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Li J, Ji J, Guo H, Wang F, Fu Y, Hu R. Stratified analysis of clinical pregnancy outcomes of sequential embryo transfer in frozen embryo transfer cycles based on different factors: a retrospective study. BMC Pregnancy Childbirth 2023; 23:806. [PMID: 37990167 PMCID: PMC10664651 DOI: 10.1186/s12884-023-06111-5] [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: 02/14/2023] [Accepted: 11/06/2023] [Indexed: 11/23/2023] Open
Abstract
OBJECTIVE To explore the effect of sequential embryo transfer (ET) on the pregnancy outcome of frozen-thawed embryo transfer (FET) cycle and the indications of sequential transfer. METHODS A total of 1440 FET cycles were enrolled in this retrospective study, of which 1080 patients received conventional ET and 360 patients received sequential ET. Further stratified analysis was performed according to the number of previous failed cycles, the number of embryos transferred and the stage of blastocyst (day 5 or 6, denoted D5 or D6) transferred. Comparison of pregnancy rates, implantation rate, miscarriage rate and multiple pregnancy rate among the groups of patients. RESULTS The clinical pregnancy rate and implantation rate of the sequential ET group were higher than those of the conventional ET group (P < 0.01); however, there was no statistical difference in multiple pregnancy rate and miscarriage rate (P > 0.05). In sequential transfer, the number of transferred embryos (2 or 3) and the stage of transferred blastocysts (D5 or D6) had no effect on clinical pregnancy rate, implantation rate, multiple pregnancy rate and miscarriage rate (P > 0.05). In patients with three or more previous failure cycles, the sequential ET group showed higher clinical pregnancy rate and implantation rate (P > 0.05). CONCLUSIONS Compared with conventional ET in FET cycle, sequential ET strategy could significantly improve the clinical pregnancy rate and implantation rate. In sequential transfer, patients with three embryos transferred don't have higher pregnancy rate and implantation rate. Besides, sequential transfer is more suitable for patients with repeated implantation failures (RIF), and increase the utilization rate of D6 blastocysts.
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Affiliation(s)
- Jialing Li
- Reproductive Medicine Center, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, 750004, China
- Institute of Medical Sciences, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, 750004, China
- Ningxia Medical University, Yinchuan, Ningxia, 750004, China
| | - Jing Ji
- Ningxia Medical University, Yinchuan, Ningxia, 750004, China
| | - Hua Guo
- Department of Gynecology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, 750004, China
| | - Feimiao Wang
- Reproductive Medicine Center, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, 750004, China
| | - Yunxing Fu
- Ningxia Medical University, Yinchuan, Ningxia, 750004, China
| | - Rong Hu
- Institute of Medical Sciences, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, 750004, China.
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2
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Zhang J, Wang C, Zhang H, Zhou Y. Sequential cleavage and blastocyst embryo transfer and IVF outcomes: a systematic review. Reprod Biol Endocrinol 2021; 19:142. [PMID: 34521412 PMCID: PMC8439041 DOI: 10.1186/s12958-021-00824-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 09/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sequential embryo transfer has been proposed as a way to improve embryo implantation in women for in vitro fertilization (IVF), but the effect on pregnancy outcomes remains ambiguous. This systematic review was conducted to investigate the efficacy of sequential embryo transfer on IVF outcomes. METHODS A literature search was performed in the PubMed, Web of Science, Cochrane Library, ScienceDirect and Wanfang databases. Data were pooled using a random- or fixed-effects model according to study heterogeneity. The results are expressed as relative risks (RRs) with 95% confidence intervals (CIs). Heterogeneity was evaluated by the I2 statistic. The study protocol was registered prospectively on INPLASY, ID: INPLASY202180019. RESULTS Ten eligible studies with 2658 participants compared sequential embryo transfer and cleavage transfer, while four studies with 513 participants compared sequential embryo transfer and blastocyst transfer. The synthesis results showed that the clinical pregnancy rate was higher in the sequential embryo transfer group than in the cleavage embryo transfer group (RR 1.42, 95% CI 1.26-1.60, P< 0.01) for both women who did experience repeated implantation failure (RIF) (RR 1.58, 95% CI 1.17-2.13, P< 0.01) and did not experience RIF (Non-RIF) (RR 1.44, 95% CI 1.20-1.66, P< 0.01). However, sequential embryo transfer showed no significant benefit over blastocyst embryo transfer. CONCLUSION The current systematic review demonstrates that sequential cleavage and blastocyst embryo transfer improve the clinical pregnancy rate over conventional cleavage embryo transfer. For women with adequate embryos, sequential transfer could be attempted following careful consideration. More high-grade evidence from prospective randomized studies is warranted.
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Affiliation(s)
- Jianeng Zhang
- Reproductive Endocrinology Center, Hangzhou Women's Hospital (Hangzhou Maternity and Child Health Care Hospital), Hangzhou, 310000, China
| | - Chong Wang
- Reproductive Endocrinology Center, Hangzhou Women's Hospital (Hangzhou Maternity and Child Health Care Hospital), Hangzhou, 310000, China.
| | - Huanhuan Zhang
- Reproductive Endocrinology Center, Hangzhou Women's Hospital (Hangzhou Maternity and Child Health Care Hospital), Hangzhou, 310000, China
| | - Yan Zhou
- Reproductive Endocrinology Center, Hangzhou Women's Hospital (Hangzhou Maternity and Child Health Care Hospital), Hangzhou, 310000, China
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Gonçalves MF, Asensi KD, Nascimento ALL, de Barros JHO, Santos RDA, Andrade CBVD, Kasai-Brunswick TH, Frajblat M, Ortiga-Carvalho TM, Goldenberg RCDS. Human Menstrual Blood-Derived Mesenchymal Cells Improve Mouse Embryonic Development. Tissue Eng Part A 2020; 26:769-779. [PMID: 32493133 DOI: 10.1089/ten.tea.2020.0034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
There is a constant need for improving embryo culture conditions in assisted reproduction. One possibility is to use mesenchymal stem/stromal cells derived from menstrual blood (mbMSCs), with an endometrial origin. In this study, we sought to analyze the expansion of mouse embryos in a direct coculture model with mbMSCs. Our results showed that after five passages, mbMSCs presented a spindle-shaped morphology, with surface markers that were comparable with the normal mesenchymal cell phenotype. mbMSCs could differentiate into adipogenic and osteogenic lineages and secrete angiopoetin-2 and hepatocyte growth factor. The coculture experiments employed 103 two-cell-stage embryos that were randomly divided into two groups: control (n = 50), embryos cultured in GV-Blast medium, and cocultured mbMSCs (n = 53), embryos cocultured with GV-Blast and mbMSCs. Typically, two to three embryos were placed in a well with 200 μL of culture medium and observed until developmental day 5. After 5 days, the cocultured group had more embryos in the blastocyst stage (69.8%) when compared with the control group (30%) (p < 0.001). It was also found that nearly 57% of blastocysts in the cocultured group reached the hatching stage, while only 13% achieved this stage in the control group (p < 0.001). Analyses of cultured mbMSCs and growth media, in the presence or absence of an embryo, were also performed. Immunofluorescence detected similar levels of collagen I and III and fibronectin in both mbMSCs and cocultured mbMSCs, and similar amounts of growth factors, VEGF, PDGF-AA, and PDGF-BB, were also observed in the conditioned medium, regardless of embryo presence. The present study describes, for the first time, an easy, noninvasive, and autologous method that could potentially increase blastocyst growth rates during assisted reproductive procedures (i.e., in vitro fertilization). It is proposed that this mbMSC coculture strategy enriches the embryonic microenvironment and promotes embryo development. This technique may complement or replace existing assisted reproduction methods and is directly relevant to the field of personalized medicine. Impact statement The study demonstrates a novel and potentially personalized assisted reproduction approach. The search for alternative and autologous methods provides assisted reproduction patients with a better chance of a successful pregnancy. In this study, mesenchymal cells derived from menstrual blood resembled the outside uterine surface and could potentially be employed for improving embryo outgrowth. Our protocol enriches the embryonic microenvironment and facilitates high-quality single-embryo transfer.
