1
|
Yang L, Leynes C, Pawelka A, Lorenzo I, Chou A, Lee B, Heaney JD. Machine learning in time-lapse imaging to differentiate embryos from young vs old mice†. Biol Reprod 2024; 110:1115-1124. [PMID: 38685607 PMCID: PMC11180621 DOI: 10.1093/biolre/ioae056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 02/15/2024] [Accepted: 04/05/2024] [Indexed: 05/02/2024] Open
Abstract
Time-lapse microscopy for embryos is a non-invasive technology used to characterize early embryo development. This study employs time-lapse microscopy and machine learning to elucidate changes in embryonic growth kinetics with maternal aging. We analyzed morphokinetic parameters of embryos from young and aged C57BL6/NJ mice via continuous imaging. Our findings show that aged embryos accelerated through cleavage stages (from 5-cells) to morula compared to younger counterparts, with no significant differences observed in later stages of blastulation. Unsupervised machine learning identified two distinct clusters comprising of embryos from aged or young donors. Moreover, in supervised learning, the extreme gradient boosting algorithm successfully predicted the age-related phenotype with 0.78 accuracy, 0.81 precision, and 0.83 recall following hyperparameter tuning. These results highlight two main scientific insights: maternal aging affects embryonic development pace, and artificial intelligence can differentiate between embryos from aged and young maternal mice by a non-invasive approach. Thus, machine learning can be used to identify morphokinetics phenotypes for further studies. This study has potential for future applications in selecting human embryos for embryo transfer, without or in complement with preimplantation genetic testing.
Collapse
Affiliation(s)
- Liubin Yang
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
- Division of Reproductive Endocrinology and Infertility, Division of Reproductive Sciences, Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, USA
| | - Carolina Leynes
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, USA
| | - Ashley Pawelka
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, USA
| | - Isabel Lorenzo
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, USA
| | - Andrew Chou
- Pain Research, Informatics, Multi-morbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Brendan Lee
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, USA
| | - Jason D Heaney
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, USA
| |
Collapse
|
2
|
Kashir J, Mistry BV, Rajab MA, BuSaleh L, Abu-Dawud R, Ahmed HA, Alharbi S, Nomikos M, AlHassan S, Coskun S, Assiri AM. The mammalian sperm factor phospholipase C zeta is critical for early embryo division and pregnancy in humans and mice. Hum Reprod 2024; 39:1256-1274. [PMID: 38670547 PMCID: PMC11145019 DOI: 10.1093/humrep/deae078] [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: 09/28/2023] [Revised: 03/13/2024] [Indexed: 04/28/2024] Open
Abstract
STUDY QUESTION Are sperm phospholipase C zeta (PLCζ) profiles linked to the quality of embryogenesis and pregnancy? SUMMARY ANSWER Sperm PLCζ levels in both mouse and humans correlate with measures of ideal embryogenesis whereby minimal levels seem to be required to result in successful pregnancy. WHAT IS KNOWN ALREADY While causative factors underlying male infertility are multivariable, cases are increasingly associated with the efficacy of oocyte activation, which in mammals occurs in response to specific profiles of calcium (Ca2+) oscillations driven by sperm-specific PLCζ. Although sperm PLCζ abrogation is extensively linked with human male infertility where oocyte activation is deficient, less is clear as to whether sperm PLCζ levels or localization underlies cases of defective embryogenesis and failed pregnancy following fertility treatment. STUDY DESIGN, SIZE, DURATION A cohort of 54 couples undergoing fertility treatment were recruited at the assisted reproductive technology laboratory at the King Faisal Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia. The recruitment criteria for males was a minimum sperm concentration of 5×106 sperm/ml, while all female patients had to have at least five oocytes. Sperm PLCζ analysis was performed in research laboratories, while semen assessments were performed, and time-lapse morphokinetic data were obtained, in the fertility clinic as part of routine treatment. The CRISPR/Cas9 system was concurrently used to induce indels and single-nucleotide mutations within the Plcζ gene to generate strains of Plcζ mutant mice. Sperm PLCζ was evaluated using immunofluorescence and immunoblotting with an antibody of confirmed consistent specificity against PLCζ. PARTICIPANTS/MATERIALS, SETTING, METHODS We evaluated PLCζ profiles in sperm samples from 54 human couples undergoing fertility treatment in the context of time-lapse morphokinetic analysis of resultant embryos, correlating such profiles to pregnancy status. Concurrently, we generated two strains of mutant Plcζ mice using CRISPR/Cas9, and performed IVF with wild type (WT) oocytes and using WT or mutant Plcζ sperm to generate embryos. We also assessed PLCζ status in WT and mutant mice sperm in the context of time-lapse morphokinetic analysis and breeding outcomes. MAIN RESULTS AND THE ROLE OF CHANCE A significant (P ≤ 0.05) positive relationship was observed between both PLCζ relative fluorescence and relative density with the times taken for both the second cell division (CC2) (r = 0.26 and r = 0.43, respectively) and the third cell division (S2) (r = 0.26). Examination of localization patterns also indicated significant correlations between the presence or absence of sperm PLCζ and CC2 (r = 0.27 and r = -0.27, respectively; P ≤ 0.025). Human sperm PLCζ levels were at their highest in the ideal times of CC2 (8-12 h) compared to time ranges outside the ideal timeframe (<8 and >12 h) where levels of human sperm PLCζ were lower. Following assignment of PLCζ level thresholds, quantification revealed a significantly higher (P ≤ 0.05) rate of successful pregnancy in values larger than the assigned cut-off for both relative fluorescence (19% vs 40%, respectively) and relative density (8% vs 54%, respectively). Immunoblotting indicated a single band for PLCζ at 74 kDa in sperm from WT mice, while a single band was also observed in sperm from heterozygous of Plcζ mutant mouse sperm, but at a diminished intensity. Immunofluorescent analysis indicated the previously reported (Kashir et al., 2021) fluorescence patterns in WT sperm, while sperm from Plcζ mutant mice exhibited a significantly diminished and dispersed pattern at the acrosomal region of the sperm head. Breeding experiments indicated a significantly reduced litter size of mutant Plcζ male mice compared to WT mice, while IVF-generated embryos using sperm from mutant Plcζ mice exhibited high rates of polyspermy, and resulted in significantly reduced numbers of these embryos reaching developmental milestones. LIMITATIONS, REASONS FOR CAUTION The human population examined was relatively small, and should be expanded to examine a larger multi-centre cohort. Infertility conditions are often multivariable, and it was not possible to evaluate all these in human patients. However, our mutant Plcζ mouse experiments do suggest that PLCζ plays a significant role in early embryo development. WIDER IMPLICATIONS OF THE FINDINGS We found that minimal levels of PLCζ within a specific range were required for optimal early embryogenesis, correlating with increased pregnancy. Levels of sperm PLCζ below specific thresholds were associated with ineffective embryogenesis and lower pregnancy rates, despite eliciting successful fertilization in both mice and humans. To our knowledge, this represents the first time that PLCζ levels in sperm have been correlated to prognostic measures of embryogenic efficacy and pregnancy rates in humans. Our data suggest for the first time that the clinical utilization of PLCζ may stand to benefit not just a specific population of male infertility where oocyte activation is completely deficient (wherein PLCζ is completely defective/abrogated), but also perhaps the larger population of couples seeking fertility treatment. STUDY FUNDING/COMPETING INTEREST(S) J.K. is supported by a faculty start up grant awarded by Khalifa University (FSU-2023-015). This study was also supported by a Healthcare Research Fellowship Award (HF-14-16) from Health and Care Research Wales (HCRW) to J.K., alongside a National Science, Technology, and Innovation plan (NSTIP) project grant (15-MED4186-20) awarded by the King Abdulaziz City for Science and Technology (KACST) for J.K. and A.M.A. The authors declare no conflicts of interest. TRIAL REGISTRATION NUMBER N/A.
Collapse
Affiliation(s)
- Junaid Kashir
- Department of Biological Sciences, College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates
- Center for Biotechnology, Khalifa University, Abu Dhabi, United Arab Emirates
- Department of Comparative Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Bhavesh V Mistry
- Department of Comparative Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Mohamed A Rajab
- Department of Comparative Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Lujain BuSaleh
- Department of Comparative Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Raed Abu-Dawud
- Department of Comparative Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
- Institute for Molecular Medicine, MSH Medical School, Hamburg, Germany
| | - Hala A Ahmed
- Department of Comparative Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Sarah Alharbi
- Department of Pathology and Laboratory Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Michail Nomikos
- College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - Saad AlHassan
- Department of Obstetrics and Gynaecology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Serdar Coskun
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
- Department of Pathology and Laboratory Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Abdullah M Assiri
- Department of Comparative Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| |
Collapse
|
3
|
Nemerovsky L, Ghetler Y, Wiser A, Levi M. Two types of cleavage, from zygote to three cells, result in different clinical outcomes and should be treated differently. Front Cell Dev Biol 2024; 12:1398684. [PMID: 38887513 PMCID: PMC11180787 DOI: 10.3389/fcell.2024.1398684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Accepted: 05/13/2024] [Indexed: 06/20/2024] Open
Abstract
Research Question What is the utilization rate of embryos that exert inadequate zygote cleavage into three daughter cells? Design This study used a retrospective dataset from a single IVF Unit. A total of 3,060 embryos from 1,811 fresh IVF cycles were analyzed. The cleavage pattern, morphokinetics, and outcome were recorded. Only 2pn embryos, fertilized by ejaculated sperm, and cultured in a time-lapse system for at least 5 days were included. We generated three study groups according to the embryo's cleavage pattern: (I) Control, normal cleavage (n = 551); (II) fast cleavage, zygote to three cells within 5 h (n = 1,587); and (III) instant direct tripolar cleavage (IDC) from zygote to three cells (n = 922). Results The rate of usable fast cleavage blastocysts was 108/1,587 (6.81%) and usable control blastocysts was 180/551 (32.67%). The time of PN fading and from fading to first cleavage differed significantly between the three groups. Although the pregnancy rate of control and fast cleavage blastocysts were comparable (40.35% and 42.55%, respectively), the amount of instant direct cleavage embryos that reached blastocyst stage was neglectable (only four embryos out of 922 analyzed IDC embryos) and unsuitable for statistical comparison of pregnancy rates. Conclusion Our results indicate the need to culture instant direct cleavage embryos for 5 days, up to the blastocyst stage, and avoid transfer of embryos that are fated to arrest even when their morphological grade on day 3 is acceptable, whereas fast cleavage embryos could be transferred on day 3 when there is no alternative.
Collapse
Affiliation(s)
- Luba Nemerovsky
- IVF Unit, Department of Obstetrics and Gynecology, Meir Medical Center, Kefar Sava, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yehudith Ghetler
- IVF Unit, Department of Obstetrics and Gynecology, Meir Medical Center, Kefar Sava, Israel
| | - Amir Wiser
- IVF Unit, Department of Obstetrics and Gynecology, Meir Medical Center, Kefar Sava, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mattan Levi
- IVF Unit, Department of Obstetrics and Gynecology, Meir Medical Center, Kefar Sava, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
4
|
Cao P, Derhaag J, Coonen E, Brunner H, Acharya G, Salumets A, Zamani Esteki M. Generative artificial intelligence to produce high-fidelity blastocyst-stage embryo images. Hum Reprod 2024; 39:1197-1207. [PMID: 38600621 PMCID: PMC11145014 DOI: 10.1093/humrep/deae064] [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: 12/19/2023] [Revised: 02/13/2024] [Indexed: 04/12/2024] Open
Abstract
STUDY QUESTION Can generative artificial intelligence (AI) models produce high-fidelity images of human blastocysts? SUMMARY ANSWER Generative AI models exhibit the capability to generate high-fidelity human blastocyst images, thereby providing substantial training datasets crucial for the development of robust AI models. WHAT IS KNOWN ALREADY The integration of AI into IVF procedures holds the potential to enhance objectivity and automate embryo selection for transfer. However, the effectiveness of AI is limited by data scarcity and ethical concerns related to patient data privacy. Generative adversarial networks (GAN) have emerged as a promising approach to alleviate data limitations by generating synthetic data that closely approximate real images. STUDY DESIGN, SIZE, DURATION Blastocyst images were included as training data from a public dataset of time-lapse microscopy (TLM) videos (n = 136). A style-based GAN was fine-tuned as the generative model. PARTICIPANTS/MATERIALS, SETTING, METHODS We curated a total of 972 blastocyst images as training data, where frames were captured within the time window of 110-120 h post-insemination at 1-h intervals from TLM videos. We configured the style-based GAN model with data augmentation (AUG) and pretrained weights (Pretrained-T: with translation equivariance; Pretrained-R: with translation and rotation equivariance) to compare their optimization on image synthesis. We then applied quantitative metrics including Fréchet Inception Distance (FID) and Kernel Inception Distance (KID) to assess the quality and fidelity of the generated images. Subsequently, we evaluated qualitative performance by measuring the intelligence behavior of the model through the visual Turing test. To this end, 60 individuals with diverse backgrounds and expertise in clinical embryology and IVF evaluated the quality of synthetic embryo images. MAIN RESULTS AND THE ROLE OF CHANCE During the training process, we observed consistent improvement of image quality that was measured by FID and KID scores. Pretrained and AUG + Pretrained initiated with remarkably lower FID and KID values compared to both Baseline and AUG + Baseline models. Following 5000 training iterations, the AUG + Pretrained-R model showed the highest performance of the evaluated five configurations with FID and KID scores of 15.2 and 0.004, respectively. Subsequently, we carried out the visual Turing test, such that IVF embryologists, IVF laboratory technicians, and non-experts evaluated the synthetic blastocyst-stage embryo images and obtained similar performance in specificity with marginal differences in accuracy and sensitivity. LIMITATIONS, REASONS FOR CAUTION In this study, we primarily focused the training data on blastocyst images as IVF embryos are primarily assessed in blastocyst stage. However, generation of an array of images in different preimplantation stages offers further insights into the development of preimplantation embryos and IVF success. In addition, we resized training images to a resolution of 256 × 256 pixels to moderate the computational costs of training the style-based GAN models. Further research is needed to involve a more extensive and diverse dataset from the formation of the zygote to the blastocyst stage, e.g. video generation, and the use of improved image resolution to facilitate the development of comprehensive AI algorithms and to produce higher-quality images. WIDER IMPLICATIONS OF THE FINDINGS Generative AI models hold promising potential in generating high-fidelity human blastocyst images, which allows the development of robust AI models as it can provide sufficient training datasets while safeguarding patient data privacy. Additionally, this may help to produce sufficient embryo imaging training data with different (rare) abnormal features, such as embryonic arrest, tripolar cell division to avoid class imbalances and reach to even datasets. Thus, generative models may offer a compelling opportunity to transform embryo selection procedures and substantially enhance IVF outcomes. STUDY FUNDING/COMPETING INTEREST(S) This study was supported by a Horizon 2020 innovation grant (ERIN, grant no. EU952516) and a Horizon Europe grant (NESTOR, grant no. 101120075) of the European Commission to A.S. and M.Z.E., the Estonian Research Council (grant no. PRG1076) to A.S., and the EVA (Erfelijkheid Voortplanting & Aanleg) specialty program (grant no. KP111513) of Maastricht University Medical Centre (MUMC+) to M.Z.E. TRIAL REGISTRATION NUMBER Not applicable.
Collapse
Affiliation(s)
- Ping Cao
- Department of Clinical Genetics, Maastricht University Medical Center+ (MUMC+), Maastricht, The Netherlands
- Department of Genetics and Cell Biology, GROW Research Institute for Oncology and Reproduction, Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, The Netherlands
| | - Josien Derhaag
- Department of Reproductive Medicine, Maastricht University Medical Center+ (MUMC+), Maastricht, The Netherlands
| | - Edith Coonen
- Department of Clinical Genetics, Maastricht University Medical Center+ (MUMC+), Maastricht, The Netherlands
- Department of Reproductive Medicine, Maastricht University Medical Center+ (MUMC+), Maastricht, The Netherlands
| | - Han Brunner
- Department of Clinical Genetics, Maastricht University Medical Center+ (MUMC+), Maastricht, The Netherlands
- Department of Genetics and Cell Biology, GROW Research Institute for Oncology and Reproduction, Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, The Netherlands
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ganesh Acharya
- Division of Obstetrics and Gynecology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden
- Women’s Health and Perinatology Research Group, Department of Clinical Medicine, UiT—The Arctic University of Norway, Tromsø, Norway
| | - Andres Salumets
- Division of Obstetrics and Gynecology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden
- Competence Centre on Health Technologies, Tartu, Estonia
- Department of Obstetrics and Gynecology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
| | - Masoud Zamani Esteki
- Department of Clinical Genetics, Maastricht University Medical Center+ (MUMC+), Maastricht, The Netherlands
- Department of Genetics and Cell Biology, GROW Research Institute for Oncology and Reproduction, Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, The Netherlands
- Division of Obstetrics and Gynecology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
5
|
Feng K, Zhang Z, Wu L, Zhu L, Li X, Li D, Ruan L, Luo Y. Predictive Factors for the Formation of Viable Embryos in Subfertile Patients with Diminished Ovarian Reserve: A Clinical Prediction Study. Reprod Sci 2024; 31:1747-1756. [PMID: 38409494 PMCID: PMC11111567 DOI: 10.1007/s43032-024-01469-z] [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: 12/06/2023] [Accepted: 01/19/2024] [Indexed: 02/28/2024]
Abstract
This study aims to construct and validate a nomogram for predicting blastocyst formation in patients with diminished ovarian reserve (DOR) during in vitro fertilization (IVF) procedures. A retrospective analysis was conducted on 445 DOR patients who underwent in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) at the Reproductive Center of Yulin Maternal and Child Health Hospital from January 2019 to January 2023. A total of 1016 embryos were cultured for blastocyst formation, of which 487 were usable blastocysts and 529 did not form usable blastocysts. The embryos were randomly divided into a training set (711 embryos) and a validation set (305 embryos). Relevant factors were initially identified through univariate logistic regression analysis based on the training set, followed by multivariate logistic regression analysis to establish a nomogram model. The prediction model was then calibrated and validated. Multivariate stepwise forward logistic regression analysis showed that female age, normal fertilization status, embryo grade on D2, and embryo grade on D3 were independent predictors of blastocyst formation in DOR patients. The Hosmer-Lemeshow test indicated no statistical difference between the predicted probabilities of blastocyst formation and actual blastocyst formation (P > 0.05). These results suggest that female age, normal fertilization status, embryo grade on D2, and embryo grade on D3 are independent predictors of blastocyst formation in DOR patients. The clinical prediction nomogram constructed from these factors has good predictive value and clinical utility and can provide a basis for clinical prognosis, intervention, and the formulation of individualized medical plans.
