1 / 31

THE ROLE OF EMBRYO ON IMPLANTATION

THE ROLE OF EMBRYO ON IMPLANTATION. Başak Balaban, BSc VKV American Hospital Assisted Reproduction Unit, Istanbul, Turkey. AMER IC AN HOSPITAL. Factors predicting live birth rates. Clinical factors: *Women’s age *No.of retrieved oocytes *Aetiology of infertility

carlsonn
Download Presentation

THE ROLE OF EMBRYO ON IMPLANTATION

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. THE ROLE OF EMBRYO ON IMPLANTATION Başak Balaban, BSc VKV American Hospital Assisted Reproduction Unit, Istanbul, Turkey AMERICAN HOSPITAL

  2. Factors predicting live birth rates • Clinical factors: *Women’s age *No.of retrieved oocytes *Aetiology of infertility *No.of embryos transferred....... • Embryological factors * QUALITY * Developmental stage Elizur et al.,RBM Online 2005

  3. Developmental Stage?? • Day 2 vs. Day 3 ET • Day 3 vs. Day 5 BT

  4. Embryo quality&Implantation • Transfer of good quality embryos results in higher pregnancy and implantation rates • Highest implantation rate with the minimum number of embryos transferred (SET) should be our final goal • Therefore selection of the TOP QUALITY EMBRYO/S for transfer is an essential process that should be achieved in IVF lab.s Hsu F&S 1999, Terriou F&S 2001, De Neubourg HR 2004, Schmidt 2005

  5. GOOD QUALITY EMBRYO: MOST VIABLE EMBRYO WITH the HIGHEST IMPLANTATION POTENTIAL Sperm IN VITRO CULTURE BLASTOCYST OOCYTE Early Cleavage Day 2 embryo Day 3 embryo PN Morphology Multinucleation 0 16-18 24-25 48 72 96-120

  6. MORPHOLOGICAL ABNORMALITIES OF MII OOCYTE • Extracytoplasmic abnormalities **Shape abnormalities (irregular shape of MII oocyte) **ZP abnormalities (dark or thick ZP) **PVS abnormalities (large PVS, PVS granulation) • Cytoplasmic abnormalities **Dark cytoplasmic colour (slight granulation) ** Excessive whole or centrally located granulation **Refractile bodies,sERC or vacuoles in the ooplasm

  7. Smooth Endoplasmic Reticulum Clusters (sERC) and vacuolization appearance in MII oocytes 2.1 % IR for sERC(+) cycles Otsuki et al.Hum.Reprod.,2004 EBNER et al. 2008. Higher incidence of obstetric problems, two babies born with imprinting diseases??, abnormal regulation of Ca2+ signaling..

  8. Effect of cytoplasmic vacuoles throughout embryo development Mean diameter of vaculoes with fertilization :9.8m Mean diameter of vaculoes with FF :17.6 m (p<.05) Cut off value :14 m Patients variables similar between vacuole(+) & (-) cycles Ebner et al. F&S, 2005

  9. Very low OPR% are obtained with the transfer of embryos obtained from CLCG oocytes CLCG-Centrally located granular cytoplasm Fert%+embryo quality: no sig., sig.higher aneoploidy Kahraman&Yakin et al.HR.,2000 Balaban et al., 2007 also reported sig. higher aneoploidy with CLCG

  10. Scott,RBM Online,2003 Tesarik,Hum Reprod,1999 PN MORPHOLOGY

  11. PN score&IR&Deliviries Scott et al.,Hum.Reprod. 2006

  12. Pronuclear patterns& aneuploidy rate Balaban et al., RBM Online,2004

  13. Relationship between pronuclear morphology, cleavage rate, blastocyst progression, blastocyst grade, and multinucleated blastomeres Balaban, Hum Reprod,2001

  14. Cleavage rate • Blastomere number • Day 2 embryos that cleave to 4-cell stage result in higher implantation (Giorgetti 1995, Ziebe 1997,Scott 2006) • Embryos with at least 4-5 blastomeres on day 2 and at least 7 blastomeres on day 3 yield higher implantation rates (Gerris 1997, Van Royen, 1999,2001) • Slow cleavage • Lower implantation potential and blastocyst formation should be expected (Alikani 2000) • Fast cleavage • High levels of mosaicism and polyspermic fertilization (Harper 1994) • > 70% chromosomally abnormality (Magli 1998)

