Autologous Endometrial Coculture

Introduction

Autologous endometrial coculture is commonly known as coculture. This is a modern technique which involves placing the fertilized eggs of the patient on top of a layer of cells derived from her own uterine lining. This creates a more natural environment for embryo development and also maximizes the chance for a successful in vitro fertilization (IVF) pregnancy.

A typical coculture cycle consists of the following:

1. First the patient is decided to be appropriate candidate for the procedure by an infertility specialist.

2. Then she undergoes an endometrial biopsy means a small piece of her uterine lining is removed.

3. The uterine lining sample is sent to the research lab, where it is treated, purified and frozen.

4. After this, the patient undergoes a typical IVF cycle and medications are given to stimulate egg growth in the ovaries.

5. The patient’s eggs are retrieved from the abdomen and mixed with the sperm. At this time, the endometrial cells are thawed.

6. Once fertilization is confirmed on the first day, the patient’s embryos are placed on top of her own thawed endometrial cells.

7. The embryos are closely monitored for growth and development for a period of two days.

8. The patient’s embryos are transferred into the uterus for implantation and continuation of pregnancy.

Potential candidates:

Coculture procedure can be an effective treatment for patients with previous failed IVF cycles or who have poor embryo quality.

Benefits:

1. It is a noninvasive and relatively pain free procedure.

2. This technique can be performed during a short office visit.

3. The coculture also can improve the embryo quality and stimulate its growth.

Risks:

The risks of coculture are very minimal. The procedure has been performed in large number of patients without any associated detrimental effects on the embryo growth. Complications such as uterine infection or damage caused by embryo biopsy are extremely rare.

Autologous Endometrial Coculture is done initially like other typical IVF procedures. The similarities are as follows:

1. Collection of eggs is done either by natural method or mild IVF method

2. The egg production is done by triggering the ovulation using hCG.

3. Sperm and egg preparation are similar

4. The fertilisation technique is similar.

5. The embryo culture is also performed.

The differences are as follows:

1. The endometrial cells are collected from the woman after a biopsy.

2. The endometrial cells are frozen and stored.

3. The cells are thawed from frozen state while the patient’s eggs are being retrieved and mixed with the sperm

4. After the fertilization, the embryo is moved to the endometrial cells to undergo a culture, until it reaches blastocyst stage.

5. Blastocyst stage is chosen for embryo transfer, as it increases the pregnancy rate.

6. For two days in the culture, the embryos are closely monitored and then transferred into the patient’s uterus for implantation and pregnancy.

Results:

A Coculture has a better pregnancy rate than the traditional sequential media culture. It is postulated to be about 39% to 41%. It also increases the implantation rate. The reason behind this success rate may be cell-to-cell interaction, cytokines and growth factor elaboration. This is possible as the technique basically creates a more natural environment for development of embryo.Recent researches also show interleukin-mediated blastocyst development is the reason behind an increase in implantation rate. The coculture also can improve the embryo quality and stimulate its growth.

In certain phase of the endometrium, which is several days after LH surge, the clinical resultsare considered to be better. This may be because theLH surge triggers the increase in level of progesterone to prepare endometrium for a possible implantation. It is postulated that the biopsies taken 5 days after LH surge are much more effective than those taken before LH surge.

This technique can improve the possibility of pregnancy and embryo quality. This technique therefore is suggested to people who have failed multiple IVF attempts or who have poor embryo quality.

A coculture is also known as an useful instrument to understand the metabolism of the embryo and its interaction with the endometrium.