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      Cleavage speed and implantation potential of early-cleavage embryos in IVF or ICSI cycles

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          Abstract

          We examined whether there is a correlation among early embryo cleavage, speed of cleavage, and implantation potential for in-vitro fertilization (IVF) treatment and intracytoplasmic sperm injection (ICSI). This retrospective study examined 112 cycles of IVF and 82 cycles of ICSI in patients less than 40 years of age. Early cleavage was defined as embryonic mitosis occurring 25–27 h after insemination. These day-3 embryos were then grouped according to cleavage speed (rapid, normal, and slow) and morphological quality (good or poor). A larger proportion of early-cleavage embryos developed normally compared to non-early-cleavage embryos (IVF: 69.1 % vs. 47.1 %, respectively; ICSI: 63.0 % vs. 45.6 %, respectively). The early-cleavage embryos also produced more good quality embryos than the non-early-cleavage embryos (IVF: 80.2 % vs. 56.4 %, respectively; ICSI: 73.4 % vs. 59.4 %). The implantation rate was significantly higher with early-cleavage embryos in both IVF (42.9 % vs. 19.7 %) and ICSI (48.1 % vs. 24 %). These results indicate that early-cleavage embryos have a higher rate of normal development and develop into better quality embryos on day 3, resulting in more and higher quality embryos to choose from for day-3 embryo transfer. Thus, early cleavage may be a useful criterion when selecting embryos for IVF or ICSI.

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          Early embryo cleavage is a strong indicator of embryo quality in human IVF.

          In order to decrease multiple birth rates without decreasing birth rates overall, it is important to increase the capability of selecting the most optimal embryos for transfer. It has been shown that human embryos which cleave early, i.e. complete the first mitotic division within 25-27 h post insemination, provide higher pregnancy and implantation rates. In this prospective study, an evaluation of 10 798 scored embryos showed that early cleavage resulted in a significantly higher proportion of good quality embryos compared with late cleavage (62.5 versus 33.4%, P < 0.0001). When examining both day 2 and day 3 transfers together, early-cleaving embryos (306 transfers) gave rise to significantly higher rates of pregnancy/transfer (40.5 versus 31.3%, P = 0.0049), implantation (28.0 versus 19.5%, P = 0.0001) and birth/ongoing pregnancy (34.3 versus 24.0%, P = 0.0009) than did late-cleaving embryos (521 transfers). A stepwise logistic regression of all data showed that the total number of good quality embryos and female age were independent predictors of both pregnancies and birth. For intracytoplasmic sperm injection (ICSI) embryos, early cleavage was found to be an independent predictor of birth. Early embryo cleavage is a strong biological indicator of embryo potential, and may be used as an additional embryo selection factor for ICSI embryos.
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            Factors influencing the success of in vitro fertilization for alleviating human infertility.

            The program for in vitro fertilization at Bourn Hall began in October 1980. Various types of infertility have been treated during this time using the natural menstrual cycle or stimulation of follicular growth with antiestrogens and gonadotrophins. Follicular growth and maturation are assayed by urinary estrogens and LH, monitored regularly during the later follicular stage. Many patients had an endogenous LH surge; others needed an injection of HCG to induce ovulation. All oocytes were recovered by laparoscopy. Wide variations occurred in the time interval between the start of the LH surge and oocyte recovery and between oocyte recovery and insemination. Embryos taken between the one- and the eight-cell stage were replaced into their mother, no standard procedure being adopted for all patients. The results of all treatments including patient's responses during the follicular and luteal phases, oocyte recovery, fertilization, cleavage, replacement, implantation, abortion, and birth and the effect of factors such as replacing two or more embryos, maternal age, and previous obstetric history are described in detail. The incidence of implantation after embryo replacement improved from 16.5% initially to 30% currently. More than 118 babies have been born, and many pregnancies are continuing.
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              Selection based on morphological assessment of oocytes and embryos at different stages of preimplantation development: a review.

              In contrast to IVF, in ICSI the surrounding cumulus and corona cells must be removed completely, as only denuded oocytes can be successfully manipulated by the holding pipette. This ancillary effect of ICSI allows us to focus on the morphology of preimplantation development from the earliest stages. Early prognosis regarding the developmental fate of oocytes would help to limit a negative impact of culture conditions. However, little evidence is available that non-invasive selection at the oocyte stage (first polar body, granular cytoplasm) may be of prognostic value. Recently, certain patterns of pronuclei (number and the distribution of nucleoli) at the zygote stage were found to correlate with treatment outcome in IVF and ICSI cycles, offering an additional prognostic tool prior to cleavage. As there is evidence that embryo selection on day 2 or 3 based on morphological criteria (fragmentation, number of blastomeres, multinucleation, uneven cleavage) may be imprecise, patients might benefit from extended embryo culture to day 5. However, not all major chromosomal aberrations are incompatible with blastocyst formation, and prolonged culture in vitro does not exclusively select embryos with a normal chromosomal complement. Consequently, special care should be taken to minimize the presence of aneuploid concepti in culture. In addition, multiple selection at different stages of development will be required to filter out the correct 'candidate' embryo which will result in a healthy newborn.
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                Author and article information

                Contributors
                swrh.a1214@msa.hinet.net
                +886-2-25433535 , +886-2-25433642 , mmh40@ms2.mmh.org.tw
                Journal
                J Assist Reprod Genet
                J. Assist. Reprod. Genet
                Journal of Assisted Reproduction and Genetics
                Springer US (Boston )
                1058-0468
                1573-7330
                25 July 2012
                25 July 2012
                August 2012
                : 29
                : 8
                : 745-750
                Affiliations
                [1 ]Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Mackay Memorial Hospital, 92, Sec. 2, Chung San North Road, Taipei, 10449 Taiwan
                [2 ]Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Hsinchu, No. 690, Sec. 2, Guangfu Rd, East Dist, Hsinchu, 30071 Taiwan
                Article
                9777
                10.1007/s10815-012-9777-z
                3430780
                22825967
                ca439fbb-3f55-47f2-a043-5b9d3e6e54cf
                © The Author(s) 2012
                History
                : 10 September 2011
                : 18 April 2012
                Categories
                Embryo Biology
                Custom metadata
                © Springer Science+Business Media, LLC 2012

                Genetics
                embryonic cleavage speed,implantation rate,embryonic quality,early cleavage,live birth rate

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