Light retardance by human oocyte spindle is positively related to pronuclear score after ICSI

Exploring the Impact of Controlled Ovarian Stimulation and Non-Invasive Oocyte Assessment in ART Treatments

Invasive and noninvasive features are normally applied to select developmentally competent oocytes and embryos that can increase the take-home baby rates in assisted reproductive technology. The noninvasive approach mainly applied to determine oocyte and embryo competence has been, since the early days of IVF, the morphological evaluation of the mature cumulus-oocyte complex at the time of pickup, first polar body, zona pellucida thickness, perivitelline space and cytoplasm appearance. Morphological evaluation of oocyte quality is one of the options used to predict successful fertilization, early embryo development, uterine implantation and the capacity of an embryo to generate a healthy pregnancy to term. Thus, this paper aims to provide an analytical revision of the current literature relating to the correlation between ovarian stimulation procedures and oocyte/embryo quality. In detail, several aspects of oocyte quality such as morphological features, oocyte competence and its surrounding environment will be discussed. In addition, the main noninvasive features as well as novel approaches to biomechanical parameters of oocytes that might be correlated with the competence of embryos to produce a healthy pregnancy and live birth will be illustrated.

Non-invasive oocyte quality assessment

Oocyte quality is perhaps the most important limiting factor in female fertility; however, the current methods of determining oocyte competence are only marginally capable of predicting a successful pregnancy. We aim to review the predictive value of non-invasive techniques for the assessment of human oocytes and their related cells and biofluids that pertain to their developmental competence. Investigation of the proteome, transcriptome, and hormonal makeup of follicular fluid, as well as cumulus-oocyte complexes are currently underway; however, prospective randomized non-selection-controlled trials of the future are needed before determining their prognostic value. The biological significance of polar body morphology and genetics are still unknown and the subject of debate. The predictive utility of zygotic viscoelasticity for embryo development has been demonstrated, but similar studies performed on oocytes have yet to be conducted. Metabolic profiling of culture media using human oocytes are also limited and may require integration of automated, high-throughput targeted metabolomic assessments in real time with microfluidic platforms. Light exposure to oocytes can be detrimental to subsequent development and utilization of time-lapse imaging and morphometrics of oocytes is wanting. Polarized light, Raman microspectroscopy, and coherent anti-Stokes Raman scattering are a few novel imaging tools that may play a more important role in future oocyte assessment. Ultimately, the integration of chemistry, genomics, microfluidics, microscopy, physics, and other biomedical engineering technologies into the basic studies of oocyte biology, and in testing and perfecting practical solutions of oocyte evaluation, are the future for non-invasive assessment of oocytes.

Paraquat Reduces the Female Fertility by Impairing the Oocyte Maturation in Mice

Paraquat (PQ) is a widely used non-selective and oxidizing herbicide in farmland, orchards, flower nursery, and grassland. Overuse of PQ will accumulate in the body and affect the reproduction in mammals. In this study, we found that PQ could reduce the female fertility by oral administration for 21 days in mice. PQ exposure could impair the nuclear maturation by perturbing the spindle assembly and kinetochore–microtubule attachment to cause the misaligned chromosomes during meiosis. In the meantime, PQ exposure disturbed the mitochondrial distribution and enhanced the level of reactive oxygen species and early apoptosis, which thereby deteriorated the early embryo development. Also, PQ administration could cause some changes in epigenetic modifications such as the level of H3K9me2 and H3K27me3. Therefore, PQ administration reduces the female fertility by impairing the nuclear and cytoplasmic maturation of oocytes in mice.

Selection of competent oocytes by morphological criteria for assisted reproductive technologies

Invasive and noninvasive methods are commonly used to select developmentally competent oocytes that can improve the take-home baby rates in assisted reproductive technology (ART) centers. One of the noninvasive methods conventionally utilized to determine competent oocytes is the morphological analysis of cumulus complex, first polar body, zona pellucida, perivitelline space, meiotic spindle, and ooplasm. Successful fertilization, early embryo development, uterine implantation, and healthy pregnancy depend on the quality of oocytes, and morphological evaluation is one of the options used to predict quality levels. In this review, the morphological criteria being utilized in certain ART centers are comprehensively evaluated with special references to their predictive values and potential contributions to selecting high-quality oocytes.

pH: the silent variable significantly impacting meiotic spindle assembly in mouse oocytes

RESEARCH QUESTION

Temperature fluctuation negatively impacts the assembly and function of the meiotic spindle, but does pH have a similar effect?

DESIGN

Polarized light microscopy was used to study the spindle in living mouse oocytes under different pH conditions. Female mice (n = 53) were superovulated, and oocytes collected, denuded and allocated to treatment groups. All experiments were performed at 37°C, and standard bicarbonate-buffered medium was used either pre-equilibrated in 6% CO₂ or unequilibrated (in ambient CO₂). Mean oocyte spindle retardance was measured over time in response to changing pH. Spindles were also assessed to understand whether this effect was reversible, by using a fixed pH in a zwitterionic buffer.

