Subscribe to RSS
DOI: 10.1055/a-1876-2231
Zygote Diameter and Total Cytoplasmic Volume as Useful Predictive Tools of Blastocyst Quality
Zygotendurchmesser und zytoplasmatisches Gesamtvolumen sind nützliche Prädiktoren zur Beurteilung der BlastozystenqualitätAbstract
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.
Zusammenfassung
Einleitung Gemäß dem Embryonenschutzgesetz muss in Deutschland die Selektion von Embryos mit dem größten Potenzial für eine erfolgreiche Einnistung im Vorkernstadium erfolgen. Das Hauptziel dieser Studie war es, die morphokinetischen Parameter zu ermitteln, die in Ländern mit restriktiven reproduktionsmedizinischen Gesetzen als nichtinvasive Biomarker für die Blastozystenqualität dienen könnten.
Material und Methoden Die Untersuchungseinheit bestand aus 191 Embryos von 40 Patientinnen, die sich einem Antagonisten-Protokoll zur Vorbereitung auf intrazytoplasmatische Spermieninjektionen unterzogen. Die gewonnenen Blastozysten wurden in einem EmbryoScope-Inkubator kultiviert, und die Videoaufnahmen wurden validiert, um die Zeitpunkte der verschiedenen Entwicklungsstadien und Spaltungsstadien nach der Injektion und die Blastozystenformation zu bestimmen. Um die Qualität der Blastozysten zu beurteilen, wurde das Gardner/Schoolcraft-Punktesystem verwendet.
Ergebnisse Die morphokinetischen Daten zeigten, dass es signifikante Unterschiede in den Durchmessern der Zygoten und im zytoplasmatischen Gesamtvolumen gab zwischen den qualitativ hochwertigen und den qualitativ minderwertigen Blastozystengruppen. Zygoten, die eine qualitativ hochwertigere Blastozyste bildeten, hatten einen kleineren Durchmesser und ein kleineres zytoplasmatisches Gesamtvolumen. Zygoten mit einem kürzerem Vorkernstadium entwickelten sich zu qualitativ hochwertigeren Blastozysten. Die Unterschiede zwischen qualitativ hochwertigen und qualitativ minderwertigen Blastozysten wurden auch bei Parametern der Spätstadien und bei der räumlichen Anordnung der Blastomere beobachtet, wobei tetrahedral angeordnete Embryos häufiger qualitativ hochwertige Blastozysten bildeten als Embryos ohne tetrahedrale Anordnung.
Schlussfolgerungen Die Ergebnisse dieser Studie könnten zur Verbesserung der Embryonenselektion verwendet werden, besonders in Ländern mit strengen Embryonenschutzgesetzen. Weitere Studien, die auch das Einnistungspotenzial sowie die Schwangerschaftsrate berücksichtigen, sind erforderlich, um diese Ergebnisse zu bestätigen.