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Affiliation(s)
| | - Karina Dutra Asensi
- Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Anna Luiza Lima Nascimento
- Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Rosana de Almeida Santos
- Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Tais Hanae Kasai-Brunswick
- Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.,National Center of Structural Biology and Bioimaging, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Marcel Frajblat
- Health Sciences Center, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Tania M Ortiga-Carvalho
- Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Regina Coeli Dos Santos Goldenberg
- Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.,National Institute of Science and Technology for Regenerative Medicine-REGENERA, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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Parks JC, McCallie BR, Patton AL, Al-Safi ZA, Polotsky AJ, Griffin DK, Schoolcraft WB, Katz-Jaffe MG. The impact of infertility diagnosis on embryo-endometrial dialogue. Reproduction 2018; 155:543-552. [PMID: 29636406 DOI: 10.1530/rep-17-0566] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 04/10/2018] [Indexed: 12/24/2022]
Abstract
Initial stages of implantation involve bi-directional molecular crosstalk between the blastocyst and endometrium. This study investigated an association between infertility etiologies, specifically advanced maternal age (AMA) and endometriosis, on the embryo-endometrial molecular dialogue prior to implantation. Co-culture experiments were performed with endometrial epithelial cells (EEC) and cryopreserved day 5 blastocysts (n = 41 ≥ Grade 3BB) donated from patients presenting with AMA or endometriosis, compared to fertile donor oocyte controls. Extracellular vesicles isolated from co-culture supernatant were analyzed for miRNA expression and revealed significant alterations correlating to AMA or endometriosis. Specifically, AMA resulted in 16 miRNAs with increased expression (P ≤ 0.05) and strong evidence for negative regulation toward 206 target genes. VEGFA, a known activator of cell adhesion, displayed decreased expression (P ≤ 0.05), validating negative regulation by 4 of these increased miRNAs: miR-126; 150; 29a; 29b (P ≤ 0.05). In endometriosis patients, a total of 10 significantly altered miRNAs displayed increased expression compared to controls (miR-7b; 9; 24; 34b; 106a; 191; 200b; 200c; 342-3p; 484) (P ≤ 0.05), targeting 1014 strong evidence-based genes. Three target genes of miR-106a (CDKN1A, E2F1 and RUNX1) were independently validated. Functional annotation analysis of miRNA-target genes revealed enriched pathways for both infertility etiologies, including disrupted cell cycle regulation and proliferation (P ≤ 0.05). These extracellular vesicle-bound secreted miRNAs are key transcriptional regulators in embryo-endometrial dialogue and may be prospective biomarkers of implantation success. One of the limitations of this study is that it was a stimulated, in vitro model and therefore may not accurately reflect the in-vivo environment.
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Affiliation(s)
- Jason C Parks
- Colorado Center for Reproductive MedicineLone Tree, Colorado, USA .,University of KentCanterbury, UK
| | - Blair R McCallie
- Colorado Center for Reproductive MedicineLone Tree, Colorado, USA.,University of KentCanterbury, UK
| | - Alyssa L Patton
- Colorado Center for Reproductive MedicineLone Tree, Colorado, USA
| | - Zain A Al-Safi
- Department of Obstetrics and GynecologyUniversity of Colorado School of Medicine, Aurora, Colorado, USA
| | - Alex J Polotsky
- Department of Obstetrics and GynecologyUniversity of Colorado School of Medicine, Aurora, Colorado, USA
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Co-culture of human embryos with autologous cumulus cell clusters and its beneficial impact of secreted growth factors on preimplantation development as compared to standard embryo culture in assisted reproductive technologies (ART). MIDDLE EAST FERTILITY SOCIETY JOURNAL 2017. [DOI: 10.1016/j.mefs.2017.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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6
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A Higher Ovarian Response after Stimulation for IVF Is Related to a Higher Number of Euploid Embryos. BIOMED RESEARCH INTERNATIONAL 2017; 2017:5637923. [PMID: 28428962 PMCID: PMC5385900 DOI: 10.1155/2017/5637923] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Accepted: 02/23/2017] [Indexed: 11/24/2022]
Abstract
This study has analysed the relationship between ovarian response and the number of euploid embryos. This is a post hoc analysis of a subset of data generated during a prospective cohort study previously published. Forty-six oocyte donors were subjected to ovarian stimulation with 150 IU of rFSH and 75 IU of hp-hMG in a GnRH agonist long protocol. Preimplantation genetic screening was performed in all viable embryos. We observed a positive relationship between ovarian response and the number of euploid embryos. When ovarian response was above the median (≥17 oocytes), the mean number of euploid embryos per donor was 5.0 ± 2.4, while when <17 oocytes were obtained the mean number of euploid embryos was 2.7 ± 1.4 (p = 0.000). Aneuploidy rate did not increase with ovarian response or gonadotropin doses. Also, the number of euploid embryos was inversely related to the amount of gonadotropins needed per oocyte obtained (ovarian sensitivity index). These results suggest that the number of euploid embryos available for embryo transfer increases as the number of oocytes obtained does. Considering the total number of euploid embryos seems more relevant than the aneuploidy rate.
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7
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Dolanbay EG, Yardimoglu M, Yalcinkaya E, Yazir Y, Aksoy A, Karaoz E, Caliskan E. Expression of trophinin and dipeptidyl peptidase IV in endometrial co-culture in the presence of an embryo: A comparative immunocytochemical study. Mol Med Rep 2016; 13:3961-8. [PMID: 27035766 DOI: 10.3892/mmr.2016.5020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 02/12/2016] [Indexed: 11/06/2022] Open
Abstract
Recurrent implantation failure leads to a reduced pregnancy rate. The expression patterns of trophinin and dipeptidyl peptidase IV (CD26) indicate the involvement of embryo implantation and early placental development. The purpose of the present study was to evaluate endometrial co‑culture cells in the presence of embryo with trophinin and CD26 immunofluorescence staining. Patients with recurrent implantation failure were enrolled in the present study. The patients were aged between 26 and 36 years. Co‑cultures were prepared from endometrial biopsies for each patient. Controlled ovarian hyperstimulation was performed on each of the patients. Certain embryos were maintained in a conventional culture environment (n=80), and others in an endometrial co‑culture environment (n=25). Following embryo transfer, the co‑culture cells were examined under an inverted wide‑field fluorescence microscope. The ratio of a successful pregnancy was 0.38 in the present study (n=5/13 pregnancies). The average age of the successful group (28±3.54 years) was younger compared with the unsuccessful (32.67±2.81) group (P≤0.05). The number of trophinin (+) endometrial cells in the presence of an embryo was significantly lower (P=0.046) in the successful group on the first day. No significant difference between the groups was observed in terms of the number of CD26 (+) cells on the first to the fourth days (P≤0.05). Trophinin and CD26 immunostaining is important in the early period of pregnancy, and it will be beneficial in terms of providing the deficit of conventional culture medium in performed studies with the endometrial co‑culture medium. The co‑culture may be important, particularly in the early period, in patients with recurrent implantation failure in terms of enabling a connection between the cells belonging to the endometrium and the embryo.
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Affiliation(s)
- Elif Gelenli Dolanbay
- Department of Histology and Embryology, Faculty of Medicine, Kocaeli University, Campus of Umuttepe, Kocaeli 41380, Turkey
| | - Melda Yardimoglu
- Department of Histology and Embryology, Faculty of Medicine, Kocaeli University, Campus of Umuttepe, Kocaeli 41380, Turkey
| | - Ender Yalcinkaya
- Training and Research Hospital, IVF Unit, Faculty of Medicine, Kocaeli University, Campus of Umuttepe, Kocaeli 41380, Turkey
| | - Yusufhan Yazir
- Department of Histology and Embryology, Faculty of Medicine, Kocaeli University, Campus of Umuttepe, Kocaeli 41380, Turkey
| | - Ayca Aksoy
- Center of Stem Cell and Gene Therapies Research and Practice, Kocaeli University, Campus of Umuttepe, Kocaeli 41380, Turkey
| | - Erdal Karaoz
- Center for Regenerative Medicine and Stem Cell Research and Manufacturing (LivMedCell), Liv Hospital, İstanbul 34340, Turkey
| | - Eray Caliskan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Bahçeşehir University, İstanbul 34353, Turkey
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8
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Bochev I, Belemezova K, Shterev A, Kyurkchiev S. Effect of cryopreservation on the properties of human endometrial stromal cells used in embryo co-culture systems. J Assist Reprod Genet 2016; 33:473-80. [PMID: 26758461 DOI: 10.1007/s10815-016-0651-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 01/03/2016] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Along with comparative investigation of the decidualization potential and IL-6 secretion by fresh and frozen ESCs, we also aimed to evaluate the effectiveness of co-culture systems based on fresh or frozen ESCs in terms of clinical pregnancy rates. METHODS Outcome analysis of a total of 215 IVF cycles with co-culture with fresh or frozen ESCs was performed. Endometrial tissue was obtained from 17 healthy donors. Concentrations of secreted prolactin, IGFBP-1, and IL-6 in conditioned media from cultured fresh and frozen ESCs (decidualized or not) were measured using ELISA or ECLIA. RESULTS Embryo co-culture with frozen ESCs resulted in a much lower pregnancy rate compared to the alternative system using fresh ESCs. Furthermore, cultivated frozen ESCs showed considerably decreased release of prolactin, IGFBP-1, and IL-6 compared to fresh ESCs, indicating that cryopreservation negatively affects their decidualization potential and cytokine production. CONCLUSIONS Altogether, this data illustrates the need for optimization and improvement of the existing autologous endometrial co-culture systems.