RESULTS

The data show the spindle is impacted by pH fluctuation, with mean retardance significantly higher at pH 7.4-7.5 than at the point of media equilibration (P < 0.001). This effect was found to be reversible; retardance significantly decreased after transition of the oocytes from pH 7.43 or pH 7.53 back to the original pre-equilibration pH of 7.32 (P < 0.05).

CONCLUSIONS

This study has shown that the meiotic spindle in mouse oocytes is highly sensitive to changes in oocyte culture media pH. If comparable in humans, this has significance as to the pH level of culture media currently used in assisted reproductive technology clinics worldwide, and reinforces the requirement for stringent control over extrinsic variables in the IVF laboratory.

Does the meiotic spindle really predicts embryo implantation and live birth rates? An update

SummaryThe aim of this study was to determine the capacity of the meiotic spindle (MS) to predict embryo implantation and live birth rates. For this purpose, we performed a broad systematic literature search. Of all publications retrieved, only those in which the implantation rates were related to some characteristics of the MS were evaluated. Despite the different methodology used in all the chosen studies, presence of the MS in oocytes was found to be positively associated with embryo implantation. Moreover, high retardance values, as well as strict criteria of normality in the MS structure, are significantly related to higher embryo implantation numbers and live birth rates.

Meiotic spindle size is a strong indicator of human oocyte quality

PURPOSE

To investigate the relationship between the meiotic spindle size in human metaphase II oocytes and embryo developmental potential after intracytoplasmic sperm injection (ICSI).

METHODS

Analyzed were 1302 oocytes with a visible meiotic spindle from 281 patients aged under 40 years undergoing ICSI cycles. The meiotic spindle was imaged by using PolScope before ICSI. The oocytes were classified into three groups, according to spindle size: group A (<90 μm2), group B (90-120 μm2), and group C (>120 μm2).

RESULTS

Overall, 389 (29.9%) oocytes were classified into group A, 662 (50.8%) into group B, and 251 (19.3%) into group C. The fertilization rate of the group B oocytes was significantly higher than for the A and C oocytes. The blastocyst formation rate in group B was significantly higher than in group A. In addition, the pregnancy rate in group B was significantly higher than in the other two groups.

CONCLUSION

The oocytes with a spindle size of 90-120 μm2 showed higher fertilization, blastocyst formation, and clinical pregnancy rates than those with larger or smaller spindles. The measurement of the meiotic spindle size thus has a positive predictive value for identifying human embryo developmental potential clinically.

Relationship between meiotic spindles visualization and intracytoplasmic sperm injection outcomes in human oocytes

In assisted reproductive techniques, the operator attempts to select morphologically best embryos to predict embryo viability. Development of polarized light microscope, which evaluates the oocytes' spindles according to birefringence of living cells, had been helpful in oocyte selection. The aim of this study is evaluating the relationship between meiotic spindles visualization and intracytoplasmic sperm injection (ICSI) outcomes in human oocytes. In this study, 264 oocytes from 24 patients with an average age of 30.5±7.5 years with infertility duration of 1 to 10 years were collected. The oocytes were randomly allocated to the control injection group (n=126) and the oocyte imaging group (spindle-aligned group) (n=138). In the spindle-aligned group, the meiotic spindle was identified by means of polarized light microscope to align the spindle at 6 or 12 o'clock. Then the spindle-aligned group was divided into three sub-groups based on spindle morphology: fine, average, and (poor). After ICSI, embryos were checked every 24 hours and scored; 72 hours later, high-grade embryos were transferred intravaginally to uterus. This study showed that the fertilization rate in the spindle-aligned group was higher than the control group (P<0.05). After cleavage, a positive correlation was observed between spindle morphology and embryo morphology. Among the sub-groups of spindle-aligned group, the embryos' morphology of the fine group was better than the other subgroups and embryos of the poor group had lower quality and more fragmentation. The results revealed that the selection of oocytes based on meiotic spindle imaging can significantly improve the rate of fertilization and embryo cleavage and certainly increase the rate of implantation.

Predictive value of spindle retardance in embryo implantation rate

PURPOSE

We evaluated the relationship between meiotic spindle characteristics and in vitro fertilization cycle outcome.

METHODS

Five hundred sixty-nine oocytes from 86 in vitro fertilization cycles were analyzed for fertilization and subsequent implantation rates. Oocytes were assessed for maturation status. The oocytes and embryos were cultured in sequential and nonsequential media (G Series, Vitrolife, Sweden) and incubated in 6% CO₂, 5% O₂ at 37 °C. Two hours following oocyte decumulation (38-39 h post-hCG/GnRH administration) and prior to microinjection, the structure of the meiotic spindle was assessed using the Oosight Imaging System (CRI, UK).

RESULTS

Four hundred fifty-six oocytes (80.5%) had a visible meiotic spindle, 82 (14.7%) had no meiotic spindle, and 31 (5.5%) were in telophase I. Oocytes exhibiting a meiotic spindle had a significantly higher fertilization rate and a lower rate of abnormal fertilization. Implantation data were obtained for 195 of the embryos transferred. The implantation rate for embryos derived from oocytes with a meiotic spindle was 32.9%, while in embryos originating from oocytes without a meiotic spindle and oocytes in telophase, this value dropped significantly (8.8 and 0%, respectively). To determine the correlation between retardance values and implantation rate for each oocyte, we established four groups, finding a range of retardance values with significantly higher implantation rates (27.5, 21, 29.3, and 53.8%, respectively).

