Embryology Laboratory Research Articles

Un cas de nouveau-né affecté d’une aprosopie, d’une monomélie et d’une célosomie

The specimen of which it is a matter here takes part of the heritage of the Museum of Anatomy and Embryology of the Faculty of Medicine of the Université Libre de Bruxelles. Its medical history is completely unknown, because it takes part of an ancient collection of pathological anatomy saved from destruction and recovered by the laboratory of Anatomy and Embryology. The specimen is strongly folded up on itself ("in extension"), its length so arranged is about 25 cm; unfolded, it develops to 45 cm. Cranial perimeter is of 31 cm. Unfortunately, the brain was removed during the initial analysis, and only the examination of the braincase allows to draw some conclusions on the probable state of the encephalon. The face is rudimentary, without any orbit, and the oral cavity is limited to a vertical slit, revealing small strongly tipped up maxillary bones. A double proboscis is present. The trunk is characterised by a rather broad celosomy, with exhibition of the intestines, the liver and the pancreas. Anal atresia is observed, and the external sexual organs are hypoplastic and ambiguous. The whole left lower limb is absent, including the left half of the pelvis, corresponding to a left unilateral complete ectromelia. The neck is in hyperextension, so that the occipital region seems extremely welded in the cervical spine. However, CT examination does not confirm the presence of such fusion, but on the other hand, reveals a severe axial diversion of the spine with hyperextension. Extremely rare in humans, the aprosopia is more readily present in some animals (sheep). Its association with a monomelia and a celosomy seems not yet described.

Enhancement of Antibacterial Activity of Short Tryptophan-rich Antimicrobial Peptide Pac-525 by Replacing Trp with His(chx)

Division of Magnetic Resonance, Korea Basic Science Institute,Chungbuk 363-883, Korea. E-mail: bangjk@kbsi.re.kr Department of Bio-Materials, Graduate School and Department of Cellular & Molecular Medicine, School of Medicine, Chosun University, Gwangju 501-759, Korea. E-mail: syshin@chosun.ac.kr Molecular Embryology Laboratory, Department of Animal Sciences, Chungbuk National University, Cheongju, Chungbuk 361-763, Korea College of Pharmacy, Chungbuk National University, Cheongju, Chungbuk 361-763, Korea Division of Electron Microscopic Research, Korea Basic Science Institute, Daejeon 305-333, Korea Received May 15, 2014, Accepted May 30, 2014

Recommended practices for the management of embryology, andrology, and endocrinology laboratories: a committee opinion

This document provides a general overview for physicians of the qualities and conditions necessary for good management practices within the endocrinology, andrology, and embryology laboratories in the United States. It is intended as an addendum to previously published guidelines that further detail these responsibilities.

The making of an embryologist, then and now!

The making of an embryologist, then and now!

Embryology training for Reproductive Endocrine fellows in the clinical human embryology laboratory.

ObjectiveTo determine if comprehensive embryology training for clinical Reproductive Endocrinology fellows could be completed to a level of proficiency equivalent to that of experienced embryologists.MethodClinical fellows were integrated into the clinical embryology team and were trained to perform all the various procedures utilized in clinical embryology. The fellows were trained to the same standards as the clinical embryology staff and underwent the same certification and sign off procedures. To determine if inclusion of clinical fellows on the embryology team impacted outcomes, outcomes for individual oocytes/embryos and the clinical cases where the fellows perform embryology procedures were compared to the outcomes of those oocytes/embryos and cases performed by the full time embryology staff.ResultsClinical procedures performed by the fellows included isolation and processing of oocytes following retrieval, loading catheters for embryo transfer, and vitrification (N = 823 cases). Micromanipulation procedures compared included ICSI and assisted hatching (N = 650 cases). For each procedure, the outcomes in those cases performed by the RE fellows were equivalent to those done by the fully trained clinical embryology staff.ConclusionsWhen fellows are trained to perform embryology procedures as an integral part of their fellowship curricula, laboratory efficiencies and clinical outcomes are fully maintained. This experience provides valuable insight into the ART process critical to this subspecialty. It also empowers fellows to fully participate in research relating to the viability of gamete and embryos and optimization of the clinical ART laboratory.

Next gen ARTs: what lies ahead?

Next gen ARTs: what lies ahead?

Temperature variations inside commercial IVF incubators

Temperature variations inside commercial IVF incubators

Morphologic assessment of human blastocyst on day 5 and day 6: which day is more associated with comprehensive chromosome screening results?

