Clin Exp Reprod Med.  2018 Sep;45(3):122-128. 10.5653/cerm.2018.45.3.122.

Early fragment removal on in vitro fertilization day 2 significantly improves the subsequent development and clinical outcomes of fragmented human embryos

• Kim SG
• Kim YY
• Park JY
• Kwak SJ
• Yoo CS
• Park IH
• Sun HG
• Kim JW
• Lee KH
• Park HD
• Chi HJ

• KMID: 2419528
• DOI: http://doi.org/10.5653/cerm.2018.45.3.122

Abstract

OBJECTIVE
To determine whether fragment removal on in vitro fertilization (IVF) day 2 improved the subsequent development and pregnancy outcomes of fragmented embryos compared to similar-grade embryos without fragment removal.
METHODS
This study was a retrospective analysis involving 191 IVF cycles in which all embryos had over 10% fragmentation (grade 3 or 4) on day 2 of the IVF-embryo transfer cycle from March 2015 to December 2017. IVF cycles were divided into the fragment removal group (n=87) and the no fragment removal group (n=104) as a control cohort. Before fragment removal, embryos with fragmentation on day 2 were incubated in Ca2+- and Mg2+-free biopsy medium under paraffin oil for 30 minutes. Microsurgical fragment removal was performed with later-assisted hatching and a handmade suction micropipette that had an outer diameter of 30 µm.
RESULTS
There were no significant differences in the characteristics of the patients between the control and the fragment removal groups. After fragment removal and subsequent in vitro culture for 24 hours, the number of blastomeres (7.1±1.7 vs. 6.9±1.6) was comparable between the transferred embryos in the two groups, but the morphological grade of the embryos in the fragment removal group (1.9±0.7) was significantly higher than that of the control group (3.1±0.5, p < 0.01). The clinical pregnancy (43.7%) and implantation rates (25.8%) in the fragment removal group were significantly higher than those in the control group (28.8% and 14.0%, respectively; p < 0.05).
CONCLUSION
Early fragment removal on day 2 significantly improved the subsequent development and pregnancy outcomes of fragmented embryos.

Keyword

Day 2 embryos; Embryo fragmentation; Embryo grade; Fragment removal; Pregnancy outcome

MeSH Terms

Biopsy
Blastomeres
Cohort Studies
Embryonic Structures*
Female
Fertilization in Vitro*
Humans*
In Vitro Techniques*
Paraffin
Pregnancy
Pregnancy Outcome
Retrospective Studies
Suction
Paraffin