CONCLUSION

Meiotic spindle imaging may be a valuable tool for prediction of oocyte quality, and retardance values of meiotic spindles, together with classical morphological classification, can be useful to select embryos with a higher implantation potential.

Improved cryotolerance and developmental potential of in vitro and in vivo matured mouse oocytes by supplementing with a glutathione donor prior to vitrification

STUDY QUESTION

Can supplementation of media with a glutathione (GSH) donor, glutathione ethyl ester (GEE), prior to vitrification protect the mouse oocyte from oxidative damage and critical changes in redox homeostasis, and thereby improve cryotolerance?

SUMMARY ANSWER

GEE supplementation supported redox regulation, rapid recovery of spindle and chromosome alignment after vitrification/warming and improved preimplantation development of mouse metaphase II (MII) oocytes.

WHAT IS KNOWN ALREADY

Cryopreservation may affect mitochondrial functionality, induce oxidative stress, and thereby affect spindle integrity, chromosome segregation and the quality of mammalian oocytes. GEE is a membrane permeable GSH donor that promoted fertilization and early embryonic development of macaque and bovine oocytes after IVM.

STUDY DESIGN, SIZE, DURATION

Two experimental groups consisted of (i) denuded mouse germinal vesicle (GV) oocytes that were matured in vitro in the presence or absence of 1 mM GEE (IVM group 1) and (ii) in vivo ovulated (IVO) MII oocytes that were isolated from the ampullae and exposed to 1 mM GEE for 1 h prior to vitrification (IVO group 2). Recovery of oocytes from both groups was followed after CryoTop vitrification/warming for up to 2 h and parthenogenetic activation.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Reactive oxygen species (ROS), spindle morphology and chromosome alignment were analyzed by confocal laser scanning microscopy (CLSM) and polarization microscopy in control and GEE-supplemented MII oocytes. The relative overall intra-oocyte GSH content was assessed by analysis of monochlorobimane (MBC)-GSH adduct fluorescence in IVM MII oocytes. The GSH-dependent intra-mitochondrial redox potential (E^m_GSH) of IVM MII oocytes was determined after microinjection with specific mRNA at the GV stage to express a redox-sensitive probe within mitochondria (mito-Grx1-roGFP2). The absolute negative redox capacity (in millivolts) was determined by analysis of fluorescence of the oxidized versus the reduced form of sensor by CLSM and quantification according to Nernst equation. Proteome analysis was performed by quantitative 2D saturation gel electrophoresis (2D DIGE). Since microinjection and expression of redox sensor mRNA required removal of cumulus cells, and IVM of denuded mouse oocytes in group 1 induces zona hardening, the development to blastocysts was not assessed after IVF but instead after parthenogenetic activation of vitrified/warmed MII oocytes from both experimental groups.

MAIN RESULTS AND ROLE OF CHANCE

IVM of denuded mouse oocytes in the presence of 1 mM GEE significantly increased intra-oocyte GSH content. ROS was not increased by CryoTop vitrification but was significantly lower in the IVM GEE group compared to IVM without GEE before vitrification and after recovery from vitrification/warming (P < 0.001). Vitrification alone significantly increased the GSH-dependent intra-mitochondrial redox capacity after warming (E^m_GSH, P < 0.001) in IVM oocytes, presumably by diffusion/uptake of cytoplasmic GSH into mitochondria. The presence of 1 mM GEE during IVM increased the redox capacity before vitrification and there was no further increase after vitrification/warming. None of the reproducibly detected 1492 spots of 2D DIGE separated proteins were significantly altered by vitrification or GEE supplementation. However, IVM of denuded oocytes significantly affected spindle integrity and chromosome alignment right after warming from vitrification (0 h) in group 1 and spindle integrity in group 2 (P < 0.05). GEE improved recovery in IVM group as numbers of oocytes with unaligned chromosomes and aberrant spindles was not significantly increased compared to unvitrified controls. The supplementation with GEE for 1 h before vitrification also supported more rapid recovery of spindle birefringence. GEE improved significantly development to the 2-cell stage for MII oocytes that were activated directly after vitrification/warming in both experimental groups, and also the blastocyst rate in the IVO GEE-supplemented group compared to the controls (P < 0.05).

LARGE SCALE DATA

None LIMITATIONS, REASONS FOR CAUTION: The studies were carried out in a mouse model, in IVM denuded rather than cumulus-enclosed oocytes, and in activated rather than IVF MII oocytes. Whether the increased GSH-dependent intra-mitochondrial redox capacity also improves male pronuclear formation needs to be studied further experimentally. The influence of GEE supplementation requires also further examination and optimization in human oocytes before it can be considered for clinical ART.

WIDER IMPLICATIONS OF THE FINDINGS

Although GEE supplementation did not alter the proteome at MII, the GSH donor may support cellular homeostasis and redox regulation and, thus, increase developmental competence. While human MII oocyte vitrification is an established procedure, GEE might be particularly beneficial for oocytes that suffer from oxidative stress and reduced redox capacity (e.g. aged oocytes) or possess low GSH due to a reduced supply of GSH from cumulus. It might also be of relevance for immature human oocytes that develop without cumulus to MII in vitro (e.g. in ICSI cycles) for ART.

