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Influence of communal growth and culture volume on the formation of blastocysts in IVF and ICSI: a prospective randomized study Rijnders P.M. and Jansen C.A.M. Dept of IVF, Reinier de Graaf Group loc Diaconessenhuis Voorburg, The Netherlands. Introduction: The culture of embryos to blastocysts is a promising new technique that may benefit patients who have many embryos on day 2 or 3. However much work needs to be done regarding the ideal composition of the culture medium and culture conditions. It has been published that micro cultures as well as communal growth of embryos may lead to improved success rates. Growth factors released by the embryos could stimulate other embryos in their development. A smaller incubation volume could prevent a dilution of these specific embryo- derived growth factors. However, these studies involved either mouse blastocysts or human embryos until 48 h post- insemination Methods: A prospective randomized study was designed to find out whether group or single culture and small or large incubation volume had any influence on human blastocyst formation in IVF or ICSI. Embryos were cultured in groups until day 3, at which time embryo- morphology was evaluated. Only couples with at least six embryos with < 20 % fragmentation or 10 embryos of mixed quality on day 3 were included in this study. They were randomized in four groups: group 1, group culture, volume was 5 ml multiplied by the number of embryos; group 2, single culture each embryo in 5 ml, group 3, single culture, each embryo in 160 ml; group 4: group culture, total volume of 160 ml.
Results The results are depicted below in the table. There were no significant differences in blastocyst formation between the groups. A borderline significance could be seen between groups 1 and 2 (P= 0.13, 95 % confidence limits –0.27/0.03), and between groups 2 and 3 (P= 0.10. 95 % confidence limits -.027/ 0.03)
G1: group G2: single G4: group G3: single culture, 5 ml culture culture, culture, per embryo each embryo total volume each embryo 5 ml, 160 ml 160 ml
No. of embryos on day 3 81 73 77 91 No of blastocysts on day 5 28 (34,6 %) 34 (46,6 %) 28 (36,4 %) 31 (34.1 %)
Conclusion: Culturing embryos in groups did not increase the formation of human blastocysts despite the expected influence of the embryo- derived growth factor. The incubation volume also had no influence on blastocyst formation, although there was a borderline significance in favor of the small volume. Since single culture of embryos in a small volume has a practical advantage ( direct and individual evaluation of embryo morphology) as well as the highest rate of blastocyst formation, although not significant, it is our preferred method. |
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