  15. Cleavage stage embryo morphology • Grade 1 embryo: no fragmentation with equal sized homogenous blastomeres • Grade 2 embryo: < 20% fragmentation with equal sized homogenous blastomeres • Grade 3 embryo: 20-50% fragmentation with unequal sized blastomeres • Grade 4 embryo: >50% fragmentation with unequal sized blastomeres. (Puissant 1987, Staessen 1992, Steer 1992, Ziebe 1997)

  16. Uneven blastomeres Grade I:no fragments, even-sized blastomeres and light, homogeneous cytoplasm Grade IIA: <20% fragments Grade IIB: uneven-sized blastomeres Grade IIC: non-homogeneous cytoplasm Grade III: >20% Grade IV: >50% Hardarson, Hum Reprod, 2001

  17. Cell symmetry&IR&Deliviries Scott et al.,Hum.Reprod.2006

  18. CPR & IR according to the degree of fragmentation **p<.001 Mean no.of ET:3.2 Alikani et al.,F&S 1999

  19. Embryo fragmentation Patterns Type I: minimal in volume and fragments associated typically with only one blastomere Type II: localized and predominantly occupy perivitelline space Type III: small, scattered fragments, these may be in cleavage cavity or peripherally positioned Type IV: large fragments, sometimes resembling whole blastomeres, often distributed randomly and associated with uneven cellsType V: fragments appear necrotic with a characteristic granularity and cytoplasmic contraction within the intact blastomeres Alikani, Fertil Steril, 1999 Sig. lower IR reported with T4

  20. Presence of early cleavage and outcome of ICSI Isiklar&Balaban, J Reprod Med, 2002 Strong indicator of embryo quality (Shoukir 1997, Sakkas 1998, Bos-Mikich 2001, Lundin 2001, Lundqvist 2001, Isiklar 2002, Fenwick 2002, Salumets 2003,Ciray 2004,2005,2006,Windt 2004,Montfoort 2004,Fancsovits 2005)

  21. The impact of presence of one or more multinucleated blastomeres on the developmental potential of the embryo until the blastocyst stage Yakin&Balaban et al., F&S 2006 • Impaired developmental capacity(Alikani 1999, Jackson 1998, Balakier 1997) • Correlated with chromosomal abnormalities(Staessen 1998, Kligman 1996, • Pickering 1995)

  22. State of nucleation&IR&Deliviries Scott et al.,Hum.Reprod.2006

  23. CUMULATIVE EMBRYO SCORING TO DETERMINE EMBRYO VIABILITY&IMPLANTATION POTENTIAL Sig.higher blast. formation and IR with embryos scored O Rienzi et al.,RBM Online 2005

  24. Cleavage stage embryo charecteristics & IR Sjoblom et al., F&S 2006 Lesourd et al., RBM Online 2006

  25. Embryo quality& Implantation Retr.anal. of 2266 IVF/ICSI double emb day 2ET, ES: Bno+frag.+Bequality+cleavage symmetry+ MNB Holte et al.,Hum.Reprod 2007

  26. Effect of Embryo Charecteristics on Ongoing IR Pelinck et al.,F&S 2010 in press 449 SET in natural IVF cycles, cohort study

  27. ALPHA & ESHRE EMB.SIG CONCENSUS WORKSHOP ON EMBRYO GRADING Concept:2 day meeting of experts to present, discuss and agree on key aspects required for embryo selection/grading. The experts were asked to join actively with the expectation thatall will agree and endorse a final grading scheme at the conclusion of our meeting. Venue: Istanbul Date: February 26th-27th. 2010

  28. CONCLUSIONS • Do embryos have any role on implantation and LBR? • YES!! The quality of the embryo is directly related with the implantation potential • Can morphological observations used in IVF labs. in practical routine help us to determine embryo quality/viability/IMPLANTATION POTENTIAL YES.Irrespective of the stage at which the selection is made,a single observation appear to be insufficient to accurately predict developmental ability. More observations should be conducted at different stages, before and after fertilization, given the fate of the embryo is often decided during oogenesis • Is there any parameter to select a top quality embryo with 100% implantation potential ? NO. In addition/without morphological diagnostic tools more predictive markers (molecular, biochemical.....) are still needed

More Related