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Affiliation(s)
- Ivan Bochev
- IVF Department, Ob/Gyn Hospital Dr. Shterev, 25-31 Hristo Blagoev Str., 1330, Sofia, Bulgaria.
| | - Kalina Belemezova
- Tissue bank BULGEN, 25-31 Hristo Blagoev Str., 1330, Sofia, Bulgaria
| | - Atanas Shterev
- IVF Department, Ob/Gyn Hospital Dr. Shterev, 25-31 Hristo Blagoev Str., 1330, Sofia, Bulgaria
| | - Stanimir Kyurkchiev
- Tissue bank BULGEN, 25-31 Hristo Blagoev Str., 1330, Sofia, Bulgaria.,Institute of Reproductive Health, 25-31 Hristo Blagoev Str., 1330, Sofia, Bulgaria
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Ismail Madkour WA, Noah B, Zaheer H, Al-Bahr A, Abdelhamid AM, Shaeer M, Moawad A. Does sequential embryo transfer improve pregnancy rate in patients with repeated implantation failure? A randomized control study. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2015. [DOI: 10.1016/j.mefs.2015.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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10
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Motato Y, de los Santos MJ, Escriba MJ, Ruiz BA, Remohí J, Meseguer M. Morphokinetic analysis and embryonic prediction for blastocyst formation through an integrated time-lapse system. Fertil Steril 2015; 105:376-84.e9. [PMID: 26598211 DOI: 10.1016/j.fertnstert.2015.11.001] [Citation(s) in RCA: 117] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 10/09/2015] [Accepted: 11/02/2015] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To describe the events associated with the blastocyst formation and implantation that occur in embryos during preimplantation development based on the largest sample size ever described with time-lapse monitoring. DESIGN Observational, retrospective, single-center clinical study. SETTING University-affiliated private IVF center. PATIENT(S) A total of 7,483 zygotes from 990 first treatments of intracytoplasmic sperm injection (ICSI; 627 of oocyte donor vs. 363 autologous oocyte cycles), of which 832 blastocysts were transferred. INTERVENTION(S) No patient intervention. Embryos were cultured in a time-lapse monitoring system, and the embryos were transferred on day 5 after ICSI. Embryo selection was based on the multivariable model previously developed and on blastocyst morphology. MAIN OUTCOME MEASURE(S) Using a time-lapse system, embryo images were acquired every 15 minutes for 120 hours. Embryos cleavage time points up to the 9-cell stage (t2-t9) as well as to the morula stage (tM) and blastocyst formation (tB) were registered in hours after ICSI. Additionally, duration of the cell cycle and synchrony of the second and third cell cycles were defined. As a result, we have monitored the embryonic development of a total of 3,215 blastocysts, of which 832 were transferred. Finally, we analyzed the characteristics of embryonic development of blastocyst (phase 1) and of implanted and not implanted (phase 2) embryos as finally validated in an independent data set (phase 3). RESULT(S) A detailed retrospective analysis of cleavage times was made for 7,483 zygotes. We analyzed 17 parameters and found several significantly correlated with subsequent blastocyst formation and implantation. The most predictive parameters for blastocyst formation were time of morula formation, tM (81.28-96.0 hours after ICSI), and t8-t5 (≤8.78 hours) or time of transition of 5-blastomere embryos to 8-blastomere embryos with a receiver operating characteristic curve (ROC) value = 0.849 (95% confidence interval [CI], 0.835-0.854; phase 1). These parameters were less predictive of implantation, with a ROC value = 0.546 (95% CI, 0.507-0.585). We also observed that time for expansion blastocyst, tEB (107.9-112.9 hours after ICSI), and t8-t5 (≤5.67 hours after ICSI) predict blastocyst implantation, with a ROC value = 0.591 (95% CI, 0.552-0.630; phase 2). The model was validated on an independent data set and gave a ROC of 0.596 (0.526-0.666; phase 3). CONCLUSION(S) The inclusion of kinetic parameters into score evaluation may improve blastocyst selection criteria and can predict blastocyst formation with high accuracy. We propose two multivariable models based on our findings to classify embryos according to their probabilities of blastocyst stage and implantation in the largest data set ever reported of human blastocysts.
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Affiliation(s)
- Yamileth Motato
- Instituto Valenciano de Infertilidad, Universidad de Valencia, Valencia, Spain
| | | | - María José Escriba
- Instituto Valenciano de Infertilidad, Universidad de Valencia, Valencia, Spain
| | - Belén Aparicio Ruiz
- Instituto Valenciano de Infertilidad, Universidad de Valencia, Valencia, Spain
| | - José Remohí
- Instituto Valenciano de Infertilidad, Universidad de Valencia, Valencia, Spain
| | - Marcos Meseguer
- Instituto Valenciano de Infertilidad, Universidad de Valencia, Valencia, Spain.
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Grau N, Escrich L, Galiana Y, Meseguer M, García-Herrero S, Remohí J, Escribá MJ. Morphokinetics as a predictor of self-correction to diploidy in tripronucleated intracytoplasmic sperm injection–derived human embryos. Fertil Steril 2015; 104:728-35. [DOI: 10.1016/j.fertnstert.2015.05.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 05/19/2015] [Accepted: 05/19/2015] [Indexed: 11/29/2022]
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12
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Braga DPAF, Halpern G, Setti AS, Figueira RCS, Iaconelli A, Borges E. The impact of food intake and social habits on embryo quality and the likelihood of blastocyst formation. Reprod Biomed Online 2015; 31:30-8. [DOI: 10.1016/j.rbmo.2015.03.007] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 03/03/2015] [Accepted: 03/17/2015] [Indexed: 01/18/2023]
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Thouas GA, Dominguez F, Green MP, Vilella F, Simon C, Gardner DK. Soluble ligands and their receptors in human embryo development and implantation. Endocr Rev 2015; 36:92-130. [PMID: 25548832 DOI: 10.1210/er.2014-1046] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Extensive evidence suggests that soluble ligands and their receptors mediate human preimplantation embryo development and implantation. Progress in this complex area has been ongoing since the 1980s, with an ever-increasing list of candidates. This article specifically reviews evidence of soluble ligands and their receptors in the human preimplantation stage embryo and female reproductive tract. The focus will be on candidates produced by the human preimplantation embryo and those eliciting developmental responses in vitro, as well as endometrial factors related to implantation and receptivity. Pathways to clinical translation, including innovative diagnostics and other technologies, are also highlighted, drawing from this collective evidence toward facilitating joint improvements in embryo quality and endometrial receptivity. This strategy could not only benefit clinical outcomes in reproductive medicine but also provide broader insights into the peri-implantation period of human development to improve fetal and neonatal health.
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Affiliation(s)
- George A Thouas
- Reproductive Biology and Assisted Conception Laboratory (G.A.T., M.P.G., D.K.G.), School of Biosciences, The University of Melbourne, Melbourne, Victoria, Australia 3010; Fundación Instituto Valenciano de Infertilidad (F.D., F.V., C.S.), Department of Obstetrics and Gynecology, University of Valencia, 46010, Valencia, Spain; La Fundación para la Investigación del Hospital Clínico de la Comunidad Valenciana Health Research Institute (F.D., F.V., C.S.), 46010 Valencia, Spain; and Department of Obstetrics and Gynecology (C.S.), Stanford University, Stanford, California 90095
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Siristatidis C, Komitopoulou MA, Makris A, Sialakouma A, Botzaki M, Mastorakos G, Salamalekis G, Bettocchi S, Palmer GA. Morphokinetic parameters of early embryo development via time lapse monitoring and their effect on embryo selection and ICSI outcomes: a prospective cohort study. J Assist Reprod Genet 2015; 32:563-70. [PMID: 25617087 DOI: 10.1007/s10815-015-0436-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 01/13/2015] [Indexed: 01/15/2023] Open
Abstract
PURPOSE To compare the outcomes of embryos selected via time lapse monitoring (TLM) versus those selected with conventional methods of selection in subfertile women undergoing ICSI. METHODS The study population (239 women) was classified into two groups, based on the monitoring method used: Group 1 (TLM) and Group 2 (conventional monitoring). Groups were compared according to the clinical and ICSI cycle characteristics and reproductive outcomes, while transfers were performed at day 2 or 3. Subgroup analyses were performed, in women of both groups according to age and clinical parameters, and in embryos of Group 1 based on their cellular events. RESULTS There was a statistically significant difference between the two study groups with regard to the outcome parameters, favoring Group 1 and especially in women >40 years of age. No differences were found in subgroup analyses in participants of both groups, regarding the stimulation protocol used, number of the oocytes retrieved and type of subfertility, while in Group 1 the percentages of "in range" cellular events were higher in certain divisions in ages 35-40, non-smokers, and the GnRH-agonist group, and in embryos that resulted in pregnancy. CONCLUSION Morphokinetic parameters of early embryo development via TLM are related to the characteristics of subfertile patients and associated with ICSI outcomes.
