Article
Towards a single embryo transfer

https://doi.org/10.1016/S1472-6483(10)62170-0Get rights and content

Abstract

The delivery of a single, healthy child is the desired outcome of human assisted reproduction techniques. To attain this goal, there is an increasing movement toward single embryo transfer. The question is, therefore, at what stage to transfer the human embryo back to the uterus? Maximal implantation rates reported to date have come from the transfer of blastocysts (70% fetal heart rate). In any given cycle of treatment the probability of conceiving a child will be further increased by the ability to cryopreserve those embryos not transferred. It is therefore proposed that the transfer of a single blastocyst is the best treatment for most patients, given the high implantation rates of fresh transfers, and that it is now possible to cryopreserve supernumerary blastocysts effectively. The next decision is how to culture the human embryo to the blastocyst stage. The use of sequential culture media, designed not only to allow for changes in nutrient requirements and metabolism as development proceeds, but also to minimize intracellular trauma, can facilitate the development of highly viable blastocysts. Sequential culture media have been evaluated against a single-step culture system. It has been shown that sequential media (G1/G2) produce more viable blastocysts than those embryos cultured in a single medium formulation (simplex optimized medium with elevated potassium and with amino acids, KSOMAA) throughout the preimplantation period. Furthermore, even if KSOMAA is used for embryo culture, it is essential that the medium be renewed after 48 h to alleviate the toxicity associated with ammonium build-up. Of great significance, embryos cultured in sequential media G1 and G2 have the same rate of development as embryos developed in vivo.

Section snippets

Dr David K Gardner was awarded his D.Phil. from the University of York in 1987 under the supervision of Professor Henry Leese. Following a postdoctoral fellowship with Professor John Biggers at Harvard Medical School, he moved to Australia in 1989 to work with Professor Alan Trounson at Monash University where he founded the Embryo Physiology Laboratory. In 1997 Dr Gardner moved to Denver, USA, to become the Scientific Director of the Colorado Centre for Reproductive Medicine. Dr Gardner is

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    Dr David K Gardner was awarded his D.Phil. from the University of York in 1987 under the supervision of Professor Henry Leese. Following a postdoctoral fellowship with Professor John Biggers at Harvard Medical School, he moved to Australia in 1989 to work with Professor Alan Trounson at Monash University where he founded the Embryo Physiology Laboratory. In 1997 Dr Gardner moved to Denver, USA, to become the Scientific Director of the Colorado Centre for Reproductive Medicine. Dr Gardner is also the Scientific Director of Houston IVF, an Adjunct Professor at Colorado State University, and Visiting Professor at the University of Zhongshan, China. His research has focused on the physiology, metabolism and culture of the mammalian preimplantation embryo. Dr Gardner has edited six books and authored over 100 papers and book chapters. David has four fully developed blastocysts with his wife Jackie in Colorado.

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