Schlüsselwörter
Zygotendurchmesser - embryonale Morphokinetik - tetrahedrale Anordnung - BlastozystenqualitätPublication History
Received: 21 November 2021
Accepted after revision: 13 June 2022
Article published online:
21 July 2022
© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
References
- 1 Racowsky C, Kovacs P, Martins WP. A critical appraisal of time-lapse imaging for embryo selection: where are we and where do we need to go?. J Assist Reprod Genet 2015; 32: 1025-1030 DOI: 10.1007/s10815-015-0510-6. (PMID: 26126876)
- 2 Desai N, Ploskonka S, Goodman LR. et al. Analysis of embryo morphokinetics, multinucleation and cleavage anomalies using continuous time-lapse monitoring in blastocyst transfer cycles. Reprod Biol Endocrinol 2014; 12: 54 DOI: 10.1186/1477-7827-12-54. (PMID: 24951056)
- 3 Bhide P, Maheshwari A, Cutting R. Time lapse imaging: is it time to incorporate this technology into routine clinical practice?. Hum Fertil (Camb) 2017; 20: 74-79 DOI: 10.1080/14647273.2017.1283068. (PMID: 28142289)
- 4 Faramarzi A, Khalili MA, Micara G. et al. Revealing the secret life of pre-implantation embryos by time-lapse monitoring: A review. Int J Reprod Biomed 2017; 15: 257-264 (PMID: 28744520)
- 5 Alfarawati S, Fragouli E, Colls P. et al. The relationship between blastocyst morphology, chromosomal abnormality, and embryo gender. Fertil Steril 2011; 95: 520-524 DOI: 10.1016/j.fertnstert.2010.04.003. (PMID: 20537630)
- 6 Sundvall L, Ingerslev HJ, Breth Knudsen U. et al. Inter- and intra-observer variability of time-lapse annotations. Hum Reprod 2013; 28: 3215-3221 DOI: 10.1093/humrep/det366. (PMID: 24070998)
- 7 Chamayou S, Patrizio P, Storaci G. et al. The use of morphokinetic parameters to select all embryos with full capacity to implant. J Assist Reprod Genet 2013; 30: 703-710 DOI: 10.1007/s10815-013-9992-2. (PMID: 23585186)
- 8 Barrie A, Homburg R, McDowell G. et al. Examining the efficacy of six published time-lapse imaging embryo selection algorithms to predict implantation to demonstrate the need for the development of specific, in-house morphokinetic selection algorithms. Fertil Steril 2017; 107: 613-621 DOI: 10.1016/j.fertnstert.2016.11.014. (PMID: 28069186)
- 9 Beier HM, Beckman JO. Implications and consequences of the German Embryo Protection Act. Hum Reprod 1991; 6: 607-608 DOI: 10.1093/oxfordjournals.humrep.a137389. (PMID: 1918316)
- 10 Kirkegaard K, Kesmodel US, Hindkjær JJ. et al. Time-lapse parameters as predictors of blastocyst development and pregnancy outcome in embryos from good prognosis patients: a prospective cohort study. Hum Reprod 2013; 28: 2643-2651 DOI: 10.1093/humrep/det300. (PMID: 23900207)
- 11 Minasi MG, Colasante A, Riccio T. et al. Correlation between aneuploidy, standard morphology evaluation and morphokinetic development in 1730 biopsied blastocysts: a consecutive case series study. Hum Reprod 2016; 31: 2245-2254 DOI: 10.1093/humrep/dew183. (PMID: 27591227)
- 12 Gardner DK, Schoolcraft WB. In vitro Culture of human Blastocysts. In: Jansen R, Mortimer D. Towards reproductive Certainty: Infertility and Genetics beyond. Carnforth: Parthenon Press; 1999: 378-388
- 13 Paternot G, Debrock S, D’Hooghe T. et al. Computer-assisted embryo selection: a benefit in the evaluation of embryo quality?. Reprod Biomed Online 2011; 23: 347-354 DOI: 10.1016/j.rbmo.2011.05.007. (PMID: 21782515)
