ITEM METADATA RECORD
Title: Selecting the embryo with the highest implantation potential using non-invasive methods
Other Titles: Het selecteren van het embryo met de hoogste implantatiekans aan de hand van niet-invasieve methoden
Authors: Paternot, Goedele
Issue Date: 6-Dec-2011
Abstract: Scientific summaryWorldwide, the incidence of multiple pregnancies has increased. These multiple pregnancies are leading to a higher incidence of pregnancy complications, higher long-term morbidity and are having a 13-fold increased risk of handicap following preterm birth meaning that there is a higher need of special education and hospitalization. Health-economics studies revealed that medical costs of an IVF treatment until the end of neonatal period per twin pregnancy is five times higher compared to the costs per singleton pregnancy. Performing more single embryo transfers (SET) is the most effective way to reduce the incidence of multiple pregnancies and more important to avoid high long-term costs. These data were the basis for the introduction of a new Belgian law in July 2003. This law proscribes the refunding of six IVF/ICSI cycles per patient with, in return, a restriction to transfer only one embryo in the first and second IVF/ICSI cycle if certain criteria are fulfilled. These criteria are based on the number of cycles, maternal age and embryo quality.Transferring a single embryo makes the embryo selection process very important. Therefore the first part of this PhD project focused on the selection of embryos using non-invasive methods. In the second part, culture conditions were investigated in order to increase the number of good quality embryos.Currently, embryo selection is based on the morphology of the embryo which has the advantage that the embryo can be evaluated in a non-invasive and fast way without compromising the development. In the first part of this project, some intra- and inter-observer variability was found in the evaluation of early stage embryos when a standard scoring system was used (mono- and multi-centre study). In order to decrease this variability, we focused on a computer-assisted scoring system. We concluded that the intra- and inter-observer variability was lower compared to the evaluation with the standard scoring system. In addition, it was found that the computer-assisted scoring system was superior to the standard scoring system in predicting life birth.New morphological characteristics (contact surface, total volume and orientation of cleavage axes) were evaluated of which the total volume on day 3 and the orientation of the cleavage axes on day 2 were promising characteristics. In addition, the peptide content in follicular fluid was found to be promising in the evaluation of embryo quality. The second part of the project revealed that the use of a single medium results in the highest utilization rate. In addition, we concluded that batch to batch variation in culture medium and mineral oil has an important impact on the embryo quality. In conclusion, the current standard scoring system can be expanded with new characteristics that need extra validation in future studies. Nevertheless, new non-invasive methods, such as peptidomics and time-lapse analysis, will be needed to substantially improve the embryo selection.
Table of Contents: TABLE OF CONTENTS
List of Abbreviations ....................................................................................................................1
Introduction ...............................................................................................................................3
Objectives of the PHD project ..................................................................................................... 29
Part I. Evaluation of embryo quality ....................................................................................... 31
Chapter 1. Intra- and inter-observer analysis in the morphological assessment of early-stage embryos ......... 33
Chapter 2. Intra- and inter-observer analysis in the morphological assessment of early-stage embryos during an IVF procedure: a multicentre study ............................................................................................. 41
Chapter 3. A computer-assisted scoring system improves the intra- and inter-observer agreement ............... 47
Chapter 4. Computer-assisted embryo selection: a benefit in the evaluation of embryo quality? ................... 59
Chapter 5. Morphometric analysis of human embryos and the impact of the total embryo volume on pregnancy rate ................................................................................................................................ 69
Chapter 6. Is there a link between blastomere contact surfaces of day 3 embryos and live birth? .................. 87
Chapter 7. The orientation of cleavage planes of 4-cell stage embryos and IVF outcome .............................. 103
Chapter 8. Peptide patterns in follicular fluid and embryo quality of day 3 embryos: a pilot study ............... 117
Part II. Optimization of culture conditions ............................................................................. 135
Chapter 9. Early embryo development in a sequential versus single medium: a randomized study .............. 137
Chapter 10. The impact of opening the incubator on the embryo quality: a randomized study ...................... 145
Chapter 11. Batch to batch variation in culture medium and oil influences IVF outcome ................................ 159
Discussion ............................................................................................................................... 175
Summary ................................................................................................................................ 183
List of publications ................................................................................................................... 193
Curriculum Vitae ...................................................................................................................... 196
References ............................................................................................................................... 199
Publication status: published
KU Leuven publication type: TH
Appears in Collections:Section Woman - Miscellaneous (-)
Assisted Reproductive Technology Laboratory (-)
Reproductive Medicine Section (-)

Files in This Item:
File Status SizeFormat
my doctorate.pdf Published 7749KbAdobe PDFView/Open

These files are only available to some KU Leuven staff members

 


All items in Lirias are protected by copyright, with all rights reserved.