Collapse
Affiliation(s)
- Keng Feng
- Center of Reproductive Medicine, Yulin Maternal and Child Health Hospital, Yulin, China
| | - Zhao Zhang
- Center of Reproductive Medicine, Qinzhou Maternal and Child Health Hospital, Qinzhou, China
| | - Ling Wu
- Pediatric Surgery, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Lingling Zhu
- Center of Reproductive Medicine, Yulin Maternal and Child Health Hospital, Yulin, China
| | - Xiang Li
- Center of Reproductive Medicine, Yulin Maternal and Child Health Hospital, Yulin, China
| | - Derong Li
- Center of Reproductive Medicine, Yulin Maternal and Child Health Hospital, Yulin, China
| | - Luhai Ruan
- Center of Reproductive Medicine, Yulin Maternal and Child Health Hospital, Yulin, China
| | - Yudi Luo
- Center of Reproductive Medicine, Yulin Maternal and Child Health Hospital, Yulin, China.
| |
Collapse
|
6
|
Kurumizaka M, Yao T, Tokoro M, Fukunaga N, Asada Y, Yamagata K. Effect of ovarian stimulation on developmental speed of preimplantation embryo in a mouse model. J Reprod Dev 2024; 70:160-168. [PMID: 38494726 PMCID: PMC11153123 DOI: 10.1262/jrd.2023-089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 02/16/2024] [Indexed: 03/19/2024] Open
Abstract
Ovarian stimulation protocols are widely used to collect oocytes in assisted reproductive technologies (ARTs). Although the influence of ovarian stimulation on embryo quality has been described, this issue remains controversial. Here, we analyzed the influence of ovarian stimulation on developmental speed and chromosome segregation using live cell imaging. Female mice at the proestrus stage were separated by the appearance of the vagina as the non-stimulation (-) group, and other mice were administered pregnant mare serum gonadotropin (PMSG) and human chorionic gonadotropin (hCG) as the stimulation (+) groups. The cumulus-oocyte complexes from both groups were inseminated with sperm suspensions from the same male mice. Fertilization rates and developmental capacities were examined, and the developmental speed and frequency of chromosome segregation errors were measured by live-cell imaging using a Histone H2B-mCherry probe. The number of fertilized oocytes obtained was 1.4-fold more frequent in the stimulation (+) group. The developmental rate and chromosome stability did not differ between the groups. Image analysis showed that the mean speed of development in the stimulation (+) group was slightly higher than that in the non-stimulation (-) group. This increase in speed seemed to arise from the slight shortening of the 2- and 4-cell stages and third division lengths and consequent synchronization of cleavage timing in each embryo, not from the emergence of an extremely rapidly developing subpopulation of embryos. In conclusion, ovarian stimulation does not necessarily affect embryo quality but rather increases the chances of obtaining high-quality oocytes in mice.
Collapse
Affiliation(s)
- Mayuko Kurumizaka
- Research Institute for Microbial Diseases, Osaka University, Osaka 565-0871, Japan
- Present: Reproductive Medical Center, Yokohama City University Medical Center, Kanagawa 232-0024, Japan
| | - Tatsuma Yao
- Research and Development Center, Fuso Pharmaceutical Industries, Ltd., Osaka 536-8523, Japan
- Present: Faculty of Biology-Oriented Science and Technology (BOST), KINDAI University, Wakayama 649-6493, Japan
| | - Mikiko Tokoro
- Asada Institute for Reproductive Medicine, Asada Ladies Clinic, Aichi 486-0931, Japan
- Present: Faculty of Biology-Oriented Science and Technology (BOST), KINDAI University, Wakayama 649-6493, Japan
| | - Noritaka Fukunaga
- Asada Institute for Reproductive Medicine, Asada Ladies Clinic, Aichi 486-0931, Japan
| | - Yoshimasa Asada
- Asada Institute for Reproductive Medicine, Asada Ladies Clinic, Aichi 486-0931, Japan
| | - Kazuo Yamagata
- Research Institute for Microbial Diseases, Osaka University, Osaka 565-0871, Japan
- Present: Faculty of Biology-Oriented Science and Technology (BOST), KINDAI University, Wakayama 649-6493, Japan
| |
Collapse
|
7
|
Zhu Y, Kratka CR, Pea J, Lee HC, Kratka CE, Xu J, Marin D, Treff NR, Duncan FE. The severity of meiotic aneuploidy is associated with altered morphokinetic variables of mouse oocyte maturation. Hum Reprod Open 2024; 2024:hoae023. [PMID: 38764910 PMCID: PMC11099657 DOI: 10.1093/hropen/hoae023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 03/04/2024] [Indexed: 05/21/2024] Open
Abstract
STUDY QUESTION Is there an association between morphokinetic variables of meiotic maturation and the severity of aneuploidy following in vitro maturation (IVM) in the mouse? SUMMARY ANSWER The severity of meiotic aneuploidy correlates with an extended time to first polar body extrusion (tPB1) and duration of meiosis I (dMI). WHAT IS KNOWN ALREADY Morphokinetic variables measured using time-lapse technology allow for the non-invasive evaluation of preimplantation embryo development within clinical assisted reproductive technology (ART). We recently applied this technology to monitor meiotic progression during IVM of mouse gametes. Whether there is a relationship between morphokinetic variables of meiotic progression and aneuploidy in the resulting egg has not been systematically examined at the resolution of specific chromosomes. Next-generation sequencing (NGS) is a robust clinical tool for determining aneuploidy status and has been reverse-translated in mouse blastocysts and oocytes. Therefore, we harnessed the technologies of time-lapse imaging and NGS to determine the relationship between the morphokinetics of meiotic progression and egg aneuploidy. STUDY DESIGN SIZE DURATION Cumulus-oocyte complexes were collected from large antral follicles from hyperstimulated CD-1 mice. Cumulus cells were removed, and spontaneous IVM was performed in the absence or presence of two doses of Nocodazole (25 or 50 nM) to induce a spectrum of spindle abnormalities and chromosome segregation errors during oocyte meiosis. Comprehensive chromosome screening was then performed in the resulting eggs, and morphokinetic variables and ploidy status were compared across experimental groups (control, n = 11; 25 nM Nocodazole, n = 13; 50 nM Nocodazole, n = 23). PARTICIPANTS/MATERIALS SETTING METHODS We monitored IVM in mouse oocytes using time-lapse microscopy for 16 h, and time to germinal vesicle breakdown (tGVBD), tPB1, and dMI were analyzed. Following IVM, comprehensive chromosome screening was performed on the eggs and their matched first polar bodies via adaptation of an NGS-based preimplantation genetic testing for aneuploidy (PGT-A) assay. Bioinformatics analysis was performed to align reads to the mouse genome and determine copy number-based predictions of aneuploidy. The concordance of each polar body-egg pair (reciprocal errors) was used to validate the results. Ploidy status was categorized as euploid, 1-3 chromosomal segregation errors, or ≥4 chromosomal segregation errors. Additionally, aneuploidy due to premature separation of sister chromatids (PSSC) versus non-disjunction (NDJ) was distinguished. MAIN RESULTS AND THE ROLE OF CHANCE We applied and validated state-of-the-art NGS technology to screen aneuploidy in individual mouse eggs and matched polar bodies at the chromosome-specific level. By performing IVM in the presence of different doses of Nocodazole, we induced a range of aneuploidy. No aneuploidy was observed in the absence of Nocodazole (0/11), whereas IVM in the presence of 25 and 50 nM Nocodazole resulted in an aneuploidy incidence of 7.69% (1/13) and 82.61% (19/23), respectively. Of the aneuploid eggs, 5% (1/20) was due to PSSC, 65% (13/20) to NDJ, and the remainder to a combination of both. There was no relationship between ploidy status and tGVBD, but tPB1 and the dMI were both significantly prolonged in eggs with reciprocal aneuploidy events compared to the euploid eggs, and this scaled with the severity of aneuploidy. Eggs with ≥4 aneuploid chromosomes had the longest tPB1 and dMI (P < 0.0001), whereas eggs with one to three aneuploid chromosomes exhibited intermediate lengths of time (P < 0.0001). LARGE SCALE DATA N/A. LIMITATIONS REASONS FOR CAUTION We used Nocodazole in this study to disrupt the meiotic spindle and induce aneuploidy in mouse oocytes. Whether the association between morphokinetic variables of meiotic progression and the severity of aneuploidy occurs with other compounds that induce chromosome segregation errors remain to be investigated. In addition, unlike mouse oocytes, human IVM requires the presence of cumulus cells, which precludes visualization of morphokinetic variables of meiotic progression. Thus, our study may have limited direct clinical translatability. WIDER IMPLICATIONS OF THE FINDINGS We validated NGS in mouse eggs to detect aneuploidy at a chromosome-specific resolution which greatly improves the utility of the mouse model. With a tractable and validated model system for characterizing meiotic aneuploidy, investigations into the molecular mechanisms and factors which may influence aneuploidy can be further elaborated. Time-lapse analyses of morphokinetic variables of meiotic progression may be a useful non-invasive predictor of aneuploidy severity. STUDY FUNDING/COMPETING INTERESTS This work was supported by the Bill & Melinda Gates Foundation (INV-003385). Under the grant conditions of the Foundation, a Creative Commons Attribution 4.0 Generic License has already been assigned to the Author Accepted Manuscript version that might arise from this submission. The authors have no conflict of interest to disclose.
Collapse
Affiliation(s)
- Yiru Zhu
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | - Jeffrey Pea
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Hoi Chang Lee
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Caroline E Kratka
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jia Xu
- Genomic Prediction Inc., North Brunswick Township, NJ, USA
| | - Diego Marin
- Genomic Prediction Inc., North Brunswick Township, NJ, USA
- Department of Genetics, Rutgers University, New Brunswick, NJ, USA
| | - Nathan R Treff
- Genomic Prediction Inc., North Brunswick Township, NJ, USA
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers University, New Brunswick, NJ, USA
| | - Francesca E Duncan
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| |
Collapse
|
8
|
Moustakli E, Zikopoulos A, Skentou C, Bouba I, Dafopoulos K, Georgiou I. Evolution of Minimally Invasive and Non-Invasive Preimplantation Genetic Testing: An Overview. J Clin Med 2024; 13:2160. [PMID: 38673433 PMCID: PMC11050362 DOI: 10.3390/jcm13082160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 03/27/2024] [Accepted: 04/06/2024] [Indexed: 04/28/2024] Open
Abstract
Preimplantation genetic testing (PGT) has become a common supplementary diagnοstic/testing tοol for in vitro fertilization (ΙVF) cycles due to a significant increase in cases of PGT fοr mοnogenic cοnditions (ΡGT-M) and de novο aneuplοidies (ΡGT-A) over the last ten years. This tendency is mostly attributable to the advancement and application of novel cytogenetic and molecular techniques in clinical practice that are capable of providing an efficient evaluation of the embryonic chromosomal complement and leading to better IVF/ICSI results. Although PGT is widely used, it requires invasive biopsy of the blastocyst, which may harm the embryo. Non-invasive approaches, like cell-free DNA (cfDNA) testing, have lower risks but have drawbacks in consistency and sensitivity. This review discusses new developments and opportunities in the field of preimplantation genetic testing, enhancing the overall effectiveness and accessibility of preimplantation testing in the framework of developments in genomic sequencing, bioinformatics, and the integration of artificial intelligence in the interpretation of genetic data.
Collapse
Affiliation(s)
- Efthalia Moustakli
- Laboratory of Medical Genetics, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece; (E.M.); (I.B.)
| | - Athanasios Zikopoulos
- Obstetrics and Gynecology, Royal Devon and Exeter Hospital Barrack Rd, Exeter EX2 5DW, UK;
| | - Charikleia Skentou
- Department of Obstetrics and Gynecology, Medical School of Ioannina, University General Hospital, 45110 Ioannina, Greece;
| | - Ioanna Bouba
- Laboratory of Medical Genetics, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece; (E.M.); (I.B.)
| | - Konstantinos Dafopoulos
- IVF Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, School of Health Sciences University of Thessaly, 41500 Larissa, Greece;
| | - Ioannis Georgiou
- Laboratory of Medical Genetics, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece; (E.M.); (I.B.)
| |
Collapse
|
9
|
Canosa S, Licheri N, Bergandi L, Gennarelli G, Paschero C, Beccuti M, Cimadomo D, Coticchio G, Rienzi L, Benedetto C, Cordero F, Revelli A. A novel machine-learning framework based on early embryo morphokinetics identifies a feature signature associated with blastocyst development. J Ovarian Res 2024; 17:63. [PMID: 38491534 PMCID: PMC10941455 DOI: 10.1186/s13048-024-01376-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 02/16/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Artificial Intelligence entails the application of computer algorithms to the huge and heterogeneous amount of morphodynamic data produced by Time-Lapse Technology. In this context, Machine Learning (ML) methods were developed in order to assist embryologists with automatized and objective predictive models able to standardize human embryo assessment. In this study, we aimed at developing a novel ML-based strategy to identify relevant patterns associated with the prediction of blastocyst development stage on day 5. METHODS We retrospectively analysed the morphokinetics of 575 embryos obtained from 80 women who underwent IVF at our Unit. Embryo morphokinetics was registered using the Geri plus® time-lapse system. Overall, 30 clinical, morphological and morphokinetic variables related to women and embryos were recorded and combined. Some embryos reached the expanded blastocyst stage on day 5 (BL Group, n = 210), some others did not (nBL Group, n = 365). RESULTS The novel EmbryoMLSelection framework was developed following four-steps: Feature Selection, Rules Extraction, Rules Selection and Rules Evaluation. Six rules composed by a combination of 8 variables were finally selected, and provided a predictive power described by an AUC of 0.84 and an accuracy of 81%. CONCLUSIONS We provided herein a new feature-signature able to identify with an high performance embryos with the best developmental competence to reach the expanded blastocyst stage on day 5. Clear and clinically relevant cut-offs were identified for each considered variable, providing an objective tool for early embryo developmental assessment.
Collapse
Affiliation(s)
- S Canosa
- Gynecology and Obstetrics 1U, Physiopathology of Reproduction and IVF Unit, Department of Surgical Sciences, S. Anna Hospital, University of Turin, Turin, Italy.
- IVIRMA Global Research Alliance, Livet, Turin, Italy.
| | - N Licheri
- Department of Computer Science, University di Turin, Turin, Italy
| | - L Bergandi
- Department of Oncology, University of Turin, Turin, Italy
| | - G Gennarelli
- Gynecology and Obstetrics 1U, Physiopathology of Reproduction and IVF Unit, Department of Surgical Sciences, S. Anna Hospital, University of Turin, Turin, Italy
- IVIRMA Global Research Alliance, Livet, Turin, Italy
| | - C Paschero
- Gynecology and Obstetrics 1U, Physiopathology of Reproduction and IVF Unit, Department of Surgical Sciences, S. Anna Hospital, University of Turin, Turin, Italy
| | - M Beccuti
- Department of Computer Science, University di Turin, Turin, Italy
| | - D Cimadomo
- IVIRMA Global Research Alliance, Genera, Clinica Valle Giulia, Rome, Italy
| | - G Coticchio
- IVIRMA Global Research Alliance, 9.Baby, Bologna, Italy
| | - L Rienzi
- IVIRMA Global Research Alliance, Genera, Clinica Valle Giulia, Rome, Italy
- Department of Biomolecular Sciences, University of Urbino "Carlo Bo", Urbino, Italy
| | - C Benedetto
- Gynecology and Obstetrics 1U, Physiopathology of Reproduction and IVF Unit, Department of Surgical Sciences, S. Anna Hospital, University of Turin, Turin, Italy
| | - F Cordero
- Department of Computer Science, University di Turin, Turin, Italy
| | - A Revelli
- Gynecology and Obstetrics 1U, Physiopathology of Reproduction and IVF Unit, Department of Surgical Sciences, S. Anna Hospital, University of Turin, Turin, Italy
- Gynecology and Obstetrics 2U, Department of Surgical Sciences, S. Anna Hospital, University of Turin, Turin, Italy
| |
Collapse
|
10
|
Chen J, Liu Z, Wang Z, Zhang X, Zhang Y, Zhan Z, Gong X, Xu T. One-step biofabrication of liquid core-GelMa shell microbeads for in situ hollow cell ball self-assembly. Regen Biomater 2024; 11:rbae021. [PMID: 38525324 PMCID: PMC10960924 DOI: 10.1093/rb/rbae021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 01/14/2024] [Accepted: 02/09/2024] [Indexed: 03/26/2024] Open
Abstract
There are many instances of hollow-structure morphogenesis in the development of tissues. Thus, the fabrication of hollow structures in a simple, high-throughput and homogeneous manner with proper natural biomaterial combination is valuable for developmental studies and tissue engineering, while it is a significant challenge in biofabrication field. We present a novel method for the fabrication of a hollow cell module using a coaxial co-flow capillary microfluidic device. Sacrificial gelatin laden with cells in the inner layer and GelMa in the outer layer are used via a coaxial co-flow capillary microfluidic device to produce homogenous micro-beads. The overall and core sizes of core-shell microbeads were well controlled. When using human vein vascular endothelial cells to demonstrate how cells line the inner surface of core-shell beads, as the core liquifies, a hollow cell ball with asymmetric features is fabricated. After release from the GelMa shell, individual cell balls are obtained and deformed cell balls can self-recover. This platform paves way for complex hollow tissue modeling in vitro, and further modulation of matrix stiffness, curvature and biochemical composition to mimic in vivo microenvironments.
