1
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Coticchio G, Lagalla C, Taggi M, Cimadomo D, Rienzi L. Embryo multinucleation: detection, possible origins, and implications for treatment. Hum Reprod 2024:deae186. [PMID: 39173609 DOI: 10.1093/humrep/deae186] [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: 05/02/2024] [Revised: 07/15/2024] [Indexed: 08/24/2024] Open
Abstract
Cell cycle regulation is crucial to assure expansion of a cell population, while preserving genome integrity. This notion is especially relevant to fertilization and early embryo development, a time when the cell cycle transforms from meiotic into mitotic cycles. Zygote-to-embryo transition is acutely error-prone, causing major developmental perturbations, including cleavage delays, tri- and multi-chotomous cleavages, and cell fragmentation. Another such alteration is bi- and multinucleation, consisting of the simultaneous formation of two or more nuclei at interphase. Indeed, multinucleation affects a large proportion of early human embryos, typically at the two-cell stage. Mechanistically, several factors, including spindle dysfunction, failed cleavage, and cell fusion, may generate this cell anomaly. In assisted reproduction treatment, multinucleation is associated with reduced developmental rates and lower implantation rates in Days 2-3 embryo transfers. However, many multinucleated embryos can develop to the blastocyst stage. In blastocyst transfers, the current evidence does not suggest a major impact of a previous history of multinucleation on the odds of euploidy or successful treatment outcomes. Human embryo multinucleation remains a not-fully-understood but developmentally relevant and intriguing phenomenon which requires further research of its generative mechanisms and clinical implications.
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Affiliation(s)
| | | | - Marilena Taggi
- IVIRMA Global Research Alliance, Genera, Clinica Valle Giulia, Rome, Italy
| | - Danilo Cimadomo
- IVIRMA Global Research Alliance, Genera, Clinica Valle Giulia, Rome, Italy
| | - Laura Rienzi
- IVIRMA Global Research Alliance, Genera, Clinica Valle Giulia, Rome, Italy
- Department of Biomolecular Sciences, University of Urbino "Carlo Bo", Urbino, Italy
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2
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Shavit M, Gonen D, Atzmon Y, Aslih N, Bilgory A, Shibli Abu-Raya Y, Sharqawi M, Estrada Garcia D, Michaeli M, Polotov D, Shalom-Paz E. Cleavage Patterns of 9600 Embryos: The Importance of Irregular Cleavage. J Clin Med 2023; 12:5656. [PMID: 37685723 PMCID: PMC10488943 DOI: 10.3390/jcm12175656] [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: 06/28/2023] [Revised: 08/24/2023] [Accepted: 08/29/2023] [Indexed: 09/10/2023] Open
Abstract
This prospective, observational study investigated the incidence of irregular cleavage (IRC) among human embryos and its influence on IVF treatment outcomes. It included 1001 women who underwent 1976 assisted reproduction treatments during 2016-2021 in a single IVF clinic. Embryo morphokinetics were analyzed and evaluated for the association between IRC and women's characteristics, treatment characteristics, and pregnancy outcomes. The incidence of IRC was 17.5% (1689/9632 embryos). Of these, 85% of the embryos had one IRC, 15% had multiple IRC and 35% of IRC events occurred during the embryo's first cell cycle. IRC embryos were found to correlate with male factor (p = 0.01) and higher ICSI rate (p = 0.01). Age, BMI, parity, basal FSH level, stimulation protocol, and number of retrieved oocytes did not differ between groups. Embryos with early IRC or more than one IRC had lower blastulation rates (p = 0.01 for each). Fresh cycles with IRC embryos had a lower clinical pregnancy rate (p = 0.01) and embryos with early IRC had a lower live birth rate (p = 0.04) compared to embryos without IRC. Frozen transfer cycles of blastocyst embryos, with or without IRC, had comparable results. In conclusion, the number of abnormal cleavage events and their timing are important factors in the prognosis of the developing human embryo.
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Affiliation(s)
- Maya Shavit
- IVF Unit, Department of Obstetrics and Gynecology, Hillel-Yaffe Medical Center, Hadera 3810000, Israel (M.S.); (E.S.-P.)
