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Archive for the ‘Embryology’ tag

Infertility Podcast Series: Journey to the Crib: Chapter 20: Co-Culture of Embryos

By David Kreiner, MD

June 24th, 2013 at 9:34 pm

 

Welcome to the Journey to the Crib Podcast.  We will have a blog discussion each week with each chapter.  This podcast covers Chapter twenty: Co-culture of Embryos. You, the listener, are invited to ask questions and make comments.  You can access the podcast here: http://podcast.longislandivf.com/?p=114

Co-Culture of Embryos

Co-Culture is a procedure whereby “helper” cells are grown along with the developing embryo.  The most popular cell lines include endometrial cells (from the endometrium or uterine lining) and cumulus cells from a woman’s ovaries.  Both cell lines are derived from patients.  Endometrial cells are more difficult to obtain and process, while cumulus cells are routinely removed along with the oocytes during the IVF retrieval.

Cumulus cells play an important role on the maturation and development of oocytes.  They produce hyaluronan which is normally involved in cell adhesion, growth and development in the body and is found in the uterus during implantation.

Co-culture of cumulus cells provides an opportunity to detoxify the embryo’s culture medium that the embryos are grown in and produce growth factors important for cell development.

Performing co-culture of embryos has improved implantation and pregnancy rates as presented by us at the national meeting of the American Society of Reproductive Medicine in 2007.

* * * * * * **  * * * *

Was this helpful in answering your questions about co-culture of embryos?

Please share your thoughts about this podcast here. Ask any questions an Dr. Kreiner will answer.

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Infertility Podcast Series: Journey to the Crib: Chapter 4

By David Kreiner MD

April 12th, 2012 at 11:57 am

Welcome to the Journey to the Crib Podcast.  We will have a blog discussion each week with each chapter.  This podcast covers Chapter Four. You, the listener, are invited to ask questions and make comments.  You can access the podcast here: http://www.longislandivf.com/podcast/Chapter_4-WhereDoYouGo.mp3

 Where Do You Go?

 I try to help the reader understand the published statistics offered online by SART, the national organization of IVF programs that provides a registry of IVF programs who submit their data for audit by SART.  Rates are offered with a numerator and a denominator with the critical goal of a live baby per retrieval or transfer being the most crucial statistic.

 The benefits and disadvantages of large programs are discussed basically offering that larger programs tend to have more experienced and often skilled personnel albeit with more waiting time for monitoring.  Some programs may provide more personalized care, some more psychological or emotional support and some offer adjunctive therapies such as acupuncture and mind body programs.

 I emphasize the importance of the embryology lab as well as the skill of the physician performing the embryo transfer.  The technique of the transfer is described including factors that I believe may affect success rates.

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Please share your thoughts about this podcast here.

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The “Dream Team”

By David Kreiner MD

March 26th, 2012 at 10:23 pm

I once had a dream that my lab would be staffed by the most skilled embryologists I could find and that my physician partners would be the recognized experts in the field. 

Throughout my career, I have met some of the world’s best specialists in Reproductive Endocrinology and IVF from my time at the Jones Institute and in my 24 years of practice since I left Norfolk to found Long Island IVF with Dr. Dan Kenigsberg. Together, in 1988, we developed the first successful IVF program onLong Island. 

I am most excited to announce that we have assembled since the merger of Long Island IVF and East Coast Fertility such a “Dream Team”. Three of our embryologists have been directors of very successful IVF labs. The other embryologists by virtue of their experience, advanced degrees, and skills could start a successful IVF lab of their own. Instead, we have assembled under the leadership of Dr. Glenn Moodie arguably the strongest embryology team in the nation. 

Likewise, Drs. Joseph Pena, Michael Zinger and myself have joined nationally recognized, Castle Connolly’s “Best Doctors in America”, Drs. Dan Kenigsberg and Steven Brenner, as well as Drs. Kathleen Droesch and Satu Kuokkanen. 

This “Dream Team” of Reproductive Endocrinologists and embryologists in our first three months together produced remarkably successful IVF as good as anywhere in the country.  

For women under 35, during our first three months as a combined program, October 1, 2011 through December 31, 2011, Long Island IVF achieved 35 clinical pregnancies in 53 fresh transfers (66.0%).  For women 35-37, 18/30 (60.0%), 38-40, 20/37 (54.1%) and for women 41 and 42, 8 of 28 (28.6%) achieved clinical pregnancies. 