Collapse
Affiliation(s)
- Jianwei Chen
- Bio-intelligent Manufacturing and Living Matter Bioprinting Center, Research Institute of Tsinghua University in Shenzhen, Tsinghua University, Shenzhen 518057, People’s Republic of China
- Precision Medicine and Healthcare Research Center, Tsinghua-Berkeley Shenzhen Institute (TBSI), Tsinghua University, Shenzhen 518055, People’s Republic of China
| | - Zeyang Liu
- Department of Mechanical and Energy Engineering, Southern University of Science and Technology, Shenzhen, Nanshan District, People’s Republic of China
| | - Zixian Wang
- Precision Medicine and Healthcare Research Center, Tsinghua-Berkeley Shenzhen Institute (TBSI), Tsinghua University, Shenzhen 518055, People’s Republic of China
| | - Xiuxiu Zhang
- Precision Medicine and Healthcare Research Center, Tsinghua-Berkeley Shenzhen Institute (TBSI), Tsinghua University, Shenzhen 518055, People’s Republic of China
| | - Yi Zhang
- Precision Medicine and Healthcare Research Center, Tsinghua-Berkeley Shenzhen Institute (TBSI), Tsinghua University, Shenzhen 518055, People’s Republic of China
| | - Zhen Zhan
- Department of Mechanical and Energy Engineering, Southern University of Science and Technology, Shenzhen, Nanshan District, People’s Republic of China
| | - Xiaohua Gong
- School of Optometry and Vision Science Program, University of California, Berkeley, CA 94720, USA
| | - Tao Xu
- Bio-intelligent Manufacturing and Living Matter Bioprinting Center, Research Institute of Tsinghua University in Shenzhen, Tsinghua University, Shenzhen 518057, People’s Republic of China
- Precision Medicine and Healthcare Research Center, Tsinghua-Berkeley Shenzhen Institute (TBSI), Tsinghua University, Shenzhen 518055, People’s Republic of China
- Tsinghua Shenzhen International Graduate School, Tsinghua University, Shenzhen 518055, People’s Republic of China
| |
Collapse
|
11
|
Hillyear LM, Zak LJ, Beckitt T, Griffin DK, Harvey SC, Harvey KE. Morphokinetic Profiling Suggests That Rapid First Cleavage Division Accurately Predicts the Chances of Blastulation in Pig In Vitro Produced Embryos. Animals (Basel) 2024; 14:783. [PMID: 38473168 DOI: 10.3390/ani14050783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 02/27/2024] [Accepted: 02/28/2024] [Indexed: 03/14/2024] Open
Abstract
The study of pig preimplantation embryo development has several potential uses: from agriculture to the production of medically relevant genetically modified organisms and from rare breed conservation to acting as a physiologically relevant model for progressing human and other (e.g., endangered) species' in vitro fertilisation technology. Despite this, barriers to the widespread adoption of pig embryo in vitro production include lipid-laden cells that are hard to visualise, slow adoption of contemporary technologies such as the use of time-lapse incubators or artificial intelligence, poor blastulation and high polyspermy rates. Here, we employ a commercially available time-lapse incubator to provide a comprehensive overview of the morphokinetics of pig preimplantation development for the first time. We tested the hypotheses that (a) there are differences in developmental timings between blastulating and non-blastulating embryos and (b) embryo developmental morphokinetic features can be used to predict the likelihood of blastulation. The abattoir-derived oocytes fertilised by commercial extended semen produced presumptive zygotes were split into two groups: cavitating/blastulating 144 h post gamete co-incubation and those that were not. The blastulating group reached the 2-cell and morula stages significantly earlier, and the time taken to reach the 2-cell stage was identified to be a predictive marker for blastocyst formation. Reverse cleavage was also associated with poor blastulation. These data demonstrate the potential of morphokinetic analysis in automating and upscaling pig in vitro production through effective embryo selection.
Collapse
Affiliation(s)
- Lucy M Hillyear
- School of Psychology and Life Sciences, Canterbury Christ Church University, Canterbury CT1 1QU, UK
| | - Louisa J Zak
- Topigs Norsvin Research Center, Meerendonkweg 25, 5216 TZ Den Bosch, The Netherlands
| | | | - Darren K Griffin
- School of Biosciences, University of Kent, Canterbury CT2 7NJ, UK
| | - Simon C Harvey
- Faculty of Engineering and Science, University of Greenwich, Medway ME4 4TB, UK
| | - Katie E Harvey
- School of Life, Health and Chemical Sciences, The Open University, Milton Keynes MK7 6AA, UK
| |
Collapse
|
12
|
Liao Z, Yan C, Wang J, Zhang N, Yang H, Lin C, Zhang H, Wang W, Li W. A clinical consensus-compliant deep learning approach to quantitatively evaluate human in vitro fertilization early embryonic development with optical microscope images. Artif Intell Med 2024; 149:102773. [PMID: 38462274 DOI: 10.1016/j.artmed.2024.102773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 12/13/2023] [Accepted: 01/14/2024] [Indexed: 03/12/2024]
Abstract
The selection of embryos is a key for the success of in vitro fertilization (IVF). However, automatic quality assessment on human IVF embryos with optical microscope images is still challenging. In this study, we developed a clinical consensus-compliant deep learning approach, named Esava (Embryo Segmentation and Viability Assessment), to quantitatively evaluate the development of IVF embryos using optical microscope images. In total 551 optical microscope images of human IVF embryos of day-2 to day-3 were collected, preprocessed, and annotated. Using the Faster R-CNN model as baseline, our Esava model was constructed, refined, trained, and validated for precise and robust blastomere detection. A novel algorithm Crowd-NMS was proposed and employed in Esava to enhance the object detection and to precisely quantify the embryonic cells and their size uniformity. Additionally, an innovative GrabCut-based unsupervised module was integrated for the segmentation of blastomeres and embryos. Independently tested on 94 embryo images for blastomere detection, Esava obtained the high rates of 0.9940, 0.9121, and 0.9531 for precision, recall, and mAP respectively, and gained significant advances compared with previous computational methods. Intraclass correlation coefficients indicated the consistency between Esava and three experienced embryologists. Another test on 51 extra images demonstrated that Esava surpassed other tools significantly, achieving the highest average precision 0.9025. Moreover, it also accurately identified the borders of blastomeres with mIoU over 0.88 on the independent testing dataset. Esava is compliant with the Istanbul clinical consensus and compatible to senior embryologists. Taken together, Esava improves the accuracy and efficiency of embryonic development assessment with optical microscope images.
Collapse
Affiliation(s)
- Zaowen Liao
- Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Chaoyu Yan
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
| | - Jianbo Wang
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
| | - Ningfeng Zhang
- Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Huan Yang
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China; Medical Big Data Center, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Chenghao Lin
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
| | - Haiyue Zhang
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
| | - Wenjun Wang
- Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
| | - Weizhong Li
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China; Center for Precision Medicine, Sun Yat-sen University, Guangzhou, China; Key Laboratory of Tropical Disease Control (Ministry of Education), Sun Yat-Sen University, Guangzhou, China.
| |
Collapse
|
13
|
Tvrdonova K, Belaskova S, Rumpikova T, Rumpik D, Myslivcova Fucikova A, Malir F. Prediction of live birth - selection of embryos using morphokinetic parameters. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2024; 168:74-80. [PMID: 36622075 DOI: 10.5507/bp.2022.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022] Open
Abstract
BACKROUND The goal of assisted reproduction is for a couple treated with IVF techniques to end the treatment by giving birth to a healthy baby. A neccessary presumption for success is the identification of the best embryo with high implantation and developmental potential. One option is to select an euploid embryo by invasive preimplantaion genetic testing for aneuploidy (PGT-A) or it is possible to select the best embryo by non-invasive time-lapse monitoring (TLM), specifically based on morphokinetic parameters and morphological markers that are able to identify an embryo with high developmental potential. MATERIALS AND METHODS The study involved a total of 1060 embryos (585 euploid and 475 aneuploid embryos after PGT-A) with good morphology from 329 patients in the period 01/2016-10/2021. All embryos were cultured in a time-lapse incubator, trophectoderm (TE) cells biopsies for PGT-A examination were performed on day 5 (D5) or day 6 (D6) of culture. During the study period, 225 frozen embryo transfers (FET) of one euploid embryo were performed. Based on the treatment outcome, the embryos were divided into 2 groups - euploid embryos, which led to the birth of a healthy child, and euploid embryos that did not show fetal heartbeat (FHB) after FET. RESULTS Based on the statistical analysis of the embryos without implantation and the embryos with live birth, it is clear that the morphokinetic parameters t5 (time of division into 5 cells) and tSB (time of start of blastulation) are significantly different. CONCLUSION The results suggest that of the morphokinetic parameters tSB and t5 are predictive indicators for selecting an embryo with high developmental potential and with a high probability of achieving the birth of a healthy child.
Collapse
Affiliation(s)
- Katerina Tvrdonova
- Department of Biology, Faculty of Sciences, University Hradec Kralove, 500 03 Hradec Kralove, Czech Republic
- Clinic of Reproductive Medicine and Gynecology Zlin, U Lomu 638, 760 01 Zlin, Czech Republic
| | - Silvie Belaskova
- Institute of Mathematics and Statistics, Faculty of Science, Masaryk University, 611 37 Brno, Czech Republic
- International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic
| | - Tatana Rumpikova
- Clinic of Reproductive Medicine and Gynecology Zlin, U Lomu 638, 760 01 Zlin, Czech Republic
| | - David Rumpik
- Clinic of Reproductive Medicine and Gynecology Zlin, U Lomu 638, 760 01 Zlin, Czech Republic
| | - Alena Myslivcova Fucikova
- Department of Biology, Faculty of Sciences, University Hradec Kralove, 500 03 Hradec Kralove, Czech Republic
| | - Frantisek Malir
- Department of Biology, Faculty of Sciences, University Hradec Kralove, 500 03 Hradec Kralove, Czech Republic
| |
Collapse
|
14
|
Ezoe K, Takahashi T, Miki T, Kato K. Developmental perturbation in human embryos: Clinical and biological significance learned from time-lapse images. Reprod Med Biol 2024; 23:e12593. [PMID: 38983691 PMCID: PMC11232294 DOI: 10.1002/rmb2.12593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 05/30/2024] [Accepted: 06/07/2024] [Indexed: 07/11/2024] Open
Abstract
Background Time-lapse technology (TLT) has gained widespread adoption worldwide. In addition to facilitating the undisturbed culture of embryos, TLT offers the unique capability of continuously monitoring embryos to detect spatiotemporal changes. Although these observed phenomena play a role in optimal embryo selection/deselection, the clinical advantages of introducing TLT remain unclear. However, manual annotation of embryo perturbation could facilitate a comprehensive assessment of developmental competence. This process requires a thorough understanding of embryo observation and the biological significance associated with developmental dogma and variation. This review elucidates the typical behavior and variation of each phenomenon, exploring their clinical significance and research perspectives. Methods The MEDLINE database was searched using PubMed for peer-reviewed English-language original articles concerning human embryo development. Main findings TLT allows the observation of consecutive changes in embryo morphology, serving as potential biomarkers for embryo assessment. In assisted reproductive technology laboratories, several phenomena have not revealed their mechanism, posing difficulties such as fertilization deficiency and morula arrest. Conclusion A profound understanding of the biological mechanisms and significance of each phenomenon is crucial. Further collaborative efforts between the clinical and molecular fields following translational studies are required to advance embryonic outcomes and assessment.
Collapse
|
15
|
Garcia-Belda A, Cairó O, Martínez-Moro Á, Cuadros M, Pons MC, de Mendoza MVH, Delgado A, Rives N, Carrasco B, Cabello Y, Figueroa MJ, Cascales-Romero L, González-Soto B, Cuevas-Saiz I. Considerations for future modification of The Association for the Study of Reproductive Biology embryo grading system incorporating time-lapse observations. Reprod Biomed Online 2024; 48:103570. [PMID: 37952277 DOI: 10.1016/j.rbmo.2023.103570] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 09/13/2023] [Accepted: 09/19/2023] [Indexed: 11/14/2023]
Abstract
The Association for the Study of Reproductive Biology (ASEBIR) Interest Group in Embryology (in Spanish 'Grupo de Interés de Embriología') reviewed key morphokinetic parameters to assess the contribution of time-lapse technology (TLT) to the ASEBIR grading system. Embryo grading based on morphological characteristics is the most widely used method in human assisted reproduction laboratories. The introduction and implementation of TLT has provided a large amount of information that can be used as a complementary tool for morphological embryo evaluation and selection. As part of IVF treatments, embryologists grade embryos to decide which embryos to transfer or freeze. At the present, the embryo grading system developed by ASEBIR does not consider dynamic events observed through TLT. Laboratories that are using TLT consider those parameters as complementary data for embryo selection. The aim of this review was to evaluate review time-specific morphological changes during embryo development that are not included in the ASEBIR scoring system, and to consider them as candidates to add to the scoring system.
Collapse
Affiliation(s)
| | | | - Álvaro Martínez-Moro
- IVF Spain Madrid, Madrid, Spain.; Animal Reproduction Department, INIA-CSIC, Madrid, Spain
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Schmidt JK, Block LN, Jones KM, Hinkle HM, Mean KD, Bowman BD, Makulec AT, Golos TG. Atypical initial cleavage patterns minimally impact rhesus macaque in vitro embryo morphokinetics and embryo outgrowth development†. Biol Reprod 2023; 109:812-820. [PMID: 37688580 PMCID: PMC10724467 DOI: 10.1093/biolre/ioad117] [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: 03/21/2023] [Revised: 07/17/2023] [Accepted: 09/01/2023] [Indexed: 09/11/2023] Open
Abstract
Embryo morphokinetic analysis through time-lapse embryo imaging is envisioned as a method to improve selection of developmentally competent embryos. Morphokinetic analysis could be utilized to evaluate the effects of experimental manipulation on pre-implantation embryo development. The objectives of this study were to establish a normative morphokinetic database for in vitro fertilized rhesus macaque embryos and to assess the impact of atypical initial cleavage patterns on subsequent embryo development and formation of embryo outgrowths. The cleavage pattern and the timing of embryo developmental events were annotated retrospectively for unmanipulated in vitro fertilized rhesus macaque blastocysts produced over four breeding seasons. Approximately 50% of the blastocysts analyzed had an abnormal early cleavage event. The time to the initiation of embryo compaction and the time to completion of hatching was significantly delayed in blastocysts with an abnormal early cleavage event compared to blastocysts that had cleaved normally. Embryo hatching, attachment to an extracellular matrix, and growth during the implantation stage in vitro was not impacted by the initial cleavage pattern. These data establish normative morphokinetic parameters for in vitro fertilized rhesus macaque embryos and suggest that cleavage anomalies may not impact embryo implantation rates following embryo transfer.
Collapse
Affiliation(s)
| | - Lindsey N Block
- Wisconsin National Primate Research Center, Madison, WI, USA
| | - Kathryn M Jones
- Wisconsin National Primate Research Center, Madison, WI, USA
| | - Hayly M Hinkle
- Wisconsin National Primate Research Center, Madison, WI, USA
| | | | | | | | - Thaddeus G Golos
- Wisconsin National Primate Research Center, Madison, WI, USA
- Department of Comparative Biosciences, School of Veterinary Medicine, University of Wisconsin–Madison, Madison, WI, USA
- Department of Obstetrics and Gynecology, School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WI, USA
| |
Collapse
|
17
|
Wang Y, Chen D, Cai B, Huang D, Xu Y, Ding C. Effects of different oocyte cytoplasmic granulation patterns on embryo development and euploidy: a sibling oocyte control study. Arch Gynecol Obstet 2023; 308:1593-1603. [PMID: 37608229 DOI: 10.1007/s00404-023-07176-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 07/26/2023] [Indexed: 08/24/2023]
Abstract
PURPOSE This study evaluated the relationship between cytoplasmic granulation patterns and the developmental potential of mature sibling oocytes. METHODS Data from 54 cycles of preimplantation genetic tests for structural rearrangement from July 2019 to June 2022 were analyzed. In total, 564 embryos were cultured using a time-lapse system. Sibling oocytes were divided into four groups based on cytoplasmic granulation patterns: fine granulation (FG) group (n = 177), central granulation (CG) group (n = 183), dispersed granulation (DG) group (n = 161), and uneven granulation (UG) group (n = 43). The CG group was further divided into three groups (grades I, II, and III) based on the tertile of the ratio of central granular distribution area to oocyte area. Fertilization rate, embryo morphokinetics, chromosomal ploidy, and clinical outcomes of the groups were compared. RESULTS No significant differences were observed in morphokinetic parameters, fertilization rate, embryo production, blastocyst formation, and aneuploidy rates among the different cytoplasmic-granulation pattern groups. However, embryos derived from CG oocytes showed significantly higher aneuploidy rates in grade III compared to grade I (86.21% vs 61.54%, P = 0.036) or grade II (86.21% vs 56.00%, P = 0.013). Thirty embryos were transferred to the uteri of female patients and the clinical pregnancy and live birth rates did not significantly differ among groups. CONCLUSIONS Cytoplasmic granulation patterns may not affect embryo fertilization, development speed, and aneuploidy rates. However, a higher grade of CG may be associated with increased aneuploidy rates. Larger sample sizes are required to explore the impact of oocyte cytoplasmic granulation patterns on embryo implantation potential.
Collapse
Affiliation(s)
- Yali Wang
- Reproductive Medicine Center, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, Guangdong, People's Republic of China
- Guangdong Provincial Key Laboratory of Reproductive Medicine, Guangzhou, 510080, Guangdong, People's Republic of China
| | - Dongjia Chen
- Reproductive Medicine Center, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, Guangdong, People's Republic of China
- Guangdong Provincial Key Laboratory of Reproductive Medicine, Guangzhou, 510080, Guangdong, People's Republic of China
| | - Bing Cai
- Reproductive Medicine Center, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, Guangdong, People's Republic of China
- Guangdong Provincial Key Laboratory of Reproductive Medicine, Guangzhou, 510080, Guangdong, People's Republic of China
| | - Dan Huang
- Reproductive Medicine Center, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, Guangdong, People's Republic of China
- Guangdong Provincial Key Laboratory of Reproductive Medicine, Guangzhou, 510080, Guangdong, People's Republic of China
| | - Yanwen Xu
- Reproductive Medicine Center, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, Guangdong, People's Republic of China
- Guangdong Provincial Key Laboratory of Reproductive Medicine, Guangzhou, 510080, Guangdong, People's Republic of China
| | - Chenhui Ding
- Reproductive Medicine Center, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, Guangdong, People's Republic of China.
- Guangdong Provincial Key Laboratory of Reproductive Medicine, Guangzhou, 510080, Guangdong, People's Republic of China.
| |
Collapse
|
18
|
Kakulavarapu R, Stensen MH, Jahanlu D, Haugen TB, Delbarre E. Altered morphokinetics and differential reproductive outcomes associated with cell exclusion events in human embryos. Reprod Biomed Online 2023; 47:103285. [PMID: 37573752 DOI: 10.1016/j.rbmo.2023.103285] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 06/19/2023] [Accepted: 07/05/2023] [Indexed: 08/15/2023]
Abstract
RESEARCH QUESTION Can embryos harbouring cell exclusion and their reproductive outcomes be classified based on morphokinetic profiles? DESIGN A total of 469 time-lapse videos of embryos transferred between 2013 and 2019 from a single clinic were analysed. Videos were assessed and grouped according to the presence or absence of one or more excluded cells before compaction. Cell division timings, intervals between subsequent cell divisions and dynamic intervals were analysed to determine the morphokinetic profiles of embryos with cell exclusion (CE+), compared with fully compacted embryos without cell exclusion or extrusion (CE-). RESULTS Transfer of CE+ embryos resulted in lower proportions of fetal heartbeat (FHB) and live birth compared with CE- embryos (both, P < 0.001). CE+ embryos were associated with delays in t2 (P = 0.030), t6 (P = 0.018), t7 (P < 0.001), t8 (P = 0.001), tSC (P < 0.001) and tM (P < 0.001). Earlier timings for t3 (P = 0.014) and t5 (P < 0.001) were positively associated with CE+; CE+ embryos indicated prolonged S2, S3, ECC3, cc2 and cc4. Logistic regression analysis revealed that t5, tM, S2 and ECC3 were the strongest predictive indicators of cell exclusion. Timings for S2 and ECC3 were useful in identifying increased odds of FHB when a cell exclusion event was present. CONCLUSION Embryos harbouring cell exclusion indicated altered morphokinetic profiles. Their overall lower reproductive success was associated with two morphokinetic parameters. Morphokinetic profiles could be used as adjunct indicators for reproductive success during cycles producing few, low-quality embryos. This may allow more objective identification of cell exclusion and refinement of embryo ranking procedures before transfer.
