Sometimes multiple IVF attempts with oocytes that are good from the point of view of embryology fail: for example, an implanted embryo does not take root and dies.
Why can this happen? The morphology of the oocyte division spindle is of great importance.
The structure of the egg, and what is the spindle of division?
The quality of the embryo and its development potential depend on the quality of the oocyte. The shape of the cell, the structure of the cytoplasm, the shell and the polar body (the cell separating from the oocyte during maturation) are usually evaluated. The egg itself may have an abnormal shape – oval or amorphous. The cytoplasm may have vacuoles (cavities inside the cell filled with cell juice), various inclusions, and an abnormal shape. The oocyte shell can be thick, thin, or carry any abnormalities: the polar body may be absent, fragmented, or located separately from the cell itself. All these anomalies affect the further development of the embryo to varying degrees.
There is another very important element in the oocyte – the spindle of division (Fig.1).
Who is shown the procedure for evaluating the division spindle?
1. For patients aged 40+. It is a well-known fact that with age, the percentage of oocytes with problems with chromosome separation increases. These problems lead to genetic mutations.
2. Patients with a large number of oocytes and poor embryo development (in particular, polycystic ovary syndrome).
3. Patients who have had multiple IVF attempts with good eggs from the point of view of embryology, but with embryos that do not take root after transplantation, or with early pregnancy losses.
How can the division spindle be evaluated?
It is impossible to see it with a conventional microscope, so no one evaluates it in routine practice. It is necessary to have a special polarizing installation for visualization. In world practice, only a few clinics have the necessary equipment in their arsenal and evaluate the spindle of division.
The importance of the quality of the division spindle in fertilization
The spindle of division can be either normal or abnormal. Normally, it should be clearly visualized and located close to the polar taurus. But there are various anomalies: vacuolization, the spindle is broken into fragments, poorly visualized, and may be completely absent (Fig. 2).
If the oocytes have a normal division spindle, the fertilization efficiency is 90%, and the embryo yield is 76%. In case of abnormal fertilization, the efficiency of fertilization is 72%, and the yield of embryos decreases to 31%. The probability of implantation of embryos that were obtained from oocytes with a normal spindle reaches 60%.
The size of the division spindle is also important. With a fission spindle from 90 to 120 microns2 , the chances of pregnancy are highest.
And one more important point: at the time of ICSI (injection of sperm into the cytoplasm), the embryologist must correctly position the oocyte. Usually, the marker is the polar body, under which the spindle of division should theoretically be located. In order not to damage the spindle, the oocyte is oriented for 6 or 12 hours, to maximize the removal of the spindle from the injection site. However, the spindle can be positioned in a cage in different ways (Fig. 3).
And since it is impossible to see the spindle during routine ICSI, there is a high probability of damage to it. The imaging system of the division spindle used in the EMC minimizes the risk of damage to it.
EMC capabilities in the evaluation of the division spindle
Specialists from the EMC Clinic for Reproductive and Prenatal Medicine conduct a detailed assessment of the spindle division. For this purpose, the European Medical Center has all the necessary equipment and experienced specialists who have worked and trained in leading clinics in Europe.
Who is shown the procedure for evaluating the division spindle?
1. For patients aged 40+. It is a well-known fact that with age, the percentage of oocytes with problems with chromosome separation increases. These problems lead to genetic mutations.
2. Patients with a large number of oocytes and poor embryo development (in particular, polycystic ovary syndrome).
3. Patients who have had multiple IVF attempts with good eggs from the point of view of embryology, but with embryos that do not take root after transplantation, or with early pregnancy losses.
How can the division spindle be evaluated?
It is impossible to see it with a conventional microscope, so no one evaluates it in routine practice. It is necessary to have a special polarizing installation for visualization. In world practice, only a few clinics have the necessary equipment in their arsenal and evaluate the spindle of division.
The importance of the quality of the division spindle in fertilization
The spindle of division can be either normal or abnormal. Normally, it should be clearly visualized and located close to the polar taurus. But there are various anomalies: vacuolization, the spindle is broken into fragments, poorly visualized, and may be completely absent (Fig. 2).