Additionally, the East Coast Fertility MicroIVF program featuring minimal stimulation and a cost of $3900 achieved 5 pregnancies in 8 women under 38 yrs of age. 

It is apparent that the whole of the combined Long Island IVF is greater than the sum of its independent parts of the two merging practices (East Coast Fertility + Long Island IVF). 

There is perhaps no more rewarding work than to help build families for those who would otherwise never be able to do so but for our efforts. Working as part of the Long Island IVF “Dream Team” is that much more enjoyable knowing that we can give our patients their very best chance to realize their own dreams of creating their families.

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Black History Month Tribute to Embryologist E.E.Just

By Tracey Minella and Sharlene Gumbs, T.s.

February 20th, 2012 at 8:52 pm

In honor of Black History Month, we’re sharing this essay from Long Island IVF Embryologist, Sharlene Gumbs. It’s a fascinating read about an African-American pioneer in embryology from the early 1900’s. Read on about how Sharlene became the master of her domain:

 

Through the Eyes of an Embryologist

“When were you introduced to the word ‘embryologist’”?   This question was posed to me at a recent dinner meeting with my colleagues and other health care professionals.

 

At the time that I was asked, my mind was preoccupied with the triple chocolate mousse on the dessert menu. Thus, a very generic reply was given.  “School,” I said. On my way home that evening, the question popped in mind and I remembered that my introduction to the word “embryologist” began with aU.S.postage stamp.

 

In my junior year of college, I received an endearing letter from a fellow classmate. The letter was posted with a stamp of Ernest E. Just.  I knew little about the man on the postage except that he was African- American, a biologist, and worthy of a commemorative stamp.

 

After doing some library research, I discovered that E.E. Just, PhD was biologist in the early-mid 1900’s who studied the process of egg fertilization and embryo development in marine invertebrates.  Just is credited with being the first biologist or embryologist to observe and document a cortical change that sweeps over the egg at the point of sperm entry. This change or shift in egg cell membrane potential was defined by Just as the “wave of negativity” that prevents fertilization by more than one sperm (i.e., polyspermy).

 

Today, this wave is referred by scientists as the “fast block”.  Just was also the first to infer that the second block to polyspermy known as the “slow block” occurs as a result of the formation of a protective membrane around the fertilized egg.

 

In addition to being a pioneer in his field, Just was a humble and unassuming man who did not flinch at challenging the theories of leading biologists of his time. In one of the 70+ scientific papers published by Just, he criticized the theory of geneticist and noble laureate, T. H. Morgan.  Morgan, a former embryologist, theorized that genes on chromosomes within the nucleus controlled inheritance and embryo development. 

 

Just, however, believed otherwise.  He was a traditional embryologist who postulated that the factors for inheritance were located in the egg cytoplasm and consequently the cytoplasm played a dominant role in embryo development.  Although Just’s cytoplasm- centered theory was ultimately erroneous, his explanation contained traces of truth.  Through scientific research, we know today that embryo development is a multi-faceted process that combines genetics, cytology, and embryology.

 

E. E. Just, PhD had a notable career in academia and in experimental embryology that spanned 50 years and two continents but he was not oblivious to the feelings of discomfort towards people of African diaspora.  Over the years, his tolerance for racial inequity in early 20th centuryAmerica waned and he relocated to theMediterranean.

 

InItaly, aside from room temperature vino rosso, Just discovered a relationship between blastomere adhesiveness in a cleavage embryo and embryo development.  Although his experiments were conducted on non-human subjects, a similar relationship can be observed when we, the clinical embryologists, assess IVF embryos.

 

With the onset of fascism in Italy, Just decided it was best to move his family to France.  It was in Francethat he completed his magnum opus The Biology of the Cell Surface, in which he writes “The cell is the biologist crucial unit of observation and the egg cell is the special domain of the embryologist”.

Sharlene Gumbs, T.S. (ABB)

 

* * * * * *

Any questions about embryology? Ask them right here.

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Long Island IVF’s IVF Info Seminar! Bring a Friend & Get a Starbucks Card!

By Tracey Minella

January 9th, 2012 at 12:00 am

So, the weather is ridiculous lately. You’re exhausted from the holiday stress. All that work you put off until after the holidays is staring you in the face. And if you started a diet or stopped smoking, you’re probably crabby by now. Understandably so.

So how about a change of plans for tomorrow night?