The reliance on blastocyst grading scales has served as an essential benchmark for embryo transfer selection for assisted reproductive treatment (ART) embryology laboratories. Embryo selection competency has been enhanced with the advent of Comprehensive Chromosome Screening (CCS), but whether morphology is correlated with ploidy remains controversial. The aim of our study is to correlate embryo morphology on Day 5 and Day 6 of culture with chromosomal competency as assessed by CCS.

Wandering-and wondering-about the pharmacological management of human infertility

Wandering-and wondering-about the pharmacological management of human infertility

Implementation of air quality control in reproductive laboratories in full compliance with the Brazilian Cells and Germinative Tissue Directive

This article describes how Androfert complied with the Brazilian Cells and Germinative Tissue Directive with regard to air quality standards and presents retrospective data of intracytoplasmic sperm injection (ICSI) outcomes performed in controlled environments. An IVF facility, composed of reproductive laboratories, operating room and embryo-transfer room, was constructed according to cleanroom standards for air particles and volatile organic compounds. A total of 2060 couples requesting IVF were treated in the cleanroom facilities, and outcome measures compared with a cohort of 255 couples treated at a conventional facility from the same practice before implementation of cleanrooms. No major fluctuations were observed in the cleanroom validation measurements over the study period. Live birth rates increased (35.6% versus 25.8%; P=0.02) and miscarriage rates decreased (28.7% versus 20.0%; P=0.04) in the first triennium after cleanroom implementation. Thereafter, the proportion of high-quality embryos steadily increased whereas pregnancy outcomes after ICSI were sustained despite the increased female age and decreased number of embryos transferred. This study demonstrates the feasibility of handling human gametes and culturing embryos in full compliance with the Brazilian directive on air quality standards and suggests that performing IVF in controlled environments may optimize its outcomes.Regulatory agencies in many countries have issued directives including specific requirements for air quality standards in embryology facilities. This article describes how we complied with the Brazilian Cells and Germinative Tissue Directive with regard to air quality standards. It also presents results of IVF cycles performed in controlled environments. An IVF facility, composed of reproductive laboratories, operating room and embryo transfer room, was constructed according to cleanroom standards for air particles and volatile organic compounds. The cleanest area was the embryology laboratory, followed by the operating room and embryo transfer room. A total of 2060 couples requesting IVF were treated in the cleanroom facilities, and outcome measures compared with a cohort of 255 couples treated at a conventional facility. Live birth rates increased by 37% and miscarriage rates decreased by 30% in the first triennium after cleanroom implementation. Thereafter, the proportion of high-quality embryos steadily increased whereas pregnancy outcomes after ICSI were sustained despite the increased female age and decreased number of embryos transferred. We demonstrate the feasibility of handling human gametes and culturing embryos in full compliance with the Brazilian Directive on air quality standards and suggest that performing IVF in controlled environments may optimize its outcomes.

The impact of suboptimal air quality in embryology laboratory on IVF outcome

The impact of suboptimal air quality in embryology laboratory on IVF outcome

Embryology training for reproductive endocrinology (RE) fellows in the clinical human embryology laboratory: comprehensive training on actual clinical cases with excellent patient outcomes

IVF has become the cornerstone of clinical RE practice and is a major focus of contemporary research. In spite of the critical nature of the IVF process, most REs receive minimal training and do not typically participate in clinical embryology care. This is in contrast to other laboratory procedures where fellows are expected to gain technical proficiency with any procedure that they utilize clinically or in research. This fellowship program requires fellows to spend 6 months in the clinical embryology lab learning and performing each aspect of human embryology from basic dish prep to complex micromanipulation.

Recent Advances in Assisted Reproductive Technology

In 1978 the world witnessed the birth of the first “test tube baby.” Since this time there have been explosive advances in assisted reproductive technologies (ART). Current optimizations surrounding the delivery of in vitro fertilization (IVF) including the utilization of minimal stimulation protocols and gonadotropin releasing hormone (GnRH) agonist cycle triggers are being increasingly utilized to maximize patient safety. Modifications, such as those seen in the embryology laboratory, continue to improve pregnancy rates. Concurrent with these advancements in IVF have been the emergence of related technologies, such as embryonic genetic testing and oocyte preservation, which potentially have broad applications to both fertile and infertile couples. As these relevant applications of ART become increasingly utilized, it is incumbent upon society to ensure that these resources are made available in a morally responsible and equitable manner.

