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Abstract
This prospective sequential, cohort study examined the two most common multinucleation
phenotypes observed in the authors' clinic, binucleated (BN) and micronucleated (MN)
blastomeres, and included all intracytoplasmic sperm injection (ICSI) patients <40
years of age with at least one multinucleated embryo in the cohort as observed on
day 2 of development. Eighty ICSI cycles of 560 consecutive cycles had multinucleated
embryos (14.3%). Of the 80 cycles, 770 embryos were derived; 183 (23.8%) were observed
to be multinucleated. Blastocyst rates were significantly higher with BN than MN embryos.
MN embryos were more often derived from embryos with poor pronuclear morphology (41/81
= 50.6%). Transferred mononucleated sibling embryos from the BN group had an ongoing
pregnancy rate of 48% (12/25) compared with 15.4% (4/26 from the group with MN embryos
(P = 0.03). The implantation rate for sibling embryos from the BN group was higher
than for those from the MN group. Fluorescence in-situ hybridization (FISH) analysis
showed that BN embryos had normal blastomeres significantly more frequently than MN
embryos (9/28 (32.1%) versus 1/27 (3.7%), P = 0.016). Time-lapse photography showed
that the nuclei of both morphologies dissolved independently before the next mitotic
division and that BN blastomeres definitely have two distinct nuclei. These observations
indicate two diverse morphologies and causal mechanisms. Time-lapse photography showed
that both were subject to independent dissolution of their nuclear membrane suggesting
an asynchrony between the nuclei and a possible interruption in proper nuclear and
cell division. Multinucleation should definitely be looked for during IVF assessment.
Excluding these embryos from transfer is prudent practice.