STUDY FUNDING AND COMPETING INTERESTS

The study has been supported by the German Research Foundation (DFG FOR 1041; EI 199/3-2). There are no conflict of interests.

Targeting oocyte maturation to improve fertility in older women

Reproductive aging is an increasingly pressing problem facing women in modern society, due to delay in child bearing. According to Statistics Canada, 52% of all Canadian births in 2011 were by women aged 30 years and older, up from 24% in 1981 ( http://www.statcan.gc.ca/pub/91-209-x/2013001/article/11784-eng.htm ). Women older than 35 years of age experience significantly increased risks of infertility, miscarriage and congenital birth defects, mostly due to poor quality of the eggs. Increasingly sophisticated, and often invasive, assisted reproductive technologies (ARTs) have helped millions of women to achieve reproductive success. However, by and large, ARTs do not address the fundamental issue of reproductive aging in women: age-related decline in egg quality. More importantly, ARTs are not, and will never be, the main solution for the general population. Here, I attempt to review the scientific literature on age-related egg quality decline, based mostly on studies in mice and in humans. Emphasis is given to the brief period of time called oocyte maturation, which occurs just prior to ovulation. The rationale for this emphasis is that oocyte maturation represents a critical window where unfavorable ovarian conditions in older females contribute significantly to the decline of egg quality, and that science-based intervention during oocyte maturation represents the best chance of improving egg quality in older women. Finally, I summarize our own work in recent years on peri-ovulatory putrescine supplementation as a possible remedy for reproductive aging.

Effects of maternal ageing on ICSI outcomes and embryo development in relation to oocytes morphological characteristics of birefringent structures

The aim of this study was to determine the morphological characteristics of the older reproductive aged women's oocytes and to reveal the influence of these characteristics on intra-cytoplasmic sperm injection (ICSI) outcomes. The oocytes of women older than 35 years of age were evaluated retrospectively. Non-invasive polarization microscopy (PolScope) examinations of mature oocytes were performed by measurement of meiotic spindles’ length, area and retardance and zona pellucida thickness and retardance. Fertilization and conception competence and the correlation with the birefringent structures were assessed. Two hundred and thirteen mature oocytes from 54 women were evaluated with a PolScope. Length of the meiotic spindle was shown to be related to fertilization success of women with advanced maternal age. In conclusion, the PolScope is a useful device used to identify the oocyte quality. Quantitative measurements of meiotic spindle parameters may be valuable for the selection of high-quality oocytes that have the potential for embryo development in the in vitro fertilization (IVF) laboratory of women older than 35 years of age who are mostly poor responders.

Embryo culture and selection: morphological criteria

In this chapter, we have outlined the various morphological criteria for selection of the best embryo at each important milestone encountered in the progress from the oocyte to the blastocyst. As Gerris et al. stated, a combination of one, two, or even three selection points should lead to a more accurate selection of the best embryo, as no one criterion is better than the other. An embryo that fails to meet the entire set of selection criteria must be avoided as culture cannot correct an impaired embryo.

The impact of examining the meiotic spindle by polarization microscopy on assisted reproduction outcomes

OBJECTIVE

To examine the effect of submitting oocytes to polarization microscopy (PM) before intracytoplasmic sperm injection (ICSI).

DESIGN

Retrospective observational study.

SETTING

University hospital in Brazil.

PATIENT(S)

Couples undergoing ICSI.

INTERVENTION(S)

PM before ICSI (PM group) compared with no PM before ICSI (No-PM group)

MAIN OUTCOMES MEASURE(S)

Fertilization and cleavage rates, formation of top-quality embryos (TQEs), and implantation, clinical pregnancy, miscarriage, and live-birth rates.

RESULT(S)

The PM group consisted of 1,000 consecutive oocytes from 201 couples submitted to PM during the year of 2008. The No-PM group consisted of 1,400 oocytes from 249 couples: 700 consecutive oocytes were retrieved before we started using PM and 700 consecutive oocytes were retrieved after we stopped using PM. In the PM group, we observed an increased fertilization rate (79.7% vs. 72.5%, PM group vs. No-PM group, respectively) but reduced cleavage rate (86.2% vs. 92.5%) and TQE formation (33.1% vs. 49.9%). Implantation (18.7% vs. 20.6%), clinical pregnancy (31.8% vs. 33.3%), miscarriage (21.9% vs. 15.7%), and live-birth (24.9% vs. 28.1%) rates were not significantly different between groups.

CONCLUSION(S)

Use of PM was associated with increased fertilization rate but reduced cleavage rate and TQE formation; no significant difference was observed for implantation, clinical pregnancy, or live-birth rates.