Importance of Supply Integrity for In Vitro Fertilization and Embryo Culture

The quality of in vitro culture conditions is a key component of a successful clinical embryology laboratory. Many, but not all, supplies used in the embryology laboratory are screened by the supplier with a bioassay. Embryology laboratories use a variety of approaches to verify the quality of mineral oil, protein, and disposables before clinical use; however, a best practice has not been determined. Some laboratories test every supply, even those already screened by the supplier, whereas other laboratories perform as little testing as possible. Despite screening by the supplier, recent reports of embryo toxicity, specifically with mineral oil, highlight that the integrity of the supply system has gaps. This review describes current bioassay quality control testing and discusses how it applies to screening of products with documented lot-to-lot variation.

Analysis of the Effects of Phasing Out IVF Laboratory Scheduled Maintenance Periods

Many IVF programs schedule patients in series to accommodate Embryology laboratory equipment maintenance, calibration and certification. A down side to these scheduled maintenance periods is that patients can be inconvenienced and treatment delayed. We have thus modified our scheduling process over the past decade from running four clinical series of patients per year down to three, and now to only two maintenance periods. We undertook this study to determine if the prolonged laboratory series resulted in any variation on patient success rates. Clinical and laboratory data from our electronic medical records database were analyzed for all fresh IVF cases (n= 6826) during 19 series, ranging from 44-163 days in length between 01/01/05 and 12/31/10. ANOVA and biserial correlation were performed to analyze for any association between patient success rates (defined as the presence of fetal heart beats) and the length of each series. Additional analysis was performed to determine if success rates were different during the last two weeks of each series. Days of series length varied significantly, but did not show any correlation with success rates across the entire study period (r=0.00, P=0.96) or during each of the different series lengths (Table). When analyzing across all 19 series, the pregnancy rate of patients treated during the last 2 weeks was not different from the rest of the series (43.0% vs. 44.5%, P=0.58). However when analyzed between series, the pregnancy rate was different during the last two weeks within 2 individual series: #18 (16.1% higher, P=0.04) and #30 (19.3% lower, P=0.01). We demonstrated that the length of a series does not impact a patient's chance of IVF success. The pregnancy rates observed towards the end of a series were not significantly different from the rest of the series. In a high quality laboratory with daily cleaning, vigilant equipment maintenance, tightly controlled QA/QC protocols and experienced personnel there should not be a need for frequent scheduled “down time.”TableSeries 12-19 (4 maintenance/yr)Series 20-28 (3 maintenance/yr)Series 29-30 (2 maintenance/yr)p-valueMean Days/Series65 ± 1498 ± 6157 ± 8<0.01Success Rate %44 (835/1916)43 (1580/3678)44 (536/1232)0.88 Open table in a new tab

Patients Need not be Concerned When Their IVF Retrievals and Transfers Fall on A Weekend: Success Rates Are Not Negatively Affected By the Day of the Week At A High Quality Center

Patients often question whether success rates are compromised when their ART procedures fall on a weekend. They may hypothesize that laboratory operations, staffing and embryologist fatigue might adversely affect outcome. We set out to determine if the day of the week that a patient had an oocyte retrieval (VOR), insemination, ICSI or embryo transfer (ET) affected success rates. Clinical and laboratory data from electronic medical records were analyzed for cycles occurring between 06/01/02 and12/31/10. A total of n=4575 fresh, autologous IVF cycles were included in the study. In order to minimize confounding variables in the analysis, our focus was on optimal candidates; thus the study was limited to patients with age <40, FSH <13 mIU/ml, >3 oocytes retrieved, maximal endometrial thickness >7mm, and stimulation days <12. χb tests were performed to analyze for dependence between patient success rates (defined as the presence of fetal heart beats) and the day of the week on which the procedure (VOR, Insemination, ICSI or ET) fell. The daily number of procedures ranged from 1-10 VOR's (mean: 3.1 ± 1.6) and from 1-8 ET's (mean: 3.0 ± 1.5) over the study period. The total number of VOR cases performed on any given day of the week varied from ∼400-850 (Figure). Patient success rates were similar regardless of the day of the week that the procedures were performed (Table). Many IVF centers, including ours, program cycle start dates to maximize weekday oocyte retrievals. However, due to the heterogeneity of patient response, in a large center, there will still be a significant percentage of patients undergoing weekend procedures. Our data demonstrate that in a well-staffed and trained embryology laboratory, the day of the week that a VOR, insemination, ICSI or ET occurred did not impact the likelihood of IVF success. Any concerns associated with being treated on a weekend can be alleviated. We encourage other centers to perform similar quality assurance evaluations by monitoring these and other variables that could potentially affect reproductive outcomes.Tabled 1ProcedureMean Pregnancy Rate (±SD)P-value*VOR56.8% (0.7)0.11Insemination56.9% (1.1)0.13ICSI56.6% (1.0)0.11ET56.8% (0.7)0.17*Comparing the 7 days of the week. Open table in a new tab