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Affiliation(s)
- Charalampos Siristatidis
- Assisted Reproduction Unit, 3rd Department of Obstetrics and Gynecology, University of Athens, Rimini 1, Chaidari, Athens, Greece, 12642,
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Is morphokinetic analysis the answer? Reprod Biomed Online 2013; 27:654-63. [DOI: 10.1016/j.rbmo.2013.07.017] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 07/25/2013] [Accepted: 07/30/2013] [Indexed: 11/23/2022]
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Influence of oocyte dysmorphisms on blastocyst formation and quality. Fertil Steril 2013; 100:748-54. [DOI: 10.1016/j.fertnstert.2013.05.021] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Revised: 05/09/2013] [Accepted: 05/15/2013] [Indexed: 11/23/2022]
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Martín J, Cervero A, Mir P, Martinez-Conejero JA, Conejero Martinez JA, Pellicer A, Simón C. The impact of next-generation sequencing technology on preimplantation genetic diagnosis and screening. Fertil Steril 2013; 99:1054-61.e3. [PMID: 23499002 DOI: 10.1016/j.fertnstert.2013.02.001] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Revised: 02/04/2013] [Accepted: 02/05/2013] [Indexed: 11/24/2022]
Abstract
Largely because of efforts required to complete the Human Genome Project, DNA sequencing has undergone a steady transformation with still-ongoing developments of high-throughput sequencing machines for which the cost per reaction is falling drastically. Similarly, the fast-changing landscape of reproductive technologies has been improved by genetic approaches. Preimplantation genetic diagnosis and screening were established more than two decades ago for selecting genetically normal embryos to avoid inherited diseases and to give the highest potential to achieve stable pregnancies. Most recent additions to the IVF practices (blastocyst/trophectoderm biopsy, embryo vitrification) and adoption of new genetics tools such as array comparative genome hybridization have allowed setting up more precise and efficient programs for clinical embryo diagnosis. Nevertheless, there is always room for improvements. Remarkably, a recent explosion in the release of advanced sequencing benchtop platforms, together with a certain maturity of bioinformatics tools, has set the target goal of sequencing individual cells for embryo diagnosis to be a realistically feasible scenario for the near future. Next-generation sequencing technology should provide the opportunity to simultaneously analyze single-gene disorders and perform an extensive comprehensive chromosome screening/diagnosis by concurrently sequencing, counting, and accurately assembling millions of DNA reads.
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Wang H, Bocca S, Anderson S, Yu L, Rhavi BS, Horcajadas J, Oehninger S. Sex steroids regulate epithelial-stromal cell cross talk and trophoblast attachment invasion in a three-dimensional human endometrial culture system. Tissue Eng Part C Methods 2013; 19:676-87. [PMID: 23320930 DOI: 10.1089/ten.tec.2012.0616] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Human embryo implantation involves a complex network of molecular signaling that is modulated by endocrine and paracrine pathways. Here, we performed studies using a unique and recently developed three-dimensional (3D) implantation model, characterized by an endometrium-like 3D culture system and Jar cell-derived spheroids mimicking the embryo/trophoblast. The aims were to investigate the effects of 17β estradiol (E2) and medroxyprogesterone acetate (MPA) on (1) the interaction between epithelial and stromal cells, and (2) the attachment and invasion of trophoblast cells. We observed that epithelial and stromal cells in the 3D culture were ERα⁺, ERβ⁺, and PR⁺. Decidualization was confirmed by enhanced prolactin gene expression on day 7 of E2 plus MPA treatment. An effect of epithelial cells on the decidualization of stromal cells was indicated by significantly higher levels of prolactin mRNA expression in the 3D culture compared to stromal cells grown within the fibrin-agarose gel matrix. On the other hand, the relative gene expressions of E-cadherin and IL-1β in epithelial cells of the 3D culture under decidualization conditions significantly differed from those in epithelial cells grown over the fibrin-agarose gel matrix without stromal cells, pointing to regulation of epithelial cells by the stroma. The attachment rate of Jar spheroids to the 3D was significantly increased by E2 plus MPA treatment. Analyses of Z-stack confocal and stained optic microscopic images demonstrated that Jar spheroids breached the epithelial cell monolayer, invaded, and were embedded into the 3D matrix in response to decidualization signals. In summary, the newly bioengineered system provides a unique model for studying interactions between the different endometrial cell compartments, via soluble-paracrine signals as well as cell-to-cell interactions, and is a useful tool to study early embryonic implantation events.
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Affiliation(s)
- Hai Wang
- Department of Obstetrics and Gynecology, The Jones Institute for Reproductive Medicine, Eastern Virginia Medical School, Norfolk, Virginia, USA
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Fang C, Huang R, Li TT, Jia L, Li LL, Liang XY. Day-2 and day-3 sequential transfer improves pregnancy rate in patients with repeated IVF–embryo transfer failure: a retrospective case–control study. Reprod Biomed Online 2013. [DOI: 10.1016/j.rbmo.2012.10.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Mir P, Rodrigo L, Mercader A, Buendía P, Mateu E, Milán-Sánchez M, Peinado V, Pellicer A, Remohí J, Simón C, Rubio C. False positive rate of an arrayCGH platform for single-cell preimplantation genetic screening and subsequent clinical application on day-3. J Assist Reprod Genet 2013; 30:143-9. [PMID: 23254309 PMCID: PMC3553356 DOI: 10.1007/s10815-012-9918-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Accepted: 12/12/2012] [Indexed: 01/11/2023] Open
Abstract
In this work, false positive rate of an arrayCGH platform for its use in day-3 single-blastomere analysis was calculated. For this purpose, 38 embryos diagnosed as abnormal on day-3 by FISH were re-biopsied on day-4. Single-cell day-4 arrayCGH diagnosis was then performed. A successful amplification was obtained in 97.4 % (37/38) of the day-4 cells analysed by arrayCGH. Day-3 FISH and day-4 arrayCGH diagnosis were concordant in 35/37 cases. The two discordant embryos were spread and all the cells from each embryo were re-analysed by FISH on day 5. The same error rate (2.7 %) for day-3 FISH and day-4 arrayCGH was obtained when comparing day-5 FISH re-analysis. After this pre-clinical phase, the platform was used for day-3 arrayCGH clinical application in 320 patients (1,760 embryos). Day-3 amplification rate was 98.6 %. An optimal reproductive outcome was obtained when applying arrayCGH to a clinical program: clinical pregnancy rate per cycle of 38.4 % and 60.3 % per transference were obtained, with an implantation rate of 53.5 %. Overall miscarriage rate was 10.6 %. Additionally, day-5 FISH re-analysis was performed in 42 of the embryos from the clinical phase, obtaining a concordance rate of 97.6 % with day-3 arrayCGH.
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Affiliation(s)
- Pere Mir
- IVIOMICS, Paterna, Valencia, Spain.
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Braga DPAF, Setti AS, de Cássia S Figueira R, Machado RB, Iaconelli A, Borges E. Patient selection criteria for blastocyst transfers in extended embryo culture programs. J Assist Reprod Genet 2012; 29:1357-62. [PMID: 23054364 DOI: 10.1007/s10815-012-9875-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Accepted: 10/02/2012] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To identify the correlation between different cycles, patient factors and blastocyst characteristics. METHODS The study included 420 patients undergoing ICSI cycles and 2781 graded blastocysts, which took into account the blastocyst quality. The correlations between the blastocyst parameters and the patient and cycle characteristics were assessed. RESULTS The blastocyst development was negatively correlated with the maternal age, BMI and dose of FSH. The ICM was negatively correlated with the FSH dose, whereas the TE quality was influenced by the FSH dose, the maternal age and the number of retrieved oocytes. The embryo morphology on days two and three may predict the blastocyst developmental competence. CONCLUSIONS Older patients and patients with high BMI should not be included in extended embryo culture programmes. The extended culture may not favour embryos with poor morphology on days two and three of development. Additionally, a lower ovarian stimulation and decreased oocyte yields may lead to the development of high-quality blastocysts.