- Ruth and Bruce Rappaport School of Medicine, Technion—Israel Institute of Technology, Haifa 3109601, Israel
| | - Daniel Gonen
- Ruth and Bruce Rappaport School of Medicine, Technion—Israel Institute of Technology, Haifa 3109601, Israel
| | - Yuval Atzmon
- IVF Unit, Department of Obstetrics and Gynecology, Hillel-Yaffe Medical Center, Hadera 3810000, Israel (M.S.); (E.S.-P.)
- Ruth and Bruce Rappaport School of Medicine, Technion—Israel Institute of Technology, Haifa 3109601, Israel
| | - Nardin Aslih
- IVF Unit, Department of Obstetrics and Gynecology, Hillel-Yaffe Medical Center, Hadera 3810000, Israel (M.S.); (E.S.-P.)
- Ruth and Bruce Rappaport School of Medicine, Technion—Israel Institute of Technology, Haifa 3109601, Israel
| | - Asaf Bilgory
- IVF Unit, Department of Obstetrics and Gynecology, Hillel-Yaffe Medical Center, Hadera 3810000, Israel (M.S.); (E.S.-P.)
- Ruth and Bruce Rappaport School of Medicine, Technion—Israel Institute of Technology, Haifa 3109601, Israel
| | - Yasmin Shibli Abu-Raya
- IVF Unit, Department of Obstetrics and Gynecology, Hillel-Yaffe Medical Center, Hadera 3810000, Israel (M.S.); (E.S.-P.)
- Ruth and Bruce Rappaport School of Medicine, Technion—Israel Institute of Technology, Haifa 3109601, Israel
| | - Moamina Sharqawi
- IVF Unit, Department of Obstetrics and Gynecology, Hillel-Yaffe Medical Center, Hadera 3810000, Israel (M.S.); (E.S.-P.)
- Ruth and Bruce Rappaport School of Medicine, Technion—Israel Institute of Technology, Haifa 3109601, Israel
| | - Daniela Estrada Garcia
- IVF Unit, Department of Obstetrics and Gynecology, Hillel-Yaffe Medical Center, Hadera 3810000, Israel (M.S.); (E.S.-P.)
| | - Mediea Michaeli
- IVF Unit, Department of Obstetrics and Gynecology, Hillel-Yaffe Medical Center, Hadera 3810000, Israel (M.S.); (E.S.-P.)
| | - Diana Polotov
- IVF Unit, Department of Obstetrics and Gynecology, Hillel-Yaffe Medical Center, Hadera 3810000, Israel (M.S.); (E.S.-P.)
| | - Einat Shalom-Paz
- IVF Unit, Department of Obstetrics and Gynecology, Hillel-Yaffe Medical Center, Hadera 3810000, Israel (M.S.); (E.S.-P.)
- Ruth and Bruce Rappaport School of Medicine, Technion—Israel Institute of Technology, Haifa 3109601, Israel
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Boucret L, Tramon L, Riou J, Ferré-L’Hôtellier V, Bouet PE, May-Panloup P. Influence of Diminished Ovarian Reserve on Early Embryo Morphokinetics during In Vitro Fertilization: A Time-Lapse Study. J Clin Med 2022; 11:jcm11237173. [PMID: 36498746 PMCID: PMC9736490 DOI: 10.3390/jcm11237173] [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: 10/17/2022] [Revised: 11/18/2022] [Accepted: 11/28/2022] [Indexed: 12/03/2022] Open
Abstract
There is great controversy as to whether women with Diminished Ovarian Reserve (DOR) exhibit only a quantitative decrease in ovarian reserve or also impaired oocyte and embryo quality. In this retrospective study, we aimed to evaluate the impact of DOR on embryo morphokinetic parameters with a time-lapse system. 1314 embryos were obtained from 256 couples undergoing IVF or ICSI cycles, with 242 embryos in the DOR group as classified by the Bologna and POSEIDON criteria and 1072 embryos derived from the Normal Ovarian Reserve (NOR) group. For each morphokinetic parameter (t2, t3, t4, t5, t8, tB, ECC2, cc2a, ECC3, s2, s3), a generalized linear mixed model was created to control for female age, BMI, smoking status, method of insemination and correlation between oocytes from a same cohort. No significant association was found between DOR and any of the morphokinetic parameters studied. In a secondary analysis, we evaluated the influence of maternal aging, comparing morphokinetic characteristics between two age groups (<37 and ≥37 years). In the univariate analysis, we found that embryos from older women displayed a slower embryo development (in particular for t3, t4, t5, tB, and ECC2), although without statistical significance in the multivariate analysis. In conclusion, our study did not reveal any substantial impact of ovarian aging on early morphokinetic parameters and suggested potential biases that may be a source of controversy in the literature.