- 14 Kim HJ, Yoon HJ, Jang JM. et al. Evaluation of human embryo development in in vitro fertilization- and intracytoplasmic sperm injection-fertilized oocytes: A time-lapse study. Clin Exp Reprod Med 2017; 44: 90-95 DOI: 10.5653/cerm.2017.44.2.90. (PMID: 28795048)
- 15 Ciray HN, Aksoy T, Goktas C. et al. Time-lapse evaluation of human embryo development in single versus sequential culture media–a sibling oocyte study. J Assist Reprod Genet 2012; 29: 891-900 DOI: 10.1007/s10815-012-9818-7. (PMID: 22714134)
- 16 Freour T, Dessolle L, Lammers J. et al. Comparison of embryo morphokinetics after in vitro fertilizationintracytoplasmic sperm injection in smoking and nonsmoking women. Fertil Steril 2013; 99: 1944-1950
- 17 Hojnik N, Vlaisavljević V, Kovačič B. Morphokinetic Characteristics and Developmental Potential of In Vitro Cultured Embryos from Natural Cycles in Patients with Poor Ovarian Response. Biomed Res Int 2016; 2016: 4286528 DOI: 10.1155/2016/4286528. (PMID: 28097133)
- 18 Bassil R, Casper RF, Meriano J. et al. Can Oocyte Diameter Predict Embryo Quality?. Reprod Sci 2021; 28: 904-908 DOI: 10.1007/s43032-020-00306-3. (PMID: 32876908)
- 19 Romão GS, Araújo MCPM, de Melo AS. et al. Oocyte diameter as a predictor of fertilization and embryo quality in assisted reproduction cycles. Fertil Steril 2010; 93: 621-625
- 20 Scott L. The biological basis of non-invasive strategies for selection of human oocytes and embryos. Hum Reprod Update 2003; 9: 237-249 DOI: 10.1093/humupd/dmg023. (PMID: 12859045)
- 21 Zollner U, Zollner KP, Steck T. et al. Pronuclear scoring. Time for international standardization. J Reprod Med 2003; 48: 365-369 (PMID: 12815911)
- 22 Hnida C, Engenheiro E, Ziebe S. Computer-controlled, multilevel, morphometric analysis of blastomere size as biomarker of fragmentation and multinuclearity in human embryos. Hum Reprod 2004; 19: 288-293 DOI: 10.1093/humrep/deh070. (PMID: 14747169)
- 23 Hnida C, Ziebe S. Total cytoplasmic volume as biomarker of fragmentation in human embryos. J Assist Reprod Genet 2004; 21: 335-340 DOI: 10.1023/b:jarg.0000045473.80338.57. (PMID: 15587147)
- 24 Paternot G, Debrock S, De Neubourg D. et al. Semi-automated morphometric analysis of human embryos can reveal correlations between total embryo volume and clinical pregnancy. Hum Reprod 2013; 28: 627-633 DOI: 10.1093/humrep/des427. (PMID: 23315063)
- 25 Chen F, De Neubourg D, Debrock S. et al. Selecting the embryo with the highest implantation potential using a data mining-based prediction model. Reprod Biol Endocrinol 2016; 14: 10 DOI: 10.1186/s12958-016-0145-1. (PMID: 26936606)
- 26 Goodman LR, Goldberg J, Falcone T. et al. Does the addition of time-lapse morphokinetics in the selection of embryos for transfer improve pregnancy rates? A randomized controlled trial. Fertil Steril 2016; 105: 275-285 DOI: 10.1016/j.fertnstert.2015.10.013. (PMID: 26522611)
- 27 Minasi MG, Greco P, Varricchio MT. et al. The clinical use of time-lapse in human-assisted reproduction. Ther Adv Reprod Health 2020; 14: 2633494120976921 DOI: 10.1177/2633494120976921. (PMID: 33336190)
- 28 Jacobs C, Nicolielo M, Erberelli R. et al. Correlation between morphokinetic parameters and standard morphological assessment: what can we predict from early embryo development? A time-lapse-based experiment with 2085 blastocysts. JBRA Assist Reprod 2020; 24: 273-277 DOI: 10.5935/1518-0557.20190088. (PMID: 32293818)
- 29 Basile N, Morbeck D, García-Velasco J. et al. Type of culture media does not affect embryo kinetics: a time-lapse analysis of sibling oocytes. Hum Reprod 2013; 28: 634-641 DOI: 10.1093/humrep/des462.
