In the field of assisted reproductive technology (ART), human embryo culture plays a pivotal role in the success of in vitro fertilization (IVF) treatments. During human embryo culture, chemical and physical parameters play a crucial role in embryo development and viability.
1. Introduction
In the field of assisted reproductive technology (ART), human embryo culture plays a pivotal role in the success of in vitro fertilization (IVF) treatments. The delicate and intricate nature of preimplantation human development demands a meticulously controlled environment. During human embryo culture, chemical and physical parameters play a crucial role in embryo development and viability
[1,2,3][1][2][3]. These parameters encompass a range of environmental conditions, including temperature, oxygen concentration, humidity conditions (HC), the use of oil overlay, and light exposure, all of which are carefully regulated within the laboratory setting. Moreover, these parameters directly influence the embryo metabolic activities
[4,5,6,7,8,9,10,11,12,13,14,15,16,17,18][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]. It is well established that temperature ensures proper enzymatic reactions and cellular functions
[4]. In addition, oxygen plays a vital role in supporting embryo metabolism and development
[5]. While a consensus has been reached regarding the utilization of 5% oxygen levels compared to atmospheric levels (20%)
[6], conflicting results have emerged when employing biphasic oxygen conditions (5–2%). Although the use of biphasic oxygen conditions appears to offer advantages in terms of blastulation, inconsistent findings have been reported in relation to clinical pregnancy
[7,8][7][8].
Oil overlay has several important functions and benefits: (i) gas exchange, (ii) temperature stability, (iii) pH regulation, (iv) preventing contamination, and (v) minimizing disturbance. The inherent chemical and physical properties of the oil exert a significant influence on this vital aspect. These properties play a crucial role in shaping and determining the outcome, emphasizing the importance of understanding and considering them when working with human embryo culture
[9]. Light exposure during mammalian embryo culture has garnered significant interest. However, despite several investigations, the impact of light on embryos remains a subject of ongoing debate, with inconclusive findings
[10,11][10][11]. Recently, due to the introduction of dry incubators, several studies have investigated the impact of humidity conditions (HC) and dry conditions (DC) on IVF outcomes. While basic research studies show increased osmolality in culture medium under DC
[12[12][13][14],
13,14], these conditions do not seem to have negative effects on biological and clinical outcomes such as blastulation and pregnancy rates
[16,17][16][17]. By carefully controlling these parameters, embryologists create an environment that mimics the natural conditions required for healthy embryo development. Nevertheless, despite these efforts, our culture conditions are unlikely to mirror precisely the dynamic environment experienced by embryos in vivo. Concerns exist that sub-optimal culture conditions could affect embryo developmental competence. Therefore, the meticulous quality control of these parameters is critical in maximizing the efficiency of treatments.
2. Oxygen
Oxygen plays a vital role in supporting embryo metabolism and development. In the female reproductive tract, oxygen concentration is typically around 2–8%
[18]. Thus, in vivo, the oxygen concentration is different from the atmospheric levels. Several studies have investigated oxygen concentration during human embryo culture. One study showed higher blastulation, pregnancy, and live birth rates using 5% oxygen concentration
[19], in contrast to another study that showed no improvements on fertilization, blastulation, and pregnancy rates
[20]. Previous studies showed no significant difference in terms of fertilization, pregnancy, and implantation rates between 5% and 20% oxygen concentrations at the cleavage stage
[21,22][21][22]. On the other hand, several studies showed higher top quality embryos, blastulation rate, and live birth in favor of 5% oxygen than 20%
[23,24,25][23][24][25]. No difference was found in fertilization rate between 5% and 20% oxygen tension, but an increased number of top quality embryos on day 3, higher blastocyst formation, clinical pregnancy, and implantation rates in favor of 5%
[26], according to one study that showed an overall increase in live birth when embryos were cultured in low oxygen tension
[27]. Finally, a meta-analysis showed an improvement in the live birth rate of 43% during embryo culture in 5% oxygen concentration
[6]. Accordingly, the latest recommendations provided from the ESHRE guidelines suggest the use of low oxygen concentration
[1].
Interestingly, recent studies investigated the use of sequential oxygen tension (5% until day 3 and, subsequently, 2% from day 3 to day 5). This is probably to mimic the natural conditions of in vivo embryo development. A sibling zygote randomized control trial showed, although a small sample size, better blastulation rate when oxygen tension is reduced from 5% to 2% on day 3 for extended embryo culture (day 5)
[7], in contrast to two studies that showed a similar blastocyst formation rate between 2%, 5% and 20% oxygen tension
[8,28][8][28]. One report showed that blastocyst utilization rate is higher in 2% oxygen tension group
[29], according to another study that showed improvement in blastocyst formation but only in low-quality human embryos cultured with 2% oxygen
[30]. No significant difference were found between 5% and 3% oxygen tension in fertilization, blastulation and euploid blastocyst
[31]. Recently, two studies suggested that biphasic oxygen culture could be an alternative strategy to increase the euploid blastocyst
[32], blastocyst formation, and cumulative live birth rate
[33].
Researchers analyzed 18 studies for the LS calculation, 10 focused on comparing between 5% and a 20% oxygen concentration, resulting in a LS of 7. Additionally, eight studies examined the comparison between monophasic (5%) and biphasic (5–2%) culture oxygen tension, resulting in a LS of 5. These findings suggest there is no evidence that biphasic culture (5–2%) is better than monophasic culture (5%), especially in terms of clinical outcomes (
Table 1).
Table 1.
Literature score of different chemical and physical parameters.