REPRODUCTICE TECHNOLOGY (ART) USED. Hlinka D. Svobodov L. Hrniarov E. - - PowerPoint PPT Presentation

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REPRODUCTICE TECHNOLOGY (ART) USED. Hlinka D. Svobodov L. Hrniarov E. - - PowerPoint PPT Presentation

Aug 28, 2023 481 likes •976 views

THE EMBRYO AS A WINDOW BACK TO THE QUALITY OF THE GAMETS AND ASSISTED REPRODUCTICE TECHNOLOGY (ART) USED. Hlinka D. Svobodov L. Hrniarov E. Reichov T. Hulvert J. Krutinov D. vbikov L. Saveljeva N. Strnska G. a Lazarovsk S.

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SLIDE 1

THE EMBRYO AS A WINDOW BACK TO THE QUALITY OF THE GAMETS AND ASSISTED REPRODUCTICE TECHNOLOGY (ART) USED.

Hlinka D. Svobodová L. Hrnčiarová E. Reichová T. Hulvert J. Krutinová

  • D. Švábiková L. Saveljeva N. Stránska G. a Lazarovská S.

Prague Fertility Centre

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SLIDE 2

THE MILESTONES OF HUMAN EMBRYOLOGY ICSI GENETIC TESTING TIME-LAPSE

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SLIDE 3

TIME-LAPSE CONTRIBUTION STANDARDISATION OF EMBRYO GRADING NEW INSIGHTS INTO EMBRYONIC DEVELOPMENT

Patient A Patient B

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SLIDE 4

TL SYSTEM IS USED JUST AS AN UNDISTURBED CULTURE

WHY?

slide-5
SLIDE 5

TL SYSTEM IS USED JUST AS AN UNDISTURBED CULTURE Healthy kids born from ugly embryos Paradoxically, sometimes it could be better to transfer the worse embryo in stimulation cycle and the better one use for next cryo cycle

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SLIDE 6

TL SYSTEM IS USED JUST AS AN UNDISTURBED CULTURE Except from PGT cycles sooner or later all developing embryos are transferred and, therefore, the exact embryo scoring is not so urgently required by embryologists No one embryolog is happy to annotate manually all of embryos

slide-7
SLIDE 7

THE POTENTIAL OF TL SYSTEM IS MUCH HIGHER THAN THE EMBRYO SCORING TL system could be used as a diagnostic and quality control tool Which marker is

  • Sperm dependent?
  • Oocyte dependent?
  • Induced by in-vitro conditions/methods?
slide-8
SLIDE 8

THE POTENTIAL OF TL SYSTEM IS MUCH HIGHER THAN THE EMBRYO SCORING Untill now no reliable diagnostic marker has been proven

? ? ? ? ? ? ? ?

The problem is in extreme embryo plasticity where one cause can be expressed by many effects and one anomaly can be caused by many different reasons

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SLIDE 9

THE POTENTIAL OF TL SYSTEM IS MUCH HIGHER THAN THE EMBRYO SCORING

? ? ? ? ? ? ? ?

We have focused on causality of the processses

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SLIDE 10

THE POTENTIAL OF TL SYSTEM IS MUCH HIGHER THAN THE EMBRYO SCORING Objects of our studies are the most important embryo contributors: Oocyte the major biological contributor to the embryo creation ICSI the ultimate unnatural intervention

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SLIDE 11

THE ROLE OF OOCYTE MATURITY AND ICSI TIMING

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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 D1

