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Time to take human embryo culture seriously
There is now evidence that the environment the early embryo is exposed to can cause reprogramming of embryonic growth leading to alterations in fetal growth trajectory, birthweight, childhood growth and long-term disease including Type II diabetes and cardiovascular problems. The mechanism for this is likely to be epigenetic changes during the preimplantation period of development.
196. Time to take human embryo culture seriously [Forum/Discussion]
from: James Stanger (office@fertaid.com ), Australia on 29/08/2016 11:21:20 AM Profession:
Comment: An excellent summary on the risks associated with embryo culture media.
Submission This free article by Dr Sunde in Human Reproduction should be on the reading list of all new IVF staff (and all others). For some older embryologists who may remember making their own culture media each week, this article will cause them to reflect on the primitive nature of IVF in the early days. When commercial media started to become available, it was not surprising that almost all embryologists quickly put away their water purification vessels and chemical bottles and relished the ease of performing IVF. Home made preparations were really only suitable for simple media formulations, appropriate for smaller clinics and were difficult to complete a quality assessment before use but may have been considerably cheaper. There was also the increasing litigation risk.
Since the 1990s, all IVF scientists and clinicians use only commercial media and have long since forgotten what is in the media they use each day. Media companies have provided little or basic information on their formulations which have become more complicated over time - both seeking the holy grail in additives and also from a fear of complications. So much so that the selection of which media to use has become almost an impossible task, the decision given more to costs, delivery and after sales (and conference) services. Yet this article should cause everyone to reflect on the possible implications of their own, their clinicians (owners) or financial officers (cost) choices.
At the end of the day, IVF is not about success rates or activity, it is about babies that grow into children and adults. The choice of culture media is just one of many decisions embryology labs make but as this article points out, it may be one that has a long lasting (and most likely unknown during the working lives of embryologists and doctors) effects. In reality, most if not all current culture media will produce similar standard outcomes since it is other environmental or technical aspects that have largely improved success rates. Changes to the way embryo culture is performed (eg time-lapse imagery) is driving choices such as continuous or stepped formulations. Also changes to media now require significant investment by companies to meet international standards will see fewer new developments going forward. Other recent articles by Kleijkers , et.al. have suggested that culture media age and formulations may influence birthweight and birthweight has been linked to adult illness. So there is some published data to support claims of long term risks.
There are few embryologist in the whole world who could clearly explain what each component of the media they are using is there for and what its function is. There is a case therefore, for media companies to ensure the education of their clients allows them to make an informed choice but few, if any, companies will detail their formulations because of commercial confidence. What is lacking is ongoing data for scientist to use to allow them to make a decision. It almost requires each clinic to conduct their own assessments in-house - data that is rarely published. This does not mean that scientists should not be concerned by or ignorant of what each component is actually doing. The liability and responsibility of using the media is the clinics.
The article by Dr Sunde asks that clinics approach the use of culture media with this long term risks in mind, to ensure the documentation trail is complete and that the manufacturers recommendations are followed. No mixing of media, no unnecessary prolonged usage etc. One complication I can see is that many clinics are using complex databases to manage the QC information but these systems are regularly changed and there is no certainty the data will be retained long term. How clinics can keep their information for a long time is a real problem. I guess one question is how long is reasonable?
At this point I can see a case for media manufacturers to produce a single use product for each step of the IVF chain - one pack per client, one use and no repeat sampling.
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