No abstract

The National Institute of Child Health and Human Development held a workshop on September 12-13, 2005, to summarize the risks for adverse pregnancy outcomes after assisted reproductive technology (ART), develop an approach to counseling couples regarding these risks, and establish a research agenda. Although the majority of ART children are normal, there are concerns about the increased risk for adverse pregnancy outcomes. More than 30% of ART pregnancies are twins or higher-order multiple gestations (triplets or greater) and more than one half of all ART neonates are the products of multifetal gestations, with an attendant increase in prematurity complications. Assisted reproductive technology singleton pregnancies also demonstrate increased rates of perinatal complications-small for gestational age infants, preterm delivery, and perinatal mortality-as well as maternal complications, such as preeclampsia, gestational diabetes, placenta previa, placental abruption, and cesarean delivery. Although it is not possible to separate ART-related risks from those secondary to the underlying reproductive pathology, the overall increased frequency of obstetric complications, including preterm birth and small for gestational age neonates, should be discussed with the couple. Significant gaps in knowledge were identified, and the basic science and clinical and epidemiologic research required to address these gaps is outlined.

Studies of cleavage stage mouse embryos are reported, with particular emphasis upon nucleolar fine structural and functional changes. Multiple fibrillar primary nucleoli are present in the early 2-cell embryo. In late 2-cell embryos, some of these nucleoli acquire a peripheral zone of granules, while others reticulate, forming nucleoli composed of fibrillo-granular cortices and fibrillar cores. The nucleoli of early 4-cell embryos are composed only of fibrils. In the middle of the 4-cell stage, some of the nucleoli acquire a peripheral granular zone, while others reticulate. The reticulated nucleoli of both the late 2-cell and 4-cell embryos can be considered, on the basis of their fine structure, to be definitive nucleoli. Early 8-cell and morula embryos usually contain only two definitive nucleoli per nucleus. H-5-uridine-pulsed embryos contain label localized in the nucleus, particularly over definitive nucleoli. Nucleolar labeling increases at each successive developmental stage. Beginning at the 8-cell stage, re-incubation in nonradioactive medium results in a significant decrease in nucleolar labeling and an increase in cytoplasmic labeling suggesting that more ribosomal RNA is transferred from the nucleus to the cytoplasm at the later cleavage stages.

Energy substrate requirements (pyruvate, lactate and amino acids) were determined for in-vitro development of hamster 1- and 2-cell embryos to blastocysts, using a chemically defined, protein free medium (hamster embryo culture medium, HECM). One-cell embryos were very sensitive to energy substrate type and concentration. Pyruvate alone could not support development of 1-cell embryos to greater than 4-cells, whereas lactate as sole energy substrate supported 14% development into morulae/blastocysts. Pyruvate, with lactate and 20 amino acids, inhibited 1-cell embryo development into blastocysts relative to lactate and 20 amino acids. The highest development of 1-cell embryos to blastocysts (up to 27%) occurred with reduced lactate concentration (less than 10 mM) and either 20 amino acids or 0.2 mM glutamine. Hamster 2-cell embryos were much less sensitive to energy substrates, requiring only lactate for development to blastocysts (53%). Lactate with 20 amino acids supported 70-75% of 2-cell embryos to blastocysts. Glutamine as sole energy and nitrogen source supported development to morulae and blastocysts of some 2-cell, but not 1-cell, embryos. Pyruvate did not enhance development of 2-cell embryos. We conclude that (i) altering the types and concentrations of available energy substrates drastically changes the developmental responses of 1-cell hamster embryos in vitro and (ii) energy substrate requirements for hamster embryo development in vitro are markedly different from those of mouse embryos, the standard model for studies on preimplantation development. This is the first report of successful in-vitro culture of hamster 1-cell embryos to the blastocyst stage.