Collapse
Affiliation(s)
- Radhika Kakulavarapu
- Department of Life Sciences and Health, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway..
| | | | - David Jahanlu
- Department of Life Sciences and Health, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Trine B Haugen
- Department of Life Sciences and Health, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Erwan Delbarre
- Department of Life Sciences and Health, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway..
| |
Collapse
|
19
|
Alhelou Y, Hamdan M, Razali N, Adenan N, Ali J. Novel image analyser-assisted morphometric methodology offer unique opportunity for selection of embryos with potential for implantation. BMC Pregnancy Childbirth 2023; 23:698. [PMID: 37770819 PMCID: PMC10538025 DOI: 10.1186/s12884-023-06025-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 09/23/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND Previous studies looked into the connections between pregnancy and the Zona Pellucida (ZP) thickness and Zona Pellucida Thickness Variation (ZPTV), as well as the embryo's radius, circumference, perimeter and global symmetry. However, no research has linked embryo implantation and pregnancy to the percentage of ZP thinning, the reduction in ooplasm volume, and the increase in perivitelline space (PVS) volume. Our objective is to correlate the percentage of ZP thinning, the percentage of ooplasm volume shrinkage and the percentage of PVS increase to the implantation. These data will be used for embryo selection as well as it can be put into a software that will assist embryo selection. MATERIALS AND METHODS Retrospective study included 281 patients, all of them had 2 embryos transferred, 149 patients got pregnant with two gestation sacs and 132 patients did not get pregnant. All of the transferred embryos had the ZP thickness measured several times from time of ICSI till Embryo Transfer (ET), the ooplasm volume was calculated from time of ICSI till two Pronuclei (2PN) fading and the PVS was calculated from the ICSI time till the 2PN fading. RESULTS The first characteristic is the change in the average ZP thickness that decreased by 32.7% + 5.3% at 70 h for the implanted embryos (Group 1) versus 23.6% + 4.8% for non-implanted embryos (Group 2) p = 0.000. The second characteristic is the average reduction in the volume of the ooplasm which is 20.5% + 4.3% in Group 1 versus 15.1% + 5.2% in Group 2, p = 0.000. The third characteristic is the increase in the volume of the PVS which was 38.1% + 7.6% in Group 1 versus 31.6% + 9.7% in Group 2 p = 0.000. CONCLUSION The implanted embryos showed higher percent of ZP thinning, higher percent of ooplasm reduction and higher percent of PVS increase.
Collapse
Affiliation(s)
- Y Alhelou
- FAKIH IVF, Sh Haza Bin Zayed st, Abu Dhabi, United Arab Emirates.
- Department of Obstetrics and Gynaecology, Universiti Malaya, Kuala Lumpur, Malaysia.
| | - M Hamdan
- Department of Obstetrics and Gynaecology, Universiti Malaya, Kuala Lumpur, Malaysia
| | - N Razali
- Department of Obstetrics and Gynaecology, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Nam Adenan
- Department of Obstetrics and Gynaecology, Universiti Malaya, Kuala Lumpur, Malaysia
| | - J Ali
- Department of Obstetrics and Gynaecology, Universiti Malaya, Kuala Lumpur, Malaysia
- IVF Department, Maternity and Children Hospital, Dammam, Saudi Arabia
| |
Collapse
|
20
|
Wang J, Guo Y, Zhang N, Li T. Research progress of time-lapse imaging technology and embryonic development potential: A review. Medicine (Baltimore) 2023; 102:e35203. [PMID: 37746957 PMCID: PMC10519478 DOI: 10.1097/md.0000000000035203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/22/2023] [Accepted: 08/23/2023] [Indexed: 09/26/2023] Open
Abstract
Cultivation and selection of high-quality human embryos are critical for the success of in vitro fertilization-embryo transfer. Time-lapse imaging technology (TLI) provides a stable culture environment for embryos, which can continuously observe and record the development process of early embryos, so that doctors can record embryo development time parameters more accurately. In this study, we review the current observation and research on the main embryo dynamics parameters in TLI and discusses their significance and development for embryo development potential. To analysis and summary, the application and research situation of TLI, we searched PubMed, Web of Science, and China National Knowledge Infrastructure, using TLI, embryo dynamics parameters, embryo development potential as Keywords, cited 50 out of the initial 89 selected literatures and summarized. With comparative analysis and research, we found that the embryo dynamic parameters provided by TLI has been intensively studied in clinical empirical and observational research, extensive experimental data verified its effectiveness and advantages in embryo development potential assessment. TLI provides technical support of embryo dynamic parameters, which may become the quantitative indicators for superior embryos and pregnancy prediction as well. Existing studies have shown that certain kinetic parameters provided by TLI culture can predict embryo implantation, but no parameter has been confirmed as the absolute correlation biological indicators yet. In this review we believe that further research is needed to verify these preliminary and sometimes contradictory results, and explore the predictive significance of various embryo kinetic parameters relying on TLI technology for embryo development potential.
Collapse
Affiliation(s)
- JinLuan Wang
- School of Basic Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ying Guo
- Reproductive and Genetic Center, Shandong University of Traditional Chinese Medicine Affiliated Hospital, Jinan, China
| | - Ning Zhang
- Reproductive and Genetic Center, Shandong University of Traditional Chinese Medicine Affiliated Hospital, Jinan, China
| | - TingTing Li
- Shandong University of Traditional Chinese Medicine, Jinan, China
| |
Collapse
|
21
|
Huayhua C, Rodríguez M, Vega J, Briones M, Rodriguez-Alvarez L, Mellisho E. Blastulation time measured with time-lapse system can predict in vitro viability of bovine blastocysts. PLoS One 2023; 18:e0289751. [PMID: 37561791 PMCID: PMC10414680 DOI: 10.1371/journal.pone.0289751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 07/26/2023] [Indexed: 08/12/2023] Open
Abstract
The objective of this study was to evaluate the time of blastulation monitored by time-lapse technology to predict in vitro viability of bovine blastocysts. This technology can be a powerful tool for bovine embryos selection with higher implantation capacity and competence. Also, in humans an early blastulation is associated with higher quality and pregnancy rate. Cumulus oocyte complexes (COCs) were matured for 20 to 22 h and then fertilized by co-incubation of COCs and spermatozoa (10,000 sperm per oocyte) for 18 h. Presumptive zygotes were placed individually in microwells, in droplets of commercial culture medium. The Primo Vision TL system (EVO+; Vitrolife) captured digital images of developing embryos every 15 minutes. The time frame from IVF to the start of blastulation (tSB) and to blastocyst development (tB) was recorded. After day 7.5, the blastocysts were in vitro culture for 48 h until day 9.5 after IVF to evaluate post hatching development. In vitro viability was evaluated at day 9.5: those with a diameter greater than 200 μm and a total cell count greater than 180 were classified as viable (value 1), while the rest were classified as non in vitro viable (value 0). The area under the ROC curve (AUC) was estimated to determine the predictive power of in vitro viability through blastulation time. In addition, binary logistic regression analysis was used to generate a mathematical model with morphokinetic variables that allow the best prediction of in vitro viability. In 13 sessions, the blastocyst production rate was 46.2% (96/208). The cut-off time to discriminate early or late blastulation was 149.8 h. The post-hatching development of the embryos with early blastulation was 63.3% (31/49), being statistically superior (p = 0.001) than the late blastulation group 14.9% (7/47). Likewise, the time of blastulation showed an accuracy of 90.8% (p < 0.001) in predicting in vitro viability of bovine blastocysts. In conclusion, the selection of blastocysts based on blastulation time (< 155 h) and blastocyst diameter measured on day 7.5 after IVF (> 180 μm) maximizes the in vitro viability.
Collapse
Affiliation(s)
- Carmen Huayhua
- Centro de Investigación en Tecnología de Embriones (CIETE), Animal Improvement Program, Universidad Nacional Agraria La Molina, Lima, Perú
| | - Misael Rodríguez
- Centro de Investigación en Tecnología de Embriones (CIETE), Animal Improvement Program, Universidad Nacional Agraria La Molina, Lima, Perú
| | - Jhorjhi Vega
- Centro de Investigación en Tecnología de Embriones (CIETE), Animal Improvement Program, Universidad Nacional Agraria La Molina, Lima, Perú
| | - Mario Briones
- Department of Animal Science, Faculty of Veterinary Sciences, Universidad de Concepción, Chillán, Concepción, Chile
| | - Lleretny Rodriguez-Alvarez
- Department of Animal Science, Faculty of Veterinary Sciences, Universidad de Concepción, Chillán, Concepción, Chile
| | - Edwin Mellisho
- Centro de Investigación en Tecnología de Embriones (CIETE), Animal Improvement Program, Universidad Nacional Agraria La Molina, Lima, Perú
| |
Collapse
|
22
|
Montgomery K, Montgomery S, Campbell A, Nash DM. A comparison of the morphokinetic profiles of embryos developed from vitrified versus fresh oocytes. Reprod Biomed Online 2023; 47:51-60. [PMID: 37188558 DOI: 10.1016/j.rbmo.2023.02.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 02/13/2023] [Accepted: 02/21/2023] [Indexed: 03/06/2023]
Abstract
RESEARCH QUESTION Do morphokinetic profiles and treatment outcomes differ between embryos developed from vitrified or fresh oocytes? DESIGN Retrospective multicentre analysis using data from eight CARE Fertility clinics across the UK between 2012 and 2019. Patients receiving treatment using embryos developed from vitrified oocytes (n = 118 women, n = 748 oocytes), providing 557 zygotes during this time period, were recruited and matched with patients undergoing treatment with embryos developed from fresh oocytes (n = 123 women, n = 1110 oocytes), providing 539 zygotes in the same time frame. Time-lapse microscopy was used to assess morphokinetic profiles, including early cleavage divisions (2- through to 8-cell), post-cleavage stages including time to start of compaction, time to morula, time to start of blastulation and time to full blastocyst. Duration of key stages such as the compaction stage were also calculated. Treatment outcomes were compared between the two groups (live birth rate, clinical pregnancy rate and implantation rate). RESULTS A significant delay of 2-3 h across all early cleavage divisions (2- through to 8-cell) and time to start of compaction occurred in the vitrified group versus fresh controls (all P ≤ 0.01). The compaction stage was significantly shorter in vitrified oocytes (19.02 ± 0.5 h) compared with fresh controls (22.45 ± 0.6 h, P < 0.001). There was no difference in the time that fresh and vitrified embryos reached the blastocyst stage (108.03 ± 0.7 versus 107.78 ± 0.6 h). There was no significant difference in treatment outcomes between the two groups. CONCLUSION Vitrification is a useful technique for extending female fertility with no effects on IVF treatment outcome.
Collapse
Affiliation(s)
- Kathryn Montgomery
- Department of Life Sciences, Aberystwyth University, Penglais, Aberystwyth, Ceredigion, UK
| | - Susan Montgomery
- CARE Fertility Manchester, 108-112 Daisy Bank Road, Victoria Park, Manchester, UK
| | - Alison Campbell
- CARE Fertility Manchester, 108-112 Daisy Bank Road, Victoria Park, Manchester, UK.
| | - Deborah Mary Nash
- Department of Life Sciences, Aberystwyth University, Penglais, Aberystwyth, Ceredigion, UK
| |
Collapse
|
23
|
Rauchfuss LK, Zhao Y, Walker D, Galantis T, Fredrickson J, Barud K, Shenoy C. Optimal Embryo Selection: The Irreplaceable Role of the Embryologist in an Age of Advancing Technology. J Hum Reprod Sci 2023; 16:227-232. [PMID: 38045503 PMCID: PMC10688284 DOI: 10.4103/jhrs.jhrs_98_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 08/26/2023] [Accepted: 09/07/2023] [Indexed: 12/05/2023] Open
Abstract
Background Time-lapse incubators allow for ongoing evaluation of embryos without culture condition disruption. The use of time-lapse incubation has been shown to improve outcomes either by improving overall conditions or providing additional information to aid in embryo selection for transfer. Time-lapse incubators can also utilise morphokinetic models to rank embryos based on morphokinetic parameters. We sought to compare a morphokinetic model for embryo comparison to traditional morphologic evaluation. Aims The aim of the study is to compare a morphokinetic model for embryo comparison to traditional morphologic evaluation. Settings and Design This is a retrospective cohort design. Materials and Methods Embryos cultured in a time-lapse culture system that had traditional morphologic evaluation, morphokinetic modelling and known live birth outcomes were included in this study. Embryos with unknown competence were excluded, including when two embryos were transferred with a single live birth resulted. Statistical Analysis Used Receiver operating characteristic (ROC) curves were determined for both the morphologic analysis and the morphokinetic model on culture day 3 and day 5. Using the ROC-determined cutoff that optimised both sensitivity and specificity, a binary outcome for each test was analysed using agreement statistics to determine if one method of embryo evaluation was superior to the other. Results Morphological and morphokinetic grading were both predictive of embryo competence on days 3 and 5. However, on day 3, morphologic grading was superior to morphokinetic grading with area under the curve (AUC) of 0.66 (P < 0.001) and 0.58 (P = 0.009), respectively. Contrarily, on day 5, the morphokinetic model had a higher AUC of 0.65 (P = 0.03) compared to the morphologic grading, AUC 0.56 (P = 0.02). Conclusion Traditional morphology was noted to be a better diagnostic tool (higher AUC) on culture day 3 while a morphokinetic model was superior on day 5.
Collapse
|
24
|
Zabari N, Kan-Tor Y, Or Y, Shoham Z, Shufaro Y, Richter D, Har-Vardi I, Ben-Meir A, Srebnik N, Buxboim A. Delineating the heterogeneity of embryo preimplantation development using automated and accurate morphokinetic annotation. J Assist Reprod Genet 2023:10.1007/s10815-023-02806-y. [PMID: 37300648 DOI: 10.1007/s10815-023-02806-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 04/03/2023] [Indexed: 06/12/2023] Open
Abstract
PURPOSE Our objective was to design an automated deep learning model that extracts the morphokinetic events of embryos that were recorded by time-lapse incubators. Using automated annotation, we set out to characterize the temporal heterogeneity of preimplantation development across a large number of embryos. METHODS To perform a retrospective study, we used a dataset of video files of 67,707 embryos from four IVF clinics. A convolutional neural network (CNN) model was trained to assess the developmental states that appear in single frames from 20,253 manually-annotated embryos. Probability-weighted superposition of multiple predicted states was permitted, thus accounting for visual uncertainties. Superimposed embryo states were collapsed onto discrete series of morphokinetic events via monotonic regression of whole-embryo profiles. Unsupervised K-means clustering was applied to define subpopulations of embryos of distinctive morphokinetic profiles. RESULTS We perform automated assessment of single-frame embryo states with 97% accuracy and demonstrate whole-embryo morphokinetic annotation with R-square 0.994. High quality embryos that had been valid candidates for transfer were clustered into nine subpopulations, as characterized by distinctive developmental dynamics. Retrospective comparative analysis of transfer versus implantation rates reveals differences between embryo clusters as marked by poor synchronization of the third mitotic cell-cleavage cycle. CONCLUSIONS By demonstrating fully automated, accurate, and standardized morphokinetic annotation of time-lapse embryo recordings from IVF clinics, we provide practical means to overcome current limitations that hinder the implementation of morphokinetic decision-support tools within clinical IVF settings due to inter-observer and intra-observer manual annotation variations and workload constrains. Furthermore, our work provides a platform to address embryo heterogeneity using dimensionality-reduced morphokinetic descriptions of preimplantation development.
Collapse
Affiliation(s)
- Nir Zabari
- School of Computer Science and Engineering, The Hebrew University of Jerusalem, The Edmond J. Safra Campus, 9190416, Jerusalem, Israel
| | - Yoav Kan-Tor
- School of Computer Science and Engineering, The Hebrew University of Jerusalem, The Edmond J. Safra Campus, 9190416, Jerusalem, Israel
- The Center for Interdisciplinary Data Science Research, The Hebrew University of Jerusalem, The Edmond J. Safra Campus, Givat Ram, 9190401, Jerusalem, Israel
| | - Yuval Or
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Kaplan Hospital, Rehovot, Israel
| | - Zeev Shoham
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Kaplan Hospital, Rehovot, Israel
| | - Yoel Shufaro
- Infertility and IVF Unit, Helen Schneider Hospital for Women, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel
| | - Dganit Richter
- The IVF Unit Gyn/Obs, Soroka University Medical Center, Beer-Sheva, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Iris Har-Vardi
- The IVF Unit Gyn/Obs, Soroka University Medical Center, Beer-Sheva, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Assaf Ben-Meir
- Department of Obstetrics and Gynecology, Hadassah Medical Center - Hebrew University of Jerusalem, Jerusalem, Israel
- Infertility and IVF Unit, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Naama Srebnik
- The Alexander Silberman Institute of Life Sciences, The Hebrew University of Jerusalem, The Edmond J. Safra Campus - Givat Ram, 9190401, Jerusalem, Israel
- In Vitro Fertilization Unit, Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, 9103102, Jerusalem, Israel
| | - Amnon Buxboim
- School of Computer Science and Engineering, The Hebrew University of Jerusalem, The Edmond J. Safra Campus, 9190416, Jerusalem, Israel.
- The Alexander Silberman Institute of Life Sciences, The Hebrew University of Jerusalem, The Edmond J. Safra Campus - Givat Ram, 9190401, Jerusalem, Israel.
- The Alexender Grass Center for Bioengineering, The Hebrew University of Jerusalem, The Edmond J. Safra Campus, Givat Ram, 9190401, Jerusalem, Israel.
| |
Collapse
|
25
|
Serrano-Novillo C, Uroz L, Márquez C. Novel Time-Lapse Parameters Correlate with Embryo Ploidy and Suggest an Improvement in Non-Invasive Embryo Selection. J Clin Med 2023; 12:jcm12082983. [PMID: 37109319 PMCID: PMC10146271 DOI: 10.3390/jcm12082983] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/12/2023] [Accepted: 04/19/2023] [Indexed: 04/29/2023] Open
Abstract
Selecting the best embryo for transfer is key to success in assisted reproduction. The use of algorithms or artificial intelligence can already predict blastulation or implantation with good results. However, ploidy predictions still rely on invasive techniques. Embryologists are still essential, and improving their evaluation tools can enhance clinical outcomes. This study analyzed 374 blastocysts from preimplantation genetic testing cycles. Embryos were cultured in time-lapse incubators and tested for aneuploidies; images were then studied for morphokinetic parameters. We present a new parameter, "st2, start of t2", detected at the beginning of the first cell cleavage, as strongly implicated in ploidy status. We describe specific cytoplasmic movement patterns associated with ploidy status. Aneuploid embryos also present slower developmental rates (t3, t5, tSB, tB, cc3, and t5-t2). Our analysis demonstrates a positive correlation among them for euploid embryos, while aneuploids present non-sequential behaviors. A logistic regression study confirmed the implications of the described parameters, showing a ROC value of 0.69 for ploidy prediction (95% confidence interval (CI), 0.62 to 0.76). Our results show that optimizing the relevant indicators to select the most suitable blastocyst, such as by including st2, could reduce the time until the pregnancy of a euploid baby while avoiding invasive and expensive methods.