The root of reduced fertility in aged women and possible therapentic options: current status and future perspects

It is well known that maternal ageing not only causes increased spontaneous abortion and reduced fertility, but it is also a high genetic disease risk. Although assisted reproductive technologies (ARTs) have been widely used to treat infertility, the overall success is still low. The main reasons for age-related changes include reduced follicle number, compromised oocyte quality especially aneuploidy, altered reproductive endocrinology, and increased reproductive tract defect. Various approaches for improving or treating infertility in aged women including controlled ovarian hyperstimulation with intrauterine insemination (IUI), IVF/ICSI-ET, ovarian reserve testing, preimplantation genetic diagnosis and screening (PGD/PGS), oocyte selection and donation, oocyte and ovary tissue cryopreservation before ageing, miscarriage prevention, and caloric restriction are summarized in this review. Future potential reproductive techniques for infertile older women including oocyte and zygote micromanipulations, derivation of oocytes from germ stem cells, ES cells, and iPS cells, as well as through bone marrow transplantation are discussed.

Effects of frozen timing on the spindle density, the angle between the polar body and spindle, and embryo development of intracytoplasmic sperm injection in mouse mature oocytes

Better pregnancy outcomes can be obtained by human mature oocyte vitrification, but many problems remain to be resolved in human mature oocyte vitrification. Since mature oocyte development possesses its own maturity cycle, there should be the optimal timing for mature oocyte vitrification. The purpose of this study was to observe the effects of frozen timing on the spindle density, the angle between the polar body and spindle, and embryo development of intracytoplasmic sperm injection (ICSI) in vitrified mouse mature oocytes and explore its possible mechanism. Mouse oocytes were randomly divided into three groups according to different frozen timing including Groups A, B, and C in which oocytes were vitrified within 2 h after ovum pick-up, and 3-4 and 5-6 h after ovum pick-up, respectively. Spindle-related parameters were measured, ICSI was performed. The spindle occurrence rate of vitrified-thawed oocytes was 98.4% in Group A, 82.3% in Group B, and 75.8% in Group C, without statistical differences between pre-vitrification and post-thawing and among the three groups (P > 0.05). The angles between the polar body and spindle were larger after thawing than before vitrification (P < 0.01). The spindle retardance values were lower after thawing than before vitrification in Groups B and C (P < 0.05), but higher in Group A (P < 0.05). The spindle retardance values before vitrification were higher in Group B than in Groups A and C (P < 0.05), but the spindle retardance value, oocyte survival and two-cell rate after thawing were higher in Group A than in Groups B and C (P < 0.05). There were no statistical differences in ICSI fertility rate between the three groups (P > 0.05). The damage on the spindle is the slightest and embryo quality is the highest in the mouse oocytes vitrified within 2 h after ovum pick-up. The spindle retardance value is more valuable than the spindle occurrence rate in the evaluation of vitrified-thawed oocyte quality, and is positively correlated with embryo quality.

Polarized light microscopy-detectable structures of human oocytes and embryos are related to the likelihood of conception in IVF

PURPOSE

To clarify if birefringent structures of human oocytes and embryos, measurable by polarized light microscopy, have any value in predicting the chance of pregnancy in human in vitro fertilization and may halp to identify the most competent oocytes and embryos.

METHODS

The inner layer of the zona pellucida (IL-ZP) and the meiotic spindle (MS) were analyzed by polarized light microscopy in 258 oocytes and in the 209 embryos deriving from them. Data obtained from 102 ICSI cycles with conception were compared with those obtained in 156 cycles without conception. The retardance and area of the IL-ZP, as well as the retardance, length of the major axis, and area of the MS were measured. Furthermore, polarized light microscopy parameters were related to the embryo morphological score by multiple regression analysis.

RESULT(S)

The mean area of the IL-ZP of both oocytes and embryos was significantly lower in conception than in non-conception cycles (p = 0.0001 for oocytes and p = 0.002 for embryos). The area of the IL-ZP in embryos was significantly, inversely related to the embryo morphological score (p = 0.011). The area, the major axis length and the retarcance of the MS, as well as the retardance of the IL-ZP in oocytes and embryos were comparable in conception and non-conception cycles.

CONCLUSION

The area of the IL-ZP of the human oocytes may represent a marker of oocyte competence, as oocytes with a low IL-ZP area are more frequently obtained in conception cycles. When measured in embryos, a low IL-ZP area identifies embryos with a high chance of implantation.

Relationship between meiotic spindle characteristics in human oocytes and the timing of the first zygotic cleavage after intracytoplasmic sperm injection

PURPOSE

To investigate the relationship between meiotic spindle characteristics in human oocytes and the timing of the first zygotic cleavage after intracytoplasmic sperm injection (ICSI).

METHODS

Zygotes that had cleaved to two-cell stage by 27 h post-ICSI were classified as early cleaving and the remainder as late cleaving. Meiotic spindle parameters previously imaged using the PolScope were compared between the two groups.

RESULTS

Of 384 embryos, 163 were classed as early cleaving and 221 as late cleaving. The rate of blastocyst formation or pregnancy by Day 2 embryo transfer was significantly higher following early cleavage than after late cleavage (52.4% vs. 24.4% or 32.6% vs. 11.4%). Spindle areas (108.0 vs. 89.8 μm(2)), lengths (14.7 vs. 13.4 μm) and PolScope retardance were also significantly greater in the early cleaving group.

CONCLUSIONS

Meiotic spindle parameters determine the timing of the first zygotic cleavage and are strong indicators of human embryo developmental potential.

