The effects of co-culturing human embryos in one-step continuous culture media on blastulation and assisted reproductive technology outcomes

Date
2021-03
Journal Title
Journal ISSN
Volume Title
Publisher
Stellenbosch : Stellenbosch University
Abstract
ENGLISH SUMMARY : Background: The embryo culture system plays a vital role in optimizing human embryos' growth and development in vitro. At present, studies determining these conditions are often limited and contradictory, especially when considering the best culture media (sequential vs. continuous) and method of embryo culture (individual vs. co-culture) to use. As such, each laboratory is recommended to perform their own internal studies to determine which culture conditions give them the best clinical outcomes based upon their patient population and laboratory settings. Aim: This study aims to investigate the effects of changing the embryo culture method from individually culturing embryos in Sequential SeriesTM embryo culture medium (ORIGIO®, Embryo Culture Method A) to co-culturing embryos in SAGETM 1-StepTM with Human Albumin Solution (ORIGIO®, Embryo Culture Method B) at Drs. Aevitas Fertility Clinic. Objectives: Primary objective: To evaluate the effects of changing the embryo culture method on the blastulation outcomes. Secondary objective: To evaluate the effects of changing the embryo culture method on the ART outcomes. Tertiary objective: To determine whether the findings from this study support the continued use of Embryo Culture Method B at Drs. Aevitas Fertility Clinic for future ART cycles. Methods and Materials: This was a retrospective study, utilizing the data obtained from the medical and laboratory records of Drs. Aevitas Fertility Clinic between January 2016 to December 2018. 479 cycles were included and separated into two sub-groups (Group A with 184 cycles and Group B with 295 cycles). All data were analysed and assessed for statistical significances (p<0.05) based on the difference in the means ± 95% confidence intervals. Results: This study concluded that Group B attained statistically better blastulation outcomes than Group A, resulting in significantly higher blastocyst development rates [total blastocysts (53.96% vs. 40.70%), good-quality (11.97% vs. 4.45%), and fair-quality blastocysts (11.97% vs. 4.45%)], a significantly higher proportion of better-quality blastocysts [significantly more good-quality blastocysts (18.92% vs. 7.61%) and fewer poor-quality blastocysts (39.77% vs. 51.03%)], and a significantly higher day 5 embryo transfer rate (95.76% vs. 88.04%). Furthermore, Group B attained a significantly better blastocyst attribution profile, resulting in significantly more and better good-quality blastocysts obtained, utilized, and available for cryopreservation. This suggested a potential advantage of attaining better cumulative pregnancy rates than Group A. Group B further attained slightly better ART outcomes, resulting in higher implantation rates (38.36% vs. 36.23%), higher clinical pregnancy rates (54.91% vs. 46.74%), lower miscarriage rates (9.15% vs. 10.33%), and higher live birth rates (47.12% vs. 41.85%). Although, no statistical significance was reported. Conclusion: This study supports the continued use of Embryo Culture Method B at Drs. Aevitas Fertility Clinic in future ART cycles.
AFRIKAANSE OPSOMMING : Die embrio kultuursisteem speel ‘n baie belangrike rol om die groei en ontwikkeling van die menslike embrio, in vitro, optimaal te maak. Studies wat hierdie kultuursisteme ondersoek is huidiglik skaars en ook soms teenstrydig, veral in die geval van watter die beste kultuurmedium (opeenvolgend vs aaneenlopend) en embrio kultuurmetode (individueel- vs saam kultuur) is. Elke laboratorium word dus aanbeveel om hul eie interne studies uit te voer om te bepaal watter kultuurkondisies vir hulle die beste kliniese uitkomste gee – gebaseer op hul unieke pasiëntpopulasie en laboratoriuminstelling. Doelwit: Die studie het ondersoek ingestel na die effek wat die verandering van die embrio kultuurmetode A [waar embrios individueel kultuur is in “Sequential SeriesTM embryo culture medium (ORIGIO®)”] na embrio kultuurmetode B [waar embrios saam kultuur is in “SAGETM 1-StepTM with Human Albumin Solution (ORIGIO®)”] teweeggebring het by die Drs Aevitas Fertiliteitskliniek. Doel: Primêre Doel: Die evaluasie van die effek wat die verandering van die embrio kultuurmetode op blastosistvorming teweeggebring het. Sekondêre Doel: Die evaluasie van die effek wat die verandering van die embrio kultuurmetode op geassisteerde reproduktiewe tegnieke (GRT) teweeggebring het. Tersiêre Doel: Bepaling of die bevindings van die studie die voortgesette gebruik van embrio kultuurmetode B vir tekomstige GRT siklusse by die Drs Aevitas Fertiliteitskliniek, ondersteun. Metodes en Materiaal: Die huidige studie was retrospektief, die data wat gebruik is vir die ondersoek is verkry uit mediese- en laboratoriumdokumente van die Drs Aevitas Fertiliteitskliniek (Januarie 2016 tot Desember 2018). 479 siklusse is in die studie ingesluit. Die siklusse is onderverdeel in twee subgroepe (Groep A met 184 siklusse en Groep B met 295 siklusse). Alle data is analiseer en stastisties ontleed vir statistiese betekenisvolheid – gebaseer op die verskil in die gemiddeldes ± 95% vertrouensintervalle. Resultate: Die studie se gevolgtrekking was dat blastosistvorming in Groep B statisties betekenisvol beter was as in Groep A. Blastosist ontwikkelingskoers [totale blastosiste (53.96% vs. 40.70%), goeie kwaliteit (11.97% vs. 4.45%) en billike kwaliteit (11.97% vs. 4.45%) was betekenisvol beter. Die proporsie van blastosiste met beter kwaliteit was ook groter. Betekenisvol meer goeie kwaliteit (18.92% vs. 7.61%) en betekenisvol minder swak kwaliteit blastosiste (39.77% vs. 51.03%) is gevind. Die dag 5 embrio terugplasingskoers (95.76% vs. 88.04%) was ook betekenisvol beter. Daar is verder gevind dat Group B se toeskrywingsprofiel betekenisvol beter was. Betekenisvol meer goeie kwaliteit blastosiste is verkry, gebruik en was beskikbaar vir kriopreservering. Hierdie uitkoms dui daarop dat ‘n beter kumulatiewe swangerskapsyfer moontlik kan wees in Groep B. Alhoewel die GRT uitkomste nie statisties betekenisvol was nie, was alle GRT uitkomste gering beter in Groep B; beter implantasiesyfer (38.36% vs. 36.23%); beter kliniese swangerskapsyfer (54.91% vs. 46.74%); swakker miskraamsyfer (9.15% vs. 10.33%) en beter lewendige geboortesyfer (47.12% vs. 41.85%). Gevolgtrekking: Die huidige studie se uitkoms ondersteun die voortgesette gebruik van embrio kultuurmetode B by die Drs Aevitas Fertiliteitskliniek vir toekomstige GRT siklusse.
Description
Thesis (MSc)--Stellenbosch University, 2021.
Keywords
Human embryo, Continuous culture (Microbiology), Reproductive technology, Embryology, Human, Fertilization in vitro, Blastula -- Development, UCTD
Citation