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Affiliation(s)
- Lisa Boucret
- Reproductive Biology Unit, Angers University Hospital, 49000 Angers, France
- Correspondence:
| | - Léa Tramon
- Reproductive Biology Unit, Angers University Hospital, 49000 Angers, France
| | - Jérémie Riou
- Delegation for Clinical Research and Innovation, Angers University Hospital, 49000 Angers, France
| | | | - Pierre-Emmanuel Bouet
- Department of Reproductive Medicine, Angers University Hospital, 49000 Angers, France
- MITOVASC, INSERM 1083, CNRS 6015, Angers University, 49000 Angers, France
| | - Pascale May-Panloup
- Reproductive Biology Unit, Angers University Hospital, 49000 Angers, France
- MITOVASC, INSERM 1083, CNRS 6015, Angers University, 49000 Angers, France
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Setti AS, Braga DPDAF, Vingris L, Iaconelli A, Borges E. Early and late paternal contribution to cell division of embryos in a time-lapse imaging incubation system. Andrologia 2021; 53:e14211. [PMID: 34437729 DOI: 10.1111/and.14211] [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: 03/31/2021] [Revised: 07/29/2021] [Accepted: 07/30/2021] [Indexed: 11/28/2022] Open
Abstract
The objective of this study was to investigate the impact of male age, semen quality and days of ejaculatory abstinence on embryo morphokinetics. A total of 1,220 zygotes obtained from 139 couples in a private in vitro fertilisation centre were analysed. The timing of specific events from the point of insemination, such as timings to pronuclei appearance and fading, to two, three, four, five, six, seven and eight cells and to blastulation were recorded. Multivariate linear regression analysis was used to evaluate the influence of paternal factors on embryo morphokinetic events. Paternal age was positively correlated with delayed cell cleavage and blastulation, and negatively associated with implantation rate, and clinical pregnancy and live-birth chances. The ejaculatory abstinence was inversely correlated with the implantation rate. Inverse relationships were observed between semen parameters (sperm count, progressive sperm motility, total motile sperm count and morphology) and the timing of specific events during embryo development. Sperm morphology was also positively associated with implantation rate and pregnancy and live-birth chances. Increased paternal age and ejaculatory abstinence, and poor semen quality correlate with delayed cell cleavage and blastulation and negatively impact intracytoplasmic sperm injection outcomes.