Maturation time

Days D-2 D-1 D0 Working Hrs

ICSI

TII AII TII TII the 2nd Pb MI AI GV TI IK MI I AI- TI the 1st Pb No 1st Pb

Ooplasmic maturation

= Developmental competences

Nuclear maturation

= Completion of meiosis

MII (metaphase) oocyte = developmentally competent oocyte

Asynchrony

slide-12
SLIDE 12

THE ROLE OF OOCYTE MATURITY AND ICSI TIMING

OPU Trigger

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 D1

Maturation time

Days D-2 D-1 D0 Working Hrs

ICSI

TII AII TII TII the 2nd Pb MI AI GV TI IK MI I AI- TI the 1st Pb No 1st Pb

Nuclear maturation

= Completion of meiosis

Ooplasmic maturation

= Developmental competences

The oocyte´s growth

  • transcription
  • protheinsynthesis

To cover the whole oocyte dependent period Fully competent oocyte

No relevant marker to assess ooplasmic maturation

slide-13
SLIDE 13

THE ROLE OF OOCYTE MATURITY AND ICSI TIMING

OPU Trigger

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 D1

Maturation time

Days D-2 D-1 D0 Working Hrs

ICSI

TII AII TII TII the 2nd Pb MI AI GV TI IK MI I AI- TI the 1st Pb No 1st Pb

Nuclear maturation

= Completion of meiosis

Ooplasmic maturation

= Developmental competences

The oocyte´s growth

  • transcription
  • protheinsynthesis

To cover the whole oocyte dependent period Fully competent oocyte

1PN

slide-14
SLIDE 14

THE ROLE OF OOCYTE MATURITY AND ICSI TIMING

OPU Trigger

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 D1

Maturation time

Days D-2 D-1 D0 Working Hrs

ICSI

TII AII TII TII the 2nd Pb MI AI GV TI IK MI I AI- TI the 1st Pb No 1st Pb

Nuclear maturation

= Completion of meiosis

Ooplasmic maturation

= Developmental competences

The oocyte´s growth

  • transcription
  • protheinsynthesis

To cover the whole oocyte dependent period Fully competent oocyte Chromosome condensation and stop of transcription

It will not be the case for all oocytes

Still growing oocytes

slide-15
SLIDE 15

THE ROLE OF OOCYTE MATURITY AND ICSI TIMING

OPU Trigger

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 D1

Maturation time

Days D-2 D-1 D0 Working Hrs

ICSI

TII AII TII TII the 2nd Pb MI AI GV TI IK MI I AI- TI the 1st Pb No 1st Pb

Nuclear maturation

= Completion of meiosis

Ooplasmic maturation

= Developmental competences

The oocyte´s growth

  • transcription
  • protheinsynthesis

Unable to cover the whole oocyte dependent period Still growing oocytes To cover the whole oocyte dependent period Fully competent oocyte Unable to cover the whole oocyte dependent period Unable to cover the whole oocyte dependent period

slide-16
SLIDE 16

THE ROLE OF OOCYTE MATURITY AND ICSI TIMING

OPU Trigger

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 D1

Maturation time

Days D-2 D-1 D0 Working Hrs

ICSI

TII AII TII TII the 2nd Pb MI AI GV TI IK MI I AI- TI the 1st Pb No 1st Pb

Nuclear maturation

= Completion of meiosis

Ooplasmic maturation

= Developmental competences

Poor (aged) responders Normal (young) responders To cover the whole oocyte dependent period Fully competent oocyte Unable to cover the whole oocyte dependent period

slide-17
SLIDE 17

DIFFERENT TIMING OF MATURATION IN DIFFERENT GROUPS OF PATIENTS

Normal responder…………tTI - MII: approx. 2 hrs Delayed responder…………tTI - MII: approx. 4,5 hrs

PLM: Maturation is delayed (TI – MII transition) in poor responders when compared to normal (young) responders Impaired competences can alter the next embryonic development