Collapse
Affiliation(s)
| | - Laia Uroz
- Gravida, Hospital de Barcelona, 08034 Barcelona, Spain
| | | |
Collapse
|
26
|
Kieslinger DC, Vergouw CG, Ramos L, Arends B, Curfs MHJM, Slappendel E, Kostelijk EH, Pieters MHEC, Consten D, Verhoeven MO, Besselink DE, Broekmans F, Cohlen BJ, Smeenk JMJ, Mastenbroek S, de Koning CH, van Kasteren YM, Moll E, van Disseldorp J, Brinkhuis EA, Kuijper EAM, van Baal WM, van Weering HGI, van der Linden PJQ, Gerards MH, Bossuyt PM, van Wely M, Lambalk CB. Clinical outcomes of uninterrupted embryo culture with or without time-lapse-based embryo selection versus interrupted standard culture (SelecTIMO): a three-armed, multicentre, double-blind, randomised controlled trial. Lancet 2023; 401:1438-1446. [PMID: 37004670 DOI: 10.1016/s0140-6736(23)00168-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 12/02/2022] [Accepted: 01/17/2023] [Indexed: 04/04/2023]
Abstract
BACKGROUND Time-lapse monitoring is increasingly used in fertility laboratories to culture and select embryos for transfer. This method is offered to couples with the promise of improving pregnancy chances, even though there is currently insufficient evidence for superior clinical results. We aimed to evaluate whether a potential improvement by time-lapse monitoring is caused by the time-lapse-based embryo selection method itself or the uninterrupted culture environment that is part of the system. METHODS In this three-armed, multicentre, double-blind, randomised controlled trial, couples undergoing in-vitro fertilisation or intracytoplasmic sperm injection were recruited from 15 fertility clinics in the Netherlands and randomly assigned using a web-based, computerised randomisation service to one of three groups. Couples and physicians were masked to treatment group, but embryologists and laboratory technicians could not be. The time-lapse early embryo viability assessment (EEVA; TLE) group received embryo selection based on the EEVA time-lapse selection method and uninterrupted culture. The time-lapse routine (TLR) group received routine embryo selection and uninterrupted culture. The control group received routine embryo selection and interrupted culture. The co-primary endpoints were the cumulative ongoing pregnancy rate within 12 months in all women and the ongoing pregnancy rate after fresh single embryo transfer in a good prognosis population. Analysis was by intention to treat. This trial is registered on the ICTRP Search Portal, NTR5423, and is closed to new participants. FINDINGS 1731 couples were randomly assigned between June 15, 2017, and March 31, 2020 (577 to the TLE group, 579 to the TLR group, and 575 to the control group). The 12-month cumulative ongoing pregnancy rate did not differ significantly between the three groups: 50·8% (293 of 577) in the TLE group, 50·9% (295 of 579) in the TLR group, and 49·4% (284 of 575) in the control group (p=0·85). The ongoing pregnancy rates after fresh single embryo transfer in a good prognosis population were 38·2% (125 of 327) in the TLE group, 36·8% (119 of 323) in the TLR group, and 37·8% (123 of 325) in the control group (p=0·90). Ten serious adverse events were reported (five TLE, four TLR, and one in the control group), which were not related to study procedures. INTERPRETATION Neither time-lapse-based embryo selection using the EEVA test nor uninterrupted culture conditions in a time-lapse incubator improved clinical outcomes compared with routine methods. Widespread application of time-lapse monitoring for fertility treatments with the promise of improved results should be questioned. FUNDING Health Care Efficiency Research programme from Netherlands Organisation for Health Research and Development and Merck.
Collapse
Affiliation(s)
- D C Kieslinger
- IVF Center, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.
| | - C G Vergouw
- IVF Center, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - L Ramos
- Division of Reproductive Medicine, Department of Obstetrics and Gynecology, Radboudumc, Nijmegen, Netherlands
| | - B Arends
- IVF Center, UMC Utrecht, Utrecht, Netherlands
| | | | - E Slappendel
- Center for Fertility, Nij Geertgen, Elsendorp, Netherlands
| | - E H Kostelijk
- IVF Center, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | | | - D Consten
- IVF Center, Elisabeth-TweeSteden Ziekenhuis Tilburg, Netherlands
| | - M O Verhoeven
- IVF Center, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - D E Besselink
- Division of Reproductive Medicine, Department of Obstetrics and Gynecology, Radboudumc, Nijmegen, Netherlands
| | - F Broekmans
- IVF Center, UMC Utrecht, Utrecht, Netherlands
| | - B J Cohlen
- Isala Fertility Center, Isala, Zwolle, Netherlands
| | - J M J Smeenk
- IVF Center, Elisabeth-TweeSteden Ziekenhuis Tilburg, Netherlands
| | - S Mastenbroek
- Center for Reproductive Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands; Amsterdam Reproduction and Development, Preconception and Conception, Amsterdam, Netherlands
| | - C H de Koning
- Center for Fertility, Tergooi Medical Centre, Blaricum, Netherlands
| | - Y M van Kasteren
- Center for Fertility, Noordwest Ziekenhuisgroep, Alkmaar, Netherlands
| | - E Moll
- Center for Fertility, Onze Lieve Vrouwe Gasthuis, Amsterdam, Netherlands
| | - J van Disseldorp
- Center for Fertility, Saint Antonius Ziekenhuis, Nieuwegein, Netherlands
| | - E A Brinkhuis
- Center for Fertility, Meander Medical Centre, Amersfoort, Netherlands
| | - E A M Kuijper
- Center for Fertility, Spaarne Gasthuis, Haarlem, Netherlands
| | - W M van Baal
- Center for Fertility, Flevo Hospital, Almere, Netherlands
| | | | - P J Q van der Linden
- Department of Obstetrics, Gynaecology and Reproductive Medicine, Deventer Ziekenhuis, Deventer, Netherlands
| | - M H Gerards
- Center for Fertility, Diakonessenhuis, Utrecht, Netherlands
| | - P M Bossuyt
- Department of Epidemiology and Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - M van Wely
- Center for Reproductive Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - C B Lambalk
- IVF Center, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| |
Collapse
|
27
|
Sciorio R, Aiello R, Janssens R. Considerations on staffing levels for a modern assisted reproductive laboratory. JBRA Assist Reprod 2023; 27:120-130. [PMID: 36515254 PMCID: PMC10065777 DOI: 10.5935/1518-0557.20220048] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 08/23/2022] [Indexed: 12/12/2022] Open
Abstract
The duties recently performed in the embryology laboratory have deeply increased compared to those realized a couple of decades ago. Currently, procedures include conventional in vitro fertilization (IVF) and ICSI techniques, or processing of surgically retrieved sperm, embryo culture and time-lapse monitoring, blastocyst culture, as well as trophectoderm biopsy for preimplantation genetic testing and cryopreservation. These techniques require not only time, but also high knowledge level and acutely concentration by the embryologist team. The existing data indicate that an IVF laboratory need to have adequate staffing levels to perform the required daily duties, and to work in optimal conditions that are critical to assure a high quality service, as well as avoiding incidents and to provide the best outcomes. As a result, IVF clinics have invested in human resources, but there is still a large discrepancy between IVF centres on the number of embryologists employed. Currently there is no golden standard on the human resource requirements for assisted reproductive technology procedures; therefore, in this review paper we aim to provide arguments to take into account to determine the embryology staffing requirements in an embryology laboratory to assure optimal safety and efficiency of operations.
Collapse
Affiliation(s)
- Romualdo Sciorio
- Edinburgh Assisted Conception Programme, EFREC, Royal Infirmary of
Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Edinburgh, Scotland, EH16
4SA, UK
| | - Raffaele Aiello
- OMNIA Lab S.C.a.R.L, Via Cesare Rosaroll 24, 80139 Naples, Italy
| | | |
Collapse
|
28
|
Duval A, Nogueira D, Dissler N, Maskani Filali M, Delestro Matos F, Chansel-Debordeaux L, Ferrer-Buitrago M, Ferrer E, Antequera V, Ruiz-Jorro M, Papaxanthos A, Ouchchane H, Keppi B, Prima PY, Regnier-Vigouroux G, Trebesses L, Geoffroy-Siraudin C, Zaragoza S, Scalici E, Sanguinet P, Cassagnard N, Ozanon C, De La Fuente A, Gómez E, Gervoise Boyer M, Boyer P, Ricciarelli E, Pollet-Villard X, Boussommier-Calleja A. A hybrid artificial intelligence model leverages multi-centric clinical data to improve fetal heart rate pregnancy prediction across time-lapse systems. Hum Reprod 2023; 38:596-608. [PMID: 36763673 PMCID: PMC10068266 DOI: 10.1093/humrep/dead023] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 01/10/2023] [Indexed: 02/12/2023] Open
Abstract
STUDY QUESTION Can artificial intelligence (AI) algorithms developed to assist embryologists in evaluating embryo morphokinetics be enriched with multi-centric clinical data to better predict clinical pregnancy outcome? SUMMARY ANSWER Training algorithms on multi-centric clinical data significantly increased AUC compared to algorithms that only analyzed the time-lapse system (TLS) videos. WHAT IS KNOWN ALREADY Several AI-based algorithms have been developed to predict pregnancy, most of them based only on analysis of the time-lapse recording of embryo development. It remains unclear, however, whether considering numerous clinical features can improve the predictive performances of time-lapse based embryo evaluation. STUDY DESIGN, SIZE, DURATION A dataset of 9986 embryos (95.60% known clinical pregnancy outcome, 32.47% frozen transfers) from 5226 patients from 14 European fertility centers (in two countries) recorded with three different TLS was used to train and validate the algorithms. A total of 31 clinical factors were collected. A separate test set (447 videos) was used to compare performances between embryologists and the algorithm. PARTICIPANTS/MATERIALS, SETTING, METHODS Clinical pregnancy (defined as a pregnancy leading to a fetal heartbeat) outcome was first predicted using a 3D convolutional neural network that analyzed videos of the embryonic development up to 2 or 3 days of development (33% of the database) or up to 5 or 6 days of development (67% of the database). The output video score was then fed as input alongside clinical features to a gradient boosting algorithm that generated a second score corresponding to the hybrid model. AUC was computed across 7-fold of the validation dataset for both models. These predictions were compared to those of 13 senior embryologists made on the test dataset. MAIN RESULTS AND THE ROLE OF CHANCE The average AUC of the hybrid model across all 7-fold was significantly higher than that of the video model (0.727 versus 0.684, respectively, P = 0.015; Wilcoxon test). A SHapley Additive exPlanations (SHAP) analysis of the hybrid model showed that the six first most important features to predict pregnancy were morphokinetics of the embryo (video score), oocyte age, total gonadotrophin dose intake, number of embryos generated, number of oocytes retrieved, and endometrium thickness. The hybrid model was shown to be superior to embryologists with respect to different metrics, including the balanced accuracy (P ≤ 0.003; Wilcoxon test). The likelihood of pregnancy was linearly linked to the hybrid score, with increasing odds ratio (maximum P-value = 0.001), demonstrating the ranking capacity of the model. Training individual hybrid models did not improve predictive performance. A clinic hold-out experiment was conducted and resulted in AUCs ranging between 0.63 and 0.73. Performance of the hybrid model did not vary between TLS or between subgroups of embryos transferred at different days of embryonic development. The hybrid model did fare better for patients older than 35 years (P < 0.001; Mann-Whitney test), and for fresh transfers (P < 0.001; Mann-Whitney test). LIMITATIONS, REASONS FOR CAUTION Participant centers were located in two countries, thus limiting the generalization of our conclusion to wider subpopulations of patients. Not all clinical features were available for all embryos, thus limiting the performances of the hybrid model in some instances. WIDER IMPLICATIONS OF THE FINDINGS Our study suggests that considering clinical data improves pregnancy predictive performances and that there is no need to retrain algorithms at the clinic level unless they follow strikingly different practices. This study characterizes a versatile AI algorithm with similar performance on different time-lapse microscopes and on embryos transferred at different development stages. It can also help with patients of different ages and protocols used but with varying performances, presumably because the task of predicting fetal heartbeat becomes more or less hard depending on the clinical context. This AI model can be made widely available and can help embryologists in a wide range of clinical scenarios to standardize their practices. STUDY FUNDING/COMPETING INTEREST(S) Funding for the study was provided by ImVitro with grant funding received in part from BPIFrance (Bourse French Tech Emergence (DOS0106572/00), Paris Innovation Amorçage (DOS0132841/00), and Aide au Développement DeepTech (DOS0152872/00)). A.B.-C. is a co-owner of, and holds stocks in, ImVitro SAS. A.B.-C. and F.D.M. hold a patent for 'Devices and processes for machine learning prediction of in vitro fertilization' (EP20305914.2). A.D., N.D., M.M.F., and F.D.M. are or have been employees of ImVitro and have been granted stock options. X.P.-V. has been paid as a consultant to ImVitro and has been granted stocks options of ImVitro. L.C.-D. and C.G.-S. have undertaken paid consultancy for ImVitro SAS. The remaining authors have no conflicts to declare. TRIAL REGISTRATION NUMBER N/A.
Collapse
Affiliation(s)
| | - D Nogueira
- INOVIE Fertilité, Institut de Fertilité La Croix Du Sud, Toulouse, France
- Art Fertility Clinics, IVF laboratory, Abu Dhabi, United Arab Emirate
| | | | | | | | - L Chansel-Debordeaux
- Service de la biologie et de la reproduction et CECOS, CHU Bordeaux Groupe Hospitalier Pellegrin, Bordeaux, France
| | - M Ferrer-Buitrago
- Crea Centro Médico de Fertilidad y Reproducción Asistida, Valencia, Spain
| | - E Ferrer
- Crea Centro Médico de Fertilidad y Reproducción Asistida, Valencia, Spain
| | - V Antequera
- Crea Centro Médico de Fertilidad y Reproducción Asistida, Valencia, Spain
| | - M Ruiz-Jorro
- Crea Centro Médico de Fertilidad y Reproducción Asistida, Valencia, Spain
| | - A Papaxanthos
- Service de la biologie et de la reproduction et CECOS, CHU Bordeaux Groupe Hospitalier Pellegrin, Bordeaux, France
| | - H Ouchchane
- INOVIE Fertilité, Gen-Bio, Clermont-Ferrand, France
| | - B Keppi
- INOVIE Fertilité, Gen-Bio, Clermont-Ferrand, France
| | - P-Y Prima
- Laboratoire FIV PMAtlantique - Clinique Santé Atlantique, Nantes, France
| | | | | | - C Geoffroy-Siraudin
- Hopital Saint Joseph, Service Médicine et Biologie de la Reproduction, Marseille, France
| | - S Zaragoza
- INOVIE Fertilité, Bioaxiome, Avignon, France
| | - E Scalici
- INOVIE Fertilité, Bioaxiome, Avignon, France
| | - P Sanguinet
- INOVIE Fertilité, LaboSud, Montpellier, France
| | - N Cassagnard
- INOVIE Fertilité, Institut de Fertilité La Croix Du Sud, Toulouse, France
| | - C Ozanon
- Clinique Hôtel Privé Natecia, Centre Assistance Médicale à la Procréation, Lyon, France
| | | | - E Gómez
- Next Fertility, Murcia, Spain
| | - M Gervoise Boyer
- Hopital Saint Joseph, Service Médicine et Biologie de la Reproduction, Marseille, France
| | - P Boyer
- Hopital Saint Joseph, Service Médicine et Biologie de la Reproduction, Marseille, France
| | | | - X Pollet-Villard
- Nataliance, Centre Assistance Médicale à la Procréation, Saran, France
| | | |
Collapse
|
29
|
Watanabe S, Yoshikai K, Matsuda Y, Miyai S, Sawada Y, Kurahashi H, Sawada T. The effect of early irregular cell division of human embryos on blastocyst euploidy: considerations from the subsequent development of the blastomeres by direct or reverse cleavage. F&S SCIENCE 2023; 4:21-29. [PMID: 36410651 DOI: 10.1016/j.xfss.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 11/11/2022] [Accepted: 11/15/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To investigate whether blastocysts that divide irregularly reduce subsequent blastocyst euploidy. DESIGN Retrospective study. SETTING Private clinic. PATIENT(S) A total of 122 blastocysts for which consent for disposal and research use was obtained. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Results of next-generation sequencing analysis of the blastocysts and whether blastomeres by normal or irregular divisions subsequently participated in blastocyst formation or not. RESULT(S) The embryos were classified according to their dynamics until the second cleavage. The blastocyst euploidy rates were 33.3% (19/57) in the normal cleavage (NC) group, 38.3% (18/47) in the direct cleavage (embryos with one cell dividing into 3 cells) (DC) group, and 72.2% (13/18) in the reverse cleavage (RC) (embryos with fused cells once divided) group. The rate of the RC group was significantly higher than that of the NC group. The blastocyst participation rate of the blastomeres were 95.6% in the NC group and 56.5% in that derived from DC of the first cleavage, and 91.7% in that of blastomeres derived from normal division of the second cleavage and 53.6% in that derived from DC of the second cleavage, both of which were significantly lower in the latter. In the RC group, the rates of fused and nonfused blastomeres were 62.1% and 87.5%, respectively, with no significant difference. CONCLUSION(S) The blastomeres generated by DC were often excluded from blastocyst formation, and we speculate that this is one reason why their division does not reduce blastocyst euploidy. The association between RC and euploidy of blastocysts merits further study.
