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Periconceptional Nutritional and environmental determinants of human embryo health

Periconceptional Nutritional and environmental determinants of human embryo health
Periconceptional Nutritional and environmental determinants of human embryo health
Introduction
Whilst undergoing artificial reproductive treatments, physicians and patients try a wide variety of approaches to improve the periconceptional environment of the developing gametes and embryos and hence the chances of success. Recently, a ‘Mediterranean’ diet, high in vegetable oils and fish, has been reported to increase pregnancy rates by up to 40%. In addition to parental dietary changes, keeping the embryos in a more stable environment (observing them via time lapse technology rather than removing them from their incubator to grade them) may improve their quality. However, up to now, few prospective randomized controlled trials have investigated the impact of periconceptional dietary interventions or the stability of the embryos’ culture environment on fertility outcomes.

Methods
Two trials have been carried out to examine these hypotheses:
1. The PREPARE trial: A randomised double blinded controlled trial of 111 couples examining the effect of a six week dietary intervention of omega-3 fatty acids and vitamin D on morphokinetic markers of embryo quality.
2. The PROMOTE trial: A prospective and randomised trial comparing embryo development and metabolic activity of embryos cultured in the MINC (standard benchtop) versus the EmbryoScope (time lapse) incubators.

Results
There was a statistically significant increases in Docosahexaenoic acid (DHA) and Eicosapentaenoic acid (EPA) in erythrocytes and in vitamin D in blood serum following the dietary intervention (all p<0.001). The development of embryos generated from the couples in the study group to the four cell stage (CC4) was accelerated compared to the control group (p<0.001). These embryos also demonstrated a significantly shortened S3 (meaning more synchronous cell division from the five to eight cell stage) (p=0.031). The fatty acid composition of follicular fluid was altered by the dietary intervention and correlations were made with the embryo quality. The short intervention did not have an effect on sperm quality. Culturing embryos in the EmbryoScope significantly increased the number of blastocysts formed on day 5 (159 EmbryoScope versus 133 MINC; P = 0.015) and altered the carbohydrate utilisation and amino acid consumption and production of those embryos.

Conclusions
Improving a couple’s preconceptional diet and providing a more stable environment for embryo culture improves markers of embryo quality. Further work is needed to examine whether this improvement causes an increase in pregnancy rates and to establish dosing and the longevity of a dietary intervention before clinical recommendations can be made.
University of Southampton
Kermack, Alexandra Jayne
b01db302-47bf-4319-a270-4cbbf26045c8
Kermack, Alexandra Jayne
b01db302-47bf-4319-a270-4cbbf26045c8
Macklon, Nick
d08e4844-96cf-4333-aa84-aec9b8febb42
Calder, Philip
1797e54f-378e-4dcb-80a4-3e30018f07a6
Houghton, Franchesca
53946041-127e-45a8-9edb-bf4b3c23005f

Kermack, Alexandra Jayne (2018) Periconceptional Nutritional and environmental determinants of human embryo health. University of Southampton, Doctoral Thesis, 236pp.

Record type: Thesis (Doctoral)

Abstract

Introduction
Whilst undergoing artificial reproductive treatments, physicians and patients try a wide variety of approaches to improve the periconceptional environment of the developing gametes and embryos and hence the chances of success. Recently, a ‘Mediterranean’ diet, high in vegetable oils and fish, has been reported to increase pregnancy rates by up to 40%. In addition to parental dietary changes, keeping the embryos in a more stable environment (observing them via time lapse technology rather than removing them from their incubator to grade them) may improve their quality. However, up to now, few prospective randomized controlled trials have investigated the impact of periconceptional dietary interventions or the stability of the embryos’ culture environment on fertility outcomes.

Methods
Two trials have been carried out to examine these hypotheses:
1. The PREPARE trial: A randomised double blinded controlled trial of 111 couples examining the effect of a six week dietary intervention of omega-3 fatty acids and vitamin D on morphokinetic markers of embryo quality.
2. The PROMOTE trial: A prospective and randomised trial comparing embryo development and metabolic activity of embryos cultured in the MINC (standard benchtop) versus the EmbryoScope (time lapse) incubators.

Results
There was a statistically significant increases in Docosahexaenoic acid (DHA) and Eicosapentaenoic acid (EPA) in erythrocytes and in vitamin D in blood serum following the dietary intervention (all p<0.001). The development of embryos generated from the couples in the study group to the four cell stage (CC4) was accelerated compared to the control group (p<0.001). These embryos also demonstrated a significantly shortened S3 (meaning more synchronous cell division from the five to eight cell stage) (p=0.031). The fatty acid composition of follicular fluid was altered by the dietary intervention and correlations were made with the embryo quality. The short intervention did not have an effect on sperm quality. Culturing embryos in the EmbryoScope significantly increased the number of blastocysts formed on day 5 (159 EmbryoScope versus 133 MINC; P = 0.015) and altered the carbohydrate utilisation and amino acid consumption and production of those embryos.

Conclusions
Improving a couple’s preconceptional diet and providing a more stable environment for embryo culture improves markers of embryo quality. Further work is needed to examine whether this improvement causes an increase in pregnancy rates and to establish dosing and the longevity of a dietary intervention before clinical recommendations can be made.

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PhD Alex Kermack - Version of Record
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Published date: December 2018

Identifiers

Local EPrints ID: 435564
URI: http://eprints.soton.ac.uk/id/eprint/435564
PURE UUID: 0849aec1-c897-4be4-8f82-d75118bf8c3f
ORCID for Alexandra Jayne Kermack: ORCID iD orcid.org/0000-0002-9176-9426
ORCID for Philip Calder: ORCID iD orcid.org/0000-0002-6038-710X
ORCID for Franchesca Houghton: ORCID iD orcid.org/0000-0002-5167-1694

Catalogue record

Date deposited: 11 Nov 2019 17:30
Last modified: 06 Jun 2024 04:01

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Contributors

Author: Alexandra Jayne Kermack ORCID iD
Thesis advisor: Nick Macklon
Thesis advisor: Philip Calder ORCID iD
Thesis advisor: Franchesca Houghton ORCID iD

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