slide-18
SLIDE 18

THE ROLE OF OOCYTE MATURITY AND ICSI TIMING

OPU Trigger

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 D1

Maturation time

Days D-2 D-1 D0 Working Hrs

ICSI

TII AII TII TII the 2nd Pb

Ooplasmic maturation

= Developmental competences

MI AI GV TI IK MII AI- TI the 1st Pb No 1st Pb

Nuclear maturation

= Completion of meiosis

1st meiosis

  • Chromosome condensation
  • Chromosome segregation

2nd meiosis

  • Chromosome condensation
  • Chromosome segregation

Oocyte growth

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SLIDE 19

THE ROLE OF OOCYTE MATURITY AND ICSI TIMING

OPU Trigger

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 D1

Maturation time

Days D-2 D-1 D0 Working Hrs

ICSI

TII AII TII TII the 2nd Pb

Ooplasmic maturation

= Developmental competences

MI AI GV TI IK MII AI- TI the 1st Pb No 1st Pb

Nuclear maturation

= Completion of meiosis

Spindle formation Spindle formation Oocyte growth

Polarized microscopy

slide-20
SLIDE 20

THE ROLE OF OOCYTE MATURITY AND ICSI TIMING

OPU Trigger

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 D1

Maturation time

Days D-2 D-1 D0 Working Hrs

ICSI

TII AII TII TII the 2nd Pb

Ooplasmic maturation

= Developmental competences

MI AI GV TI IK MII AI- TI the 1st Pb No 1st Pb

Nuclear maturation

= Completion of meiosis

Cytokinesis 1st polar body Cytokinesis 2nd polar body Oocyte growth

Standard microscopy

slide-21
SLIDE 21

THE ROLE OF OOCYTE MATURITY AND ICSI TIMING

OPU Trigger

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 D1

Maturation time

Days D-2 D-1 D0 Working Hrs

ICSI

TII AII TII TII the 2nd Pb MI AI GV TI IK MII AI- TI the 1st Pb No 1st Pb

Nuclear maturation

= Completion of meiosis

Ooplasmic maturation

= Developmental competences

Oocyte growth

Mature MII oocyte = oocyte with the 1st polar body

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SLIDE 22

THE ROLE OF OOCYTE MATURITY AND ICSI TIMING

OPU Trigger

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 D1

Maturation time

Days D-2 D-1 D0 Working Hrs

ICSI

TII AII TII TII the 2nd Pb MI AI GV TI IK MII AI- TI the 1st Pb No 1st Pb

Nuclear maturation

= Completion of meiosis

Ooplasmic maturation

= Developmental competences

Oocyte growth

Mature MII oocyte = oocyte with the 1st polar body

It is not allways true

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SLIDE 23

THE ROLE OF OOCYTE MATURITY AND ICSI TIMING

OPU Trigger

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 D1

Maturation time

Days D-2 D-1 D0 Working Hrs

ICSI

TII AII TII TII the 2nd Pb MI AI GV TI IK MII AI- TI No 1st Pb

Ooplasmic maturation

= Developmental competences

Oocyte growth

Nuclear maturation

= Completion of meiosis

the 1st Pb Normal responder:TI - MII: 2 hrs Delayed responder:TI - MII: 4,5 hrs

slide-24
SLIDE 24

THE ROLE OF OOCYTE MATURITY AND ICSI TIMING

OPU Trigger

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 D1

Maturation time

Days D-2 D-1 D0 Working Hrs

ICSI

TII AII TII TII the 2nd Pb MI AI GV TI IK MII AI- TI No 1st Pb

Ooplasmic maturation

= Developmental competences

Nuclear maturation

= Completion of meiosis

the 1st Pb Normal responder:TI - MII: 2 hrs Delayed responder:TI - MII: 4,5 hrs

Heterogenous population of maturing oocytes Heterogenous population of growing oocytes

slide-25
SLIDE 25

THE ROLE OF OOCYTE MATURITY AND ICSI TIMING

OPU Trigger

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 D1

Maturation time

Days D-2 D-1 D0 Working Hrs

ICSI

TII AII TII TII the 2nd Pb MI AI GV TI IK MII AI- TI No 1st Pb

Ooplasmic maturation

= Developmental competences

Nuclear maturation

= Completion of meiosis

the 1st Pb Normal responder:TI - MII: 2 hrs Delayed responder:TI - MII: 4,5 hrs

Heterogenous population of maturing oocytes Different timing

  • f ICSI

Heterogenous population of growing oocytes What is a correct time for ICSI?

slide-26
SLIDE 26

THE ROLE OF OOCYTE MATURITY AND ICSI TIMING

OPU Trigger

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 D1

Maturation time

Days D-2 D-1 D0 Working Hrs

ICSI

TII AII TII TII the 2nd Pb MI AI GV TI IK MII AI- TI No 1st Pb

Ooplasmic maturation

= Developmental competences

Nuclear maturation

= Completion of meiosis

the 1st Pb

Fertilizing ability of the oocytes is aquired gradually with the optimum at MII stage and it is loosing after some time

Graph of oocyte´s fertilisability

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SLIDE 27

THE ROLE OF OOCYTE MATURITY AND ICSI TIMING

OPU Trigger

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 D1

Maturation time

Days D-2 D-1 D0 Working Hrs

ICSI

TII AII TII TII the 2nd Pb MI AI GV TI IK MII AI- TI No 1st Pb

Ooplasmic maturation

= Developmental competences

Nuclear maturation

= Completion of meiosis

the 1st Pb

Rescue ICSI

  • High FR
  • No healthy

embryos Graph of oocyte´s fertilisability

Fertilizing ability is not enough…

slide-28
SLIDE 28

THE ROLE OF OOCYTE MATURITY AND ICSI TIMING

OPU Trigger

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 D1

Maturation time

Days D-2 D-1 D0 Working Hrs

ICSI

TII AII TII TII the 2nd Pb MI AI GV TI IK MII AI- TI No 1st Pb

Ooplasmic maturation

= Developmental competences

Nuclear maturation

= Completion of meiosis

the 1st Pb

Graph of oocyte´s fertilisability Rescue ICSI

  • High FR
  • No healthy

embryos Graph of oocyte´s ability to create the healthy embryos

slide-29
SLIDE 29

THE ROLE OF OOCYTE MATURITY AND ICSI TIMING

OPU Trigger

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 D1

Maturation time

Days D-2 D-1 D0 Working Hrs

ICSI

TII AII TII TII the 2nd Pb MI AI GV TI IK MII AI- TI No 1st Pb

Ooplasmic maturation

= Developmental competences

Nuclear maturation

= Completion of meiosis

the 1st Pb

Graph of oocyte´s fertilisability Graph of oocyte´s ability to create the healthy embryos ICSI ICSI ICSI ICSI

