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R2011.02
Efficiency of polarized microscopy as a predictive tool for human oocyte quality READ ON
This article by B. Heindryckx, et.al in Human Reproduction reviews the relationship between the mitotic spindle and the fertilisation ability of the oocyte
 
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Non-invasive assessment of the oocyte
   
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While visual assessment of the oocyte remains the primary tool, morphology does not identify whether an oocyte is meiotically mature and capable of fertilisation since under normal conditions, the embryologist cannot see the spindle and chromosomes. Previous studies using polarised light have shown that these can be seen real time without any apparent damage to the oocyte.
 
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Observations.
   
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In this study, the authors have extended and confirmed that not all oocytes that have a polar body have completed the first meiotic division and the spindle has reformed ready for fertilisation. They looked at 1089 oocytes from 121 patients from either in vivo (follicle) or in virto maturation. They reported that 81.8% of injected oocytes had a intact spindle and the the fertilisation rate was significantly higher where a spindle was observed (78%) compared to when it was not observed (65%). There was no apparent relationship to oocyte quality (in other words, once the polar body has been expelled, there are no visual clues to indicate the spindle has reformed). The incidence of reformed spindle was slightly higher in women under 30 and 35 to those over 35 years of age (85% cf 74%). The relationship of the spindle to the polar body was closer in in vitro matured oocytes and in vivo collected oocytes (This is an issue when one is deciding where to inject an oocyte). The use of confocal microscopy to extend the predictive power of polarised light was unrewarding.
 
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Comments
   
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This article has confirmed that not all mature oocytes have a identifiable spindle using polarised light inspection and when injected, more will fertilise if a spindle is present than when not present. This difference is real but not great (78% cf 65%). The lack of a spindle does not preclude fertilisation. Unlike other studies, a visible spindle was not associated with embryo quality nor pregnancy reflecting variations in spindle imaging and possibly embryo classification? They also observed that spindle rotation (that is where the spindle does not lie under the polar body) is more common in in vivo matured oocytes indicating previous suggestions that this is linked to oocyte manipulation during denuding may be correct. This a timely reminder that ICSI does have additional costs. Whether the application of polarised light inspection of the oocyte prior to ICSI will alter the outcome remains in doubt after this report but as they point out, in cases of abnormal embryology (including fertilisation), the technique would be of value in subsequent attempts.
B. Heindryckx, S. De Gheselle, S. Lierman, J. Gerris, and P. De Sutter (2011) Efficiency of polarized microscopy as a predictive tool for human oocyte quality. Hum. Reprod. 26(3):535-544 - View
Reviewed on 12/02/2011 9:44:06 AM by J Stanger
Review Groups: Follicles & Oocytes / Stimulation /
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