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Kermack AJ, Fesenko I, Christensen DR, Parry KL, Lowen P, Wellstead SJ, Harris SF, Calder PC, Macklon NS, Houghton FD. Incubator type affects human blastocyst formation and embryo metabolism: a randomized controlled trial. Hum Reprod 2022; 37:2757-2767. [PMID: 36287638 DOI: 10.1093/humrep/deac233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 09/08/2022] [Indexed: 12/14/2022] Open
Abstract
STUDY QUESTION Does the type of incubator used to culture human preimplantation embryos affect development to the blastocyst stage and alter amino acid utilization of embryos in assisted reproduction? SUMMARY ANSWER Culturing embryos in a time lapse system (TLS) was associated with a higher Day 5 blastocyst formation rate and altered amino acid utilization when measured from Day 3 to Day 5 compared to the standard benchtop incubator. WHAT IS KNOWN ALREADY Culture environment is known to be important for the developing preimplantation embryo. TLSs provide a stable milieu allowing embryos to be monitored in situ, whereas embryos cultured in standard benchtop incubators experience environmental fluctuations when removed for morphological assessment. STUDY DESIGN, SIZE, DURATION A prospective clinical trial randomizing 585 sibling embryos to either the TLS (289 embryos) or the standard benchtop incubator (296 embryos) over a 23-month period in a UK University Hospital Fertility Clinic. PARTICIPANTS/MATERIALS, SETTING, METHODS Participants were aged 42 years or under, had an antral follicle count of ≥12 and ≥6 2 pronucleate zygotes. Zygotes were cultured individually in 25 µl of medium. Randomized embryos were graded and selected for transfer or cryopreservation on Day 5. For those embryos produced by women who underwent stimulation with recombinant FSH injections and were triggered with hCG, spent medium was collected on Day 5 for amino acid analysis by high pressure liquid chromatography. Clinical pregnancy was defined as the presence of a foetal heart beat on ultrasound scan at 7 weeks. MAIN RESULTS AND THE ROLE OF CHANCE Overall, blastocyst formation rate on Day 5 was significantly higher in embryos cultured in the TLS (55%) compared to the standard incubator (45%; P = 0.013). Similarly, there was an increase in the number of blastocysts suitable for cryopreservation in the TLS (31%) compared to the standard incubator (23%; P = 0.032). There was a significant difference in the utilization of 12 amino acids by blastocysts cultured from Day 3 to Day 5 in the TLS compared to the standard incubator. Embryos cultured in the TLS displayed an increased total amino acid utilization (P < 0.001) and reduced amino acid production (P < 0.001) compared to those in the standard incubator. Irrespective of incubator used, embryos fertilized by ICSI depleted significantly more amino acids from the medium compared to those fertilized by conventional IVF. There was no difference in the mean score of blastocysts transferred, or the clinical pregnancy rate after transfer of embryos from either of the incubators. LIMITATIONS, REASONS FOR CAUTION The study was not powered to discern significant effects on clinical outcomes. WIDER IMPLICATIONS OF THE FINDINGS The metabolism and development of preimplantation embryos is impacted by the type of incubator used for culture. Further research is required to investigate the long-term implications of these findings. STUDY FUNDING/COMPETING INTEREST(S) NIHR Southampton Biomedical Research Centre Commercial and Enterprise Incubator Fund funded this study. The TLS was provided on loan for the study by Vitrolife. The authors declare no conflict of interests. TRIAL REGISTRATION NUMBER ISRCTN73037149. TRIAL REGISTRATION DATE 12 January 2012. DATE OF FIRST PATIENT’S ENROLMENT 21 January 2012.