What is a correct time for ICSI?

slide-30
SLIDE 30

THE ROLE OF OOCYTE MATURITY AND ICSI TIMING

OPU Trigger

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 D1

Maturation time

Days D-2 D-1 D0 Working Hrs

ICSI

TII AII TII TII the 2nd Pb MI AI GV TI IK MII AI- TI No 1st Pb

Ooplasmic maturation

= Developmental competences

Nuclear maturation

= Completion of meiosis

ICSI ICSI ICSI ICSI

ICSI

TI vs. MII

?

slide-31
SLIDE 31

ICSI TIME: TI VS. MII - the impact upon the 2nd polar body extrusion Fertilisation of immature TI oocytes affects (delayes) the timing of the 2nd Pb extrusion

Fertilisation rate (FR) No of TI 148: FR 91% Average FR of the clinic: 88% Timing of the 2nd Pb extrusion MII - ICSI: 3 hrs TI – ICSI:: 5 hrs

TI - MII: 2 hrs t2nd Pb: 3 hrs

slide-32
SLIDE 32

THE ROLE OF OOCYTE MATURITY AND ICSI TIMING

OPU Trigger

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 D1

Maturation time

Days D-2 D-1 D0 Working Hrs

ICSI

TII AII TII TII the 2nd Pb MI AI GV TI IK MII AI- TI No 1st Pb

Ooplasmic maturation

= Developmental competences

Nuclear maturation

= Completion of meiosis

ICSI ICSI ICSI ICSI

ICSI

Late AI/early TI

?

slide-33
SLIDE 33

ICSI TIME : the impact upon ploidy of resulting embryo

Decreased fertilisation anad abnormal embryo develpoment can be echieved if the oocytes are fertilised in late AI/early TI phase

Diploid maternal PN Missing 2nd meiosis 2nd Pb is not extruded One cause is expressed by different ways: one embryo is arrested and the second produced a low grade blastocyst Fertilisation rate (FR) No of TI 56: FR 43% Average FR of the clinic: 88%

Low grade blastocyst Arrested embryo

slide-34
SLIDE 34

CONCLUSION

OPU Trigger

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 D1

Maturation time

Days D-2 D-1 D0 Working Hrs

ICSI

TII AII TII TII the 2nd Pb MI AI GV TI IK MII AI- TI No 1st Pb

Ooplasmic maturation

= Developmental competences

Nuclear maturation

= Completion of meiosis

the 1st Pb

Oocytes with different developmental competences Oocytes at different stages

  • f maturity

ICSI of oocytes at different stages

  • f maturity

Still ongoing studies:

The impact of different ICSI timing on the cleavage, timings and blastocyst rate...

WHAT TO DO?

Patients with delayed timing of maturation

slide-35
SLIDE 35

STOP PLAYING THIS NEVERENDING GAME WITH PATIENTS

OPU Trigger

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 D1

Maturation time

Days D-2 D-1 D0 Working Hrs

ICSI

TII AII TII TII the 2nd Pb MI AI GV TI IK MII AI- TI No 1st Pb

Ooplasmic maturation

= Developmental competences

Nuclear maturation

= Completion of meiosis

the 1st Pb

Heterogenous population of growing oocytes Heterogenous population of maturing oocytes ICSI of oocytes at different stages

  • f maturity

How many follicles? How many oocytes? How many mature? How many fertilised?

slide-36
SLIDE 36

STOP PLAYING THIS NEVERENDING GAME WITH PATIENTS

OPU Trigger

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 D1

Maturation time

Days D-2 D-1 D0 Working Hrs

ICSI

TII AII TII TII the 2nd Pb MI AI GV TI IK MII AI- TI No 1st Pb

Ooplasmic maturation

= Developmental competences

Nuclear maturation

= Completion of meiosis

the 1st Pb

Heterogenous population of growing oocytes Heterogenous population of maturing oocytes ICSI of oocytes at different stages

  • f maturity

How many follicles? How many oocytes? How many mature? How many fertilised?