Relevance and Methodology for the Morphological Analysis of Oocyte Quality in IVF and ICSI

Oocytes collected from patients following ovarian stimulation exhibit varying qualities. The quality of oocytes has an effect on its subsequent fertilization, developmental competence post-fertilization and the viability of resultant embryos. The aim of this article was to review the morphological criteria devised for assessment of oocyte quality by ordinary light and polarized light microscopy before IVF or ICSI. The parameters employed in the evaluation of oocyte morphology include the appearance of: structure of the cumulus–oocyte complex, oocyte cytoplasm, perivitelline space, zona pellucida, polar body and meiotic spindle.

Laboratory evaluation in oocyte cryopreservation suggests retrieved oocytes are comparable whether frozen for medical indications, deferred reproduction or oocyte donation

PURPOSE

to compare pre-cryo data from oocyte cryopreservation (OC) cycles performed for malignancy (MED) vs. elective deferment of reproduction (DR) or oocyte donation (OD).

METHODS

all patients were ≤40 y and underwent standard ovarian stimulation and retrieval. Prior to OC, meiotic spindle (MS) and zona pellucida (ZP) retardance was measured using digital polarized light microscopy (DPLM).

RESULTS

of 130 OC cycles, 49 were for MED, 73 for DR, and 8 for OD. Cycles completed for MED had an average of 9 ±1 spindle-positive oocytes with a mean MS retardance of 1.2  ± 02 nm and ZP retardance of 2.1 ± .06 nm, which was clinically comparable to the other groups.

CONCLUSIONS

women with malignancy can achieve adequate ovarian response and similar oocyte parameters to those of women undergoing fertility preservation for non-cancer indications. Such information, coupled with the ability to noninvasively study oocyte dynamics, may improve the counseling of cancer patients seeking fertility preservation.

Predictive value of oocyte morphology in human IVF: a systematic review of the literature

BACKGROUND

Non-invasive selection of developmentally competent human oocytes may increase the overall efficiency of human assisted reproduction and is regarded as crucial in countries where legal, social or religious factors restrict the production of supernumerary embryos. The purpose of this study was to summarize the predictive value for IVF success of morphological features of the oocyte that can be obtained by light or polarized microscopic investigations.

METHODS

Studies about oocyte morphology and IVF/ICSI outcomes were identified by using a systematic literature search.

RESULTS

Fifty relevant articles were identified: 33 analysed a single feature, 9 observed multiple features and investigated the effect of these features individually, 8 summarized the effect of individual features. Investigated structures were the following: meiotic spindle (15 papers), zona pellucida (15 papers), vacuoles or refractile bodies (14 papers), polar body shape (12 papers), oocyte shape (10 papers), dark cytoplasm or diffuse granulation (12 papers), perivitelline space (11 papers), central cytoplasmic granulation (8 papers), cumulus–oocyte complex (6 papers) and cytoplasm viscosity and membrane resistance characteristics (2 papers). None of these features were unanimously evaluated to have prognostic value for further developmental competence of oocytes.

CONCLUSIONS

No clear tendency in recent publications to a general increase in predictive value of morphological features was found. These contradicting data underline the importance of more intensive and coordinated research to reach a consensus and fully exploit the predictive potential of morphological examination of human oocytes.

Time course of meiotic spindle development in MII oocytes

The aim of this study was to examine changes in meiotic spindle morphology over time to potentially optimize timing for ICSI. Using polarized light microscopy, images of MII oocytes were captured after retrieval of oocytes in stimulated cycles at six time intervals in culture: 36–36.5 h, 36.5–37.0 h, 38–38.5 h, 39–39.5 h, 40–40.5 h and 40.5–41 h post hCG. Captured images were analysed for spindle presence and their retardance. Results showed that spindles were detected in 58% (45/78) of oocytes at 36–36.5 h. This percentage rose to a peak (96% vs. 58%, p < 0.001) at 39–39.5 h and stabilized between 39–40.5 h post trigger then significantly declined at 40.5–41 h post hCG (96% vs. 77%, p < 0.001). Average spindle retardance increased from 36–36.5 h (1.8 ± 0.7 nm) until it peaked at 39–40.5 h (3.8 ± 0.8 nm, p < 0.0001) and then declined significantly after 40.5–41 h (3.2 ± 0.9 nm, p = 0.0001). These results show that the meiotic spindle appearance is time dependent with the majority of oocytes having detectable spindles and highest retardance between 39–40.5 h post hCG under currently used stimulation protocol after which they start to disaggregate. 39–40.5 h post hCG may be the optimal time for ICSI.

A PolScope evaluation of meiotic spindle dynamics in frozen-thawed oocytes

In mature human oocytes, the metaphase II (MII) spindle presence and birefringence signal detected through the PolScope may vary before and after freezing. In particular, spindle dynamics during the first few hours after thawing is still under study. In this study, oocytes from stimulated ovaries were cryopreserved in 1.5 mol/l 1,2-propanediol with 0.3 mol/l sucrose using a slow freezing-rapid thawing method. Oocytes were examined with the PolScope for the presence, intensity of signal birefringence and size of the meiotic spindle before freezing and at 0, 1 and 2 h post-thaw (where 0 h = the time of the end of the thawing procedure). Of the 173 surviving oocytes exhibiting a spindle before freezing, 82.7% (143/173) showed spindle birefringence within 1 h of thawing. However, at the end of the thawing procedure the intensity of spindle birefringence (retardance) and the spindle length were smaller in comparison to the pre-freezing condition. These parameters increased after 1 h, although were not restored to the value observed before freezing. No significant changes were observed by extending the culture to 2 h.

