Time-lapse imaging of inner cell mass splitting with monochorionic triamniotic triplets after elective single embryo transfer: a case report

2019 ◽  
Vol 38 (4) ◽  
pp. 491-496 ◽  
Author(s):  
Karina Sutherland ◽  
Joanne Leitch ◽  
Helen Lyall ◽  
Bryan J Woodward
Keyword(s):  
Case Report ◽  
Embryo Transfer ◽  
Inner Cell Mass ◽  
Cell Mass ◽  
Time Lapse ◽  
Mass Splitting ◽  
Single Embryo Transfer ◽  
Elective Single Embryo Transfer ◽  
Time Lapse Imaging

P–253 Description of a rare spontaneous monozygotic blastocyst splitting into two discrete euploid blastocysts in vitro detected with time-lapse imaging and preimplantation genetic testing (PGT)

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
S Corcoran ◽  
D Corcoran ◽  
A Wachter ◽  
E Andrews ◽  
J Campbell ◽  
...  
Keyword(s):  
Embryo Transfer ◽  
Treatment Plan ◽  
Cell Mass ◽  
Time Lapse ◽  
Reproductive Technologies ◽  
Single Embryo Transfer ◽  
Assisted Hatching ◽  
Monozygotic Twinning ◽  
Time Lapse Imaging

Abstract Study question Can spontaneous and complete blastocyst splitting into two, in vitro, be investigated using time-lapse imaging and biopsy of each trophectoderm, for inference of ploidy? Summary answer Time-lapse imaging combined with PGT-A gives insights into the incidence, dynamics and timing of rare blastocyst splitting and the ploidy status of each resulting blastocyst. What is known already It is well known that multiple births occur more often with Assisted Reproductive Technologies (ART) than spontaneous conception, even after single embryo transfer. The mechanism of Monozygotic Twinning (MZT) during ART is still unclear but cryopreservation, extended culture, PGT, maternal age and assisted hatching are reported risk factors. MZT is a rare phenomenon, with an incidence of 0.4% in natural conception compared with up to 4.9% in ART. The timing of embryo splitting dictates the type of twinning, in terms of chorionicity and amnionicty, and this is officially determined using ultrasound scanning. Study design, size, duration This is a case study describing the detection of the complete splitting of an IVF blastocyst at 140 hours post insemination (hpi), using time-lapse imaging. The 40-year-old patient previously experienced biochemical pregnancy and several miscarriages; an ectopic molar pregnancy and a probable cornual ectopic. The 39-year-old male partner was normozoospermic. Participants/materials, setting, methods Facilitative laser breaching was performed, according to standard operating procedure, of the morula at 96hpi of embryo development, prior to PGT. Images were collected every 10 minutes and developmental events and embryos morphology annotated using the EmbryoScope+™ time lapse incubator and software. Main results and the role of chance Over 50,000 hatching blastocysts have been time-lapse imaged, scrutinised and annotated within this group of fertility clinics. This is the first time that such a rare blastocyst splitting event has been recorded and studied. Following observation of two pronuclei following IVF and typical cleavage development to blastocyst, with facilitative zona breaching on, at 106.7hpi, the full blastocyst’s trophectoderm (TE) began to herniate and hatch. By 114.3hpi a second internal blastocoel cavity formed appearing to divide the inner cell mass (ICM) within the zona pellucida (ZP). This resulting blastocyst proceeded to hatch as its discrete ICM migrated out of the ZP, along with its TE. TE cells from the original blastocyst then began to hatch at 117.5hpi at the same breached site in the ZP with its ICM visibly evacuating the ZP. By 140hpi the blastocyst had split into two discrete blastocysts while hatching from the ZP. Both resulting blastocysts had clear and separate ICMs and TEs present. Biopsy of approximately 5 cells was performed for each TE, and the blastocysts were vitrified individually. Next Generation Sequencing (NGS) reported both blastocysts to be euploid. Limitations, reasons for caution This case may have been detectable without time-lapse imaging, as the splitting was completed prior to biopsy. More expert scrutiny of the images may result in earlier signs of twinning in progress being detected. Wider implications of the findings: The nature of this detectable in vitro blastocyst splitting, indicates these embryos (if they implanted) to be monozygotic, dichoriol-diamniotic ‘identical’ twins. However – as single embryo transfer is the preferred treatment plan; they may be born years apart. These observations could shed light on the debated models of monozygotic twinning. Trial registration number Not applicable

scholarly journals The Influence of Day 2 Blastomere Symmetry on Blastocyst Grade and Ploidy Status

2019 ◽  
Vol 01 (02) ◽  
pp. 115-118
Author(s):  
Diana Chieh Xing Tain ◽  
Michelle Sheng Rong Lim ◽  
Bee Lian Ng ◽  
Elizabeth Hammond ◽  
Pak Seng Wong
Keyword(s):  
Inner Cell Mass ◽  
Formation Rate ◽  
Cell Mass ◽  
Time Lapse ◽  
Blastocyst Stage ◽  
Chi Square ◽  
Cell Stage ◽  
Cell Asymmetry ◽  
Time Lapse Imaging ◽  
Ploidy Status

