.9 ± 3.8 years, range 28-46) who underwent minimal ovarian stimulation, prolonged embryo culture in a time-lapse monitoring (TLM) incubator and elective single blastocyst transfers during 2012-2014. Early (PNf, t2-t9, cc2a, b, s2, s3) and late (tM, tSB, tfullB, texpB1, and texpB2) morphokinetic variables were scored according to published consensus criteria and were normalized to the time of pronuclear fading. For each variable, the ranges with the highest proportion of female embryos (optimal range) were determined by detailed examination of histograms. RESULTS Female embryo gender was associated both with late cleavage (t8), morula (tM), and blastocyst stage morphokinetic variables. The strongest associations (adjusted ORs, 7.0-7.8) were found for late, expanded stage blastocyst parameters; tfullB, texpB1, and texpB2. The proportion of female embryos was 69-71 and 25-26 % inside and outside of the optimal ranges, respectively. This allowed to predict 74-78 % of them, increasing their proportion by 57 % compared to the average. CONCLUSIONS Although the sample size of our cohort was limited, our findings suggest that several expanded blastocyst stage morphokinetic parameters are associated with female embryo gender. If confirmed on a larger sample these could be potentially used to increase the proportion of female embryos among non-invasively selected blastocysts following single embryo transfer.
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Daughtry BL, Chavez SL. Chromosomal instability in mammalian pre-implantation embryos: potential causes, detection methods, and clinical consequences. Cell Tissue Res 2016; 363:201-225. [PMID: 26590822 PMCID: PMC5621482 DOI: 10.1007/s00441-015-2305-6] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 09/24/2015] [Indexed: 01/08/2023]
Abstract
Formation of a totipotent blastocyst capable of implantation is one of the first major milestones in early mammalian embryogenesis, but less than half of in vitro fertilized embryos from most mammals will progress to this stage of development. Whole chromosomal abnormalities, or aneuploidy, are key determinants of whether human embryos will arrest or reach the blastocyst stage. Depending on the type of chromosomal abnormality, however, certain embryos still form blastocysts and may be morphologically indistinguishable from chromosomally normal embryos. Despite the implementation of pre-implantation genetic screening and other advanced in vitro fertilization (IVF) techniques, the identification of aneuploid embryos remains complicated by high rates of mosaicism, atypical cell division, cellular fragmentation, sub-chromosomal instability, and micro-/multi-nucleation. Moreover, several of these processes occur in vivo following natural human conception, suggesting that they are not simply a consequence of culture conditions. Recent technological achievements in genetic, epigenetic, chromosomal, and non-invasive imaging have provided additional embryo assessment approaches, particularly at the single-cell level, and clinical trials investigating their efficacy are continuing to emerge. In this review, we summarize the potential mechanisms by which aneuploidy may arise, the various detection methods, and the technical advances (such as time-lapse imaging, "-omic" profiling, and next-generation sequencing) that have assisted in obtaining this data. We also discuss the possibility of aneuploidy resolution in embryos via various corrective mechanisms, including multi-polar divisions, fragment resorption, endoreduplication, and blastomere exclusion, and conclude by examining the potential implications of these findings for IVF success and human fecundity.
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Affiliation(s)
- Brittany L Daughtry
- Department of Cell, Developmental & Cancer Biology, Graduate Program in Molecular & Cellular Biosciences, Oregon Health & Science University School of Medicine, Portland, Ore., USA
- Division of Reproductive & Developmental Sciences, Oregon National Primate Research Center, 505 NW 185th Avenue, Beaverton, OR 97006, USA
| | - Shawn L Chavez
- Division of Reproductive & Developmental Sciences, Oregon National Primate Research Center, 505 NW 185th Avenue, Beaverton, OR 97006, USA.
- Physiology & Pharmacology, Oregon Health & Science University School of Medicine, Portland, Ore., USA.
- Department of Obstetrics & Gynecology, Oregon Health & Science University School of Medicine, Portland, Ore., USA.
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Assessment of human embryos by time-lapse videography: A comparison of quantitative and qualitative measures between two independent laboratories. Reprod Biol 2015; 15:210-6. [DOI: 10.1016/j.repbio.2015.09.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 09/24/2015] [Accepted: 09/25/2015] [Indexed: 11/19/2022]
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27
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Time-lapse deselection model for human day 3 in vitro fertilization embryos: the combination of qualitative and quantitative measures of embryo growth. Fertil Steril 2015; 105:656-662.e1. [PMID: 26616439 DOI: 10.1016/j.fertnstert.2015.11.003] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 10/21/2015] [Accepted: 11/02/2015] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To present a time-lapse deselection model involving both qualitative and quantitative parameters for assessing embryos on day 3. DESIGN Retrospective cohort study and prospective validation. SETTING Private IVF center. PATIENT(S) A total of 270 embryos with known implantation data (KID) after day 3 transfer from 212 IVF/intracytoplasmic sperm injection (ICSI) cycles were retrospectively analyzed for building the proposed deselection model, followed by prospective validation using an additional 66 KID embryos. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Morphological score on day 3, embryo morphokinetic parameters, abnormal cleavage patterns, and known implantation results. RESULT(S) All included embryos were categorized either retrospectively or prospectively into 7 grades (A+, A, B, C, D, E, F). Qualitative deselection parameters included poor conventional day 3 morphology, abnormal cleavage patterns identified via time-lapse monitoring, and <8 cells at 68 hours postinsemination. Quantitative parameters included time from pronuclear fading (PNF) to 5-cell stage and duration of 3-cell stage. KID implantation rates of embryos graded from A+ to F were 52.9%, 36.1%, 25.0%, 13.8%, 15.6%, 3.1%, and 0 respectively (area under the curve [AUC] = 0.762; 95% confidence interval [CI], 0.701-0.824), and a similar pattern was seen in either IVF (AUC = 0.721; 95% CI, 0.622-0.821) or ICSI embryos (AUC = 0.790; 95% CI, 0.711-0.868). Preliminary prospective validation using 66 KID embryos also showed statistically significant prediction in Medicult (AUC = 0.750; 95% CI, 0.588-0.912) and Vitrolife G-Series (AUC = 0.820; 95% CI, 0.671-0.969) suites of culture media. CONCLUSION(S) The proposed model involving both qualitative and quantitative deselection effectively predicts day 3 embryo implantation potential and is applicable to all IVF embryos regardless of insemination method by using PNF as the reference starting time point.
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