Collapse
Affiliation(s)
| | | | | | - Shunsuke Miyai
- Institute for Comprehensive Medical Science, Fujita Health University, Toyoake, Japan
| | - Yuki Sawada
- Sawada Women's Clinic, Nagoya, Japan; Department of Obstetrics and Gynecology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Hiroki Kurahashi
- Institute for Comprehensive Medical Science, Fujita Health University, Toyoake, Japan
| | | |
Collapse
|
30
|
Govahi A, Nasr-Esfahani MH, Amjadi F, Mahdevar M, Mehdizadeh R, Mehdizadeh M. Cutting-edge techniques provide insights regarding repeated implantation failure patients. Reprod Biomed Online 2022; 46:687-696. [PMID: 36792416 DOI: 10.1016/j.rbmo.2022.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 11/30/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022]
Abstract
RESEARCH QUESTION Can time-lapse parameters and the transcriptional profile of cumulus cells be used to achieve a more stringent and non-invasive method of embryo assessment and to identify possible factors affecting the embryo's ability to implant in repeated implantation failure (RIF) patients? DESIGN A total of 190 embryos from 18 oocyte donors and 145 embryos from 15 RIF patients were evaluated based on time-lapse parameters. Three morphokinetic parameters including T5 (time to reach five cells), T3 (time to reach three cells) and CC2 (time to two to three cells) were recorded for all embryos. Embryos that had all three parameters in the normal range were graded as high quality and comparison between these parameters were compared in high-quality embryos between two groups. The transcriptional profile of cumulus cells related to high-quality embryos of both groups were analysed by RNA sequencing and compared. Finally, the possible relationship between differentially expressed genes and time-lapse parameters was examined. RESULTS T5 was significantly lower in the RIF group than the donor group (P = 0.011). The cumulus cell transcriptome analysis showed 193 genes were down-regulated and 222 genes up-regulated. The mammalian target of rapamycin and the transforming growth factor beta pathways were significantly increased in the RIF group compared to the donor group (P = 0.007 and 0.01, respectively). Vitamin B12 and fatty acid beta-oxidation pathways were also significantly reduced in the RIF group compared to the donor group (P = 0.006 and 0.01, respectively). CONCLUSIONS Differences in the transcriptomic profiles of cumulus cells and some morphokinetic parameters may be one of the main factors contributing to unexplained RIF.
Collapse
Affiliation(s)
- Azam Govahi
- Endometriosis Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad-Hossein Nasr-Esfahani
- Department of Animal Biotechnology, Reproductive Biomedicine Research Center, Royan Institute for Biotechnology, ACECR, Isfahan, Iran
| | - Fatemehsadat Amjadi
- Department of Anatomy, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | | | - Rana Mehdizadeh
- School of Dentistry, Central Tehran Branch, Islamic Azad University, Tehran, Iran
| | - Mehdi Mehdizadeh
- Reproductive Sciences and Technology Research Center, Department of Anatomy, Iran University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
31
|
de Castro P, Vendrell X, Escrich L, Grau N, Gonzalez-Martin R, Quiñonero A, Dominguez F, Escribá MJ. Comparative single-cell transcriptomic profiles of human androgenotes and parthenogenotes during early development. Fertil Steril 2022; 119:675-687. [PMID: 36563838 DOI: 10.1016/j.fertnstert.2022.12.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 12/02/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To unravel the differential transcriptomic behavior of human androgenotes (AGs) and parthenogenotes (PGs) throughout the first cell cycles, analyze the differential expression of genes related to key biologic processes, and determine the time frame for embryonic genome activation (EGA) in AGs and PGs. DESIGN Laboratory study. SETTING Private fertility clinic. PATIENT(S) Mature oocytes were retrieved from healthy donors and subjected to artificial oocyte activation using calcium ionophore and puromycin to generate PGs (n = 6) or enucleated and subjected to intracytoplasmic sperm injection to generate AGs (n = 10). INTERVENTION(S) Uniparental constructs at different early stages of development were disaggregated into constituent single cells (we suggest the terms parthenocytes and androcytes) to characterize the single-cell transcriptional landscape using next-generation sequencing. MAIN OUTCOMES MEASURE(S) Transcriptomic profiles comparison between different stages of early development in AGs and PGs. RESULT(S) The uniparental transcriptomic profiles at the first cell cycle showed 68 down-regulated and 26 up-regulated differentially expressed genes (DEGs) in PGs compared with AGs. During the third cell cycle, we found 60 up-regulated and 504 down-regulated DEGs in PGs compared with AGs. In the fourth cell cycle, 1,771 up-regulated and 1,171 down-regulated DEGs were found in PGs compared with AGs. The AGs and PGs had reduced EGA profiles during the first 3 cell cycles, and a spike of EGA at the fourth cell cycle was observed in PGs. CONCLUSION(S) Transcriptomic analysis of AGs and PGs revealed their complementary behavior until the fourth cell cycle. Androgenotes undergo a low wave of transcription during the first cell cycle, which reflects the paternal contribution to cell cycle coordination, mechanics of cell division, and novel transcription regulation. Maternal transcripts are most prominent in the third and fourth cell cycles, with amplification of transcription related to morphogenic progression and embryonic developmental competence acquisition. Regarding EGA, in PGs, a primitive EGA begins at the 1-cell stage and gradually progresses until the 4-cell stage, when crucial epigenetic reprogramming (through methylation) is up-regulated. In addition, our longitudinal single-cell transcriptomic analysis challenges that the zygote and early cleavage stages are the only totipotent entities, by revealing potential totipotency in cleavage-stage AGs and implications of paternal transcripts.
Collapse
Affiliation(s)
- Pedro de Castro
- Grupo de Investigación en Medicina Reproductiva, Fundación FIVI, Instituto de Investigación Sanitaria La Fe (IIS LA FE), Valencia, Spain
| | | | | | | | - Roberto Gonzalez-Martin
- Grupo de Investigación en Medicina Reproductiva, Fundación FIVI, Instituto de Investigación Sanitaria La Fe (IIS LA FE), Valencia, Spain
| | - Alicia Quiñonero
- Grupo de Investigación en Medicina Reproductiva, Fundación FIVI, Instituto de Investigación Sanitaria La Fe (IIS LA FE), Valencia, Spain
| | - Francisco Dominguez
- Grupo de Investigación en Medicina Reproductiva, Fundación FIVI, Instituto de Investigación Sanitaria La Fe (IIS LA FE), Valencia, Spain.
| | - María José Escribá
- Grupo de Investigación en Medicina Reproductiva, Fundación FIVI, Instituto de Investigación Sanitaria La Fe (IIS LA FE), Valencia, Spain; IVI Valencia, Valencia, Spain
| |
Collapse
|
32
|
Marsh P, Radif D, Rajpurkar P, Wang Z, Hariton E, Ribeiro S, Simbulan R, Kaing A, Lin W, Rajah A, Rabara F, Lungren M, Demirci U, Ng A, Rosen M. A proof of concept for a deep learning system that can aid embryologists in predicting blastocyst survival after thaw. Sci Rep 2022; 12:21119. [PMID: 36477633 PMCID: PMC9729222 DOI: 10.1038/s41598-022-25062-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 11/24/2022] [Indexed: 12/12/2022] Open
Abstract
The ability to understand whether embryos survive the thaw process is crucial to transferring competent embryos that can lead to pregnancy. The objective of this study was to develop a proof of concept deep learning model capable of assisting embryologist assessment of survival of thawed blastocysts prior to embryo transfer. A deep learning model was developed using 652 labeled time-lapse videos of freeze-thaw blastocysts. The model was evaluated against and along embryologists on a test set of 99 freeze-thaw blastocysts, using images obtained at 0.5 h increments from 0 to 3 h post-thaw. The model achieved AUCs of 0.869 (95% CI 0.789, 0.934) and 0.807 (95% CI 0.717, 0.886) and the embryologists achieved average AUCs of 0.829 (95% CI 0.747, 0.896) and 0.850 (95% CI 0.773, 0.908) at 2 h and 3 h, respectively. Combining embryologist predictions with model predictions resulted in a significant increase in AUC of 0.051 (95% CI 0.021, 0.083) at 2 h, and an equivalent increase in AUC of 0.010 (95% CI -0.018, 0.037) at 3 h. This study suggests that a deep learning model can predict in vitro blastocyst survival after thaw in aneuploid embryos. After correlation with clinical outcomes of transferred embryos, this model may help embryologists ascertain which embryos may have failed to survive the thaw process and increase the likelihood of pregnancy by preventing the transfer of non-viable embryos.
Collapse
Affiliation(s)
- P. Marsh
- grid.266102.10000 0001 2297 6811Center for Reproductive Health, Department of Medicine, University of California, San Francisco, USA
| | - D. Radif
- grid.168010.e0000000419368956Department of Computer Science, Stanford University, Stanford, USA
| | - P. Rajpurkar
- grid.168010.e0000000419368956Department of Computer Science, Stanford University, Stanford, USA
| | - Z. Wang
- grid.168010.e0000000419368956Department of Computer Science, Stanford University, Stanford, USA
| | - E. Hariton
- grid.266102.10000 0001 2297 6811Center for Reproductive Health, Department of Medicine, University of California, San Francisco, USA
| | - S. Ribeiro
- grid.266102.10000 0001 2297 6811Center for Reproductive Health, Department of Medicine, University of California, San Francisco, USA
| | - R. Simbulan
- grid.266102.10000 0001 2297 6811Center for Reproductive Health, Department of Medicine, University of California, San Francisco, USA
| | - A. Kaing
- grid.266102.10000 0001 2297 6811Center for Reproductive Health, Department of Medicine, University of California, San Francisco, USA
| | - W. Lin
- grid.266102.10000 0001 2297 6811Center for Reproductive Health, Department of Medicine, University of California, San Francisco, USA
| | - A. Rajah
- grid.266102.10000 0001 2297 6811Center for Reproductive Health, Department of Medicine, University of California, San Francisco, USA
| | - F. Rabara
- grid.266102.10000 0001 2297 6811Center for Reproductive Health, Department of Medicine, University of California, San Francisco, USA
| | - M. Lungren
- grid.168010.e0000000419368956Center for Artificial Intelligence in Medicine & Imaging, Stanford University, Stanford, USA
| | - U. Demirci
- grid.168010.e0000000419368956Canary Center for Cancer Early Detection, Stanford University, Stanford, USA
| | - A. Ng
- grid.168010.e0000000419368956Department of Computer Science, Stanford University, Stanford, USA
| | - M. Rosen
- grid.266102.10000 0001 2297 6811Center for Reproductive Health, Department of Medicine, University of California, San Francisco, USA
| |
Collapse
|
33
|
Ma BX, Huang B, Chen D, Jin L, Rao Q. Are Early Embryo Cleavage Kinetics Affected by Energy Substrates in Different Culture Media? Curr Med Sci 2022; 42:1297-1304. [PMID: 36544035 DOI: 10.1007/s11596-022-2648-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 04/12/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE This study aimed to investigate the influence of different culture media on early embryonic cleavage kinetics using time-lapse analysis and to determine the possible relationships between energy substrates in culture media and the cleavage kinetics. METHODS A total of 10 021 embryos from 1310 couples were cultured in time-lapse incubators. Embryos cultured in Vitrolife media were allocated to group I, and those in COOK media to group II. Embryo cleavage time points up to the 8-cell stage (t2-t8) were observed after pronuclei fading. RESULTS The baseline demographic features, in vitro fertilization indications, ovarian stimulation protocol, oocyte-cumulus complexes, fertilization rate, together with pregnancy and perinatal outcomes were similar (P>0.05) between groups I and II. According to the time-lapse analysis, all embryos in group I showed significantly faster cleavage speed than those in group II (P<0.05). Furthermore, there was better synchrony in division (s3) and a longer length of the third cell cycle duration (cc3) in group II. Interestingly, implanted embryos in group II showed faster cleavage speed than those in group I, especially at t4 and t7. The glucose contents and multiple major amino acids were similar between the two groups. Lactic and pyruvic acid contents were generally higher in group I than those in group II. CONCLUSION Because different commercial culture media may influence cleavage kinetics of embryos, it is essential for embryologists to take culture media into consideration in selecting a potential embryo when using a time-lapse system before implantation.
Collapse
Affiliation(s)
- Bing-Xin Ma
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Bo Huang
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Dan Chen
- Guangdong Institute of Sport Science, Guangzhou, 510663, China
| | - Lei Jin
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
| | - Qun Rao
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
| |
Collapse
|
34
|
Kim J, Lee J, Jun JH. Non-invasive evaluation of embryo quality for the selection of transferable embryos in human in vitro fertilization-embryo transfer. Clin Exp Reprod Med 2022; 49:225-238. [PMID: 36482497 PMCID: PMC9732075 DOI: 10.5653/cerm.2022.05575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 11/09/2022] [Accepted: 11/10/2022] [Indexed: 07/28/2023] Open
Abstract
The ultimate goal of human assisted reproductive technology is to achieve a healthy pregnancy and birth, ideally from the selection and transfer of a single competent embryo. Recently, techniques for efficiently evaluating the state and quality of preimplantation embryos using time-lapse imaging systems have been applied. Artificial intelligence programs based on deep learning technology and big data analysis of time-lapse monitoring system during in vitro culture of preimplantation embryos have also been rapidly developed. In addition, several molecular markers of the secretome have been successfully analyzed in spent embryo culture media, which could easily be obtained during in vitro embryo culture. It is also possible to analyze small amounts of cell-free nucleic acids, mitochondrial nucleic acids, miRNA, and long non-coding RNA derived from embryos using real-time polymerase chain reaction (PCR) or digital PCR, as well as next-generation sequencing. Various efforts are being made to use non-invasive evaluation of embryo quality (NiEEQ) to select the embryo with the best developmental competence. However, each NiEEQ method has some limitations that should be evaluated case by case. Therefore, an integrated analysis strategy fusing several NiEEQ methods should be urgently developed and confirmed by proper clinical trials.
Collapse
Affiliation(s)
- Jihyun Kim
- Department of Obstetrics and Gynaecology, Seoul Medical Center, Seoul, Republic of Korea
| | - Jaewang Lee
- Department of Biomedical Laboratory Science, College of Health Science, Eulji University, Seongnam, Republic of Korea
| | - Jin Hyun Jun
- Department of Biomedical Laboratory Science, College of Health Science, Eulji University, Seongnam, Republic of Korea
- Department of Senior Healthcare, Graduate School, Eulji University, Seongnam, Republic of Korea
| |
Collapse
|
35
|
Tokuoka Y, Yamada TG, Mashiko D, Ikeda Z, Kobayashi TJ, Yamagata K, Funahashi A. An explainable deep learning-based algorithm with an attention mechanism for predicting the live birth potential of mouse embryos. Artif Intell Med 2022; 134:102432. [PMID: 36462898 DOI: 10.1016/j.artmed.2022.102432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 08/13/2022] [Accepted: 10/19/2022] [Indexed: 11/09/2022]
Abstract
In assisted reproductive technology (ART), embryos produced by in vitro fertilization (IVF) are graded according to their live birth potential, and high-grade embryos are preferentially transplanted. However, rates of live birth following clinical ART remain low worldwide. Grading is based on the embryo shape at a limited number of stages and does not consider the shape of embryos and intracellular structures, e.g., nuclei, at various stages important for normal embryogenesis. Here, we developed a Normalized Multi-View Attention Network (NVAN) that directly predicts live birth potential from the nuclear structure in live-cell fluorescence images of mouse embryos from zygote to across a wide range of stages. The input is morphological features of cell nuclei, which were extracted as multivariate time-series data by using the segmentation algorithm for mouse embryos. The classification accuracy of our method (83.87%) greatly exceeded that of existing machine-learning methods and that of visual inspection by embryo culture specialists. Our method also has a new attention mechanism that allows us to determine which values of multivariate time-series data, used to describe nuclear morphology, were the basis for the prediction. By visualizing the features that contributed most to the prediction of live birth potential, we found that the size and shape of the nucleus at the morula stage and at the time of cell division were important for live birth prediction. We anticipate that our method will help ART and developmental engineering as a new basic technology for IVF embryo selection.
Collapse
Affiliation(s)
- Yuta Tokuoka
- Center for Biosciences and Informatics, Graduate School of Fundamental Science and Technology, Keio University, 3-14-1 Hiyoshi, Kouhoku-ku, Yokohama, 223-8522, Japan
| | - Takahiro G Yamada
- Center for Biosciences and Informatics, Graduate School of Fundamental Science and Technology, Keio University, 3-14-1 Hiyoshi, Kouhoku-ku, Yokohama, 223-8522, Japan; Department of Biosciences and Informatics, Keio University, 3-14-1 Hiyoshi, Kouhoku-ku, Yokohama, 223-8522, Japan
| | - Daisuke Mashiko
- Faculty of Biology-Oriented Science and Technology, Kindai University, 930 Nishimitani, Kinokawa, Wakayama, 649-6493, Japan
| | - Zenki Ikeda
- Faculty of Biology-Oriented Science and Technology, Kindai University, 930 Nishimitani, Kinokawa, Wakayama, 649-6493, Japan
| | - Tetsuya J Kobayashi
- Institute of Industrial Science, The University of Tokyo, 4-6-1 Komaba, Meguro-ku, Tokyo, 153-8505, Japan
| | - Kazuo Yamagata
- Faculty of Biology-Oriented Science and Technology, Kindai University, 930 Nishimitani, Kinokawa, Wakayama, 649-6493, Japan
| | - Akira Funahashi
- Center for Biosciences and Informatics, Graduate School of Fundamental Science and Technology, Keio University, 3-14-1 Hiyoshi, Kouhoku-ku, Yokohama, 223-8522, Japan; Department of Biosciences and Informatics, Keio University, 3-14-1 Hiyoshi, Kouhoku-ku, Yokohama, 223-8522, Japan.
| |
Collapse
|
36
|
Rahmawati P, Wiweko B, Boediono A. Mitochondrial DNA copy number in cumulus granulosa cells as a predictor for embryo morphokinetics and chromosome status. Syst Biol Reprod Med 2022; 69:101-111. [PMID: 36426586 DOI: 10.1080/19396368.2022.2145248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
While morphokinetic evaluation of embryos has become the most commonly used technique in IVF to select embryos for transfer, studies have demonstrated that mitochondrial DNA (mtDNA) copy number is correlated with embryo viability and transfer outcomes. Correspondingly, this cohort study aims to evaluate the association between the mtDNA copy number in cumulus granulosa cells (CGCs) with embryo morphokinetic parameters and chromosomal status. Real-time PCR was employed to measure the mtDNA copy number of the 129 CGCs in samples obtained from 30 patients undergoing the IVF-IMSI program at Morula IVF Jakarta between July and October 2020. Bivariate and multiple analyses were utilized to determine its relationship with embryo morphokinetics, blastocyst yield, and chromosomal status. According to the analysis, there was a significant correlation between the mtDNA copy number and the blastocyst status after adjusting for the maternal age and sperm morphology (coefficient 0.832, p value = 0.032, RR value 2.299). Moreover, a significant link was observed between mtDNA copy number in CGC and early embryo developmental phase M1 (t2-t8), using the equation of M1 is 5.702-0.271 mtDNA copy number of CGCs + 0.017 maternal age + 0.013 sperm motility -0.115 sperm morphology (p value = 0.032). However, no correlation was found between the mtDNA copy number in CGCs with the other morphokinetic parameters (M2: tC-tEB, M3: t2-tEB, DC, RC, MN with p > 0.05), or the chromosomal status of the embryos (euploid: 139.44 ± 133.12, aneuploid: 142.40 ± 111.30, p = 0.806). In conclusion, our study suggests that mtDNA copy number in CGCs can serve as a useful biomarker for blastocyst status and early embryo developmental phase but not for chromosomal status.