Previous studies have suggested that aneuploidy rates are co-related with cell asymmetry at the cleavage stage. A retrospective study was carried out to determine the significance of blastomere symmetry at the 4-cell stage on blastocyst grade and ploidy status. 732 Day 5/6 blastocysts from 191 patients undergoing Pre-implantation Genetic Testing for Aneuploidy were analysed with time-lapse imaging (Embryoscope, Vitrolife) during 2017. Blastomere symmetry was measured at the first image of 4-cells on Day 2 by tabulating the mean diameter of 2 lines drawn perpendicularly on each blastomere. Symmetry was defined as the blastomere diameter difference of [Formula: see text] 25%. Trophectoderm (TE) biopsy was performed on Day 5/6 followed by chromosomal evaluation using Next Generation Sequencing (VeriSeq Protocol, Illumina). Blastocyst grade was classified as either “Good” (inner cell mass (ICM) and TE, AA respectively), “Fair/Good” (AB, BA), “Fair” (BB) and “Poor” (early blastocyst grade 2 or TE grading of C). The significance of blastomere symmetry on blastocyst grade and ploidy status was measured using chi-square tests. There was no significance difference in resulting blastocyst quality for symmetrical and asymmetrical embryos (Table 1: p [Formula: see text] 0.10). Furthermore, there was no significance difference in the euploid rate (42.5% vs. 45.3%) or mosaic rate (22.1% vs. 16.2%) between symmetrical and asymmetrical embryos (p [Formula: see text] 0.24). In conclusion, the presence of asymmetrical blastomeres at the 4-cell stage do not impact the good quality blastocyst formation rate and euploidy rate for embryos that progress into blastocysts. However, this study excludes embryos that do not develop to the blastocyst stage and those with erratic division patterns, direct cleavage and reverse cleavage on Day 2, both of which have potential to influence ploidy result. Asymmetrical 4-cell embryos have the potential for high quality euploid blastocyst progression and can be considered for day 2 embryo transfer in the absence of symmetrical 4-cell embryos.

scholarly journals The Morphology of Inner Cell Mass Is the Strongest Predictor of Live Birth After a Frozen-Thawed Single Embryo Transfer

2021 ◽  
Vol 12 ◽  
Author(s):  
Jihui Ai ◽  
Lei Jin ◽  
Yu Zheng ◽  
Peiwen Yang ◽  
Bo Huang ◽  
...  
Keyword(s):  
Embryo Transfer ◽  
Live Birth ◽  
Pregnancy Outcomes ◽  
Birth Rate ◽  
Inner Cell Mass ◽  
Cell Mass ◽  
Live Birth Rate ◽  
Single Embryo Transfer ◽  
Clinical Pregnancy ◽  
Stage 4

BackgroundThe scoring system for human blastocysts is traditionally based on morphology; however, there are controversies on the effect of morphology parameters on pregnancy outcomes. The aim of this study is to evaluate the predicting value of each morphology parameter on pregnancy outcomes in a setting of single embryo transfer.MethodsThis is a retrospective cohort study on patients undergoing frozen-thawed single blastocyst transfer at our center, between Jan. 2009 and Dec. 2018. A total of 10,482 cycles were analyzed. The blastocysts were scored according to the expansion and hatching status, morphology of inner cell mass (ICM), and cells of trophectoderm (TE). The primary outcome measure was live birth rate. One-way analysis of variance, chi-square test, and multiple logistic regression were used for statistical analysis.ResultsThe clinical pregnancy rate was lower in the blastocysts of stage 3 (48.15%), compared with those of stage 4 (56.15%), stage 5 (54.91%), and stage 6 (53.37%). The live birth rate was lower in the blastocysts of stage 3 (37.07%), compared with those of stage 4 (44.21%) and stage 5 (41.67%). The rates of clinical pregnancy (A: 66.60%, B: 53.25%, C: 39.33%) and live birth (A: 54.62%, B: 41.29%, C: 28.45%) were both decreased with decreasing grade of ICM morphology, and these differences were pairwise significant. The miscarriage rate of blastocysts with ICM grade A was lower, compared with ICM grade C (17.53 vs. 27.66%). Blastocysts with TE morphology of C had lower rates of clinical pregnancy (43.53%) and live birth (32.57%), compared with those with TE morphology of A and B (clinical pregnancy rate: 64.26% for A, 58.11% for B; live birth rate: 52.74% for A, 45.64% for B). There were no significant differences in rates of clinical pregnancy, live birth, and miscarriage between the blastocysts with TE grade A and B.ConclusionsThe blastocyst expansion stage, ICM grade, and TE grade are all associated with pregnancy outcomes. ICM grade is the strongest predictor of live birth. A blastocyst with stage 4–5, ICM grade A, and TE grade A/B should be given priority for single embryo transfer.