Prenatal Development of the Maxillary Sinus

To review the prenatal development of the maxillary sinus under the perspective of the sinus surgery. Cross-sectional study. Basic embryology laboratory. Morphometry and morphology of the maxillary sinus and its ostium were studied under stereomicroscopy in 100 human fetuses from the 9th to the 37th week. Fetuses were obtained from the Fetal Collection of the School of Medicine of the Universidad Autónoma de Nuevo León. Approval was granted by the Ethics Committee. Statistics were applied. The maxillary sinus begins its development at the 10th week. On the 37th week, the anterior-posterior diameter has a mean of 4.36 mm; ossification of the medial wall was absent, and the floor was located below the attachment of the inferior turbinate. Septa and recesses were temporarily observed. Some variations in shape were observed; however, only the oval shape persisted. Maxillary sinus hypoplasia was not found, although asymmetry was present in 30% of cases. The ostium was located at the anterior third of the ethmoid infundibulum; its final dimensions were 1.96 mm in length and 0.44 mm in width. The mean length between the ostium to the lamina papyracea and nasolacrimal duct was 1 mm. One case of double maxillary sinus was observed. Significant difference between the variables, in accordance with the age, was found (P = .02). Knowledge of prenatal development of the maxillary sinus improves the perspective of the sinus surgeon and helps the understanding of postnatal anatomy, especially in children.

Microsurgical versus conventional single-biopsy testicular sperm extraction in nonobstructive azoospermia: a prospective controlled study

To compare the success rates of sperm retrieval using either microsurgical testicular sperm extraction (micro-TESE) or conventional testicular sperm extraction (TESE) in a group of men with nonobstructive azoospermia (NOA). Prospective and controlled study. Sixty men with NOA were enrolled in this study and each patient served as his own control. For conventional TESE, two large (6x6x6 mm) biopsies of random testicular parenchyma were obtained. One biopsy specimen was sent for pathology examination and classified according to the predominant histological pattern, i.e., Sertoli-cell only (SCO), maturation arrest (MA) and hypospermatogenesis (HYPO), while the other was dissected and examined for the presence of sperm in the embryology laboratory (EL). After that, the testicular microdissection was carried out as described by Schlegel (1998), with minor modifications. Tubules were sent to the EL for sperm search. Successful sperm retrieval (SSR) rates, both overall and stratified by histology category, were compared between conventional and microsurgical TESE. Overall, the SSR rate was significantly higher using micro-TESE (27/60; 45%) as compared to TESE (15/60; 25%; P=0.02). In successful retrievals, a positive retrieval with TESE was always coupled with a positive one by micro-TESE. SSR rates according to testicular histology results were 92.9% (13/14), 63.6% (7/11) and 20.0% (7/35) in the subgroups of HYPO, MA and SCO, respectively. In addition, micro-TESE success rates were significantly higher than TESE in all testicular histology categories of HYPO (92.9% micro-TESE; 64.3% TESE), MA (63.6% micro-TESE; 9.1% TESE) and SCO (20% micro-TESE; 5.7% TESE) (P<0.01). Micro-TESE is a better method to retrieve spermatozoa from men with NOA than conventional single-biopsy TESE. SSR rates in NOA, either by micro-TESE or TESE, are correlated to the testicular histopathology results. Regardless of testicular histology category, micro-TESE yields higher SSR rates than TESE.

