The Upper Egypt Assisted Reproduction Conference 2017, produced some interesting discussions but Dr Mohamed Fawzy of the IVF Laboratory, Egypt pinpointed one in particular: current culture media and incubator designs. He says "Culture media for in vitro human embryo development affects not only the embryo development and the subsequent clinical outcomes but also offspring health and gene expressions. Many brands of culture media are commercially available with encouragement from the manufacturers in usage, to get superior results for IVF outcomes. These brands include two paradigms (sequential media and single-step media). Sequential media paradigm formed of three sequences of media, one for fertilization, the second is to culture from zygote to the cleaved embryo until day 3, and the third is for culturing the embryo from day 3 to 5 or 6. This approach of culture is based on the assumption that each stage of embryo development needs different requirements in regard to nutrition, and others. The single-step approach has been built on the assumption that the embryo should be provided with all the nutrients and to let the embryo choose from them. Both paradigms are basically accepted and supportive to embryo development. The emerging evidence in two meta-analyses suggests that both approaches are equal and there is no preferred medium yet. A recent publication that has presented at UEARS 2017 inferred that adding insulin into single-step culture media is associated with better embryological and clinical outcomes. The culture media effect on gene expression is, to some extent, lacking. For that, a gap exists in the current design of culture media and the culture media need revisiting, however, from different perspectives."
Dr Fawzy goes on: "The incubator is a second crucial piece that can affect the human embryo development and the subsequent outcomes. The incubator is responsible for maintaining a non-stressful regulatory environment for the developing embryo. Inside the incubator, pH, gas exchange, recovery time and humidity should be optimal. According to Armstrong et al. in a Cochrane review, they inferred that there is no evidence to support time-lapse superiority over the conventional incubator. However, there is an anecdotal belief that the Benchtop incubators may offer faster recovery of temperature and gas and this, in turn, could improve the results. To date, there is no agreement on which model of Benchtop is superior. This could notify us that a gap exists in defining the best incubator and leaving us to the designer's wishes." He suggests culture media and incubators should be the first items to be validated through the concept of no harm to the embryo, clinical outcomes, and more importantly the offspring health.
The next UEARC 2018 conference will be held in Cairo on February 21-23, 2018.