Blastocyst Vitrification BASAK BALABAN BSc. American Hospital of Istanbul Assisted Reproduction Unit...
-
Upload
rosalyn-chambers -
Category
Documents
-
view
217 -
download
1
Transcript of Blastocyst Vitrification BASAK BALABAN BSc. American Hospital of Istanbul Assisted Reproduction Unit...
Blastocyst Vitrification
BASAK BALABAN BSc.
American Hospital of IstanbulAssisted Reproduction Unit
AMERICANHOSPITAL
Vitrification• Process that produces a glasslike
solidification of living cells that completely avoids ice crystal formation during cooling. It completely avoids ice crystal formation in cryopreserved cells during warming to recover the cells for biological applications
Vitrification TechniquesVitrification Techniques
• Traditional Vitrification
(1998- early 2000s)
• Ultrarapid vitrification
(2000-...today)
Problems Associated with Traditional Vitrification Procedures
• High levels of cryoprotectants are toxic to embryos • (4-10 M compared to 0.5-1.0M)
• Procedure must be performed at 4oC• Technically demanding
Advantages of Ultra-Rapid Vitrification
• Increases in cooling rates alleviates toxicity of high levels of cryoprotectants
• Can be performed at room temperature or 37oC
Vitrification solutions
DMSO+Acetamide+ propylene glycol
Ethylene glycol+ Ficoll+Sucrose
Ethylene glycol+ DMSO
Ethylene glycol+ glycerol
Slow Freezing solutions
DMSO /1-2 PROH + Sucrose
Glycerol+
Sucrose
From Kasai et al. RBM Online 2004
Base medium+
Cryoprotectant
Differences of slow freezing and vitrification
Slow-freezing• low levels of
cryoprotectants• slow controlled rates
of cooling (0.3oC/min)• slow dehydration to
minimize ice-crystal formation
• takes hours
Vitrification• high levels of
cryoprotectants• very fast cooling rates• (~20,000oC/min)• fast cooling rates result in
solidification of solution into glass-like structure (no crystallization)
• takes seconds
Vitrification Slow cooling
Control of solute penetration Yes No
Control of dehydration rate Yes No
Duration out of the incubator 10min. 3 hrs.
Prolonged temperature shock No Yes
Fracture of ZP No Possible
Capture by growing ice crystals
No Possible
Equipment and running costs Inexpensive Expensive
Vitrification & Slow-cooling
Kuleshova et al. F&S 2002
Variables in Vitrification
• Cooling &warming rates:Ideal vitrification protocol must pass rapidly through the critical temperature zone of 15 to – 5ºC to decrease chilling injuries. High warming rates by directly plunging cells into the warming solution is suggested (-196 to 37ºC)
Variables in Vitrification• Concentration of the cryoprotectant:
To achieve high cooling rates requires the use of high concentrations of the cryoprotectant solution which depresses ice crystal formation, so a critical concentration is required but in some cryoprotectants, this minimal concentration (Cv) can lead to either osmotic or chemical toxicity
Variables in Vitrification• Sample size and carrier systems
• Sample size should be minimized to reduce the duration of vapour coat and to increase the cooling rate, minimizing the volume of the vitrification solution as much as possible is necessary to facilitate vitrification by higher cooling rates
• To minimize the volume of the vitrification solution special carriers are used for vitrification process
** Open pulled straws ** Flexipet- denuding pipette ** Microdrops ** Electron-microscopic copper grids ** Hemistraw system ** small nylon coils or nylon mash ** Cryotop,cryotip ** Cryoloop
Carriers for vitrification
Cryotop
Cryotip
Cryotip
Kuwayama et al.,RBM Online 2005
Cryoloop
Hampton Research, Laguna Niguel, CA, USA
Nylon loop
(20µm wide; 0.5-0.7 mm in diameter)
Thin film of cryoprotectant solution by surface tension
Embryos are placed by pipette
Advantages of Cryoloop Vitrification
• Lack of thermoinsulating layer maximizes
heat transfer (>20,000oC/min)
• Easy manipulations
• Constant visualization of embryo
• Cryoloop stored within cryovial
• Procedure is performed at 37oC
Concerns with Regards to Sterility of Liquid N2 storage
Tedder et al., 1995Hepatitis B transmission
Bielanski et al., 2000Viral contamination
Bielanski et al., 2003Microbial contamination, no viral cross contamination
Kyuma et al., 2003No microbial or viral cross contamination
Necessity of blastocyst vitrification ?