Daily IVF retrieval variation does not affect patient success rates with high quality equipment and appropriate laboratory staffing

ObjectiveConcerns are often raised on busy days as to whether the more complicated clinical laboratory operations, laboratory staffing, equipment use and incubator door openings adversely affect patient IVF outcomes. Deep statistical analysis of large clinical and laboratory datasets allows for extensive exploration of individual and multiplexed variables. Through deep phenotyping statistical analysis we now routinely interrogate >290 individual items from our vast IVF database. Our objective in this study was to determine whether the number of oocyte retrievals (VORs) being performed on any given day was correlated with IVF clinical success.DesignRetrospective data analysis at a large private-academic fertility centerMaterials and MethodsClinical and laboratory data were analyzed from electronic medical records for all fresh IVF cycles, 6822 consecutive patients, who cycled from 01/05 to 12/10. Biserial correlation was performed to analyze for association between patient success rates (defined as the presence of fetal heart beats) and the number of VORs performed on any given day.ResultsTabled 1VORs/DayOccurrences%Pregnancy Rate ± SD11401.7%53 ± 4%22286.1%38 ± 2%331312.6%43 ± 2%431016.6%43 ± 1%527618.2%43 ± 1%620816.4%43 ± 1%713212.2%46 ± 2%8667.1%41 ± 2%9424.9%42 ± 3%10172.2%48 ± 4%1160.9%52 ± 7%1220.3%30 ± 10%1310.2%42 ± 16%1410.2%17 ± 12% Open table in a new tab ConclusionOur data demonstrates that in a well equipped, staffed and trained embryology laboratory, the number of VORs on a given day does not impact IVF success rates significantly. Concerns associated with being treated on a busy day can be alleviated due to our findings in this large data set analysis of daily case-load over time. Multiplexed analysis of additional variables to determine the extent of the effect of laboratory and equipment workload on outcomes is ongoing. ObjectiveConcerns are often raised on busy days as to whether the more complicated clinical laboratory operations, laboratory staffing, equipment use and incubator door openings adversely affect patient IVF outcomes. Deep statistical analysis of large clinical and laboratory datasets allows for extensive exploration of individual and multiplexed variables. Through deep phenotyping statistical analysis we now routinely interrogate >290 individual items from our vast IVF database. Our objective in this study was to determine whether the number of oocyte retrievals (VORs) being performed on any given day was correlated with IVF clinical success. Concerns are often raised on busy days as to whether the more complicated clinical laboratory operations, laboratory staffing, equipment use and incubator door openings adversely affect patient IVF outcomes. Deep statistical analysis of large clinical and laboratory datasets allows for extensive exploration of individual and multiplexed variables. Through deep phenotyping statistical analysis we now routinely interrogate >290 individual items from our vast IVF database. Our objective in this study was to determine whether the number of oocyte retrievals (VORs) being performed on any given day was correlated with IVF clinical success. DesignRetrospective data analysis at a large private-academic fertility center Retrospective data analysis at a large private-academic fertility center Materials and MethodsClinical and laboratory data were analyzed from electronic medical records for all fresh IVF cycles, 6822 consecutive patients, who cycled from 01/05 to 12/10. Biserial correlation was performed to analyze for association between patient success rates (defined as the presence of fetal heart beats) and the number of VORs performed on any given day. Clinical and laboratory data were analyzed from electronic medical records for all fresh IVF cycles, 6822 consecutive patients, who cycled from 01/05 to 12/10. Biserial correlation was performed to analyze for association between patient success rates (defined as the presence of fetal heart beats) and the number of VORs performed on any given day. ResultsTabled 1VORs/DayOccurrences%Pregnancy Rate ± SD11401.7%53 ± 4%22286.1%38 ± 2%331312.6%43 ± 2%431016.6%43 ± 1%527618.2%43 ± 1%620816.4%43 ± 1%713212.2%46 ± 2%8667.1%41 ± 2%9424.9%42 ± 3%10172.2%48 ± 4%1160.9%52 ± 7%1220.3%30 ± 10%1310.2%42 ± 16%1410.2%17 ± 12% Open table in a new tab ConclusionOur data demonstrates that in a well equipped, staffed and trained embryology laboratory, the number of VORs on a given day does not impact IVF success rates significantly. Concerns associated with being treated on a busy day can be alleviated due to our findings in this large data set analysis of daily case-load over time. Multiplexed analysis of additional variables to determine the extent of the effect of laboratory and equipment workload on outcomes is ongoing. Our data demonstrates that in a well equipped, staffed and trained embryology laboratory, the number of VORs on a given day does not impact IVF success rates significantly. Concerns associated with being treated on a busy day can be alleviated due to our findings in this large data set analysis of daily case-load over time. Multiplexed analysis of additional variables to determine the extent of the effect of laboratory and equipment workload on outcomes is ongoing.

Maturitas ex vivo: the case for oocyte in vitro maturation in human ARTs

Maturitas ex vivo: the case for oocyte in vitro maturation in human ARTs