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Labarta E, Bosch E, Alamá P, Rubio C, Rodrigo L, Pellicer A. Moderate ovarian stimulation does not increase the incidence of human embryo chromosomal abnormalities in in vitro fertilization cycles. J Clin Endocrinol Metab 2012; 97:E1987-94. [PMID: 22865900 PMCID: PMC3462940 DOI: 10.1210/jc.2012-1738] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
CONTEXT A high chromosomal abnormalities rate has been observed in human embryos derived from in vitro fertilization (IVF) treatments. The real incidence in natural cycles has been poorly studied, so whether this frequency may be induced by external factors, such as use of gonadotropins for ovarian stimulation, remains unknown. DESIGN We conducted a prospective cohort study in a University-affiliated private infertility clinic with a comparison between unstimulated and stimulated ovarian cycles in the same women. Preimplantation genetic screening by fluorescence in situ hybridization was performed in all viable d 3 embryos. OBJECTIVE The primary objective was to compare the incidence of embryo chromosomal abnormalities in an unstimulated cycle and in an ulterior moderate ovarian stimulated cycle. Secondary outcome measures were embryo quality, blastocyst rate of biopsied embryos, number of normal blastocysts per donor, type of chromosomal abnormalities, and clinical outcome. RESULTS One hundred eighty-five oocyte donors were initially recruited for the unstimulated cycle, and preimplantation genetic screening could be performed in 51 of them, showing 35.3% of embryo chromosomal abnormalities. Forty-six of them later completed a stimulated cycle. The sperm donor sample was the same for both cycles. The proportion of embryos displaying abnormalities in the unstimulated cycle was 34.8% (16 of 46), whereas it was 40.6% (123 of 303) in the stimulated cycle with risk difference=5.8 [95% confidence interval (CI)=-20.6-9.0], and relative risk=1.17 (95% CI=0.77-1.77) (P=0.45). When an intrasubject comparison was made, the abnormalities rate was 34.8% (95% CI=20.5-49.1) in the unstimulated cycle and 38.2% (95% CI=30.5-45.8) in the stimulated cycle [risk difference=3.4 (95% CI=-17.9-11.2); P=0.64]. No differences were observed for embryo quality and type of chromosomal abnormalities. CONCLUSIONS Moderate ovarian stimulation in young normo-ovulatory women does not significantly increase the embryo aneuploidies rate in in vitro fertilization-derived human embryos as compared with an unstimulated cycle. Whether these results can be extrapolated to infertile patients is still unknown.
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Affiliation(s)
- Elena Labarta
- Department of Human Reproduction, Instituto Valenciano de Infertilidad, University of Valencia, Plaza de la Policía Local 3, 46015 Valencia, Spain.
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Abstract
During the 1970s, domestic animal biotechnology, i.e., embryo transfer in farm animals, was confronted with the problem of embryonic developmental arrest observed in vitro, especially during the cycle in which maternal to zygotic transition (MZT) cycle takes place. In farm animals, obtaining blastocysts is mandatory, as transfer at earlier stages results in expulsion of the embryo from the vagina. In humans, the first attempts to obtain blastocysts with classical culture media were disappointing, and the use of a coculture strategy was naturally tempting: the first significant results of successful blastocyst development were obtained in the early 1980s, using trophoblastic tissue as a feeder layer in order to mimic an autocrine embryotrophic system. The next supporting cell systems were based on oviduct epithelial cells and uterine cells in order to achieve a paracrine effect. Non-hormone dependence was then demonstrated with the use of prepubertal cells, and finally with the use of established cell lines of nongenital origin (African Green Monkey Kidney, Vero cells). The embryotrophic properties are linked to features of "transport epithelia." Vero cells have been extensively used in human ART, and most of our knowledge about the human blastocyst was gathered with the use of this technology. Coculture is still in current use, but with systems that employ autologous uterine cells. Results following the use of this technology in human ART are superior to those observed with the use of sequential media. The benefit is linked to the release of free radical scavengers and growth factors by the feeder cells. In animal biotechnology, an important part of the "precious embryos," i.e., those resulting from cloning technology, involves coculture with buffalo rat liver (BRL) cells or Vero cells.
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Ahlstrom A, Westin C, Reismer E, Wikland M, Hardarson T. Trophectoderm morphology: an important parameter for predicting live birth after single blastocyst transfer. Hum Reprod 2011; 26:3289-96. [DOI: 10.1093/humrep/der325] [Citation(s) in RCA: 182] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Meseguer M, Herrero J, Tejera A, Hilligsoe KM, Ramsing NB, Remohi J. The use of morphokinetics as a predictor of embryo implantation. Hum Reprod 2011; 26:2658-71. [DOI: 10.1093/humrep/der256] [Citation(s) in RCA: 595] [Impact Index Per Article: 45.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Autologous embryo–cumulus cells co-culture and blastocyst transfer in repeated implantation failures: a collaborative prospective randomized study. ZYGOTE 2011; 20:173-80. [DOI: 10.1017/s0967199411000062] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
SummaryIn repeated implantation failure, the co-culture of human embryos with somatic cells has been reported to promote the improvement of embryos quality, implantation and pregnancy rate. It was reported that feeder cells can be more beneficial to the oocyte and embryo by detoxifying the culture medium and supporting embryo development via different pathways. In this study, 432 patients, each with a minimum of three repeated implantation failures, were accepted for a prospective randomized study with or without autologous cumulus cell embryo co-culture and transfer at day 3 or day 5–6. We also investigated the expression of leukaemia inhibitor factor (LIF) and platelet activating factor receptor (PAF-R) on day 3 confluent cumulus cells. The statistic analysis of the data showed significant difference of implantation and clinical pregnancy rates between classical culture and day 3 compared with co-culture and day 5–6 transfer. The molecular analysis showed that cumulus cells express the LIF and the PAF-R genes and confirmed the possible positive role of growth factors and cytokines in early embryo development. Embryo co-culture systems with autologous cells can be beneficial in routine in vitro fertilization for embryo selection and implantation improvement. More molecular investigations need to be done to improve elucidation of the complex dialogue between the embryo and feeder cells prior to implantation and to understand the involved biological function and molecular process during embryo development.
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Santos MA, Teklenburg G, Macklon NS, Van Opstal D, Schuring-Blom GH, Krijtenburg PJ, de Vreeden-Elbertse J, Fauser BC, Baart EB. The fate of the mosaic embryo: chromosomal constitution and development of Day 4, 5 and 8 human embryos. Hum Reprod 2010; 25:1916-26. [PMID: 20519247 DOI: 10.1093/humrep/deq139] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Post-zygotic chromosome segregation errors are very common in human embryos after in vitro fertilization, resulting in mosaic embryos. However, the significance of mosaicism for the developmental potential of early embryos is unknown. We assessed chromosomal constitution and development of embryos from compaction to the peri-implantation stage. METHODS From 112 cryopreserved Day 4 human embryos donated for research, 21 were immediately fixed and all cells were analysed by fluorescent in situ hybridization (FISH) for chromosomes 1, 7, 13, 15, 16, 18, 21, 22, X and Y. The remaining 91 embryos were thawed, with 54 embryos undergoing biopsy of one or two cells which were fixed and analysed by FISH. Biopsied embryos were kept in standard culture conditions for 24 h. Embryos arrested before cavitation (n = 24) were fixed whereas developing Day 5 blastocysts (n = 24) were co-cultured for a further 72 h on an endometrial monolayer followed by fixation. Cell numbers were counted and all nuclei were analysed by FISH. Data from a previous FISH analysis on cryopreserved good-quality Day 5 blastocysts (n = 36) were also included in the present study. RESULTS FISH analysis was successful for 18 Day 4 fixed embryos and, according to our definition, 83% were mosaic and 11% showed a chaotic chromosomal constitution. FISH analysis of two blastomeres from Day 4 developing embryos showed that 54% were mosaic, 40% were normal and 6% were abnormal. Analysis of Day 4, 5 and 8 whole embryos showed a decrease in incidence of mosaicism over time, from 83% on Day 4 to 42% on Day 8. A significant positive correlation was observed between the total cell number and the percentage of normal cells in developing Day 5 and Day 8 embryos but not in developing Day 4 or embryos arrested before cavitation. CONCLUSIONS These data suggest that both the developmental arrest of a significant proportion of mosaic embryos on Day 4, and the cell death or reduced proliferation of aneuploid cells within an embryo may be responsible for the observed decrease of aneuploid blastomeres from compaction to the peri-implantation stage.
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Affiliation(s)
- Margarida Avo Santos
- Department of Reproductive Medicine and Gynaecology, University Medical Centre, Utrecht, The Netherlands.
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Mir P, Rodrigo L, Mateu E, Peinado V, Milan M, Mercader A, Buendia P, Delgado A, Pellicer A, Remohi J, Rubio C. Improving FISH diagnosis for preimplantation genetic aneuploidy screening. Hum Reprod 2010; 25:1812-7. [DOI: 10.1093/humrep/deq122] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Källén B, Finnström O, Lindam A, Nilsson E, Nygren KG, Olausson PO. Blastocyst versus cleavage stage transfer in in vitro fertilization: differences in neonatal outcome? Fertil Steril 2010; 94:1680-3. [PMID: 20137785 DOI: 10.1016/j.fertnstert.2009.12.027] [Citation(s) in RCA: 118] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2009] [Revised: 12/07/2009] [Accepted: 12/07/2009] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To compare neonatal outcome of blastocyst and cleavage stage embryo transfers after IVF. DESIGN Register study. SETTING Births recorded in the Swedish Medical Birth Register after IVF performed, 2002-2006. PATIENT(S) Treatments reported from all Swedish IVF clinics. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Some neonatal characteristics were compared in 1,311 infants born after blastocyst-stage transfer and 12,562 infants born after cleavage-stage transfer. Comparisons were also made with all births, 2002-2007 (n = 598,687). RESULT(S) After adjusting for year of birth, maternal age, parity, smoking habits, and body mass index, the risk of preterm birth among singletons was significantly greater after blastocyst-stage transfer than after cleavage-stage transfer. The risk of congenital malformations was also significantly higher. When the analysis was restricted to clinics where blastocyst transfers were made, the risk estimates increased for preterm birth, low birth weight, low APGAR score, and respiratory diagnoses, but did not change for congenital malformations. CONCLUSION(S) The results indicate a small increase in risk associated with blastocyst transfer, perhaps owing to the longer period of in vitro culture. There is a possibility that this effect is due, at least in part, to a selection of women for blastocyst transfers. Further studies are needed either to verify or to refute the found associations.