If the oocytes have a normal division spindle, the fertilization efficiency is 90%, and the embryo yield is 76%. In case of abnormal fertilization, the efficiency of fertilization is 72%, and the yield of embryos decreases to 31%. The probability of implantation of embryos that were obtained from oocytes with a normal spindle reaches 60%.
The size of the division spindle is also important. With a fission spindle from 90 to 120 microns2 , the chances of pregnancy are highest.
And one more important point: at the time of ICSI (injection of sperm into the cytoplasm), the embryologist must correctly position the oocyte. Usually, the marker is the polar body, under which the spindle of division should theoretically be located. In order not to damage the spindle, the oocyte is oriented for 6 or 12 hours, to maximize the removal of the spindle from the injection site. However, the spindle can be positioned in a cage in different ways (Fig. 3).And since it is impossible to see the spindle during routine ICSI, there is a high probability of damage to it. The imaging system of the division spindle used in the EMC minimizes the risk of damage to it.
EMC capabilities in the evaluation of the division spindle
Specialists from the EMC Clinic for Reproductive and Prenatal Medicine conduct a detailed assessment of the spindle division. For this purpose, the European Medical Center has all the necessary equipment and experienced specialists who have worked and trained in leading clinics in Europe.
It is impossible to see it with a conventional microscope, so no one evaluates it in routine practice. It is necessary to have a special polarizing installation for visualization. In world practice, only a few clinics have the necessary equipment in their arsenal and evaluate the spindle of division.
The importance of the quality of the division spindle in fertilization
The spindle of division can be either normal or abnormal. Normally, it should be clearly visualized and located close to the polar taurus. But there are various anomalies: vacuolization, the spindle is broken into fragments, poorly visualized, and may be completely absent (Fig. 2).
If the oocytes have a normal division spindle, the fertilization efficiency is 90%, and the embryo yield is 76%. In case of abnormal fertilization, the efficiency of fertilization is 72%, and the yield of embryos decreases to 31%. The probability of implantation of embryos that were obtained from oocytes with a normal spindle reaches 60%.
The size of the division spindle is also important. With a fission spindle from 90 to 120 microns2 , the chances of pregnancy are highest.
And one more important point: at the time of ICSI (injection of sperm into the cytoplasm), the embryologist must correctly position the oocyte. Usually, the marker is the polar body, under which the spindle of division should theoretically be located. In order not to damage the spindle, the oocyte is oriented for 6 or 12 hours, to maximize the removal of the spindle from the injection site. However, the spindle can be positioned in a cage in different ways (Fig. 3).And since it is impossible to see the spindle during routine ICSI, there is a high probability of damage to it. The imaging system of the division spindle used in the EMC minimizes the risk of damage to it.
EMC capabilities in the evaluation of the division spindle
Specialists from the EMC Clinic for Reproductive and Prenatal Medicine conduct a detailed assessment of the spindle division. For this purpose, the European Medical Center has all the necessary equipment and experienced specialists who have worked and trained in leading clinics in Europe.
And since it is impossible to see the spindle during routine ICSI, there is a high probability of damage to it. The imaging system of the division spindle used in the EMC minimizes the risk of damage to it.
Specialists from the EMC Clinic for Reproductive and Prenatal Medicine conduct a detailed assessment of the spindle division. For this purpose, the European Medical Center has all the necessary equipment and experienced specialists who have worked and trained in leading clinics in Europe.
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Questions and answers
Lump in my breast
I have noted the lump in my breast periodically appeared following breastfeeding my first child (as a result of plugged duct). I did an ultrasound, but it revealed nothing, as if everything was normal. I knead my breast periodically and feel pain at those moments. Now I am pregnant, due date is on 20th. What should I
do?? When to examine my breasts, is it possible to perform the examination during pregnancy and lactation?
...more The "lump" in the breast cannot occur after feeding, even if it was the plugged duct. You should not "knead" the breasts. If there is a problem or even if you think it is – the breast should be examined. Pregnancy and breastfeeding are not contraindications for this. Under normal conditions for pregnant women we
recommend a breast examination during 1 and 3 trimester (before childbirth). There are no contraindications for breast examination in your case. You are welcome at any convenient time for examination and advice on breastfeeding.