Instead of plopping down on the couch with your carrot sticks and diet dressing after a long day at work, why not grab a friend* and come down to meet some of the team and we’ll give you a Starbucks card for yourself?

Can’t get your friends to come with you? Well, in that case we’ll still give you riveting, cutting edge fertility information from some of the most respected doctors, embryologists, and staff members in the reproductive medicine business. Hey, maybe you’ll make a new friend.

And we’ll have cookies. That’s right. Cookies to snack on. Haven’t you earned one? Leave the rabbit food for a night.

Plus, after you’ve learned everything there is to know about IVF, you can have all your personal questions answered privately right after the speakers wrap up their quick presentations. And the best part is that you don’t even have to be a current patient to come! Just come in off the street. Have an early dinner and come over afterwards. Or swing by after work.

Have you been trying to conceive without success? Maybe suffered one or more miscarriages? Is your day 3 FSH in the stratosphere? Have other programs told you to give up?  Have they said you’re too heavy to conceive? Do you need info on grant programs and financing? Would you like to hear of contests where you could win great prizes like restaurant certificates and free or discounted infertility services? If so, you really need to come down and meet the some of our professional team.

Don’t you owe it to yourself to just check it out? When was the last time you could corner a RE and ask all your questions without them politely dashing out? For free.

Come on. We’re waiting for you. And your legitimately interested friend*…who, by the way, can’t be a spouse, partner, parent, child, pregnant neighbor, octogenarian, or octomom. (That would be cheating!)

Seminar begins Tuesday  January 10th at 6:30 pm at:

LI-IVF, 245 Newtown Rd., Suite 300, PLAINVIEW, New York 11803

(Yes we’ve merged, but the sign here in PLAINVIEW still says “East Coast Fertility” right now)

We’ll be there ‘til the last question is asked and answered…or we run out of cookies…whichever comes first ;-) Be there. (or you could sit home with all the holiday bills that came in the mail…)

What better time to get to know some of us as our practices merge? Come on down!

Photo credit: http://www.publicdomainpictures.net/view-image.php?image=5684&picture=cup-of-coffee

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History of Embryology

By admin

December 26th, 2011 at 8:55 pm


Know what a “wave of negativity” is? It’s the phrase embryologists use to describe the moment when “the” one sperm penetrates the egg cell and all other sperm are shut out as if a door slammed in their faces. Um, if they had faces. Well, you know what I mean.

Even if you don’t generally love history, this essay from Embryologist, Sharlene Gumbs, is a fascinating read about an African-American pioneer in embryology from the early 1900’s. Read on about how Sharlene became the master of her domain:

Through the Eyes of an Embryologist

“When were you introduced to the word ‘embryologist’”?   This question was posed to me at a recent dinner meeting with my colleagues and other health care professionals.

At the time that I was asked, my mind was preoccupied with the triple chocolate mousse on the dessert menu. Thus, a very generic reply was given.  “School,” I said. On my way home that evening, the question popped in mind and I remembered that my introduction to the word “embryologist” began with a U.S. postage stamp.

In my junior year of college, I received an endearing letter from a fellow classmate. The letter was posted with a stamp of Ernest E. Just.  I knew little about the man on the postage except that he was African- American, a biologist, and worthy of a commemorative stamp.

After doing some library research, I discovered that E.E. Just, PhD was biologist in the early-mid 1900’s who studied the process of egg fertilization and embryo development in marine invertebrates.  Just is credited with being the first biologist or embryologist to observe and document a cortical change that sweeps over the egg at the point of sperm entry. This change or shift in egg cell membrane potential was defined by Just as the “wave of negativity” that prevents fertilization by more than one sperm (i.e., polyspermy).

Today, this wave is referred by scientists as the “fast block”.  Just was also the first to infer that the second block to polyspermy known as the “slow block” occurs as a result of the formation of a protective membrane around the fertilized egg.

In addition to being a pioneer in his field, Just was a humble and unassuming man who did not flinch at challenging the theories of leading biologists of his time. In one of the 70+ scientific papers published by Just, he criticized the theory of geneticist and noble laureate, T. H. Morgan.  Morgan, a former embryologist, theorized that genes on chromosomes within the nucleus controlled inheritance and embryo development. 