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Affiliation(s)
- Alexandra J Kermack
- Centre for Human Development, Stem Cells and Regeneration, School of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, UK.,Complete Fertility Centre, Department of Obstetrics & Gynaecology, Princess Anne Hospital, Southampton, UK.,Department of Obstetrics and Gynaecology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Irina Fesenko
- Centre for Human Development, Stem Cells and Regeneration, School of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
| | - David R Christensen
- Centre for Human Development, Stem Cells and Regeneration, School of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Kate L Parry
- Centre for Human Development, Stem Cells and Regeneration, School of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Philippa Lowen
- Complete Fertility Centre, Department of Obstetrics & Gynaecology, Princess Anne Hospital, Southampton, UK
| | - Susan J Wellstead
- Complete Fertility Centre, Department of Obstetrics & Gynaecology, Princess Anne Hospital, Southampton, UK.,Department of Obstetrics and Gynaecology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Scott F Harris
- Medical Statistics, School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Philip C Calder
- Centre for Human Development, Stem Cells and Regeneration, School of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, UK
| | - Nicholas S Macklon
- Centre for Human Development, Stem Cells and Regeneration, School of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, UK.,Complete Fertility Centre, Department of Obstetrics & Gynaecology, Princess Anne Hospital, Southampton, UK.,Department of Obstetrics and Gynaecology, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,London Women's Clinic, London, UK
| | - Franchesca D Houghton
- Centre for Human Development, Stem Cells and Regeneration, School of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
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Kermack AJ, Wellstead SJ, Fisk HL, Cheong Y, Houghton FD, Macklon NS, Calder PC. The Fatty Acid Composition of Human Follicular Fluid Is Altered by a 6-Week Dietary Intervention That Includes Marine Omega-3 Fatty Acids. Lipids 2020; 56:201-209. [PMID: 33047321 DOI: 10.1002/lipd.12288] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/11/2020] [Accepted: 09/22/2020] [Indexed: 01/13/2023]
Abstract
The fatty acid composition of human follicular fluid is important for oocyte development and for pregnancy following in vitro fertilization (IVF). This study investigated whether a dietary intervention that included an increase in marine omega-3 fatty acids, olive oil and vitamin D alters the fatty acid composition of human follicular fluid. The association of lifestyle factors with follicular fluid fatty acid composition was also investigated. Fifty-five couples awaiting IVF were randomized to receive the 6-week treatment intervention of olive oil for cooking, an olive oil-based spread, and a daily supplement drink enriched with vitamin D and the marine omega-3 fatty acids docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) and 56 couples were randomized to receive placebo equivalents. Dietary questionnaires were completed, and samples of blood were taken before and after the intervention. Follicular fluid was collected at oocyte retrieval and the fatty acid profile assessed using gas chromatography. In the control group, individual fatty acids in red blood cells and follicular fluid were significantly correlated. Furthermore, a healthier diet was associated with a lower percentage of follicular fluid arachidonic acid. The follicular fluid of women in the treatment group contained significantly higher amounts of EPA and DHA compared to the control group, while the omega-6 fatty acids linoleic, γ-linolenic, dihomo-γ-linolenic, and arachidonic were lower. This is the first report of a dietary intervention altering the fatty acid composition of follicular fluid in humans. Further research is required to determine whether this intervention improves oocyte quality.
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Affiliation(s)
- Alexandra J Kermack
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, UK.,Centre for Human Development, Stem Cells & Regeneration, Faculty of Medicine, University of Southampton, Southampton, UK.,Complete Fertility Centre, Department of Obstetrics & Gynaecology, Princess Anne Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,School of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Susan J Wellstead
- Complete Fertility Centre, Department of Obstetrics & Gynaecology, Princess Anne Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Helena L Fisk
- School of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Ying Cheong
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, UK.,Centre for Human Development, Stem Cells & Regeneration, Faculty of Medicine, University of Southampton, Southampton, UK.,Complete Fertility Centre, Department of Obstetrics & Gynaecology, Princess Anne Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,School of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Franchesca D Houghton
- Centre for Human Development, Stem Cells & Regeneration, Faculty of Medicine, University of Southampton, Southampton, UK.,School of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Nicholas S Macklon
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, UK.,Centre for Human Development, Stem Cells & Regeneration, Faculty of Medicine, University of Southampton, Southampton, UK.,Complete Fertility Centre, Department of Obstetrics & Gynaecology, Princess Anne Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,School of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK.,Zealand University Hospital, Roskilde, Denmark.,London Women's Clinic, London, UK
| | - Philip C Calder
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, UK.,School of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
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