[Sequential assessment of individually cultured embryos in IVF]. / Suivi individuel des embryons en FIV.

OBJECTIVE: It is a challenge for IVF centers to propose a method to select the most viable embryo to transfer, thereby minimizing the risk of multiple births. In this study, a prospective investigation was made to determine if non-invasive developmental markers on day 1 combined to conventional evaluation on day 2 can predict in vitro blastocyst development. PATIENTS AND METHODS: A total of 4190 individually cultured embryos from patients undergoing IVF/ICSI treatment at the Tours University Hospital Center from January 2002 to December 2004 were included. Individual embryos were cultured in sequential media in microdrops under mineral oil from j1 to j5/j6 allowing to record their sequential growth until the blastocyst stage. RESULTS: The results showed a significant positive relationship between pattern 0 zygote, early cleavage, 4 cells embryos with < 20% fragmentation on day 2 and the rate of blastocyst development on day 5 (P < 0.05). In our hands, zygote pattern does not bring additional benefit to better select embryo. DISCUSSION AND CONCLUSION: Zygote and early cleavage assessments on day 1, morphological appearance on day 2 are some other parameters related individually to blastocyst development on days 5 and 6. These parameters can be used collectively to establish a predictive in vitro sequential embryo assessment model for routine use in IVF clinics.

Limited value of morphological assessment at days 1 and 2 to predict blastocyst development potential: a prospective study based on 4042 embryos.

BACKGROUND: Non-invasive and routine developmental markers are available to select the most viable embryo; however their respective values in terms of blastocyst development potential remain difficult to distinguish. METHODS: During this prospective study, the sequential growth of 4042 embryos individually cultured from day 1 to day 5/6 was recorded. Pronuclear morphology on day 1, and early cleavage, cell number and fragmentation rate on day 2 were evaluated for each zygote. Additionally, blastocyst transfers were analysed with regard to their implantation ability and early embryo development parameters. RESULTS: Once adjusted to each other, each of the four parameters remained related to blastocyst development. Early cleavage and cell number on day 2 were the most powerful parameters to predict the development of a good morphology blastocyst at day 5. Moreover, whereas transfers of a good morphology blastocyst were associated with high implantation and live birth rates, parameters of early development were not helpful in predicting their implantation ability. CONCLUSIONS: The combination of all four parameters allowed the prediction of blastocyst development with an area under the receiver operating characteristics curve of 0.688, which represents a fairly low prediction of embryo viability. Such results indicate that it is necessary to search for additional criteria, including the ability of the blastocyst to develop.

[Type II familial hyperlipoproteinaemia : value of plasma exchange treatment (author's transl)]. / Hypercholestérolémie xanthomateuse familiale homozygote. Que faut-il attendre des échanges plasmtiques?

A 13-year-old boy with homozygous type II familial hyperlipoproteinaemia with marked cutaneous and tendinous xanthomatosis has been followed-up for a 3-year period. Signs of unstable angina developed at the age of 14 years, followed by the onset of a posterodiaphragmatic infarction at 16 years-ion. The usual poor spontaneous prognosis, and the lack of efficacy of medical treatment on blood cholesterol levels, led to suggest the use of plasmapheresis. Treatment was interrupted after three months in spite of its efficacy (blood cholesterol levels reduced by 36.2 p. 100 by the 3rd month); in fact, marked alterations in ventricular function, as shown by non-invasive exploratory tests, risked to provoke an ischaemic accident from hypovolaemia during plasma exchanges. This method is nevertheless the only one currently available that can appreciably lower cholesterolaemia levels in this affection. The treatment, which is not devoid of risks, should be undertaken during the early stages, before ventricular function deteriorates due to progression of atheroma.