Success through quality

Blastocyst Culture


In order to make their dream of having a child come true, many couples have to undergo fertilization outside the body. Due to their liberal legislation it is possible in countries such as the US, England, Austria, the Czech Republic etc. to culture fertilized oocytes (zygotes) and all resulting embryos (choice of blastocysts).


Kinderwunsch-Wettlauf-Blastozysten-Selektion




1. Why does it make sense to choose the best blastocysts?


Example based on nature: 
Only about three out of an average of 12 oocytes produced within one year by a woman having a regular menstrual cycle (an ovulation each month = 12 ovulations per year) are capable of developing into a child after fertilization. Additionally, one or two more oocytes may lead to pregnancy, however, eventually end in miscarriage.

In theory, almost all 12 oocytes could develop up to day 3 (including those not leading to pregnancy), even though they have never met a sperm. This is referred to as parthenogenesis (may also be triggered by an electric pulse or some other stimulus, e.g. “pricking” with a pipette).

It is only then that the egg cells “realize” the absence of the sperm. Such oocytes often present a chromosomal abnormality (aneuploidy). These chromosomal disorders may be identified by aid of the pre-implantation genetic diagnosis (examination of the egg’s polar body). Unfortunately, there is a negative correlation between increasing age and the frequency of chromosomal abnormalities, since the oocytes are aging.

Suboptimal incubation conditions or less than optimum fertilization techniques might be the reason why fertilized eggs and the resulting embryos may stop developing on days 2-3.

It is only by choosing the best blastocysts that one can make a statement as to whether 2-3 day embryos really have the potential for further development.

Choosing the best blastocysts implies that the poorly developing blastocysts have to be identified and discarded!
Using this technique in the IVF treatment of a young woman (25-30 years of age), pregnancy rates of up to 80% may be achieved. The risk of miscarriage is about 5-10%, which corresponds to a baby-take-home-rate of 70-75%.


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2. Culture of embryos up to the blastocyst stage

  
Owing to new insights into embryonic physiology, advanced culture media have been developed permitting in vitro incubation up to the blastocyst stage.
Kinderwunsch-Blastozystenselektion-Brustschrank    Kinderwunsch-Kultur-Schälchen    Kinderwunsch-Kultur-Schälchen
Incubator and culture - dishes for embryos

These innovative media minimize the detrimental effects on the viability of the embryos, which used to occur previously in prolonged culture.

The following new media are used for in vitro culture:

1. Sequential media 

These media apply the principle „back to nature“:
  • Medium I is used for incubation until day 3 (= 8-cell-stage). Each blastomere is like a unicellular organism.
  • Medium II is used for embryo culture after compaction (morula-stage) and embryonic gene activation (paternal effect). Neighboring cells start forming cell clusters and communication between blastocyst cells is established.
The enormous differences in embryonic metabolism before and after compaction are taken into account by these new media.

2. KSOM Media 
This is an optimized medium, which is referred to as „Let the Embryo Choose"- medium“, or “KCl-enriched simplex optimization medium“ (KSOM). After having intensively investigated the requirements of oocytes and embryos throughout their first days in culture, a simple optimized medium („one-step“-protocol) has been designed. International clinical studies confirmed clearly, that this medium supports effectively the development of human embryos up to blastocyst stage. In a comprehensive prospective study the best results were achieved when using both media for culture (sequential media + KSOM). It seems that each individual embryo has its own “preferences”, which we cannot predict yet. Using this technique, we try to benefit from the advantages of both media in order to improve pregnancy rates! It is desirable to keep the embryos in culture up to day 5 (blastocyst – stage), because of the advantages outlined below:
    • Culture of the most viable embryos: Applying this technique, embryos showing high developmental potential can be identified and used for transfer.
    Patients exhibiting certain chromosomal disorders might benefit from blastocyst culture, too, since specific chromosomal disorders often result in a halt of early embryonic development during a prolonged embryo culture. Blastocyst culture provides us with the opportunity to choose a viable embryo and thus improving the chances of giving birth to a healthy child.

    In that context blastocyst culture is advisable for women beyond 38 years of age. The risk for aneuploidy (abnormal number of chromosomes) increases in correlation with female age. Embryos with aneuploidy tend to stop development after day 3. Higher implantation rates may be achieved by transferring one to two embryos at the blastocyst stage.



    Kinderwunsch-Blastozystenselektion-Implantation


    Another important advantage consists in the reduced uterine contractility from the 5th day onwards. Performing embryo transfer beyond that day may prevent the failure of the embryo to implant into the uterine wall. This was clearly confirmed by a scientific study based on measuring uterine contractions. Literature
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    Literature on the subject


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    Tel.: +43 5574 44836
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    Italy
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    Lagos State, Nigeria
    Tel.: +234 1 461 9006