Are there non-invasive markers in human oocytes that can predict pregnancy outcome?

Predictive criteria for selection of the best embryo for single embryo transfer remain elusive. This study aimed to determine if non-invasive markers in human oocytes, detectable using polarized light microscopy, can predict pregnancy outcome. Twenty-two pregnancy-producing oocytes from 19 patients had their morphological features compared with 30 oocytes from 19 age-matched patients whose transfer did not result in a pregnancy. Both pregnant and non-pregnant patients had similar numbers of oocytes collected (average: 11.9 +/- 2.8 versus 11.3 +/- 2.9) and similar fertilization rates (70.1% versus 69.6%). All embryos transferred were 4-cell cleavage-stage on day 2 with <10% fragmentation. Meiotic spindles were examined at 39-40 h following human chorionic gonadotrophin administration for spindle normality, length, density and angle from first polar body. There was a significant difference in spindle normality in oocytes in the pregnant patients compared with oocytes in the non-pregnant patients (100% versus 33%, P < 0.001). Spindle density was significantly higher in those oocytes resulting in pregnancy (3.0 +/- 1.23 nm versus 2.5 +/- 0.7 nm, P = 0.02). These oocyte markers may provide a useful non-invasive tool in the selection of the embryo most likely to produce a pregnancy.

Relationship between visualization of meiotic spindle in human oocytes and ICSI outcomes: a meta-analysis

The objective of this meta-analysis was to investigate the influence of meiotic spindle visualization in human oocytes on intracytoplasmic sperm injection (ICSI) outcomes. Search strategies included on-line surveys of databases (MEDLINE, EMBASE, Science Citation Index, Cochrane Controlled Trials Register and Ovid). The fixed effect was used for odds ratio. Ten trials fulfilled the inclusion criteria comparing in-vitro and clinical ICSI outcomes with or without visualization of meiotic spindle in fresh and in-vivo matured oocytes. According to the meta-analysis, the results showed statistically significant higher fertilization rate (P < 0.0001) when the meiotic spindle was viewed than when it was not. Moreover, the percentage of pro-nuclear-stage embryos with good morphology (P = 0.003), cleavage rate (P < 0.0001), percentage of day-3 top-quality embryos (P = 0.003) and percentage of embryos that reached the blastocyst stage (P < 0.0001) were statistically significantly better among embryos derived from oocytes in which meiotic spindle was viewed compared with those in which meiotic spindle was not observed. However, these differences were not observed in the clinical pregnancy or implantation rates. This observation has clinical relevance mainly in countries where there is a legal limit on the number of oocytes to be fertilized. However, additional controlled trials are needed to further confirm these results.

Phase-subtraction cell-counting method for live mouse embryos beyond the eight-cell stage

Since 1978 in vitro fertilization (IVF) procedures have resulted in the birth of over 3 million babies. Yet in 2005, IVF procedures had a live birth rate of only 34%, with 32% of these births resulting in multiple pregnancies. These multiple pregnancies were directly attributed to the transfer of multiple embryos to increase the probability that a single, healthy embryo was included. The predominantly accepted noninvasive viability markers for embryos created by IVF are (1) number of cells at specific time points during development and (2) overall morphology of the embryo. Currently, it is difficult to count the number of cells beyond the eight-cell stage noninvasively. We report a nontoxic cell-counting method capable of counting cell numbers ranging from 8 to 26 in live mouse embryos. This method is derived from the fusion of differential interference contrast and optical quadrature microscopy and is verified by epifluorescence images of Hoechst-stained nuclei. The phase-subtraction cell-counting method is the first accurate, nontoxic technique to count cells through the morula stage in mouse embryos and may enhance the use of cell number as a viability marker if adopted for use with human embryos in the IVF clinic.

Meiosis in oocytes: predisposition to aneuploidy and its increased incidence with age

Mammalian oocytes begin meiosis in the fetal ovary, but only complete it when fertilized in the adult reproductive tract. This review examines the cell biology of this protracted process: from entry of primordial germ cells into meiosis to conception. The defining feature of meiosis is two consecutive cell divisions (meiosis I and II) and two cell cycle arrests: at the germinal vesicle (GV), dictyate stage of prophase I and at metaphase II. These arrests are spanned by three key events, the focus of this review: (i) passage from mitosis to GV arrest during fetal life, regulated by retinoic acid; (ii) passage through meiosis I and (iii) completion of meiosis II following fertilization, both meiotic divisions being regulated by cyclin-dependent kinase (CDK1) activity. Meiosis I in human oocytes is associated with an age-related high rate of chromosomal mis-segregation, such as trisomy 21 (Down's syndrome), resulting in aneuploid conceptuses. Although aneuploidy is likely to be multifactorial, oocytes from older women may be predisposed to be becoming aneuploid as a consequence of an age-long decline in the cohesive ties holding chromosomes together. Such loss goes undetected by the oocyte during meiosis I either because its ability to respond and block division also deteriorates with age, or as a consequence of being inherently unable to respond to the types of segregation defects induced by cohesion loss.