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Affiliation(s)
- Bengt Källén
- Tornblad Institute, University of Lund, Lund, Sweden.
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Embryologic outcome and secretome profile of implanted blastocysts obtained after coculture in human endometrial epithelial cells versus the sequential system. Fertil Steril 2010; 93:774-782.e1. [DOI: 10.1016/j.fertnstert.2008.10.019] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2008] [Revised: 09/30/2008] [Accepted: 10/15/2008] [Indexed: 11/24/2022]
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Rubio C, Buendía P, Rodrigo L, Mercader A, Mateu E, Peinado V, Delgado A, Milán M, Mir P, Simón C, Remohí J, Pellicer A. Prognostic factors for preimplantation genetic screening in repeated pregnancy loss. Reprod Biomed Online 2009; 18:687-93. [PMID: 19549449 DOI: 10.1016/s1472-6483(10)60015-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The objective of this study was to identify specific subgroups of recurrent pregnancy loss (RPL) patients of unknown aetiology in whom the selection of chromosomally normal embryos for transfer improves reproductive outcome in preimplantation genetic screening (PGS). A total of 428 PGS cycles were included and chromosomes 13, 15, 16, 18, 21, 22, X and Y were evaluated. In RPL patients < or =37 years, a lower incidence of chromosomal abnormalities (P = 0.0004) and miscarriages (P = 0.0283) was observed, and there were significantly higher pregnancy (P < 0.0384) and implantation (P < 0.0434) rates than in patients >37 years. In the former subset, results showed: (i) significantly higher implantation rates (P = 0.0411) in couples that had experienced a previous aneuploid miscarriage; (ii) similar aneuploidy, pregnancy and implantation rates in couples suffering previous miscarriages during fertility treatments and in those with previous spontaneous pregnancies; (iii) no miscarriages after PGS in couples in whom a fluorescence in-situ hybridization assay showed the male partner's sperm to be abnormal; and (iv) lower implantation rates in couples with > or =5 previous miscarriages, associated with a lower percentage of chromosomally abnormal embryos. It is concluded that PGS is to be strongly recommended when RPL is associated with miscarriages during infertility treatments, chromosomopathy in a previous miscarriage, up to five previous miscarriages and a high incidence of chromosomal abnormalities in spermatozoa.
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The use of coculture in assisted reproductive technology: does it have any impact? Curr Opin Obstet Gynecol 2009; 21:253-9. [DOI: 10.1097/gco.0b013e32832a17a5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Thomas MR, Sparks AE, Ryan GL, Van Voorhis BJ. Clinical predictors of human blastocyst formation and pregnancy after extended embryo culture and transfer. Fertil Steril 2009; 94:543-8. [PMID: 19409548 DOI: 10.1016/j.fertnstert.2009.03.051] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2009] [Revised: 03/01/2009] [Accepted: 03/11/2009] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To determine the clinical factors associated with blastocyst development and pregnancy. DESIGN Evaluation of a prospectively collected IVF database. SETTING An academic IVF practice. PATIENT(S) Couples (n = 529) undergoing their first IVF cycle who qualified for extended embryo culture (more than six zygotes) over the past 5 years. INTERVENTION(S) Seven or eight zygotes were cultured for 5 days, assessed for quality, and then transferred with excess zygotes cryopreserved at the pronuclear stage. MAIN OUTCOME MEASURE(S) Clinical predictors of blastocyst development and pregnancy. RESULT(S) The mean blastocyst development rate was 49.8%, with a median number of total and good-quality blastocysts of 4 and 2, respectively. Clinical factors that were significantly associated with good-quality blastocyst formation were younger female age, increased parity, standard insemination, and lower doses of gonadotropins. Clinical factors that were significantly associated with successful pregnancy were younger female age, higher antral follicle counts, greater numbers of total and good-/excellent-quality blastocysts, and absence of male factor infertility. CONCLUSION(S) Several clinical factors are associated with the development of good-quality blastocysts after extended embryo culture and successful pregnancy outcome. These patient and cycle characteristics may be very useful in selecting the best candidates for extended embryo culture and single blastocyst transfers, thus optimizing outcomes while reducing the risks associated with multiple pregnancies.
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Affiliation(s)
- Mika R Thomas
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology, University of Iowa College of Medicine, Iowa City, Iowa, USA
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Eyheremendy V, Raffo FGE, Papayannis M, Barnes J, Granados C, Blaquier J. Beneficial effect of autologous endometrial cell coculture in patients with repeated implantation failure. Fertil Steril 2009; 93:769-73. [PMID: 19249034 DOI: 10.1016/j.fertnstert.2008.10.060] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2008] [Revised: 10/22/2008] [Accepted: 10/29/2008] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To confirm the beneficial effect of endometrial coculture in patients with repeated failures with assisted reproductive techniques (ART). DESIGN Patients with previous failures were offered a repetition of ART in conjunction with autologous endometrial coculture. SETTING Private fertility center. PATIENT(S) Sixty-eight couples who had attempted 92 cycles of IVF or intracytoplasmic sperm injection without obtaining an evolutive pregnancy. INTERVENTION(S) Patients repeated one cycle of ART with concomitant endometrial coculture of their embryos. MAIN OUTCOME MEASURES(S) Comparative pregnancy and delivery rates in conventional ART cycles vs. cycles with autologous endometrial coculture. RESULT(S) In the previous 92 cycles (146 ETs, fresh plus frozen) only 8 pregnancies were initiated, and all ended in spontaneous abortion. Upon repeating 68 cycles (76 ETs) using coculture, 39 pregnancies were obtained, of which 19 resulted in live births, 10 are ongoing evolutive pregnancies, and 10 ended in spontaneous abortions. CONCLUSION(S) These results confirm the usefulness of autologous endometrial coculture for the treatment of patients with repeated implantation failure.
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Nematollahi-mahani SN, Pahang H, Moshkdanian G, Nematollahi-mahani A. Effect of embryonic fibroblast cell co-culture on development of mouse embryos following exposure to visible light. J Assist Reprod Genet 2009; 26:129-35. [PMID: 19184398 DOI: 10.1007/s10815-008-9290-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2008] [Accepted: 12/23/2008] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To determine the effects of visible light on development of mouse embryos and the potential of fibroblast cells to overcome deleterious effects of visible light on mouse preimplantation stage embryos. METHODS Two-cell mouse embryos were randomly allocated to un-exposed group (control) and exposed group receiving 1600 lx visible light for various time lengths. Both exposed and un-exposed embryos were co-cultured with either Mouse Embryonic Fibroblast (MEF) or Human Embryonic Fibroblast (HEF). Developmental rate of embryos at day 3 (morula), 4 (expanded blastocyst) and 5 (hatching or hatched blastocyst) was evaluated. RESULTS Exposure of embryos to visible light for 30 min decreased developmental rate significantly (P<0.01). Developmental rate of exposed embryos co-cultured with MEF (58%; p<0.05 both at day 4 and 5) and HEF (67%; P<0.01 both at day 4 and 5) was higher than control. CONCLUSIONS Visible light adversely affects embryo development in a time-dependent manner. Feeder cells may enhance embryo development particularly when suboptimal conditions are involved.
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Role of coculture in human in vitro fertilization: a meta-analysis. Fertil Steril 2008; 90:1069-76. [DOI: 10.1016/j.fertnstert.2007.07.1349] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2007] [Revised: 07/18/2007] [Accepted: 07/18/2007] [Indexed: 11/17/2022]
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Desai N, Abdelhafez F, Bedaiwy MA, Goldfarb J. Live births in poor prognosis IVF patients using a novel non-contact human endometrial co-culture system. Reprod Biomed Online 2008; 16:869-74. [PMID: 18549698 DOI: 10.1016/s1472-6483(10)60154-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Patients with repeated implantation failures or poor embryo quality may benefit from embryo culture using the co-culture technique; growth factors secreted by co-culture cells may act as survival factors. Autologous endometrial co-culture has been suggested as a safe alternative to animal cells for co-culture of human embryos. However, the technique is fairly labour intensive and its effectiveness can vary from patient-to-patient. This study presents clinical outcome data on a novel noncontact co-culture system using a human endometrial cell line rather than autologous tissue. Embryos from 316 poor prognosis patients with repeated IVF failures, previous cycles with poor embryo quality or advanced maternal age were cultured in Transwell chambers with a monolayer of endometrial cells. The clinical pregnancy rate in patients less than 39 years of age was 53% and for patients aged between 39 and 42 years it was 33%. To date, 76 patients have delivered 111 healthy infants with no congenital anomalies and 18 pregnancies are ongoing. This is the first report on the potential benefits of a non-contact co-culture system in the IVF laboratory. This study shows that an established human endometrial cell line can be used to obtain the benefits of co-culture without the potential disadvantages associated with using autologous endometrial tissue.
