Embryo culture goes back to the future
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COMMENTARY
Embryo culture goes back to the future David F. Albertini 1 Published online: 12 August 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
“There is no such thing as unprejudiced observation. Every act of observation we make is biased. What we see, or otherwise sense, is a function of what we have seen or sensed in the past.” Sir Peter Medawar Of the many insights Medawar provided to an embryonic cast of scientists and curiosity seekers in the 1960s was one prescient commentary made in an essay entitled “Is the scientific paper a fraud?” (From The Strange Case of the Spotted Mice and other classic essays on science, Oxford University Press, 1996, ISBN 0–19-286,193). The aforementioned quote from that essay introduced Medawar’s overarching treatment of what was at that time the status quo for publishing novel findings that could or should influence advances in medicine. His skepticism was directed at a process we continue to engage in some 60 years later- a matter that has as much to do with reproductive medicine today as it did back then. For those of you unfamiliar with Sir Peter, bear in mind he was a Nobel laureate in 1960 for his ground breaking research in immunology and fittingly recognized as the prime mover of the concept of immunological recognition of pregnancy and the importance of host tolerance of the fetal allograft. This month we build on the subject of embryo culture from present to past and in the process take a decidedly skeptical (Medawarian) point of view given the congruence of practices today and evolving concerns over how human ARTs impacts the epigenetic health and lifestyle of offspring. In some ways the story of human embryo culture from 1978 to today resembles more a matter a denouncement of the “Mother Nature” approach of yesteryear to an accommodation of workflow and commercial forces taking an ever greater hold on clinical ARTs in the moment. Sunde and
* David F. Albertini [email protected] 1
Bedford Research Foundation, Bedford, MA, USA
colleagues took aim at the misguided efforts having to do with not simply the matter of media formulations, but single vs sequential, the high/low oxygen tension, Day 3 or day 5 and supplements or not (note how binary our options have been) among other manipulations, fostering a sense of confusion for the average practitioner looking out, supposedly, for the benefit of the patient [1]. Contemporaneously, we can add to the litany: to biopsy or not, to PGT-A or not, to deploy timelapse (morphokinetics) or not, to analyze medium for cell free DNA (or proteins, or metabolites), or not-all things embryo culture designed by and for our specialty with the expressed purpose of choosing the embryo most likely to yield a healthy child following transfer. Recall if you will that among the founding fathers and mothers of embryo culture for the mouse, recognizing and attempting to recapitulate the natural environment within which development occurs was a laudable and rewarding strategy, setting the stage for implementing a “chem
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