IVF Treatments Available and Embryo Process
IVF Treatments Available and Embryo Process
Embryo culture
Typically, embryos are cultured until having reached the 68 cell stage three days after retrieval. In many Canadian, American and Australian programs, however, embryos are placed into an extended culture system with a transfer done at the blast cyst stage at around five days after retrieval, especially if many good-quality embryos are still available on day 3. Blast cyst stage transfers have been shown to result in higher pregnancy rates. In Europe, transfers after 2 days are common.
Culture of embryos can either be performed in an artificial culture medium or in an antilogous endometrial co culture (on top of a layer of cells from the woman's own uterine lining). With artificial culture medium, there can either be the same culture medium throughout the period, or a sequential system can be used, in which the embryo is sequentially placed in different media. For example, when culturing to the blast cyst stage, one medium may be used for culture to day 3, and a second medium is used for culture thereafter. Single or sequential medium are equally effective for the culture of human embryos to the blast cyst stage. Artificial embryo culture media basically contain glucose, private, and energy-providing components, but addition of amino acids, nucleotides, vitamins, and cholesterol improve the performance of embryonic growth and development.
Embryo selection
Laboratories have developed grading methods to judge oocyte and embryo quality. In order to optimise pregnancy rates, there is significant evidence that a morphological scoring system is the best strategy for the selection of embryos.However, presence of soluble HLA-G might be considered as a second parameter if a choice has to be made between embryos of morphologically equal quality.Also, two-pronuclear zygotes (2PN) transitioning through 1PN or 3PN states tend to develop into poorer-quality embryos than those who constantly remain 2PN.In addition to tests that optimise pregnancy chances, Preimplantation genetic diagnosis (PGD) or screening may be performed prior to transfer in order to avoid inheritable diseases.Methods are emerging in making comprehensive analyses of transcriptomes of embryos in order to assess embryo quality.
Embryo transfer
Embryos are graded by the embryologist based on the number of cells, evenness of growth and degree of fragmentation. The number to be transferred depends on the number available, the age of the woman and other health and diagnostic factors. In countries such as Canada, the UK, Australia and New Zealand, a maximum of two embryos are transferred except in unusual circumstances. In the UK and according to HFEA regulations, a woman over 40 may have up to three embryos transferred, whereas in the USA, younger women may have many embryos transferred based on individual fertility diagnosis. Most clinics and country regulatory bodies seek to minimize the risk of pregnancies carrying multiples. The embryos judged to be the "best" are transferred to the patient's uterus through a thin, plastic catheter, which goes through her vagina and cervix. Several embryos may be passed into the uterus to improve chances of implantation and pregnancy.
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