• Increasing application of BT especially for some selected cases results with supernumerary blastocysts for freezing to increase cumulative pregnancy rates per oocyte retrieval
• A reliable procedure for the cryopreservation of blastocysts is needed, because after fresh ET, only small number of supernumerary blastocysts are likely to be available for cryopreservation
• Based on the published cochrane data (2008), vitrification appears to result in significantly higher survival and pregnancy rates
Blastocyst vitrification
• First pregnancy after human blastocyst vitrification was achieved by Yokota et al., HR 2000
• EG- based vitrification solutions are widely used as it has a low toxicity with rapid diffusion into the cell through ZP and cellular membrane
• 1st. Vit.sol. EG+DMSO• 2nd. EG+DMSO+Ficoll+ Sucrose, • Warming: Decreasing concentrations of Sucrose sol.
are preferred• Concentration of cryoprotectants are decreased to
7.5% from 25% over the years of experience
Youssry et al.,RBM Online 2008>10.000 blasts. vitrified
Blastocyst vitrification
• Is it the most effective and successful method to cryopreserve embryos at blastocyst stage???
Superior results with Vitrification
Stehlik et al.,RBM Online 2005**Retrospective, carrier: Cryotop
Faster re-expansion after thawing with vitrification method
Stehlik et al.,RBM Online 2005
Vitrification versus slow freezing method for blastocyst cryopreservation
Liebermann et al., F&S 2006**Retrospective, carrier: cryotop
Vitrification versus slow freezing method for blastocyst cryopreservation
Liebermann et al., F&S 2006
Slow freezing & vitrification method for human blastocysts
Kuwayama et al.,RBM Online 2005
Slow Freezing Vitrification
No of. blastocysts
72 81
Survival Rate(%) 56.9 (41/72) 84 (68/81)*
Higher survival rates with blastocyst vitrification
Huang et al., HR 2005Vitrification: 13 patients,CPR: 53.8%, IR: 23.3%
*p<0.001
Cryopreservation of human embryos by vitrification or slow freezing: A systematic review and meta-analysis
Loutradi et al., F&S 2008
Pubmed search: 873, only 4 included!!,Primary outcome: Postthaw survival rate,Sec.Outcome: Cleavage&Blastocyst dev.& hatching, CPR
Heterogenity of the studies included
Loutradi et al., F&S 2008
Pooled data on cleavage, blastocyst development &hatching, CPR, IR, and LBRwere NOT feasible
Artifical shrinkage by microneedle
Artifical shrinkage by laser
Mukaida et al., HR 2006
1st.clin.appl- Vanderzwalmen et al., HR 2002,3,4
Large blatocoele of more developed blastocysts may disturb the efficacy of vitrification due to
inappropriate Dehydration and permeation of cryoprotectant, which may cause ice crystal formation in the rapid cooling and warming steps of vitrification. Ice crystal formation can be avoided by reducing fluid content of the blastocoele of more
developed blastocysts
Artifical shrinkage of the blastocoel cavity prior vitrification
Mukaida et al.,HR 2006
Better cryosurvival rates with vitrification of blastocysts after artifical zona opening
Zech et al., RBM Online 2005Galan et al., ESHRE 2003 reported 73% cryosurvival with blastocyst vitrification
Escriba et al., F&S 2008
Similar OPR after ET of biopsied vitrified blastocysts
Retrospective study, Carrier: 0.25ml. French straws
Escriba et al., F&S 2008
Vitrification of blastocysts after PGD yields similar cumulative OPR
Takahashi et al.,F&S 2005Liebermann et al., F&S 2006 also reported no adverse effect
RESULTS• Vitrification as a cryopreservation method
has many primary advantages and benefits based on the published data
• Vitrification protocols are now starting to enter the mainstream of human ART
• The reports of successfully completed pregnancies following vitrification are encouraging for further research
• More studies on vitrification and thawing procedures are needed to develop more efficient and optimal vitrification methods
Concerns regarding Vitrification• LN2 still remains to be a potential source of contamination since the
technique is based on direct contact between the vitrification solution containing cryoprotectant agents and LN2. So from a clinical point of view:
• Is there a need to sterilize LN2? How is it possible to maintain its sterility
• Cross contamination with viruses?? ( No publication since 1985, about 450 publications)
• Closed systems should be used in clinical human IVF in the future to avoid this concern.(Like CBS HS vitrification straws, Cryotip……) New clinical trials with safer closed systems should be applied
• Low toxicity vitrification solutions must be designed in the future
• Genetical structure of the vitrified cell?? Chromosal abnormalities, gene expressions ...... More studies are needed to prove the safety of the technique
Mukaida et al.,HR 2003
Vitrification of human blastocysts with the Cryoloop
223 cycles, 725 blastocysts!!
Successful Vitrification
Liebermann et al., Biol. Reprod 2002
Vitrification results with higher cryosurvival rates for biopsied human embryos
Poor cryosurvival rates (approx. 30%) and clinical outcome reported after conventional slow freezingof biopsied cleavage stage embryos ( Joris et al., HR 1999, Magliet al., HR 1999)
Zheng et al.,HR 2005