30 May Autologous Endometrial Coculture for Couples who have Poor Embryo Quality
Autologous endometrial coculture is a form of assisted reproductive technology (ART). This procedure involves manipulation of fertilized eggs to improve chances of in vitro fertilization (IVF).
Who needs autologous endometrial coculture?
Autologous endometrial coculture is not applied to all IVF cases. Usually, this procedure is used for poor prognosis couples. Women with poor embryo quality could benefit from autologous endometrial coculture, as could women over 40 years of age. In addition, women who have failed on previous IVF cycles, women who respond poorly to gonadotropins for ovarian stimulation, and women with elevated follicle-stimulating hormone levels are all candidates for this procedure.
How does coculture work?
In vitro fertilization (IVF) with coculture has been used over the last decade to improve pregnancy rates. The basic concept involves using a special medium culture from the female’s own uterine lining cells to grow embryos. The monolayer of cells are often referred to as helper cells or feeder cells. Endometrial cells are thought to remove toxins, add growth factors, and nurture the developing embryos.
How is the procedure done?
With autologous endometrial coculture, the woman’s fertilized eggs are placed on top of a layer of cells from her uterus lining. This creates a natural environment for development of embryos, and increases the chance of IVF pregnancy. The steps of a typical coculture cycle are:
- 1 – After the client is deemed a candidate for the autologous endometrial coculture procedure, she has an endometrial (uterine lining) biopsy.
- 2 – A piece of the uterine lining (endometrium) is sent to the laboratory to be treated, purified, and then, frozen.
- 3 – The woman undergoes an IVF cycle, and takes medication to stimulate the growth of eggs in the ovaries.
- 4 – The client’s eggs are retrieved and combined with sperm in the laboratory. At this time, the endometrial cells are prepared.
- 5 – Once embryos develop, they are placed on top of the endometrial cells.
- 6 – Over the next 2-3 days, the embryos are monitored in the laboratory for growth and development.
- 7 – The embryos are transferred into the female’s uterus, where they implant into the endometrium.
How effective is autologous endometrial coculture?
In a large study of more than 12,000 embryo cultures, endometrial coculture was found to be a significantly better culture media than others. The rates of embryos developing to normal were 56% compared to 46% with other media. When eggs from donors were used, the rate increased to 71% using this method. Pregnancy rates have been reported to be 11% better when this form of culture is used to mature the embryos.
Why don’t all fertility clinics use endometrial coculture?
Not ever fertility center will offer autologous endometrial coculture. Reasons why coculture is not offered for IVF are:
- Coculture involves tedious laboratory work, which increases expense of IVF.
- Many IVF laboratories are not experienced with culture of endometrial cells.
- Concerns regarding the transmissions of viruses from the cells to the embryos.
What happens after the endometrial coculture procedure?
Once embryos develop, they must be transferred into the woman’s uterus (blastocyst transfer). The embryologist selects embryos based on quality. The highest quality embryos are inserted into the uterus using a special tiny tube. The woman must take certain medications to prepare the uterus lining to maintain the newly implanted embryos. Coculture has been show to produce higher quality embryos for transfer, with once study showing a 68% success rate for IVF pregnancy.