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Affiliation(s)
- Nina Desai
- Cleveland Clinic Fertility Centre/Department of Obstetrics-Gynecology, Cleveland Clinic Foundation, Beachwood, OH, USA. @ccf.org
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Aghajanova L, Hamilton AE, Giudice LC. Uterine receptivity to human embryonic implantation: histology, biomarkers, and transcriptomics. Semin Cell Dev Biol 2008; 19:204-11. [PMID: 18035563 PMCID: PMC2829661 DOI: 10.1016/j.semcdb.2007.10.008] [Citation(s) in RCA: 105] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2007] [Accepted: 10/14/2007] [Indexed: 12/16/2022]
Abstract
Embryonic implantation is a dynamic process of paracrine interactions between the maternal compartment and the conceptus and involves a receptive endometrium and a developmentally competent blastocyst. Herein, we review histology, clinical approaches, and the promise of transcriptomics in elucidating mechanisms underlying implantation and development of biomarkers of uterine receptivity-with an eye to diagnose and treat implantation-based disorders of miscarriage, fetal growth restriction, pre-eclampsia, and infertility.
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Affiliation(s)
- L Aghajanova
- Department of Obstetrics, Gynecology and Reproductive Sciences, UCSF, 513 Parnassus Avenue, Box 0556, San Francisco, 94143-0556, CA, USA , ,
| | - AE Hamilton
- Department of Obstetrics, Gynecology and Reproductive Sciences, UCSF, 513 Parnassus Avenue, Box 0556, San Francisco, 94143-0556, CA, USA , ,
| | - LC Giudice
- Department of Obstetrics, Gynecology and Reproductive Sciences, UCSF, 513 Parnassus Avenue, Box 0556, San Francisco, 94143-0556, CA, USA , ,
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Escribá MJ, Zulategui JF, Galán A, Mercader A, Remohí J, de los Santos MJ. Vitrification of preimplantation genetically diagnosed human blastocysts and its contribution to the cumulative ongoing pregnancy rate per cycle by using a closed device. Fertil Steril 2007; 89:840-6. [PMID: 17681342 DOI: 10.1016/j.fertnstert.2007.04.035] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2006] [Revised: 04/04/2007] [Accepted: 04/04/2007] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate the survival rate and clinical results of our vitrification procedure on preimplantation genetic diagnosis (PGD) blastocysts and to calculate its actual contribution to the reproductive outcome per cycle. DESIGN Retrospective clinical study. SETTING University Institute IVI, Valencia, Spain. PATIENT(S) Patients who requested cryotransfer of surplus PGD blastocysts after failed fresh elective transfer. INTERVENTION(S) Retrospectively collected data during 2 years of experience with blastocyst vitrification. MAIN OUTCOME MEASURE(S) Primary outcome measures were the following: blastocyst recovery and survival; cryotransfer cancellation; and the implantation, pregnancy (PR), and ongoing-pregnancy rates. The secondary outcome measure was cumulative ongoing PR (COPR). RESULT(S) Cocultured vitrified PGD blastocysts were recovered and progressed in development after overnight culture (survival rate) at rates comparable to those of non-PGD blastocysts (49% and 42%, respectively). After transfer to 64% of patients, no statistical differences were found between PGD and non-PGD blastocyst groups concerning the following: PR (44% vs. 37%), implantation rate (40% vs. 27%), and ongoing-pregnancy rate (32% vs. 37%). Moreover, blastocyst vitrification significantly increased the COPR in both PGD and non-PGD cycles, from 47% (62/133) to 53% (70/133) and from 45% (24/53) to 53% (28/53), respectively. CONCLUSION(S) A preimplantation genetic diagnosis blastocyst vitrification procedure showed survival rates and improvements on the COPR that were comparable to those in non-PGD blastocyst cycles. Moreover, vitrification of biopsied and diagnosed embryos at the more advanced stages instead of at earlier cleavage stages is presented as an attractive strategy to consider in PGD programs.
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Affiliation(s)
- María-José Escribá
- Clinical Embryology Laboratory, Instituto Universitario IVI, Valencia, Spain.
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Diedrich K, Fauser BCJM, Devroey P, Griesinger G. The role of the endometrium and embryo in human implantation. Hum Reprod Update 2007; 13:365-77. [PMID: 17548368 DOI: 10.1093/humupd/dmm011] [Citation(s) in RCA: 198] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Despite many advances in assisted reproductive technologies (ART), implantation rates are still low. The process of implantation requires a reciprocal interaction between blastocyst and endometrium, culminating in a small window of opportunity during which implantation can occur. This interaction involves the embryo, with its inherent molecular programme of cell growth and differentiation, and the temporal differentiation of endometrial cells to attain uterine receptivity. Implantation itself is governed by an array of endocrine, paracrine and autocrine modulators, of embryonic and maternal origin. Implantation failure is thought to occur as a consequence of impairment of embryo developmental potential and/or impairment of uterine receptivity and the embryo-uterine dialogue. Therefore a better comprehension of implantation, and the relative importance of the factors involved, is warranted. New techniques for monitoring changes in the endometrium and/or the embryo at the level of gene regulation and protein expression may lead to the identification of better markers for implantation. Moreover, the use of predictive sets of markers may prove to be more reliable than a single marker. Continuing refinements to ART protocols, such as optimizing ovarian stimulation regimens, the timing of human chorionic gonadotrophin injection, or the timing of embryo transfer, should help to increase implantation rates further.
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Affiliation(s)
- K Diedrich
- Department of Obstetrics and Gynecology, University Hospital Schleswig-Holstein, Campus Lübeck, 23538 Luebeck, Germany
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Rao CV, Lei ZM. The past, present and future of nongonadal LH/hCG actions in reproductive biology and medicine. Mol Cell Endocrinol 2007; 269:2-8. [PMID: 17382462 DOI: 10.1016/j.mce.2006.07.007] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2006] [Revised: 07/01/2006] [Accepted: 07/01/2006] [Indexed: 11/28/2022]
Abstract
The past and present published studies reaffirm that nongonadal LH and hCG actions are real and here to stay. These actions have led to a better understanding of the biology of the hormones and more importantly begin to pave the way for novel therapies in reproductive medicine and in other areas.
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Affiliation(s)
- C V Rao
- Division of Research, Department of Obstetrics, Gynecology and Women's Health, University of Louisville Health Sciences Center, Louisville, KY 40292, USA.
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Budak E, Garrido N, Soares SR, Melo MAB, Meseguer M, Pellicer A, Remohí J. Improvements achieved in an oocyte donation program over a 10-year period: sequential increase in implantation and pregnancy rates and decrease in high-order multiple pregnancies. Fertil Steril 2007; 88:342-9. [PMID: 17335819 DOI: 10.1016/j.fertnstert.2006.11.118] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2006] [Revised: 11/17/2006] [Accepted: 11/27/2006] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To compare outcome parameters and cumulative pregnancy rates (PRs) in oocyte donation cycles over a period of 10 years. DESIGN Retrospective study. SETTING University-affiliated assisted reproductive technology program. PATIENT(S) Women undergoing oocyte donation (10,537 cycles) between 1995 and 2005. INTERVENTION(S) Ovarian stimulation and oocyte retrieval in donors. Embryo transfer performed in recipients after endometrial preparation. MAIN OUTCOME MEASURE(S) Outcome parameters and cumulative PRs were calculated and compared in relation to indication, age, and origin of sperm used. RESULT(S) Overall PR, implantation rate, clinical PR, and miscarriage rate per embryo transfer performed were 54.9%, 27%, 50.3%, and 19%, respectively. Ongoing PR per transfer was 40.2%, and twin and high-order multiple PRs were 39% and 6%, respectively. Mean number of embryos transferred was reduced from 3.6 +/- 0.8 to 1.9 +/- 0.3, implantation rate improved from 16.7% to 38.3%, and ongoing PR improved from 31% to 44.3%. Cumulative PRs did not differ significantly among different indications for oocyte donation, age groups, or origin of sperm used for oocyte insemination. Overall cumulative PRs after three and five cycles were calculated as 87% and 96.8%, respectively. CONCLUSION(S) Significant improvements in outcome parameters were achieved within 10 years. Similar cumulative PRs were observed regardless of recipient age, indication for oocyte donation, or sperm origin.