Collapse
Affiliation(s)
- Pitra Rahmawati
- Master Program in Biomedical Science, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Morula IVF Jakarta, IVF Center, Jakarta, Indonesia
| | - Budi Wiweko
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Yasmin IVF Clinic, Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
- Human Reproductive, Infertility and Family Planning Research Center, Indonesia Medical Education and Research Institute (IMERI), Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Arief Boediono
- Morula IVF Jakarta, IVF Center, Jakarta, Indonesia
- Department of Anatomy, Physiology and Pharmacology, IPB University, Bogor, Indonesia
| |
Collapse
|
37
|
Embryo Morphokinetic Activity Evident in Short Videos of In Vitro Bovine Embryos. DAIRY 2022. [DOI: 10.3390/dairy3040058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Embryo transfer (ET) and in vitro fertilization (IVF) are increasing in use by dairy producers as a means to breed their animals as these assisted reproductive techniques can optimize the genetics of the dairy breed or enable “beef on dairy” programs to increase the profitability of the dairy. Due to the advantages of ET and IVF, it is anticipated that their use will continue to increase despite the status of underwhelmingly low pregnancy outcomes. Pregnancy rates of bovine ET/IVF remain below 56%, with many dairy producers implementing beef on dairy programs reporting pregnancy to be lower than 23%. The inability to objectively evaluate embryo health prior to transfer into a recipient is a contributing factor to this problem as 20% of transferred embryos are inviable at the time of transfer and have little chance of establishing a pregnancy. The objective of this research was to evaluate bovine embryo real-time morphokinetic activity based on 30 s video recordings of day 7.5 morulas and correlate morphokinetic activity to developmental outcomes. Eighty-eight embryos were recorded in standard embryo culture conditions with an SMZ-1000 Stereo zoom microscope and TE-300 Nikon inverted microscope. The difference in the embryo’s morphokinetic activity was measured frame-by-frame and correlated to embryo hatching outcomes. It was found that embryos with lower morphokinetic activity demonstrated higher hatching rates and developmental outcomes, suggesting measurement of embryo morphokinetic activity is a noninvasive and non-subjective method to evaluate embryo competency prior to transfer and can be used to improve the reproductive efficiency and profitability of IVF/ET of dairy cattle.
Collapse
|
38
|
Yaacobi-Artzi S, Kalo D, Roth Z. Seasonal variation in the morphokinetics of in-vitro-derived bovine embryos is associated with the blastocyst developmental competence and gene expression. FRONTIERS IN REPRODUCTIVE HEALTH 2022; 4:1030949. [PMID: 36406891 PMCID: PMC9670144 DOI: 10.3389/frph.2022.1030949] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 10/05/2022] [Indexed: 11/06/2022] Open
Abstract
Summer heat stress is a major cause of reduced development of preimplantation embryos. Nevertheless, seasonal effects on embryo morphokinetics have been less studied. We used a non-invasive time-lapse system that allows continuous monitoring of embryos to study the seasonal impact on embryo morphokinetics. The experiments were performed during the cold and the hot seasons. Cumulus-oocyte complexes were aspirated from ovaries, in-vitro-matured, and fertilized. Putative zygotes were cultured in an incubator equipped with a time-lapse system. The cleavage and blastocyst formation rates were lower in the hot vs. the cold season (p < 0.01). The kinetics of the embryos differed between seasons, reflected by a delay in the second cleavage in the hot vs. the cold season (p < 0.03). The distribution of the embryos into different morphological grades (good, fair, and poor) throughout the first three cleavages differed between seasons, with a higher proportion of good-grade embryos in the hot season (p < 0.03). Cleaved embryos were categorized as either normal or abnormal, based on their first cleavage pattern. Normal cleavage was defined as when the first cleavage resulted in two equal blastomeres and further classified as either synchronous or asynchronous, according to their subsequent cleavages. Abnormal cleavage was defined as when the embryo directly cleaved into more than two blastomeres, it cleaved unequally into two unevenly sized blastomeres, or when the fusion of already divided blastomeres occurred. The proportion of abnormally cleaved embryos was higher in the hot season vs. the cold one (p < 0.01), reflected by a higher proportion of unequally cleaved embryos (p < 0.02). In the cold season, abnormally cleaved embryos had a lower potential to develop into blastocysts relative to their normally cleaved counterparts (p < 0.001). Blastocysts that developed in the cold and the hot seasons differed in the expression of genes that related to the cell cycle (STAT1; p < 0.01), stress (HSF1; p < 0.03), and embryo development (ZP3; p < 0.05). A higher expression level was recorded for the STAT1 and UHRF1 genes in blastocysts that developed from unequally vs. the synchronously cleaved embryos (p < 0.04). We provide the first evidence for a seasonal effect on embryo morphokinetics, which might explain the reduced embryo development during the hot season.
Collapse
|
39
|
Yaacobi-Artzi S, Kalo D, Roth Z. Association between the morphokinetics of in-vitro-derived bovine embryos and the transcriptomic profile of the derived blastocysts. PLoS One 2022; 17:e0276642. [PMID: 36288350 PMCID: PMC9604948 DOI: 10.1371/journal.pone.0276642] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 10/10/2022] [Indexed: 11/18/2022] Open
Abstract
The time-lapse system is a non-invasive method that enables a continuous evaluation through embryo development. Here, we examined the association between the morphokinetics of the developing embryo and the transcriptomic profile of the formed blastocysts. Bovine oocytes were matured and fertilized in vitro; then, the putative zygotes were cultured in an incubator equipped with a time-lapse system. Based on the first-cleavage pattern, embryos were categorized as normal or abnormal (68.5±2.2 and 31.6±2.3%, respectively; P<0.001). A cleaved embryo was defined as normal when it first cleaved into two equal blastomeres; it was classified as synchronous or asynchronous according to its subsequent cleavages. An abnormal pattern was defined as direct, unequal, or reverse cleavage. Direct cleavage was classified as division from one cell directly into three or more blastomeres; unequal cleavage was classified as division that resulted in asymmetrically sized blastomeres; and reverse cleavage of the first division was classified as reduced number of blastomeres from two to one. Of the normally cleaving embryos, 60.2±3.1% underwent synchronous cleavage into 4, 8, and 16 blastomeres, and 39.7±3.1% cleaved asynchronously (P<0.001). The blastocyte formation rate was lower for the synchronously vs. the asynchronously cleaved embryos (P<0.03). The abnormally cleaved embryos showed low competence to develop to blastocysts, relative to the normally cleaved embryos (P<0.001). Microarray analysis revealed 895 and 643 differentially expressed genes in blastocysts that developed from synchronously and asynchronously cleaved embryos, respectively, relative to those that developed from directly cleaved embryos. The genes were related to the cell cycle, cell differentiation, metabolism, and apoptosis. About 180 differentially expressed genes were found between the synchronously vs. the asynchronously cleaved embryos, related to metabolism and the apoptosis mechanism. We provide the first evidence indicating that an embryo's morphokinetics is associated with the transcriptome profile of the derived blastocyst, which might be practically relevant for the embryo transfer program.
Collapse
Affiliation(s)
- Shira Yaacobi-Artzi
- Department of Animal Sciences, Robert H. Smith Faculty of Agriculture, Food and Environment, The Hebrew University, Rehovot, Israel
| | - Dorit Kalo
- Department of Animal Sciences, Robert H. Smith Faculty of Agriculture, Food and Environment, The Hebrew University, Rehovot, Israel
| | - Zvi Roth
- Department of Animal Sciences, Robert H. Smith Faculty of Agriculture, Food and Environment, The Hebrew University, Rehovot, Israel,* E-mail:
| |
Collapse
|
40
|
Piquette T, Rydze RT, Pan A, Bosler J, Granlund A, Schoyer KD. The effect of maternal body mass index on embryo division timings in women undergoing in vitro fertilization. F S Rep 2022; 3:324-331. [PMID: 36568924 PMCID: PMC9783148 DOI: 10.1016/j.xfre.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 10/08/2022] [Accepted: 10/14/2022] [Indexed: 11/05/2022] Open
Abstract
Objective To measure the impact of maternal body mass index (BMI) on the morphokinetics of embryo development as monitored by a time-lapse system. Design A retrospective chart review of in vitro fertilization (IVF) cycles from September 2016 to January 2019. Setting Academic IVF practice. Patients Patients <age 38 years undergoing IVF with their own gametes. Interventions Not applicable. Main outcome measures The primary outcome was to compare embryo division timings between morbidly obese, obese, overweight, and normal-weight patients. A multilevel mixed effects model was performed to investigate the relationships between BMI categories and embryo division timings. Log or square transformation were used to improve fit. Results A total of 366 patients met inclusion criteria, yielding 4,475 embryos: 1,948 embryos from 162 normal-weight women (BMI 18.5-24.9), 1,242 embryos from 96 overweight women (BMI 25.0-29.9), 1,119 embryos from 91 obese women (BMI 30.0-39.9), and 166 embryos from 17 morbidly obese women (BMI ≥40). There were no differences in age, Antimüllerian hormone, or IVF cycle outcomes among the different BMI categories. When comparing embryo division timings based on BMI, controlling for covariates, embryos from obese patients had a shorter time to division to 2 cell embryo (T2) than normal-weight patients. When analyzing BMI as a continuous variable, there was no significant relationship between BMI and embryo division timing. Conclusions Early embryo divisions were accelerated in only certain categories of obesity. This suggests a more complex mechanism for the effect of obesity on embryo development that may not be perceptible through the assessment of cell division timing events.
Collapse
Affiliation(s)
- Theresa Piquette
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Robert T. Rydze
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Amy Pan
- Division of Quantitative Health Sciences, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Jayme Bosler
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Amy Granlund
- Reproductive Medicine Center, Froedtert Hospital, North Hills Health Center, Menomonee Falls, Wisconsin
| | - Kate D. Schoyer
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, Wisconsin,Reprint requests: Kate D. Schoyer, M.D., Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Medical College of Wisconsin, 8701 W. Watertown Plank Rd, Milwaukee, Wisconsin; 53226.
| |
Collapse
|
41
|
Jacobs K, Doerdelmann C, Krietsch J, González-Acosta D, Mathis N, Kushinsky S, Guarino E, Gómez-Escolar C, Martinez D, Schmid JA, Leary PJ, Freire R, Ramiro AR, Eischen CM, Mendez J, Lopes M. Stress-triggered hematopoietic stem cell proliferation relies on PrimPol-mediated repriming. Mol Cell 2022; 82:4176-4188.e8. [PMID: 36152632 DOI: 10.1016/j.molcel.2022.09.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 07/01/2022] [Accepted: 09/08/2022] [Indexed: 11/17/2022]
Abstract
Stem cell division is linked to tumorigenesis by yet-elusive mechanisms. The hematopoietic system reacts to stress by triggering hematopoietic stem and progenitor cell (HSPC) proliferation, which can be accompanied by chromosomal breakage in activated hematopoietic stem cells (HSCs). However, whether these lesions persist in their downstream progeny and induce a canonical DNA damage response (DDR) remains unclear. Inducing HSPC proliferation by simulated viral infection, we report that the associated DNA damage is restricted to HSCs and that proliferating HSCs rewire their DDR upon endogenous and clastogen-induced damage. Combining transcriptomics, single-cell and single-molecule assays on murine bone marrow cells, we found accelerated fork progression in stimulated HSPCs, reflecting engagement of PrimPol-dependent repriming, at the expense of replication fork reversal. Ultimately, competitive bone marrow transplantation revealed the requirement of PrimPol for efficient HSC amplification and bone marrow reconstitution. Hence, fine-tuning replication fork plasticity is essential to support stem cell functionality upon proliferation stimuli.
Collapse
Affiliation(s)
- Kurt Jacobs
- Institute of Molecular Cancer Research, University of Zurich, Winterthurerstrasse 190, 8057 Zurich, Switzerland
| | - Cyril Doerdelmann
- Institute of Molecular Cancer Research, University of Zurich, Winterthurerstrasse 190, 8057 Zurich, Switzerland
| | - Jana Krietsch
- Institute of Molecular Cancer Research, University of Zurich, Winterthurerstrasse 190, 8057 Zurich, Switzerland
| | - Daniel González-Acosta
- Institute of Molecular Cancer Research, University of Zurich, Winterthurerstrasse 190, 8057 Zurich, Switzerland; DNA Replication Group, Molecular Oncology Programme, Spanish National Cancer Research Centre (CNIO), Melchor Fernández Almagro 3, 28029 Madrid, Spain
| | - Nicolas Mathis
- Institute of Molecular Cancer Research, University of Zurich, Winterthurerstrasse 190, 8057 Zurich, Switzerland
| | - Saul Kushinsky
- Department of Cancer Biology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - Estrella Guarino
- DNA Replication Group, Molecular Oncology Programme, Spanish National Cancer Research Centre (CNIO), Melchor Fernández Almagro 3, 28029 Madrid, Spain
| | - Carmen Gómez-Escolar
- B Lymphocyte Biology Laboratory, Spanish National Center for Cardiovascular Research (CNIC), Melchor Fernández Almagro 3, 28029 Madrid, Spain
| | - Dolores Martinez
- Flow Cytometry Unit, Biotechnology Programme, Spanish National Cancer Research Centre (CNIO), Melchor Fernández Almagro 3, 28029 Madrid, Spain
| | - Jonas A Schmid
- Institute of Molecular Cancer Research, University of Zurich, Winterthurerstrasse 190, 8057 Zurich, Switzerland
| | - Peter J Leary
- Institute of Molecular Cancer Research, University of Zurich, Winterthurerstrasse 190, 8057 Zurich, Switzerland; Functional Genomic Center Zurich, University of Zurich, Winterthurerstrasse 190, 8057 Zurich, Switzerland
| | - Raimundo Freire
- Unidad de Investigación, Hospital Universitario de Canarias, Tenerife, Spain; Instituto de Tecnologías Biomédicas, Universidad de La Laguna, La Laguna, Spain; Universidad Fernando Pessoa Canarias, Las Palmas de Gran Canaria, Spain
| | - Almudena R Ramiro
- B Lymphocyte Biology Laboratory, Spanish National Center for Cardiovascular Research (CNIC), Melchor Fernández Almagro 3, 28029 Madrid, Spain
| | - Christine M Eischen
- Department of Cancer Biology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - Juan Mendez
- DNA Replication Group, Molecular Oncology Programme, Spanish National Cancer Research Centre (CNIO), Melchor Fernández Almagro 3, 28029 Madrid, Spain.
| | - Massimo Lopes
- Institute of Molecular Cancer Research, University of Zurich, Winterthurerstrasse 190, 8057 Zurich, Switzerland.
| |
Collapse
|
42
|
Bamford T, Barrie A, Montgomery S, Dhillon-Smith R, Campbell A, Easter C, Coomarasamy A. Morphological and morphokinetic associations with aneuploidy: a systematic review and meta-analysis. Hum Reprod Update 2022; 28:656-686. [PMID: 35613016 DOI: 10.1093/humupd/dmac022] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/10/2022] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND A time lapse system (TLS) is utilized in some fertility clinics with the aim of predicting embryo viability and chance of live birth during IVF. It has been hypothesized that aneuploid embryos display altered morphokinetics as a consequence of their abnormal chromosome complement. Since aneuploidy is one of the fundamental reasons for IVF failure and miscarriage, attention has focused on utilizing morphokinetics to develop models to non-invasively risk stratify embryos for ploidy status. This could avoid or reduce the costs associated with pre-implantation genetic testing for aneuploidy (PGT-A). Furthermore, TLS have provided an understanding of the true prevalence of other dysmorphisms. Hypothetically, the incorporation of morphological features into a model could act synergistically, improving a model's discriminative ability to predict ploidy status. OBJECTIVE AND RATIONALE The aim of this systematic review and meta-analysis was to investigate associations between ploidy status and morphokinetic or morphological features commonly denoted on a TLS. This will determine the feasibility of a prediction model for euploidy and summarize the most useful prognostic markers to be included in model development. SEARCH METHODS Five separate searches were conducted in Medline, Embase, PubMed and Cinahl from inception to 1 July 2021. Search terms and word variants included, among others, PGT-A, ploidy, morphokinetics and time lapse, and the latter were successively substituted for the following morphological parameters: fragmentation, multinucleation, abnormal cleavage and contraction. Studies were limited to human studies. OUTCOMES Overall, 58 studies were included incorporating over 40 000 embryos. All except one study had a moderate risk of bias in at least one domain when assessed by the quality in prognostic studies tool. Ten morphokinetic variables were significantly delayed in aneuploid embryos. When excluding studies using less reliable genetic technologies, the most notable variables were: time to eight cells (t8, 1.13 h, 95% CI: 0.21-2.05; three studies; n = 742; I2 = 0%), t9 (2.27 h, 95% CI: 0.5-4.03; two studies; n = 671; I2 = 33%), time to formation of a full blastocyst (tB, 1.99 h, 95% CI 0.15-3.81; four studies; n = 1640; I2 = 76%) and time to expanded blastocyst (tEB, 2.35 h, 95% CI: 0.06-4.63; four studies; n = 1640; I2 = 83%). There is potentially some prognostic potential in the degree of fragmentation, multinucleation persisting to the four-cell stage and frequency of embryo contractions. Reverse cleavage was associated with euploidy in this meta-analysis; however, this article argues that these are likely spurious results requiring further investigation. There was no association with direct unequal cleavage in an embryo that progressed to a blastocyst, or with multinucleation assessed on Day 2 or at the two-cell stage. However, owing to heterogeneous results and poor-quality evidence, associations between these morphological components needs to be investigated further before conclusions can be reliably drawn. WIDER IMPLICATIONS This first systematic review and meta-analysis of morphological and morphokinetic associations with ploidy status demonstrates the most useful morphokinetic variables, namely t8, t9 and tEB to be included in future model development. There is considerable variability within aneuploid and euploid embryos making definitively classifying them impossible; however, it is feasible that embryos could be prioritized for biopsy. Furthermore, these results support the mechanism by which algorithms for live birth may have predictive ability, suggesting aneuploidy causes delayed cytokinesis. We highlight significant heterogeneity in our results secondary to local conditions and diverse patient populations, therefore calling for future models to be robustly developed and tested in-house. If successful, such a model would constitute a meaningful breakthrough when accessing PGT-A is unsuitable for couples.