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Affiliation(s)
- Amanda Souza Setti
- Scientific Research Department, Fertility Medical Group, São Paulo, Brazil.,Scientific Research Department, Sapientiae Institute - Centro de Estudos e Pesquisa em Reprodução Humana Assistida, São Paulo, Brazil
| | - Daniela Paes de Almeida Ferreira Braga
- Scientific Research Department, Fertility Medical Group, São Paulo, Brazil.,Scientific Research Department, Sapientiae Institute - Centro de Estudos e Pesquisa em Reprodução Humana Assistida, São Paulo, Brazil
| | | | - Assumpto Iaconelli
- Scientific Research Department, Sapientiae Institute - Centro de Estudos e Pesquisa em Reprodução Humana Assistida, São Paulo, Brazil.,Clinical Department, Fertility Medical Group, São Paulo, Brazil
| | - Edson Borges
- Scientific Research Department, Sapientiae Institute - Centro de Estudos e Pesquisa em Reprodução Humana Assistida, São Paulo, Brazil.,Clinical Department, Fertility Medical Group, São Paulo, Brazil
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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: 60] [Impact Index Per Article: 20.0] [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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Rebhan D. Anti-Müller-Hormon – prädiktiver Marker der Ovarreserve. GYNAKOLOGISCHE ENDOKRINOLOGIE 2021. [DOI: 10.1007/s10304-021-00382-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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7
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Cornille AS, Sapet C, Reignier A, Leperlier F, Barrière P, Caillet P, Fréour T, Lefebvre T. Is low anti-Mullerian hormone (AMH) level a risk factor of miscarriage in women <37 years old undergoing in vitro fertilization (IVF)? HUM FERTIL 2021; 25:600-606. [DOI: 10.1080/14647273.2021.1873431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Anne-Sophie Cornille
- Service de Médecine et Biologie de la Reproduction, Hôpital Mère et Enfant, CHU de Nantes, Nantes, France
| | - Clémence Sapet
- Service de Médecine et Biologie de la Reproduction, Hôpital Mère et Enfant, CHU de Nantes, Nantes, France
| | - Arnaud Reignier
- Service de Médecine et Biologie de la Reproduction, Hôpital Mère et Enfant, CHU de Nantes, Nantes, France
- Faculté de Médecine, Nantes, France
- Centre de Recherche en Transplantation et Immunologie (ou CRTI), Inserm, Université de Nantes, Nantes, France
| | - Florence Leperlier
- Service de Médecine et Biologie de la Reproduction, Hôpital Mère et Enfant, CHU de Nantes, Nantes, France
| | - Paul Barrière
- Service de Médecine et Biologie de la Reproduction, Hôpital Mère et Enfant, CHU de Nantes, Nantes, France
- Faculté de Médecine, Nantes, France
| | - Pascal Caillet
- Service de Santé Publique, CHU de Nantes, Nantes, France
| | - Thomas Fréour
- Service de Médecine et Biologie de la Reproduction, Hôpital Mère et Enfant, CHU de Nantes, Nantes, France
- Faculté de Médecine, Nantes, France
- Centre de Recherche en Transplantation et Immunologie (ou CRTI), Inserm, Université de Nantes, Nantes, France
| | - Tiphaine Lefebvre
- Service de Médecine et Biologie de la Reproduction, Hôpital Mère et Enfant, CHU de Nantes, Nantes, France
- Faculté de Médecine, Nantes, France
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Li HWR, Nelson SM. Clinical Application of AMH Measurement in Assisted Reproduction. Front Endocrinol (Lausanne) 2020; 11:606744. [PMID: 33362720 PMCID: PMC7757755 DOI: 10.3389/fendo.2020.606744] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 10/30/2020] [Indexed: 12/27/2022] Open
Abstract
Anti-Müllerian hormone reflects the continuum of the functional ovarian reserve, and as such can predict ovarian response to gonadotropin stimulation and be used to individualize treatment pathways to improve efficacy and safety. However, consistent with other biomarkers and age-based prediction models it has limited ability to predict live birth and should not be used to refuse treatment, but rather to inform counselling and shared decision making. The use of absolute clinical thresholds to stratify patient phenotypes, assess discordance and individualize treatment protocols in non-validated algorithms combined with the lack of standardization of assays may result in inappropriate classification and sub-optimal clinical decision making. We propose that holistic baseline phenotyping, incorporating antral follicle count and other patient characteristics is critical. Treatment decisions driven by validated algorithms that use ovarian reserve biomarkers as continuous measures, reducing the risk of misclassification, are likely to improve overall outcomes for our patients.
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Affiliation(s)
- Hang Wun Raymond Li
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Pokfulam, Hong Kong
- *Correspondence: Hang Wun Raymond Li,
| | - Scott M. Nelson
- School of Medicine, University of Glasgow, Glasgow, Scotland, United Kingdom
- NIHR Bristol Biomedical Research Centre, Bristol, United Kingdom
- The Fertility Partnership, Oxford, United Kingdom
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