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Affiliation(s)
- Erdal Budak
- Instituto Valenciano de Infertilidad, University of Valencia, Valencia, Spain
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Hendriks J, Riesle J, van Blitterswijk CA. Co-culture in cartilage tissue engineering. J Tissue Eng Regen Med 2007; 1:170-8. [DOI: 10.1002/term.19] [Citation(s) in RCA: 106] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Rubio C, Rodrigo L, Mercader A, Mateu E, Buendía P, Pehlivan T, Viloria T, De los Santos MJ, Simón C, Remohí J, Pellicer A. Impact of chromosomal abnormalities on preimplantation embryo development. Prenat Diagn 2007; 27:748-56. [PMID: 17546708 DOI: 10.1002/pd.1773] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To evaluate the influence of numerical chromosomal abnormalities on preimplantation embryo development. METHODS This study includes 6936 embryos from 1245 women undergoing preimplantation genetic diagnosis (PGD). Indications for aneuploidy screening were: recurrent miscarriages, implantation failure, severe male factor, advanced maternal age, and mixed causes. Embryo biopsy was performed on day 3, and embryos were co-cultured until day 5, when embryo transfer was performed. RESULTS In the aneuploidy screening regimen, normal euploid embryos showed significantly higher blastocyst rates (68.2%) compared to chromosomally abnormal (42.8%, p < 0.0001) and mosaic (53.7%, p < 0.0001) embryos. Among aneuploid embryos for autosomes, higher blastocyst rates were observed in trisomies than monosomies, although only statistically significant in patients over 36 years of age (50.8 vs 38.9%; p < 0.0001). In contrast, in embryos with sex chromosomes aneuploidy, similar blastocyst rates were observed between trisomies and monosomy X. CONCLUSION Embryos with certain types of chromosomal abnormalities were negatively selected during preimplantation embryo development. Despite this selection, a remarkable percentage of chromosomally abnormal embryos can develop normally to blastocyst stage with high probability of implantation and pregnancy.
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Affiliation(s)
- Carmen Rubio
- Instituto Valenciano de Infertilidad, Universidad de Valencia, Valencia, Spain.
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Heteroparental blastocyst production from microsurgically corrected tripronucleated human embryos. Fertil Steril 2006; 86:1601-7. [PMID: 17067583 DOI: 10.1016/j.fertnstert.2006.04.047] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2006] [Revised: 04/28/2006] [Accepted: 04/28/2006] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To prove the efficiency of identification and removal of one of the surplus paternal pronuclei in dispermic IVF zygotes to obtain heteroparental blastocysts. DESIGN Experimental. SETTING One hundred fourteen tripronucleated (3PN) embryos from conventional IVF. PATIENT(S) After informed and signed consent, the patients from Instituto Valenciano Infertilidad (IVI), Valencia, donated their abnormally fertilized embryos. INTERVENTION(S) Seventy-two embryos were diploidized by microsurgical removal of the pronucleus located at the farthest position to the second polar body. Forty-two 3PN embryos served as controls. MAIN OUTCOME MEASURE(S) Survival and correction rate; in vitro development up to the blastocyst stage; X, Y, and 18 chromosome determination by triple fluorescent in situ hybridization and, inheritance analysis for 10 polymorphic repeat regions using polymerase chain reaction (PCR) amplification and sequencing. RESULT(S) Seventy-eight percent of 3PN zygotes (56/72) survived manipulation and eventually 51 zygotes had two pronuclei (71%). Forty-one percent of manipulated embryos progressed in vitro to the blastocyst stage (21/51). Fluorescent in situ hybridization analysis performed on eight manipulated embryos confirmed their diploid state; all four controls were triploid. Heteroparental inheritances were also confirmed in four of six manipulated embryos. CONCLUSION(S) Heteroparental blastocysts can be derived from corrected dispermic zygotes.
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Gardner DK, Lane M. Ex vivo early embryo development and effects on gene expression and imprinting. Reprod Fertil Dev 2006; 17:361-70. [PMID: 15745644 DOI: 10.1071/rd04103] [Citation(s) in RCA: 112] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2004] [Accepted: 12/02/2004] [Indexed: 11/23/2022] Open
Abstract
The environment to which the mammalian embryo is exposed during the preimplantation period of development has a profound effect on the physiology and viability of the conceptus. It has been demonstrated that conditions that alter gene expression, and in some instances the imprinting status of specific genes, have all previously been shown to adversely affect cell physiology. Thus, questions are raised regarding the aetiology of abnormal gene expression and altered imprinting patterns, and whether problems can be averted by using more physiological culture conditions. It is also of note that the sensitivity of the embryo to its surroundings decreases as development proceeds. Post compaction, environmental conditions have a lesser effect on gene function. This, therefore, has implications regarding the conditions used for IVF and the culture of the cleavage stage embryo. The developmental competence of the oocyte also impacts gene expression in the embryo, and therefore superovulation has been implicated in abnormal methylation and imprinting in the resultant embryo. Furthermore, the genetics and dietary status of the mother have a profound impact on embryo development and gene expression. The significance of specific animal models for human assisted reproductive technologies (ART) is questioned, given that most cattle data have been obtained from in vitro-matured oocytes and that genes imprinted in domestic and laboratory animals are not necessarily imprinted in the human. Patients treated with ART have fertility problems, which in turn may predispose their gametes or embryos to greater sensitivities to the process of ART. Whether this is from the drugs involved in the ovulation induction or from the IVF, intracytoplasmic sperm injection or culture procedures themselves remains to be determined. Alternatively, it may be that epigenetic alterations are associated with infertility and symptoms are subsequently revealed through ART. Whatever the aetiology, continued long-term monitoring of the children conceived through ART is warranted.
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Affiliation(s)
- David K Gardner
- Colorado Center for Reproductive Medicine, Englewood, 80113, USA.
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Escribá MJ, Escobedo-Lucea C, Mercader A, de los Santos MJ, Pellicer A, Remohí J. Ultrastructure of preimplantation genetic diagnosis-derived human blastocysts grown in a coculture system after vitrification. Fertil Steril 2006; 86:664-71. [PMID: 16831437 DOI: 10.1016/j.fertnstert.2006.01.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2005] [Revised: 01/27/2006] [Accepted: 01/27/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To evaluate ultrastructural features of preimplantation genetic diagnosis (PGD) blastocysts before and after vitrification. DESIGN Descriptive study of both vitrified and fresh hatching blastocysts. SETTING PGD program at the Instituto Universitario, Instituto Valenciano de Infertilidad. PATIENT(S) Patients undergoing PGD donated their abnormal embryos for research (n = 26). INTERVENTION(S) Biopsied embryos were cultured in the presence of human endometrial cells until day 6. Sixteen blastocysts were vitrified. A total of 11 high-scored hatching blastocysts, 6 warmed and 5 fresh, were fixed for ultrastructure. MAIN OUTCOME MEASURE(S) The cytoskeleton structure, type of intercellular junctions, and basic intracellular organelles in trophoectoderm cells and the inner cell mass were analyzed. RESULT(S) Ten of 16 blastocysts (62%) survived the warming process. Six of these showed no signs of cell degeneration and light microscopy revealed similar ultrastructural characteristics to those of controls. However, in trophoectoderm cells from both fresh and cryopreserved blastocysts, a reduced number of tight junctions and the presence of degradation bodies were detected. CONCLUSION(S) The particular ultrastructural features observed in PGD-derived blastocysts could be related to embryo manipulation and culture conditions. Vitrification does not seem to alter blastocysts, as those that survive hatching do not display detectable cellular alterations when observed through electron microscopy.
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Abstract
Human embryonic stem cells (hESCs) are derived from preimplantation embryos. Approximately 60% of human embryos are blocked during in vitro development. Although statistics are inconclusive, experience demonstrates that hESCs are more effectively derived from high-quality embryos. In this way, optimal human embryo culture conditions are a crucial aspect in any derivation laboratory. Embryos can be cultured solely with sequential media or cocultured on a monolayer of a given cell type. This chapter explores general aspects of human embryonic development, the concept of sequential culture and coculture, and specific protocols and procedures in which the authors are experienced, including the results obtained.
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Affiliation(s)
- Amparo Mercader
- Instituo Valenciano de Infertilidad, Instituto Universitario, Vanencia, Spain
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Abstract
Implantation is a complicated process that requires the orchestration of a series of events involving both the embryo and the endometrium. Even with the transfer of high quality embryos, implantation rates remain relatively low. The growing tendency towards transferring fewer embryos provides further incentives to improve implantation rates. In this article, the various clinical strategies employed to increase the chance of implantation are reviewed. Embryo transfer technique is a critical step in assisted reproductive technology cycles. Recent studies have shown significant improvements in clinical pregnancy rates resulting from careful embryo transfer technique, appropriate catheter type and placing for embryo transfer. Increasingly, adjuvant pharmaceutical therapies are also being applied with the aim of improving embryo implantation. However, the evidence for their efficacy and safety is limited. Recent evidence suggests that adoption of milder ovarian stimulation regimens may provide a more effective clinical approach to improving implantation, since beneficial effects have been shown for both endometrial receptivity and embryo quality.
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Affiliation(s)
- C M Boomsma
- Department of Reproductive Medicine and Gynaecology, University Medical Centre Utrecht, The Netherlands.
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