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Objective: To analyze whether the cleavage pattern redefined for all cleavage stages according to the relative blastomere size as a function of cell number has an additive value in predicting implantation potential of day-2 and day-3 embryos., Design: Retrospective analysis of standard embryo morphologic parameters (cleavage rate and degree of fragmentation) supplemented by cleavage pattern findings of 347 implanted embryos compared with those of a matched control group of 307 embryos that failed to implant., Setting: University-based tertiary medical center., Patient(s): Two hundred and nine women with successful implantation and 181 controls matched for age and demographic parameters with failed implantation., Intervention(s): In vitro fertilization (IVF), embryo assessment, and embryo transfer., Main Outcome Measure(s): Determination of cleavage patterns in synchronized and unsynchronized cleaving embryos and correlations with implantation outcomes., Result(s): Statistically significantly more embryos of the implanted group had good cleavage patterns compared with the failed implantation group (88% vs. 70%). A good cleavage pattern predicted implantation outcome even for nonsynchronized cleaving blastomeres at three, five, six, and seven cells (79% vs. 59%). Regression analysis demonstrated that adding cleavage pattern to the scoring system increased our ability to predict implantation in the training set; the area under the curve was the highest (0.707) as was the proportion of correct classification (>70%) when the cleavage pattern was assessed on both days 2 and 3., Conclusion(s): When combined with measurements of the cleavage rate and degree of fragmentation, the cleavage pattern refines our ability to predict the likelihood of implantation, representing a definitive tool in the selection of top-quality embryos., (Copyright © 2012 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: To investigate the incidence of embryos' self-correction during preimplantation development in terms of mosaicism and in correlation with its developmental stage., Design: Prospective study to compare the chromosome status of embryos on day 3 with that of day 5, in correlation with their developmental stage., Setting: In vitro fertilization unit of a university-affiliated hospital., Patient(s): Eighty-three aneuploid embryos., Intervention(s): Fluorescence in situ hybridization (FISH) reanalysis., Main Outcome Measure(s): Day 3 embryos classified as mosaic or chromosomally abnormal by preimplantation genetic screening (PGS) were reanalyzed on day 5. The results were evaluated in correlation with the embryos' developmental stage., Result(s): Out of 83 day 3 aneuploid embryos, 15 (18.1%) were diagnosed with mosaicism. The FISH reanalysis on day 5 demonstrated that 27 embryos (32.6%) were partly or entirely normal disomic. Of these 83 aneuploid embryos, 8 (9.7%) underwent complete self-correction. The PGS results demonstrated that 26.5% of the embryos were trisomic, of which 41.0% underwent trisomic rescue by day 5. Self-correction was in correlation with the embryo's developmental stage, i.e., 38.1% of aneuploid embryos that developed to the blastocyst stage underwent self-correction compared with only 12.5% of embryos that only cleaved after biopsy., Conclusion(s): Our results demonstrate that self-correction of aneuploid and mosaic embryos occurs probably more significantly during development toward the blastocyst stage than in delayed embryos. In addition, trisomic embryos correct themselves more than other aneuploidies. These findings suggest that PGS results must be interpreted with caution.

Objective: To describe isolation and in vitro maturation of primary oocytes from the ovarian cortex in the presence of hypothalamic pituitary down-regulation., Design: Case report., Setting: Tertiary care university-affiliated hospital., Patient(s): An 18-year-old patient was given treatment with the ABVD (Adriamycin, bleomycin, vinblastine, and dacarbazine) protocol for Hodgkin's disease. She underwent ovarian tissue cryopreservation while being cotreated with GnRH agonist because of disease relapse., Intervention(s): Laparoscopic oophorectomy, ovarian tissue cryopreservation, and in vitro maturation of primary oocytes., Main Outcome Measure(s): Maturation of primary oocytes isolated from the medium used for preparation of ovarian tissue., Result(s): Twenty-one immature germinal vesicle-stage oocytes were isolated from the medium of dissection. All were incubated in in vitro maturation medium, and five were maturated and frozen., Conclusion(s): The fact that germinal vesicle-stage oocytes were present in our patient's medium despite hormonal down-regulation demonstrates that GnRH agonist does not completely inhibit antral follicle development.