POTENTIAL IMPACT OF CULTURE MEDIUM REFRESH AT DAY 3 ON DEVELOPMENT AND QUALITY OF EMBRYOS IN ICSI TREATMENT CYCLES

Background: The introduction of Intracytoplasmic Sperm Injection (ICSI) in 1992, followed by reports of high success rates using this method, has opened a new era in the treatment of previously untreatable cases of infertility especially male factor infertility. Embryo culture refers to the culture of human gametes and embryos during in vitro fertilization treatments. The procedure is initiated when eggs and sperm are combined in a culture dish and it ends with the transfer of the resulting embryo to the uterus. The culture period varies between one and six days, and the embryo culture process is vital to the success of any IVF or ICSI procedure. The type of culture medium used may affect embryo quality and hence the success rate of the treatment. Aim of the Study: To evaluate the potential impact of culture medium refresh on day 3 on the development and quality of embryos during in vitro fertilization in ICSI treatment cycles. Patients and Methods: This Randomized Comparative Prospective Controlled Trail study was conducted on 200 patients(corresponding to 763 day 3 embryos in each group) undergoing ICSI at Assisted Reproduction unit - Ain Shams University Maternity Hospital Starting from October of 2015 to October of 2017. At day 3 Cleavage stage, patients were divided to two groups according to randomized table. Group I: embryos were refreshed with pre incubated single culture media Global ? total media for at least 8hr, extending to day 5 Blastocyst stage. Group II: embryos cultures were continued with the same culture media extending to day 5 without refreshment. Results: Significant differences in pregnancy rates and implantation rates were not observed between the two groups; but there is significant difference in blastocyst formation were observed, in day-3 Grade-I embryos, improvement was significantly more frequent among renewal group, stability of embryo condition was non-significantly different between renewal and non-renewal media groups, while deterioration of grade was significantly more frequent among non-renewal group. Conclusion: In spite of a statistically significant difference was found between the groups in the blastocyst formation and quality of formed blastocyst a non-significant trend was observed between the two groups in implantation and pregnancy rates