Low-oxygen compared with high-oxygen atmosphere in blastocyst culture, a prospective randomized study
Urban Waldenström, Ann-Britt Engström, Dan Hellberg, Staffan Nilsson, Urban Waldenström, Ann-Britt Engström, Dan Hellberg, Staffan Nilsson
Abstract
Objective: To investigate birth rates with two oxygen (O(2)) concentrations in blastocyst culture.
Design: Randomized trial.
Setting: Private in vitro fertilization (IVF) clinic.
Patient(s): Six hundred women undergoing IVF.
Intervention(s): Blastocyst culture in atmospheres with either 6% carbon dioxide (CO(2)) in air, the equivalent to 19% O(2), a two-gas system; or 5% O(2), 6% CO(2), and 90% nitrogen (N(2)), a three-gas system.
Main outcome measure(s): Birth rate.
Result(s): The inclusion criterion for blastocyst culture (at least five fertilized oocytes) was fulfilled in 396 women, randomized to 197 cultures with the three-gas system and 199 cultures with the two-gas system. The outcome with the three-gas system compared with the two-gas system showed a statistically significantly increased blastocyst rate (47.8% vs. 42.1%), mean number of blastocysts (3.8 vs. 3.3), and number of cryopreserved blastocysts (1.7 vs. 1.1). The mean number of transferred blastocysts was 1.2 versus 1.3. Culture with the three-gas system increased the relative birth rate by 10% compared with the two-gas system (42% vs. 32%, respectively), a statistically significant difference. The overall twin rate was 4.8%.
Conclusion(s): Blastocyst culture with low-oxygen (5%) versus high-oxygen (19%) concentration yielded a better blastocyst outcome and a marked improvement in birth rate. Generation of cytotoxic reactive oxygen species with prolonged embryo culture might deteriorate blastocyst viability.
Source: PubMed