Collapse
Affiliation(s)
| | | | | | - Rima Dhillon-Smith
- Tommy's National Centre for Miscarriage Research, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, UK
| | | | - Christina Easter
- Tommy's National Centre for Miscarriage Research, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, UK
| | - Arri Coomarasamy
- Tommy's National Centre for Miscarriage Research, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, UK
| |
Collapse
|
43
|
Palmerola KL, Amrane S, De Los Angeles A, Xu S, Wang N, de Pinho J, Zuccaro MV, Taglialatela A, Massey DJ, Turocy J, Robles A, Subbiah A, Prosser B, Lobo R, Ciccia A, Koren A, Baslan T, Egli D. Replication stress impairs chromosome segregation and preimplantation development in human embryos. Cell 2022; 185:2988-3007.e20. [PMID: 35858625 DOI: 10.1016/j.cell.2022.06.028] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 09/03/2021] [Accepted: 06/15/2022] [Indexed: 10/17/2022]
Abstract
Human cleavage-stage embryos frequently acquire chromosomal aneuploidies during mitosis due to unknown mechanisms. Here, we show that S phase at the 1-cell stage shows replication fork stalling, low fork speed, and DNA synthesis extending into G2 phase. DNA damage foci consistent with collapsed replication forks, DSBs, and incomplete replication form in G2 in an ATR- and MRE11-dependent manner, followed by spontaneous chromosome breakage and segmental aneuploidies. Entry into mitosis with incomplete replication results in chromosome breakage, whole and segmental chromosome errors, micronucleation, chromosome fragmentation, and poor embryo quality. Sites of spontaneous chromosome breakage are concordant with sites of DNA synthesis in G2 phase, locating to gene-poor regions with long neural genes, which are transcriptionally silent at this stage of development. Thus, DNA replication stress in mammalian preimplantation embryos predisposes gene-poor regions to fragility, and in particular in the human embryo, to the formation of aneuploidies, impairing developmental potential.
Collapse
Affiliation(s)
- Katherine L Palmerola
- Department of Obstetrics and Gynecology, Columbia University, New York, NY 10032, USA
| | - Selma Amrane
- Department of Obstetrics and Gynecology, Columbia University, New York, NY 10032, USA
| | - Alejandro De Los Angeles
- Department of Pediatrics and Naomi Berrie Diabetes Center, Columbia Stem Cell Initiative, Columbia University, New York, NY 10032, USA
| | - Shuangyi Xu
- Department of Pediatrics and Naomi Berrie Diabetes Center, Columbia Stem Cell Initiative, Columbia University, New York, NY 10032, USA; Masters of Biotechnology Program, Columbia University, New York, NY 10027, USA
| | - Ning Wang
- Department of Pediatrics and Naomi Berrie Diabetes Center, Columbia Stem Cell Initiative, Columbia University, New York, NY 10032, USA
| | - Joao de Pinho
- Department of Obstetrics and Gynecology, Columbia University, New York, NY 10032, USA
| | - Michael V Zuccaro
- Department of Pediatrics and Naomi Berrie Diabetes Center, Columbia Stem Cell Initiative, Columbia University, New York, NY 10032, USA
| | - Angelo Taglialatela
- Department of Genetics and Development, Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY 10032, USA
| | - Dashiell J Massey
- Department of Molecular Biology and Genetics, Cornell University, Ithaca, NY 14853, USA
| | - Jenna Turocy
- Department of Obstetrics and Gynecology, Columbia University, New York, NY 10032, USA
| | - Alex Robles
- Department of Obstetrics and Gynecology, Columbia University, New York, NY 10032, USA
| | - Anisa Subbiah
- Department of Obstetrics and Gynecology, Columbia University, New York, NY 10032, USA
| | - Bob Prosser
- Department of Obstetrics and Gynecology, Columbia University, New York, NY 10032, USA
| | - Rogerio Lobo
- Department of Obstetrics and Gynecology, Columbia University, New York, NY 10032, USA
| | - Alberto Ciccia
- Department of Genetics and Development, Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY 10032, USA
| | - Amnon Koren
- Department of Molecular Biology and Genetics, Cornell University, Ithaca, NY 14853, USA
| | - Timour Baslan
- Cancer Biology and Genetics Program, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Dieter Egli
- Department of Obstetrics and Gynecology, Columbia University, New York, NY 10032, USA; Department of Pediatrics and Naomi Berrie Diabetes Center, Columbia Stem Cell Initiative, Columbia University, New York, NY 10032, USA.
| |
Collapse
|
44
|
Ezoe K, Shimazaki K, Miki T, Takahashi T, Tanimura Y, Amagai A, Sawado A, Akaike H, Mogi M, Kaneko S, Okimura T, Kato K. Association of a deep learning-based scoring system with morphokinetics and morphological alterations in human embryos. Reprod Biomed Online 2022; 45:1124-1132. [DOI: 10.1016/j.rbmo.2022.08.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 07/19/2022] [Accepted: 08/08/2022] [Indexed: 11/25/2022]
|
45
|
Wignarajah A, Alvero R, Lathi RB, Aghajanova L, Eisenberg M, Winn VD, Behr B, Murugappan G. Implementation of a comprehensive fertility biobanking initiative. F&S SCIENCE 2022; 3:228-236. [PMID: 35977803 PMCID: PMC9386165 DOI: 10.1016/j.xfss.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/04/2022] [Accepted: 01/07/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To present the framework of Stanford Fertility and Reproductive Health's comprehensive reproductive biobanking initiatives and the results of the first year of recruitment. DESIGN Technical description article. SETTING Academic fertility center. PATIENT(S) Fertility patients >18 years of age. INTERVENTION(S) Enroll the patients interested in research in biobanking protocols. MAIN OUTCOME MEASURE(S) Patient recruitment and sample inventory from September 2020 to September 2021. RESULT(S) A total of 253 patients have enrolled in the Stanford Fertility and Reproductive Health biobanking initiatives since September 2020. The current inventory consists of 1,176 samples, including serums, plasmas, buffy coats, endometria, maternal deciduae, miscarriage chorionic villi, and human embryos (zygote, cleavage, and blastocyst stages). CONCLUSION(S) This biobanking initiative addresses a critical, unmet need in reproductive health research to make it possible for patients to donate excess embryos and gametes and preserves, for future research, valuable somatic and reproductive tissues that would otherwise be discarded. We present the framework of this biobanking initiative in order to support future efforts of establishing similar biorepositories.
Collapse
Affiliation(s)
- Anjali Wignarajah
- Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Stanford University, Sunnyvale, California
| | - Ruben Alvero
- Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Stanford University, Sunnyvale, California
| | - Ruth B Lathi
- Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Stanford University, Sunnyvale, California
| | - Lusine Aghajanova
- Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Stanford University, Sunnyvale, California
| | | | - Virginia D Winn
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Stanford University, Stanford, California
| | - Barry Behr
- Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Stanford University, Sunnyvale, California
| | - Gayathree Murugappan
- Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Stanford University, Sunnyvale, California.
| |
Collapse
|
46
|
Kljajic M, Saymé N, Krebs T, Wagenpfeil G, Baus S, Solomayer EF, Kasoha M. Zygote Diameter and Total Cytoplasmic Volume as Useful Predictive Tools of Blastocyst Quality. Geburtshilfe Frauenheilkd 2022; 83:97-105. [PMID: 36643875 PMCID: PMC9833892 DOI: 10.1055/a-1876-2231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 06/13/2022] [Indexed: 01/18/2023] Open
Abstract
Introduction According to the Embryo Protection Act, the selection of embryos with the greatest potential for successful implantation in Germany must be performed in the pronucleus stage. The main aim of this study was to identify morphokinetic parameters that could serve as noninvasive biomarkers of blastocyst quality in countries with restrictive reproductive medicine laws. Materials and Methods The sample comprised 191 embryos from 40 patients undergoing antagonist cycles for intracytoplasmic sperm injection. Blastocysts were cultured in an EmbryoScope chamber and video records were validated to determine the post-injection timing of various developmental stages, cleavage stages, and blastocyst formation. The Gardner and Schoolcraft scoring system was used to characterize blastocyst quality. Results Morphokinetic data showed that the zygote diameter and total cytoplasmic volume were significantly different between good and poor blastocysts quality groups, where zygotes, which formed better blastocyst quality, had smaller diameter and smaller total cytoplasmic volume. Zygotes with more rapid pronuclear disappearance developed in better-quality blastocysts. Differences between good- and poor-quality blastocysts were also observed for late-stage parameters and for the spatial arrangement of blastomere where tetrahedral embryos more frequently forming good-quality blastocyst compare to the non-tetrahedral. Conclusions The study findings could be used to enhance embryo selection, especially in countries with strict Embryo Law Regulations. Further studies, including those in which the implantation potential and pregnancy rate are considered, are warranted to confirm these preliminary results.
Collapse
Affiliation(s)
- Marija Kljajic
- 39072Department of Gynecology, Obstetrics and Reproductive Medicine, Saarland University Hospital, Homburg, Saarland, Germany,Korrespondenzadresse Marija Kljajic 39072Department of Gynecology, Obstetrics and Reproductive Medicine, Saarland University
HospitalKirrberger Str. 10066421 Homburg,
SaarlandGermany
| | - Nabil Saymé
- Team Kinderwunsch Hannover, Hannover, Germany
| | | | - Gudrun Wagenpfeil
- 9379Institute of Medical Biometry, Epidemiology and Medical Informatics, Saarland University, Homburg, Saar, Germany
| | - Simona Baus
- 39072Department of Gynecology, Obstetrics and Reproductive Medicine, Saarland University Hospital, Homburg, Saarland, Germany
| | - Erich-Franz Solomayer
- 39072Department of Gynecology, Obstetrics and Reproductive Medicine, Saarland University Hospital, Homburg, Saarland, Germany
| | - Mariz Kasoha
- 39072Department of Gynecology, Obstetrics and Reproductive Medicine, Saarland University Hospital, Homburg, Saarland, Germany
| |
Collapse
|
47
|
Song X, Li T, Xiong X, Shan H, Feng T, Cui K, Shi D, Liu Q, Li Z. RNA-Seq Reveals the Underlying Molecular Mechanism of First Cleavage Time Affecting Porcine Embryo Development. Genes (Basel) 2022; 13:genes13071251. [PMID: 35886034 PMCID: PMC9320770 DOI: 10.3390/genes13071251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/12/2022] [Accepted: 07/13/2022] [Indexed: 02/01/2023] Open
Abstract
The selection and evaluation of high-quality embryos are the key factors affecting in vitro embryo development and pregnancy outcome. The timing of first embryonic cleavage has been considered a positive indicator of the in vitro developmental potential of embryos, while the underlying molecular mechanism is still not fully understood. In this study, the embryos generated by parthenogenetic activation (PA) or in vitro fertilization (IVF) were monitored and recorded every 2 h and divided into two groups (early cleavage or late cleavage) based on the cleavage rate and blastocyst formation data. RNA sequencing was used to analyze the gene expression pattern of the embryos. We identified 667 and 71 different expression genes (DEGs) in early cleavage and late cleavage porcine PA and IVF embryos, respectively. Further Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses showed that the DEGs are mainly enriched in pathways concerning the proteasome, DNA repair, cell cycle arrest, autophagy, and apoptosis, suggesting that severe endoplasmic reticulum stress (ERS) and DNA damage may be the key factors that led to the low development potential of late cleavage embryos. This study provides a theoretical basis for the following application and offers important information about the understanding of the timely manner of porcine embryo development.
Collapse
Affiliation(s)
- Xinhui Song
- State Key Laboratory for Conservation and Utilization of Subtropical Agro-Bioresources, Guangxi University, Nanning 530004, China; (X.S.); (H.S.); (T.F.); (K.C.); (D.S.)
| | - Tiantian Li
- Guangdong-Hong Kong-Macao Central Nervous Research Institute, Medical School, Jinan University, Guangzhou 510632, China; (T.L.); (X.X.)
| | - Xin Xiong
- Guangdong-Hong Kong-Macao Central Nervous Research Institute, Medical School, Jinan University, Guangzhou 510632, China; (T.L.); (X.X.)
| | - Huiquan Shan
- State Key Laboratory for Conservation and Utilization of Subtropical Agro-Bioresources, Guangxi University, Nanning 530004, China; (X.S.); (H.S.); (T.F.); (K.C.); (D.S.)
| | - Tong Feng
- State Key Laboratory for Conservation and Utilization of Subtropical Agro-Bioresources, Guangxi University, Nanning 530004, China; (X.S.); (H.S.); (T.F.); (K.C.); (D.S.)
| | - Kuiqing Cui
- State Key Laboratory for Conservation and Utilization of Subtropical Agro-Bioresources, Guangxi University, Nanning 530004, China; (X.S.); (H.S.); (T.F.); (K.C.); (D.S.)
| | - Deshun Shi
- State Key Laboratory for Conservation and Utilization of Subtropical Agro-Bioresources, Guangxi University, Nanning 530004, China; (X.S.); (H.S.); (T.F.); (K.C.); (D.S.)
| | - Qingyou Liu
- Guangdong Provincial Key Laboratory of Animal Molecular Design and Precise Breeding, School of Life Science and Engineering, Foshan University, Foshan 528225, China;
| | - Zhipeng Li
- State Key Laboratory for Conservation and Utilization of Subtropical Agro-Bioresources, Guangxi University, Nanning 530004, China; (X.S.); (H.S.); (T.F.); (K.C.); (D.S.)
- Correspondence: ; Tel.: +86-185-0136-1752
| |
Collapse
|
48
|
Mashiko D, Ikeda Z, Tokoro M, Hatano Y, Yao T, Kobayashi TJ, Fukunaga N, Asada Y, Yamagata K. Asynchronous division at 4-8-cell stage of preimplantation embryos affects live birth through ICM/TE differentiation. Sci Rep 2022; 12:9411. [PMID: 35672442 PMCID: PMC9174281 DOI: 10.1038/s41598-022-13646-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 05/18/2022] [Indexed: 11/30/2022] Open
Abstract
To improve the performance of assisted reproductive technology, it is necessary to find an indicator that can identify and select embryos that will be born or be aborted. We searched for indicators of embryo selection by comparing born/abort mouse embryos. We found that asynchronous embryos during the 4-8-cell stage were predisposed to be aborted. In asynchronous mouse embryos, the nuclear translocation of YAP1 in some blastomeres and compaction were delayed, and the number of ICMs was reduced. Hence, it is possible that asynchronous embryos have abnormal differentiation. When the synchrony of human embryos was observed, it was confirmed that embryos that did not reach clinical pregnancy had asynchrony as in mice. This could make synchrony a universal indicator common to all animal species.
Collapse
Affiliation(s)
- Daisuke Mashiko
- Graduate School of Biology-Oriented Science and Technology, Kindai University, Kinokawa, Wakayama, 649-6493, Japan
| | - Zenki Ikeda
- Graduate School of Biology-Oriented Science and Technology, Kindai University, Kinokawa, Wakayama, 649-6493, Japan
| | - Mikiko Tokoro
- Graduate School of Biology-Oriented Science and Technology, Kindai University, Kinokawa, Wakayama, 649-6493, Japan
- Asada Institute for Reproductive Medicine, Asada Ladies Clinic, Nagoya, Aichi, 450-0002, Japan
| | - Yu Hatano
- Graduate School of Biology-Oriented Science and Technology, Kindai University, Kinokawa, Wakayama, 649-6493, Japan
| | - Tatsuma Yao
- Graduate School of Biology-Oriented Science and Technology, Kindai University, Kinokawa, Wakayama, 649-6493, Japan
- Research and Development Center, Fuso Pharmaceutical Industries, Ltd., Joto, Osaka, 536-8523, Japan
| | - Tetsuya J Kobayashi
- Institute of Industrial Science, The University of Tokyo, Tokyo, 153-8505, Japan
| | - Noritaka Fukunaga
- Asada Institute for Reproductive Medicine, Asada Ladies Clinic, Nagoya, Aichi, 450-0002, Japan
| | - Yoshimasa Asada
- Asada Institute for Reproductive Medicine, Asada Ladies Clinic, Nagoya, Aichi, 450-0002, Japan
| | - Kazuo Yamagata
- Graduate School of Biology-Oriented Science and Technology, Kindai University, Kinokawa, Wakayama, 649-6493, Japan.
| |
Collapse
|
49
|
Metabolic and epigenetic dysfunctions underlie the arrest of in vitro fertilized human embryos in a senescent-like state. PLoS Biol 2022; 20:e3001682. [PMID: 35771762 PMCID: PMC9246109 DOI: 10.1371/journal.pbio.3001682] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 05/19/2022] [Indexed: 12/18/2022] Open
Abstract
Around 60% of in vitro fertilized (IVF) human embryos irreversibly arrest before compaction between the 3- to 8-cell stage, posing a significant clinical problem. The mechanisms behind this arrest are unclear. Here, we show that the arrested embryos enter a senescent-like state, marked by cell cycle arrest, the down-regulation of ribosomes and histones and down-regulation of MYC and p53 activity. The arrested embryos can be divided into 3 types. Type I embryos fail to complete the maternal-zygotic transition, and Type II/III embryos have low levels of glycolysis and either high (Type II) or low (Type III) levels of oxidative phosphorylation. Treatment with the SIRT agonist resveratrol or nicotinamide riboside (NR) can partially rescue the arrested phenotype, which is accompanied by changes in metabolic activity. Overall, our data suggests metabolic and epigenetic dysfunctions underlie the arrest of human embryos.
Collapse
|
50
|
Yang L, Peavey M, Kaskar K, Chappell N, Zhu L, Devlin D, Valdes C, Schutt A, Woodard T, Zarutskie P, Cochran R, Gibbons WE. Development of a dynamic machine learning algorithm to predict clinical pregnancy and live birth rate with embryo morphokinetics. F S Rep 2022; 3:116-123. [PMID: 35789724 PMCID: PMC9250114 DOI: 10.1016/j.xfre.2022.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 04/11/2022] [Accepted: 04/12/2022] [Indexed: 11/28/2022] Open
Abstract
Objective Design Setting Patient(s) Intervention(s) Main Outcome Measure(s) Result(s) Conclusion(s)
Collapse
Affiliation(s)
- Liubin Yang
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Baylor College of Medicine, Huston, Texas
- Reprint requests: Liubin Yang, M.D., Ph.D., Baylor College of Medicine, 1 Baylor Plaza, Mailstop BCM610, Houston, Texas 77030.
| | - Mary Peavey
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Baylor College of Medicine, Huston, Texas
| | - Khalied Kaskar
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Baylor College of Medicine, Huston, Texas
| | - Neil Chappell
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Baylor College of Medicine, Huston, Texas
| | - Lynn Zhu
- Department of BioSciences, Rice University, Houston, Texas
| | - Darius Devlin
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Baylor College of Medicine, Huston, Texas
- Interdepartmental Program in Translational Biology and Molecular Medicine, Baylor College of Medicine, Houston, Texas
| | - Cecilia Valdes
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Baylor College of Medicine, Huston, Texas
| | - Amy Schutt
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Baylor College of Medicine, Huston, Texas
| | - Terri Woodard
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Baylor College of Medicine, Huston, Texas
| | - Paul Zarutskie
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Baylor College of Medicine, Huston, Texas
| | - Richard Cochran
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Baylor College of Medicine, Huston, Texas
| | - William E. Gibbons
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Baylor College of Medicine, Huston, Texas
| |
Collapse
|