Efficiency of polarized microscopy as a predictive tool for human oocyte quality

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B. Heindryckx*, S. De Gheselle, S. Lierman, J. Gerris and P. De Sutter

Department for Reproductive Medicine, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium *Correspondence address. Tel: +32-9-332-4748; Fax: +32-9-332-4972; E-mail: bjorn.heindryckx{at}ugent.beReceived September 1, 2010. Revision received October 29, 2010. Accepted December 3, 2010. BACKGROUND Conflicting results have been reported regarding the use of polarized microscopy as a predictive tool for human oocyte quality.

METHODS Oocytes from 121 ICSI cycles were analysed with polarized microscopy. Both qualitative (spindle presence) and quantitative (retardance) data were correlated to the key assisted reproduction technology outcome parameters. Second, polarized microscopy was applied on in vitro matured (IVM) oocytes from germinal vesicle oocytes that matured after 24 or 48 h and from metaphase I oocytes matured after 3 or 24 h. These data were correlated with confocal analysis of spindle-chromosome complex.

RESULTS Spindles were detected in 82% of in vivo matured oocytes and in 64% adjacent to the first polar body (PB). Fertilization rate was higher in oocytes with a visible spindle (P = 0.0002). In patients aged over 35 years, the percentage of a visible spindle and mean spindle retardance was lower than in younger patients (P < 0.03). A higher number of spindles were located adjacent to the first PB in IVM matured oocytes (94%) versus in vivo matured oocytes (P < 0.0001). Confocal imaging revealed that spindle absent IVM metaphase II (MII) oocytes had a higher degree of aberrant spindle and chromosomal configurations versus IVM MII oocytes with a visible spindle (P = 0.002).

CONCLUSIONS Oocytes with absent spindles were associated with lower fertilization rates and advanced female age. Other important outcome parameters (embryo quality, pregnancy rates) were not correlated to spindle nor zona inner layer analysis. Interestingly, confocal imaging showed that polarized microscopy might be used as a qualitative predictive tool of human oocyte quality but no correlation could be demonstrated with quantitative polarized microscopy.

© The Author 2011. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oup.com This ArticleHum. Reprod. (2011) 26 (3): 535-544. doi: 10.1093/humrep/deq376 First published online: January 12, 2011

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Editorial: Two cheers for clinical practice guidelines: the hopes and headaches of quality improvement in reproductive healthcare

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Ed Hughes*

Professor of Obstetrics and Gynecology, McMaster University, 1200 Main Street West, Hamilton, ON, Canada L8N 3Z5*Correspondence address. E-mail: hughese{at}mcmaster.caReceived January 12, 2011. Revision received January 12, 2011. Accepted January 14, 2011. Effective and timely knowledge transfer is the engine of evidence-based medicine. ESHRE and other professional societies are key players in the process of knowledge transfer. They facilitate scientific dialogue in many different ways and provide frameworks for the generation of clinical practice guidelines (CPGs). While enormous thought and effort goes into the execution of clinical trials and the subsequent development of CPGs based on them, little is known about the effectiveness of guideline uptake in the field of reproductive medicine. How successful are guidelines in improving quality of care? What strategies beyond simple guideline publication, most effectively lead to change in practice? The study by Mourad et al. ( 2010) takes a bold and pragmatic look at these questions, on behalf of fertility care-givers and patients.

Based in Holland, this group used a relatively new and increasingly common design platform: cluster randomization. This means that the unit of allocation was not, as is usual, the individual patient, but instead a group of patients, in this case those attending a particular fertility clinic. The main reason for using cluster randomization is to avoid the risk of contamination: to keep separate the influences of the two strategies under study. Here, it would have been impossible to provide two types of CPG reinforcement strategy to the same physicians and expect them to apply them separately to individual patients within their practices. Important limitations of cluster randomization stem from the correlation that exists between patients within …

This ArticleHum. Reprod. (2011) 26 (4): 815-816. doi: 10.1093/humrep/der023 First published online: February 2, 2011

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