10 10 10 10

slide-37
SLIDE 37

STOP PLAYING THIS NEVERENDING GAME WITH PATIENTS

OPU Trigger

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 D1

Maturation time

Days D-2 D-1 D0 Working Hrs

ICSI

TII AII TII TII the 2nd Pb MI AI GV TI IK MII AI- TI No 1st Pb

Ooplasmic maturation

= Developmental competences

Nuclear maturation

= Completion of meiosis

the 1st Pb

Heterogenous population of growing oocytes Heterogenous population of maturing oocytes ICSI of oocytes at different stages

  • f maturity

How many follicles? How many oocytes? How many mature? How many fertilised?

10 2 2 10

slide-38
SLIDE 38

OPU Trigger

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 D1

Maturation time

Days D-2 D-1 D0 Working Hrs

ICSI

TII AII TII TII the 2nd Pb MI AI GV TI IK MII AI- TI No 1st Pb

Ooplasmic maturation

= Developmental competences

Nuclear maturation

= Completion of meiosis

the 1st Pb

Heterogenous population of growing oocytes Heterogenous population of maturing oocytes ICSI of oocytes at different stages

  • f maturity

ICSI planning

feedback

Optimalisation

  • f stimulation
  • Spindle detection
  • Knowledge of timing
  • Patients data
  • Follicular diameter
  • Hormone levels
  • Patients data etc.

WE HAVE TO COORDINATE AND PERSONALIZE THE APROACH

slide-39
SLIDE 39

UNIVERSAL PRINCIPLES OF OUR EXISTENCE

Timing & order of events

The cleavages 2cc, 4cc, 8 cc etc. Blastocyst growth Maturity of

  • ocytes

Growth of

  • ocyte

ICSI timing Trigger timing The doses and the lenght of stimulation Fullicular growth/diameter ET timing, receptivity

Ability to deliver a healthy child Ability to become pregnant

Age: 10 - 50

Because everything is connected with everything and everything in our life has its

  • wn time and specific order.
slide-40
SLIDE 40

The cleavages 2cc, 4cc, 8 cc etc. Blastocyst growth Maturity of

  • ocytes

Growth of

  • ocyte

ICSI timing Trigger timing The doses and the lenght of stimulation Fullicular growth/diameter ET timing, receptivity

Because everything is connected with everything and everything in our life has its

  • wn time and specific order.

UNIVERSAL PRINCIPLES OF OUR EXISTENCE

Timing & order of events

slide-41
SLIDE 41

The cleavages 2cc, 4cc, 8 cc etc. Blastocyst growth Maturity of

  • ocytes

Growth of

  • ocyte

ICSI timing Trigger timing The doses and the lenght of stimulation Fullicular growth/diameter ET timing, receptivity

Because everything is connected with everything and everything in our life has its

  • wn time and specific order.

UNIVERSAL PRINCIPLES OF OUR EXISTENCE

Timing & order of events

slide-42
SLIDE 42

The cleavages 2cc, 4cc, 8 cc etc. Blastocyst growth Maturity of

  • ocytes

Growth of

  • ocyte

ICSI timing Trigger timing The doses and the lenght of stimulation Fullicular growth/diameter ET timing, receptivity

Because everything is connected with everything and everything in our life has its

  • wn time and specific order.

UNIVERSAL PRINCIPLES OF OUR EXISTENCE

Timing & order of events

slide-43
SLIDE 43

The cleavages 2cc, 4cc, 8 cc etc. Blastocyst growth Maturity of

  • ocytes

Growth of

  • ocyte

ICSI timing Trigger timing The doses and the lenght of stimulation Fullicular growth/diameter ET timing, receptivity

We cannot separate these events UNIVERSAL PRINCIPLES OF OUR EXISTENCE

Timing & order of events

slide-44
SLIDE 44

OUR VISION

Electronic Avatar

Anthropomorphic software AI automated

4D

Personalised approach

  • Objective records
  • Objective analysis
  • Precise proposals
slide-45
SLIDE 45

VISION SHOULD BECOME REALITY OUR PLATFORMS

FERTILITYPEDIA

  • PATIENTS
  • PHYSICIANS
  • CLINICS

CATI

  • EMBRYOLOGISTS
  • SCIENTIST
  • STUDENTS
slide-46
SLIDE 46

VISION SHOULD BECOME REALITY OUR PLATFORMS

FERTILITYPEDIA

  • PATIENTS
  • PHYSICIANS
  • CLINICS

CATI

  • EMBRYOLOGISTS
  • SCIENTIST
  • STUDENTS
slide-47
SLIDE 47

ONE PLATFORM

slide-48
SLIDE 48

I HOPE OUR VISION WILL BECOME REALITY AVATAR