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Fertil Steril. 2014 Nov;102(5):1295-1300.e2. doi: 10.1016/j.fertnstert.2014.07.1235. Epub 2014 Sep 12.

Prevalence, consequence, and significance of reverse cleavage by human embryos viewed with the use of the Embryoscope time-lapse video system.

Author information

1
Fertility North, Joondalup Health Campus, Joondalup, Western Australia, Australia; School of Medical Sciences, Edith Cowan University, Joondalup, Western Australia, Australia. Electronic address: yanhe@fertilitynorth.com.au.
2
Fertility North, Joondalup Health Campus, Joondalup, Western Australia, Australia.
3
School of Medical Sciences, Edith Cowan University, Joondalup, Western Australia, Australia.
4
Fertility North, Joondalup Health Campus, Joondalup, Western Australia, Australia; School of Medical Sciences, Edith Cowan University, Joondalup, Western Australia, Australia.

Abstract

OBJECTIVE:

To investigate the prevalence and potential causes of reverse cleavage (RC) by human early-cleavage embryos and its associations with embryonic development and implantation after transfer.

DESIGN:

Clinical retrospective cohort study.

SETTING:

Private fertility treatment center.

PATIENT(S):

A total of 126 consecutive in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) treatment cycles, with 353 IVF and 436 ICSI embryos cultured in the Embryoscope until day 3.

INTERVENTION(S):

None.

MAIN OUTCOME MEASURE(S):

Embryo assessment on day 3, incidence of abnormal division, embryo morphokinetic parameters, and fetal heart beat.

RESULT(S):

RC, referring to either blastomere fusion or failed cytokinesis, occurred up to three times per individual embryo in 27.4% of embryos during the first three cleavage cycles. A higher incidence was associated with GnRH antagonist cycles compared with agonist cycles (odds ratio [OR] 1.683), or with ICSI compared with IVF (OR 1.600). After ICSI, sperm progressive motility was associated with RC (area under the receiver operating characteristic curve: 0.573). Compared with RC-negative embryos, a lower proportion of RC-positive embryos reached 6-cell stage or beyond by day 3 (47.7% vs. 71.7%), and were more likely to have multinucleation at the 4-cell stage (10.1% vs. 5.0%). Embryos showing RC had significantly poorer performance in both conventional grading and morphokinetic parameters, and they implanted less (0/22 vs. 29/131) than those not showing RC.

CONCLUSION(S):

RC significantly compromised embryo development, culminating in poor implantation potential. For each embryo, it can occur on more than one occasion at any stage during the first 3 days of culture. It is associated with factors affecting both oocyte and sperm.

KEYWORDS:

Reverse cleavage; abnormal cleavage pattern; embryo development; implantation; time lapse

[Indexed for MEDLINE]

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