An oocyte score for use in assisted reproduction

PURPOSE

In this work, we describe a system for the morphological scoring of human oocytes prior to fertilisation and use this system to test whether oocyte morphology is an indicator of fertilisation, embryo development and implantation potential.

METHODS

The study is a prospective trial of the use of oocyte morphological scores in 822 patients undergoing their first cycle of ICSI. Analyses of oocytes were performed prior to ICSI procedures and the scores compared with fertilisation rates, embryo quality and clinical results.

RESULTS

'Top quality' oocytes had a significantly higher level of fertilisation (96%) as compared to low scoring oocytes (25.6%). Where top quality oocytes formed top quality embryos, we noted a clinical success rate of 63.4%.

CONCLUSIONS

Clinical success rates were increased in cases where top quality oocytes formed top quality embryos after ICSI. The analysis of oocyte morphology may represent a positive selection feature during ICSI.

Meiotic spindle and zona pellucida characteristics as predictors of embryonic development: a preliminary study using PolScope imaging

This study assesses meiotic spindle and zona pellucida characteristics using the PolScope, and analyses their relationship to embryonic development potential. A total of 205 matured oocytes retrieved from 25 patients undergoing ovarian stimulation were imaged for meiotic spindle and zona pellucida characteristics using the PolScope. After intracytoplasmic sperm injection, the oocytes were cultured and assessed for progression to blastocysts. Meiotic spindles were visualized in 78.0% of oocytes. Significantly more oocytes with visible spindles fertilized and progressed to blastocysts compared with oocytes without visible spindles. Oocytes with spindle retardance of >3 nm showed a greater progression to blastocysts compared with those with a retardance of 2-3 nm or <2 nm. More blastocysts were obtained from oocytes with spindle lengths of >12 nm than from oocytes with spindle lengths 10-12 nm or <10 nm. A difference in progression to blastocyst was observed in oocytes with a zona inner layer retardance of >3 nm compared with oocytes with retardance of 2-3 nm or <2 nm. Oocytes with an inner layer zona of 10-12 nm thickness showed better progression compared with those with a thickness of 8-10 nm or <8 nm. Quantitative measurement of length and retardance of the meiotic spindle and zona pellucida has a positive predictive value in relation to embryonic development.

Donor oocyte dysmorphisms and their influence on fertilization and embryo quality

The aim of this study was to identify predictors of fertilization rate (FR) and embryo quality (EQ) in 126 donor women who underwent 160 intracytoplasmic sperm injection (ICSI) cycles. Main outcome measures were oocyte dysmorphisms (OD) [perivitelline space (normal/large), perivitelline debris (no/yes), oocyte shape (spherical/non-spherical), zona pellucida (normal/abnormal), first polar body morphology (normal/fragmented or irregular), cytoplasmic granularity (normal/excessive), cytoplasmic vacuoles (no/yes) and colour of cytoplasm (normal/dark)], semen source (ejaculated or testicular), donor age, number of days of stimulation, plasma oestradiol concentration (pg/ml) on the day of human chorionic gonadotrophin administration, FR and day 2 EQ. No significant predictors of fertilization were identified. However, the presence of a dark cytoplasm decreased by 83% the likelihood of obtaining good quality embryos (OR=0.17; 95% CI: 0.04-0.74). Oocytes with a larger than normal perivitelline space were associated with 1.8 times higher chance of having good quality embryos (OR=1.80; 95% CI: 1.15-2.80). Patients and ovarian stimulation characteristics evaluated here did not affect FR and EQ. ICSI technique may guarantee good FR in spite of OD; however, certain cytoplasmic anomalies at the oocyte level, such as a dark cytoplasm, could compromise subsequent embryo development.

Objective evaluation of the viability of cryopreserved oocytes

Recent studies of fundamental cryobiology, empirical observations and more systematic clinical experiences have generated a renewed interest in oocyte cryopreservation. Poor survival rate has long been the limiting factor which has prevented widespread adoption of oocyte storage. Slow-cooling and vitrification protocols developed in the last few years have apparently solved this problem, ensuring high recovery of viable oocytes from liquid nitrogen storage. However, the definition of oocyte viability appears rather vague. In fact, post-storage survival as assessed on morphological criteria, indicated by the absence of overt cell degeneration, is not necessarily synonymous with viability. Despite its sensitivity to low temperatures, the meiotic spindle can be preserved after cryopreservation and its constitution after thawing can be monitored non-invasively through polarized light microscopy. Assessment of oocyte cryopreservation via clinical parameters is a daunting task. Most studies are small and difficult to interpret because of confounding factors, such as age, patient selection and quality and strategy of use of the cryopreserved material. Some progress has been made, however, as suggested by recent experiences in which the implantation efficiency of embryos produced from thawed oocytes approaches that reported using cryopreserved embryos directly.