- 30 Costa-Borges N, Bellés M, Meseguer M. et al. Blastocyst development in single medium with or without renewal on day 3: a prospective cohort study on sibling donor oocytes in a time-lapse incubator. Fertil Steril 2016; 105: 707-713 DOI: 10.1016/j.fertnstert.2015.11.038. (PMID: 26690010)
- 31 Desai N, Yao M, Richards EG. et al. Randomized study of G-TL and global media for blastocyst culture in the EmbryoScope: morphokinetics, pregnancy, and live births after single-embryo transfer. Fertil Steril 2020; 114: 1207-1215 DOI: 10.1016/j.fertnstert.2020.06.049. (PMID: 32861442)
- 32 Desai N, Gill P. Blastomere cleavage plane orientation and the tetrahedral formation are associated with increased probability of a good-quality blastocyst for cryopreservation or transfer: a time-lapse study. Fertil Steril 2019; 111: 1159-1168 DOI: 10.1016/j.fertnstert.2019.02.019. (PMID: 30982605)
- 33 Cauffman G, Verheyen G, Tournaye H. Developmental capacity and pregnancy rate of tetrahedral- versus non-tetrahedral-shaped 4-cell stage human embryos. J Assist Reprod Genet 2014; 31: 427-434 DOI: 10.1007/s10815-014-0185-4. (PMID: 24522985)
- 34 Paternot G, Debrock S, De Neubourg D. et al. The spatial arrangement of blastomeres at the 4-cell stage and IVF outcome. Reprod Biomed Online 2014; 28: 198-203 DOI: 10.1016/j.rbmo.2013.10.008. (PMID: 24365017)
- 35 Wong CC, Loewke KE, Bossert NL. et al. Non-invasive imaging of human embryos before embryonic genome activation predicts development to the blastocyst stage. Nat Biotechnol 2010; 28: 1115-1121
- 36 Dal Canto M, Coticchio G, Mignini Renzini M. et al. Cleavage kinetics analysis of human embryos predicts development to blastocyst and implantation. Reprod Biomed Online 2012; 25: 474-480 DOI: 10.1016/j.rbmo.2012.07.016. (PMID: 22995750)
- 37 Cetinkaya M, Pirkevi C, Yelke H. et al. Relative kinetic expressions defining cleavage synchronicity are better predictors of blastocyst formation and quality than absolute time points. J Assist Reprod Genet 2015; 32: 27-35 DOI: 10.1007/s10815-014-0341-x. (PMID: 25370178)
- 38 Cruz M, Garrido N, Herrero J. et al. Timing of cell division in human cleavage-stage embryos is linked with blastocyst formation and quality. Reprod Biomed Online 2012; 25: 371-381 DOI: 10.1016/j.rbmo.2012.06.017. (PMID: 22877944)
- 39 Boynukalin FK, Serdarogullari M, Gultomruk M. et al. The impact of endometriosis on early embryo morphokinetics: a case-control study. Syst Biol Reprod Med 2019; 65: 250-257 DOI: 10.1080/19396368.2019.1573275. (PMID: 30741013)
- 40 Fréour T, Dessolle L, Lammers J. et al. Comparison of embryo morphokinetics after in vitro fertilization-intracytoplasmic sperm injection in smoking and nonsmoking women. Fertil Steril 2013; 99: 1944-1950 DOI: 10.1016/j.fertnstert.2013.01.136. (PMID: 23465820)
- 41 Toth B, Baston-Büst DM, Behre HM. et al. Diagnosis and therapy before assisted reproductive treatments. Guideline of the DGGG, OEGGG and SGGG (S2k Level, AWMF Register Number 015–085, February 2019)—part 1, basic assessment of the woman. Geburtshilfe Frauenheilkd 2019; 79: 1278-1292 DOI: 10.1055/a-1017-3389. (PMID: 31875858)
- 42 Wischmann T, Borkenhagen A, Dorn A. et al. Psychosomatically oriented diagnostics and therapy for fertility disorders. Guideline of the DGPFG (S2k-Level, AWMF Registry Number 016/003, December 2019). Geburtshilfe Frauenheilkd 2021; 81: 749-768 DOI: 10.1055/a-1341-9664. (PMID: 34276062)