Just, however, believed otherwise.  He was a traditional embryologist who postulated that the factors for inheritance were located in the egg cytoplasm and consequently the cytoplasm played a dominant role in embryo development.  Although Just’s cytoplasm- centered theory was ultimately erroneous, his explanation contained traces of truth.  Through scientific research, we know today that embryo development is a multi-faceted process that combines genetics, cytology, and embryology.

E. E. Just, PhD had a notable career in academia and in experimental embryology that spanned 50 years and two continents but he was not oblivious to the feelings of discomfort towards people of African diaspora.  Over the years, his tolerance for racial inequity in early 20th century America waned and he relocated to the Mediterranean.

In Italy, aside from room temperature vino rosso, Just discovered a relationship between blastomere adhesiveness in a cleavage embryo and embryo development.  Although his experiments were conducted on non-human subjects, a similar relationship can be observed when we, the clinical embryologists, assess IVF embryos.

With the onset of fascism in Italy, Just decided it was best to move his family to France.  It was in France that he completed his magnum opus The Biology of the Cell Surface, in which he writes “The cell is the biologist crucial unit of observation and the egg cell is the special domain of the embryologist”.

Sharlene Gumbs, T.S. (ABB)

* * * * * *

Any questions about embryology? Ask them

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Washing Your Sheets May Help You Conceive

By Tracey Minella and David Kreiner MD

November 22nd, 2011 at 4:26 pm


No, not the laundry, silly. I’m talking about your sheets of cumulus cells. If you want to improve your chances for pregnancy, washing and separating these sheets of cells at the time of your IVF retrieval, and placing them in the dish with your embryos, may be just what the doctor ordered to get your pee stick to come back positive.

This revolutionary procedure is known as co-culture. Unfortunately, many IVF programs do not offer this pregnancy rate-boosting option. Fortunately for you, Long Island IVF and East Coast Fertility do offer co-culture.

Dr. David Kreiner explains the benefits of this exciting and promising weapon in the IVF arsenal:

Successful IVF is dependent on many factors.  The quality of the egg and embryo, the placement of the embryo into the uterus and the environment surrounding implantation are all paramount to the ultimate goal of creating a pregnancy that leads to a live baby.

Typically, patients present with their own gametes so the genetics and pregnancy potential of the eggs and sperm is usually predetermined when patients first present to an IVF program.  As a specialist in REI and IVF, I have dedicated my career to optimizing those other factors that we may influence.

In the late 1990’s I recorded data on all my embryo transfers including distance the catheter tip was placed into the uterine cavity, number of cells and grade of the embryos, difficulty of the transfer, use of tenaculum etc.  I presented my results at the ASRM in 2000 that highlighted the two step transfer to the middle of the uterine cavity and replaced the tenaculum with a cervical suture when needed and this radically improved pregnancy rates.

The uterine environment has been optimized through screening for anatomic issues in the uterine cavity with a hydrosonogram to identify polyps, fibroids and scar tissue that may impede implantation.  Hormonally, we have supplemented patient’s cycles with progesterone through both vaginal and parenteral (intramuscular) administration as well as estrogen that we monitor closely after embryo transfer and make adjustments when deemed helpful.

The greatest improvement in pregnancy rates for the past several years however has been due to a “Culture Revolution” in IVF that is the media environment bathing and feeding the embryos.  All these advances have had a great impact on IVF success rates to the point that 50% of retrievals will result in a pregnancy.  Unfortunately, older patients and some younger ones have yet to share in this success.

Many IVF programs have reintroduced the concept of utilizing a co-culture medium to improve the quality and implantation of embryos. Co-culture is a procedure whereby “helper” cells are grown along with the developing embryo. Today, the most popular cell lines include endometrial cells (from the endometrium, or uterine lining) and cumulus cells from women’s ovaries.  Both cell lines are derived from the patient, thereby eliminating any concerns regarding transmission of viruses. Endometrial cells are much more difficult to obtain and process, while cumulus cells are routinely removed along with the oocytes during IVF retrieval.

Cumulus cells play an important role in the maturation and development of oocytes.  After ovulation cumulus cells normally produce a chemical called Hyaluronan.   Hyaluronan is secreted by many cells of the body and is involved in regulating cell adhesion, growth and development. Recent evidence has shown that Hyaluronan is found normally in the uterus at the time of implantation.

Co-culture of cumulus cells provides an opportunity to detoxify the culture medium that the embryos are growing in and produce growth factors important for cell development.  This may explain why some human embryos can experience improved development with the use of co-culture.

