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Fertile Research

Medical resident Jennifer Ambroggio looks for new methods for identifying the best embryos to ensure successful implantation

A decade ago, Jennifer Ambroggio, M.D., was a seasoned embryologist living in California with her husband and young child. But something wasn’t quite right. “I felt isolated in the lab,” she remembers. “It was my relationship with the patients who benefited from my work that was the most fulfilling.” So Ambroggio and her family packed their bags and moved east, so she could attend medical school.

Now, Ambroggio, a resident at GW’s School of Medicine and Health Sciences (SMHS), is glad she made the move — and GW is glad too, presenting her with the 2011 Clinical Research Award during this year’s Research Day for a study that could influence future assisted reproductive technology (ART) procedures.

Patients undergoing ART procedures, such as in vitro fertilization (IVF) or fertility drug treatment, are more likely to have multiple-birth pregnancies than women who conceive naturally. Although just 1 percent of the infants born in the United States were conceived through some form of ART in 2006, according to CDC reports, they account for almost 20 percent of multiple births nationwide. For many women, multiple-birth pregnancies are not just undesirable — they are dangerous, posing a higher risk of complications, including preterm births and low birth weight.

Ambroggio’s study, called “Multi­nucleation of a Sibling Blastomere on Day 2 Suggests Unsuitability for Embryo Transfer in In Vitro Fertilization — Preimplantation Genetic Screening Cycles,” explores new methods of predicting which embryos are healthiest and best suited for implantation, a technique that could lead to both an increased likelihood of a successful pregnancy following IVF and a reduction in the number of multiple-birth pregnancies. The study was published in the American Society for Reproductive Medicine journal Fertility and Sterility (v. 94, n. 4, p. S127).

Ambroggio and researchers at the GW IVF Center analyzed cells from 1,189 three-day-old embryos to test for aneuploidy — genetic damage resulting in any number of chromosomes other than the normal 23. Their data showed that embryos containing multinucleated blastomeres, even when found to be normal following preimplantation genetic diagnosis, did not result in any successful pregnancies.

Blastomeres are the cells that make up an embryo during its first few days of development. During normal meiosis, each cell nucleus must replicate itself. When the cell divides, sometimes the nucleus will double itself but the cytoplasm won’t divide, resulting in a multi-nucleated blastomere. “Not every embryo, even one created in vivo, is genetically normal,” says Ambroggio. Those with inherent genetic abnormalities are more prone to multinucleation, she explains.

Ambroggio concluded that given the choice, physicians should pick an embryo without multi-nucleated blastomeres. “Or, if you have a lot of embryos to choose from and you are undergoing preimplantation genetic testing,” she adds, “you can forgo biopsying those embryos with multi-nucleated blastomeres, because you can be pretty certain that they’re not going to lead to a pregnancy. This would save money for patients, and help them achieve better outcomes.”