Embryo culture

Embryo culture is a component of in vitro fertilisation where in resultant embryos are allowed to grow for some time in an artificial medium.

Duration

The duration of embryo culture can be varied, conferring different stages of embryogenesis at embryo transfer. The main stages at which embryo transfer is performed are cleavage stage (day 2 to 4 after co-incubation) or the blastocyst stage (day 5 or 6 after co-incubation).[1]

Embryos which reach the day 3 cell stage can be tested for chromosomal or specific genetic defects prior to possible transfer by preimplantation genetic diagnosis (PGD). Embryo culture until the blastocyst stage confers a significant increase in live birth rate per embryo transfer, and there is no evidence of a difference between the groups in cumulative pregnancy rates.[2] Transfer day 2 instead of day 3 after fertilization has no differences in live birth rate.[3]

Monozygotic twinning is not increased after blastocyst transfer compared with cleavage-stage embryo transfer.[4]

There are significantly higher odds of preterm birth (odds ratio 1.3) and congenital anomalies (odds ratio 1.3) among births from embryos cultured until the blastocyst stage compared with cleavage stage.[1]

Techniques

Culture of embryos can either be performed in an artificial culture medium or in an autologous endometrial coculture (on top of a layer of cells from the woman's own uterine lining). With artificial culture medium, there can either be the same culture medium throughout the period (monoculture medium), or a sequential system can be used, in which the embryo is sequentially placed in different media, with different formulations based on the different concentration and composition of the tubal and uterine fluid in relation to change in the metabolic activity of the embryo during its development.[5] For example, when culturing to the blastocyst stage, one medium may be used for culture to day 3, and a second medium is used for culture thereafter.[6] Single or sequential medium are equally effective for the culture of human embryos to the blastocyst stage.[7] Artificial embryo culture media basically contain glucose, pyruvate, and energy-providing components, but the addition of amino acids, nucleotides, vitamins, and cholesterol improve the performance of embryonic growth and development.[8] Also substances like antioxidants, antibiotics, macromolecules, hormones and growth factors can be added.[5] Methods to permit dynamic embryo culture with fluid flow and embryo movement are also available.[9] A new method in development uses the uterus as an incubator and the naturally occurring intrauterine fluids as culture medium by encapsulating the embryos in a permeable intrauterine vessel.[10]

A review in 2013 meta-analysis of commercially available IVF culture media was unable to identify a specific media that was superior in terms of pregnancy outcome.[11]

Usage of low oxygen concentrations of 5% rather than about 20% in the atmosphere has been shown to increase live birth rate to a relative probability of 1.24, without any evidence of increased risk for multiple pregnancies, miscarriages or congenital abnormalities.[12]

Buffering system

Control and regulation of pH are mandatory for in vitro embryo culture. Culture media can be classified according to type of buffer used:

CO₂ / bicarbonate - buffered medium: uses the same physiological buffering system surrounding mammalian cells. Require the use of CO₂ incubators at 5-7%;

Phosphate-buffered medium: does not require CO₂ environment. Seems to have detrimental effects in embryo development in vitro;

HEPES-buffered medium: used as buffered medium for human oocyte collection and embryo handling;

MOPS-buffered medium: like HEPES, has the potential advantage that the buffering capacity is less temperature dependent.[13]

Temperature

While it has been hypothesized that incubating at a temperature lower than 37°C may be a more accurate recreation of the temperature in the female reproductive tract, the evidence is uncertain whether different temperatures for embryo culture have different effects on pregnancy or live birth rates.[14]

Risks

Animal studies have detected epigenetic abnormalities in embryos having undergone embryo culture, indicating a need to optimize the procedures.[15]