...more
Benign disease
I have a benign lump in one breast size of 12.0*9.9 mm. Puncture or a biopsy will be done next week. I was told by mammologist that surgery is needed. As far as I know, concerning the surgery, axillary lymph nodes are to be removed together with the tumor. I also know that in Europe lymph nodes are testes for
specific markers and only affected ones should be removed; if lymph nodes are no affected, they are not to be dissected and the surgery is minimally invasive. So what is your approach? Does it make sense to do it or you have the same methods and the same equipment?
...more If histological examination of the sample reveals fibroadenoma of basic type or tissue hyperplasia without atypia, or nodular type fibrocystic condition of the breast tissue, the question of surgical treatment should not arise. If biopsy reveals giant fibroadenoma sectoral resection is indicated, i.e. mass excision
within the healthy tissues and lymph nodes will be removed. In case of non- benign histological result, i.e. carcinoma is detected, subsequent immunohistochemical examination is required as well as a clinical oncologist and surgeon consultation; and the decision on complex treatment will be taken by case management team. With regard to the diagnosis and treatment methods in our center, each case is addressed individually. Sometimes we remove a benign area (for example, the area of hyperplasia with atypia) using the vacuum-needle technique through 3-4 mm incision. As for the surgical procedure protocols for benign breast tumors, benign simple fibroadenoma is not removed in America, Europe, Israel, etc. I would like to discuss your case with you in more details and perform some additional tests if needed, so I would be glad to see you at EMC’s Breast center.
...more
Melanoma
My mom had a mole (suspected for melanoma) removed in November 2015. Histology revealed lentigo melanoma in situ. We checked the slides back in the Netherlands, and the diagnosis was a superficial spreading melanoma of Clark 3 Т1а Beslow 0,8 stage; re-excision with capture of 1 cm of healthy skin is recommended. Is
it possible to make re-excision and subsequent histology in your hospital? If so, how soon?
...more We absolutely agree with the opinion of the European colleagues: re-excision with a wider offset is required; according to the Russian Protocol it is necessary to move 2 cm from the peripheral edge. This is for counter insurance, as lentigo-melanoma is a favorable type, and previous surgery is likely to put an end to
this story and the forecast is favorable. All the necessary manipulations for the study are possible in our Clinic; we have our own well-equipped laboratory with the possibility to ask the advice concerning the sample in Germany and Israel.
You should make an appointment with the surgeon-oncologist (Marina Bissessar) in the nearest time to conduct the diagnostic re-excision. Hope to help!
...more
A spot on the back and chest
I have a spot on the back and chest, what could it be?
A spot on the skin is one of the most common symptoms of various skin diseases. Infectious (viral, bacterial or fungal) as well as noninfectious skin including serious diseases and nevi (moles or birthmarks) can manifest as spots on the skin. You should go to the dermatologist for accurate diagnosis. The doctor will
examine you and, if necessary, a special instrument (Dermatoscope, wood lamp) will be used. A skin scraping can also be done in the lesion for microscopy, cytology or culture. A treatment will be prescribed after diagnosis.
...more 
Batkaeva Nadezhda
07 September 2016
Uterine cancer
My mom was diagnosed with the uterine cancer. She is 68 years of age and has an obesity of 4th grade (the growth of 166 cm, weight 135 kg) and hypertension. Admission to the radiology department was recommended. What should we do? As far as I know the surgery is the only method for cancer of the uterus to be removed.
Is it really so that this surgery is only possible for young and relatively healthy persons?
...more It is not quite so. We can operate on any patient, but the issue is which complications can lead to patient’s death and which of them can just delay the recovery. From the anesthesiologist’s point of view, it is a major challenge to intubate patients with 4th degree obesity; the abdominal section is also possible,
but there is a 100% risk of suture line disruption and inflammation, let alone the postoperative pneumonia, venous thrombosis, etc. There is another option such as vaginal hysterectomy which is more acceptable and relatively safe in obese patients. It is not a «treatment standard», however, as it allows not obtaining pelvic washings, but still there is a possibility of complete cure. Anesthesia remains a problem - both general and spinal. Radiation therapy without surgery is another acceptable treatment option besides vaginal hysterectomy. A chance of complete cure is still exists, but the survival rate is on average lower than in surgical treatment
...more 
Vladimir Nosov
07 September 2016
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