Prevalence consequence and significance of reverse cleavage by human embryos viewed with the use of the Embryoscope time lapse video system

Capsule:
This study investigated the prevalence and significance of reverse cleavage by human embryos observed via time-lapse monitoring. Embryos showing reverse cleavage were associated with compromised subsequent development and implantation potential.

Authors:
Yanhe Liu, M.Sc., Vincent Chapple, M.B., B.S., F.R.A.N.Z.C.O.G., M.R.Med., Peter Roberts, Ph.D., Phillip Matson, Ph.D.

Volume 102, Issue 5, Pages 1295-1300

Abstract:

Objective:
To investigate the prevalence and potential causes of reverse cleavage (RC) by human early-cleavage embryos and its associations with embryonic development and implantation after transfer.

Design:
Clinical retrospective cohort study.

Setting:
Private fertility treatment center.

Patient(s):
A total of 126 consecutive in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) treatment cycles, with 353 IVF and 436 ICSI embryos cultured in the Embryoscope until day 3.

Intervention(s):
None.

Main Outcome Measure(s):
Embryo assessment on day 3, incidence of abnormal division, embryo morphokinetic parameters, and fetal heart beat.

Result(s):
RC, referring to either blastomere fusion or failed cytokinesis, occurred up to three times per individual embryo in 27.4% of embryos during the first three cleavage cycles. A higher incidence was associated with GnRH antagonist cycles compared with agonist cycles (odds ratio [OR] 1.683), or with ICSI compared with IVF (OR 1.600). After ICSI, sperm progressive motility was associated with RC (area under the receiver operating characteristic curve: 0.573). Compared with RC-negative embryos, a lower proportion of RC-positive embryos reached 6-cell stage or beyond by day 3 (47.7% vs. 71.7%), and were more likely to have multinucleation at the 4-cell stage (10.1% vs. 5.0%). Embryos showing RC had significantly poorer performance in both conventional grading and morphokinetic parameters, and they implanted less (0/22 vs. 29/131) than those not showing RC.

Conclusion(s):
RC significantly compromised embryo development, culminating in poor implantation potential. For each embryo, it can occur on more than one occasion at any stage during the first 3 days of culture. It is associated with factors affecting both oocyte and sperm.

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