References

  1. 1 2 Dar, S.; Lazer, T.; Shah, P. S.; Librach, C. L. (2014). "Neonatal outcomes among singleton births after blastocyst versus cleavage stage embryo transfer: a systematic review and meta-analysis". Human Reproduction Update. 20 (3): 439–448. doi:10.1093/humupd/dmu001. ISSN 1355-4786. PMID 24480786.
  2. ↑ Glujovsky, Demián; Farquhar, Cindy; Quinteiro Retamar, Andrea Marta; Alvarez Sedo, Cristian Roberto; Blake, Deborah (2016-06-30). "Cleavage stage versus blastocyst stage embryo transfer in assisted reproductive technology". The Cochrane Database of Systematic Reviews (6): CD002118. doi:10.1002/14651858.CD002118.pub5. ISSN 1469-493X. PMID 27357126.
  3. ↑ Brown, Julie; Daya, Salim; Matson, Phill (2016). "Day three versus day two embryo transfer following in vitro fertilization or intracytoplasmic sperm injection". The Cochrane Database of Systematic Reviews. 12: CD004378. doi:10.1002/14651858.CD004378.pub3. ISSN 1469-493X. PMC 6463848. PMID 27976360.
  4. ↑ Papanikolaou EG, Fatemi H, Venetis C, et al. (February 2009). "Monozygotic twinning is not increased after single blastocyst transfer compared with single cleavage-stage embryo transfer". Fertil. Steril. 93 (2): 592–7. doi:10.1016/j.fertnstert.2008.12.088. PMID 19243755.
  5. 1 2 Sunde, Arne; Brison, Daniel; Dumoulin, John; Harper, Joyce; Lundin, Kersti; Magli, M. Cristina; Van den Abbeel, Etienne; Veiga, Anna (October 2016). "Time to take human embryo culture seriously: Table I". Human Reproduction. 31 (10): 2174–2182. doi:10.1093/humrep/dew157. ISSN 0268-1161. PMID 27554442.
  6. ↑ Comparison Of A Single Medium With Sequential Media For Development Of Human Embryos To The Blastocyst Stage Archived 2012-03-21 at the Wayback Machine Melanie R. Freeman and Don Rieger. Nashville Fertility Center, Nashville, TN, U.S.A. and LifeGlobal, Guelph, ON, Canada
  7. ↑ Schneider, D.T.; Verza, S.; Esteves, S.C. (2009). "Single or sequential medium are equally effective for the culture of human embryos to the blastocyst stage: a pilot study". Fertility and Sterility. 92 (3): S231–S232. doi:10.1016/j.fertnstert.2009.07.1564.
  8. ↑ Xella S, Marsella T, Tagliasacchi D, et al. (April 2010). "Embryo quality and implantation rate in two different culture media: ISM1 versus Universal IVF Medium". Fertil. Steril. 93 (6): 1859–63. doi:10.1016/j.fertnstert.2008.12.030. PMID 19152877.
  9. ↑ Swain JE, Smith GD (2011). "Advances in embryo culture platforms: novel approaches to improve preimplantation embryo development through modifications of the microenvironment". Hum. Reprod. Update. 17 (4): 541–57. doi:10.1093/humupd/dmr006. PMID 21454356.
  10. ↑ Blockeel, C.; Mock, P.; Verheyen, G.; Bouche, N.; Le Goff, P.; Heyman, Y.; Wrenzycki, C.; Höffmann, K.; Niemann, H.; Haentjens, P.; De Los Santos, M. J.; Fernandez-Sanchez, M.; Velasco, M.; Aebischer, P.; Devroey, P.; Simón, C. (2008). "An in vivo culture system for human embryos using an encapsulation technology: A pilot study". Human Reproduction. 24 (4): 790–796. doi:10.1093/humrep/dep005. PMC 2656929. PMID 19273881.
  11. ↑ Mantikou, E.; Youssef, M. A. F. M.; Van Wely, M.; Van Der Veen, F.; Al-Inany, H. G.; Repping, S.; Mastenbroek, S. (2013). "Embryo culture media and IVF/ICSI success rates: A systematic review". Human Reproduction Update. 19 (3): 210–220. doi:10.1093/humupd/dms061. PMID 23385469.
  12. ↑ Mantikou, E.; Bontekoe, S.; Van Wely, M.; Seshadri, S.; Repping, S.; Mastenbroek, S. (2013). "Low oxygen concentrations for embryo culture in assisted reproductive technologies". Human Reproduction Update. 19 (3): 209. doi:10.1093/humupd/dms055. PMID 23377864.
  13. ↑ Swain, Jason E.; Pool, Thomas B. (June 2009). "New pH-buffering system for media utilized during gamete and embryo manipulations for assisted reproduction". Reproductive Biomedicine Online. 18 (6): 799–810. doi:10.1016/s1472-6483(10)60029-6. ISSN 1472-6491. PMID 19490784.
  14. ↑ Baak, NA; Cantineau, AE; Farquhar, C; Brison, DR (17 September 2019). "Temperature of embryo culture for assisted reproduction". The Cochrane Database of Systematic Reviews. 9: CD012192. doi:10.1002/14651858.CD012192.pub2. PMC 6748832. PMID 31529804.
  15. ↑ Anckaert, E.; De Rycke, M.; Smitz, J. (2012). "Culture of oocytes and risk of imprinting defects". Human Reproduction Update. 19 (1): 52–66. doi:10.1093/humupd/dms042. PMID 23054129.
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