Blastocyst inner cell mass grade predicts outcome for single embryo transfer in fresh cycles

2004 ◽  
Vol 82 ◽  
pp. S219 ◽  
Author(s):  
D.E. Marek ◽  
M.T. Langley ◽  
L.A. Weiand ◽  
A.C. Nackley ◽  
K.M. Doody ◽  
...  
Keyword(s):  
Embryo Transfer ◽  
Inner Cell Mass ◽  
Cell Mass ◽  
Single Embryo Transfer

Time lapse microscopy is useful for elective single-embryo transfer

2016 ◽  
Vol 32 (10) ◽  
pp. 816-818 ◽  
Author(s):  
Einat Haikin Herzberger ◽  
Yehudith Ghetler ◽  
Rina Tamir Yaniv ◽  
Arie Berkovitz ◽  
Ofer Gonen ◽  
...  
Keyword(s):  
Embryo Transfer ◽  
Time Lapse ◽  
Single Embryo Transfer ◽  
Elective Single Embryo Transfer ◽  
Time Lapse Microscopy

scholarly journals Optimization of a single-embryo transfer in patients with good ovarian reserve

2020 ◽  
Author(s):  
NV Saraeva ◽  
NV Spiridonova ◽  
MT Tugushev ◽  
OV Shurygina ◽  
AI Sinitsyna ◽  
...  
Keyword(s):  
Embryo Transfer ◽  
Ovarian Reserve ◽  
Selection Procedure ◽  
Time Lapse ◽  
Single Embryo Transfer ◽  
Main Group ◽  
Control Group ◽  
Fisher Exact Test ◽  
Elective Single Embryo Transfer

Due to refinements of assisted reproductive technology, the number of multiple pregnancies has increased substantially. Time-lapse microscopy (TLM) is a tool for selecting quality embryos for transfer. This study aimed to assess the outcomes of single-embryo transfer of autologous oocytes performed on day 5 of embryo incubation in a TLM-equipped system in patients with good ovarian reserve. The study was carried out in 208 infertile women with good ovarian reserve (over 8 oocytes retrieved). Single-embryo transfer following incubation in a TLM-equipped incubator was performed in 95 patients, who formed the main group; the control group consisted of 113 patients undergoing single-embryo transfer following a traditional culture and embryo selection procedure. We assessed the quality of transferred embryos, the rates of clinical pregnancy and pregnancy loss. Two subgroups were identified in each group of the participants: the 5SET subgroup (nonelective single-embryo transfer), which included 45 patients from the main group and 67 controls, and the 5eSET subgroup (elective single-embryo transfer), which consisted of 50 main group patients and 46 controls. The groups did not differ in terms of age, infertility factors and infertility duration. The quality of transferred embryos was excellent or good in all main group patients (100%); in the control group, the quality of transferred embryos was excellent or good in 93.8% of cases (p = 0.037). Clinical pregnancies were achieved in 64.2% of women in the main group and in 60.2% of controls (p = 0.65). Delivery rates were 54% and 51.1% in the 5eSET and 5SET subgroups of the main group, respectively (p = 0.940). For the control group, delivery rates were 54.4% and 34.3% in the 5eSET and 5SET subgroups, respectively (p = 0.052, Fisher exact test). Elective single-embryo transfer (5eSET) and the use of TLM increased the chance of pregnancy 2.17-fold (p = 0.01).

Experience of using time-lapse microscopy in IVF and ICSI programs

2020 ◽  
pp. 47-50
Author(s):  
N. V. Saraeva ◽  
N. V. Spiridonova ◽  
M. T. Tugushev ◽  
O. V. Shurygina ◽  
A. I. Sinitsyna
Keyword(s):  
Pregnancy Rate ◽  
Embryo Transfer ◽  
Selection Procedure ◽  
Time Lapse ◽  
Single Embryo Transfer ◽  
Main Group ◽  
Clinical Pregnancy ◽  
Control Group ◽  
Time Lapse Microscopy

In order to increase the pregnancy rate in the assisted reproductive technology, the selection of one embryo with the highest implantation potential it is very important. Time-lapse microscopy (TLM) is a tool for selecting quality embryos for transfer. This study aimed to assess the benefits of single-embryo transfer of autologous oocytes performed on day 5 of embryo incubation in a TLM-equipped system in IVF and ICSI programs. Single-embryo transfer following incubation in a TLM-equipped incubator was performed in 282 patients, who formed the main group; the control group consisted of 461 patients undergoing single-embryo transfer following a traditional culture and embryo selection procedure. We assessed the quality of transferred embryos, the rates of clinical pregnancy and delivery. The groups did not differ in the ratio of IVF and ICSI cycles, average age, and infertility factor. The proportion of excellent quality embryos for transfer was 77.0% in the main group and 65.1% in the control group (p = 0.001). In the subgroup with receiving eight and less oocytes we noted the tendency of receiving more quality embryos in the main group (р = 0.052). In the subgroup of nine and more oocytes the quality of the transferred embryos did not differ between two groups. The clinical pregnancy rate was 60.2% in the main group and 52.9% in the control group (p = 0.057). The delivery rate was 45.0% in the main group and 39.9% in the control group (p > 0.050).

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