IVF Başarısında Kültür Medyumlarının Rolü;
Rivayetler ve Gerçekler
Prof.Dr.Lale Karakoç Sökmensüer Hacettepe Üniversitesi Tıp Fakültesi
Kadın Hastalıkları ve Doğum A.D. Tüp Bebek Üniversitesi
sub-optimal culture conditions
impaired embryo development
loss of viability
(-‐) ART outcome
more physiological and effective culture media decrease in
the number of pregnancies
lost
increase in implantation
rates
increase in the overall success rates of ART
embryos more able to survive cryopreservation
human embryo culture
• mammalian embryo culture in vitro should not be regarded as
an imperfect copy of the in-vivo procedures
• an artificial process
• standard embryo culture procedures use somatic cell cultures as templates
• situation, morphology, function and regulation of somatic cells in vivo are basically different from those of
preimplantation mammalian embryos
differences and their consequence
• preimplanta+on embryos are not part of the maternal body: they exist physically and biologically as largely independent living
• while soma+c cells of mammals are surrounded by the extracellular fluid that is rich in nutrients, proteins and other factors, preimplanta+on
embryos are surrounded by oviductal and uterine fluid
• soma+c cells are unable to proliferate without external trophic ligands , mammalian zygotes are intrinsically programmed to develop to the
hatched blastocyst stage without any external s+muli.
( in vivo these embryos are exposed and respond to a number of interrelated endocrine, paracrine and autocrine factors)
differences and their consequence
• oviductal and uterine fluid is not just the product of the epithelial cells. It contains factors derived from the maternal body, and may have profound consequences on the future of the fetus and offspring
• role of oviductal and uterine epithelial cells includes a passive filtra+on or ac+ve transport of these factors as well; this role cannot be reconstructed by a simple monolayer of a co-‐culture system
• establishment and maintenance of the microenvironment plays a crucial role in embryo development both in vivo and in vitro. Autocrine factors seem to be
decisive cons+tuents of this microenvironment. With the current methods, tools and dishes (established originally for soma+c cells), this microenvironment
cannot be properly maintained in vitro.
• first successes of embryo culture in the mouse ……Krebs–
Ringer bicarbonate medium (Tyrode’s medium) supplemented
with lactate
(McLaren and Biggers, 1958; Whitten, 1957)
• human ……..complex media (e.g. Earle’s balanced salt solution or Ham’s F-10)
(Edwards, 1981)
two major approaches
• ‘empirical op+miza+on’ or ‘let the embryos choose’ (KSOM-‐Global family)
(Biggers, 2001)
• ‘back to nature’ principle, (make media with composi+on similar to the oviductal fluid)
(Mor+mer, 1986; Quinn, 1995; 2000; Quinn et al., 1985)
Lane and Gardner, 2007
Lane and Gardner, 2007
sequential or single medium?
Renew medium or not?
• embryos are le\ undisturbed;
• accumulated endogenous growth factors are le\ in place;
• the rela+ve environmental stress is ‘low’
• labour intensity is lower;
• cost is lower;
• less quality control is required disadvantages :
Ø essen+al nutrients are not replaced Ø toxins may accumulate
Renew medium or not?
• only material that was supposed to have detrimental effect is
ammonium: by replacing glutamine with stable dipep+des (Biggers et al., 2004), this danger can be safely eliminated.
• a single medium without renewal may be a realis+c alterna+ve of the present culture systems.
• It may offer many prac+cal benefits for embryologists and it may also help embryos to build up and maintain their microenvironment.
alternative possibilities for embryo culture
Ø Tubes
Ø Microchannel microfluidic system (con+nuous or stepwise medium exchange)
Ø Glass oviduct system Ø Well of the Well system
COMPOSITION OF EMBRYO CULTURE MEDIA
• Carbohydrates
• An+bio+cs
• Nucleic Acid Precursors
• Amino Acids
• Water
• Ions
• Chelators
• An+oxidants
• Protein/macromolecules
• Hormones and growth factors
• Buffer system
• Vitamins
Lane and Gardner, 2007
embryo culture medium: which is the best ???
ü first week of mammalian embryo development consists of crucial events including the first cleavage, ac-va-on of the maternal
genome, compac-on of morula and differen-a-on with blastocyst development …….. programmed and orchestrated events.
ü adapta+on to an inappropriate environment may cause changes in epigene-cs, transcrip-on, metabolism and cell alloca-on
ü components of media can produce serious altera-ons in the gene expression pa<ern of preimplanta-on embryos with poten-al long-‐
term consequences
ü
culture media is only one part of the culture system, op+malperformance of the medium is dependent on the quality of other aspects such as contact supplies and oil
ü
importance of the quality of the en+re system increases withextended culture, high levels of quality control and assurance exist in the laboratory to enable any culture medium to perform to its maximum
ü
not only examine the ability of a culture system to produce apregnancy with the one or two highest-‐grade embryos, but also to determine how many embryos from the en+re cohort (both fresh and frozen embryos) are capable of producing a live birth
ü
understand the role of each medium component and toidentify possible sources of cellular stress to the embryo that will ultimately affect the function and viability of the
conceptus