Preparation of co-culture cells starts with separation of the cumulus cells from the oocytes after aspiration of the follicles. These sheets of cells are washed thoroughly and then placed in a solution that permits the sheets to separate into individual cells.  The cells are then washed again and transferred to a culture dish with medium and incubated overnight. During this time individual cells will attach to the culture dish and create junctions between adjoining cells. This communication is important for normal development. The following morning, cells are washed again and all normally fertilized oocytes (embryos) are added to the dish. Embryos are grown with the cumulus cells for a period of three days to achieve maximum benefit.

Performing co-culture of embryos has improved implantation and pregnancy rates above and beyond those seen with the IVF advances previously described. More importantly, it promises to offer advantages for those patients whose previous IVF cycles were unsuccessful.

* * * * * ** * * **** * * * **

Have you tried this yet?

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You Need a “Wave of Negativity For a Healthy Pregnancy”

By Tracey Minella and Sharlene Gumbs, T.s.

May 10th, 2011 at 12:00 am

No, I’m not talking about depression. It’s the phrase coined by one of the earliest embyologists to describe the moment when the "chosen” single sperm penetrates the egg cell and all other sperm are instantly shut out, as if a door slammed in their faces. Um, if they had faces. Well, you know what I mean.

Even if you don’t generally love history, this essay from East Coast Fertility Embryologist, Sharlene Gumbs, is a fascinating read about an African-American pioneer in embryology from the early 1900’s. Read on about how he inspired Sharlene to become the master of her domain:

Through the Eyes of an Embryologist

“When were you introduced to the word ‘embryologist’”?   This question was posed to me at a recent dinner meeting with my colleagues and other health care professionals.

At the time that I was asked, my mind was preoccupied with the triple chocolate mousse on the dessert menu. Thus, a very generic reply was given.  “School,” I said. On my way home that evening, the question popped in mind and I remembered that my introduction to the word “embryologist” began with a U.S. postage stamp.

In my junior year of college, I received an endearing letter from a fellow classmate. The letter was posted with a stamp of Ernest E. Just.  I knew little about the man on the postage except that he was African- American, a biologist, and worthy of a commemorative stamp.

After doing some library research, I discovered that E.E. Just, PhD was biologist in the early-mid 1900’s who studied the process of egg fertilization and embryo development in marine invertebrates.  Just is credited with being the first biologist or embryologist to observe and document a cortical change that sweeps over the egg at the point of sperm entry. This change or shift in egg cell membrane potential was defined by Just as the “wave of negativity” that prevents fertilization by more than one sperm (i.e., polyspermy).

Today, this wave is referred by scientists as the “fast block”.  Just was also the first to infer that the second block to polyspermy known as the “slow block” occurs as a result of the formation of a protective membrane around the fertilized egg.

In addition to being a pioneer in his field, Just was a humble and unassuming man who did not flinch at challenging the theories of leading biologists of his time. In one of the 70+ scientific papers published by Just, he criticized the theory of geneticist and noble laureate, T. H. Morgan.  Morgan, a former embryologist, theorized that genes on chromosomes within the nucleus controlled inheritance and embryo development. 

Just, however, believed otherwise.  He was a traditional embryologist who postulated that the factors for inheritance were located in the egg cytoplasm and consequently the cytoplasm played a dominant role in embryo development.  Although Just’s cytoplasm- centered theory was ultimately erroneous, his explanation contained traces of truth.  Through scientific research, we know today that embryo development is a multi-faceted process that combines genetics, cytology, and embryology.

E. E. Just, PhD had a notable career in academia and in experimental embryology that spanned 50 years and two continents but he was not oblivious to the feelings of discomfort towards people of African diaspora.  Over the years, his tolerance for racial inequity in early 20th century America waned and he relocated to the Mediterranean.

In Italy, aside from room temperature vino rosso, Just discovered a relationship between blastomere adhesiveness in a cleavage embryo and embryo development.  Although his experiments were conducted on non-human subjects, a similar relationship can be observed when we, the clinical embryologists, assess IVF embryos.

With the onset of fascism in Italy, Just decided it was best to move his family to France.  It was in France that he completed his magnum opus The Biology of the Cell Surface, in which he writes “The cell is the biologist crucial unit of observation and the egg cell is the special domain of the embryologist”.

Sharlene Gumbs, T.S. (ABB)

* * * * * *

Any questions about embryology

no comments


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