Assisted Reproduction Safety and Risks

The cumulative effect of assisted reproduction procedures on placental development and epigenetic perturbations in a mouse model

de Waal E, Vrooman LA, Fischer E, Ord T, Mainigi MA, Coutifaris C, Schultz RM, Bartolomei MS

Published December 15, 2015 Human molecular genetics
DOI 10.1093/hmg/ddv400 PMID 26401051 PMC PMC4654053

RRM Academy Synopsis

Embryo transfer alone enlarges the placenta in mice

In mice, embryo transfer alone made placentas 50% heavier than natural conception did. The study also compared superovulation plus transfer and full IVF. Full IVF also lowered DNA methylation at select imprinted genes in mouse placentas.

Key Findings

  • In one mouse cross, researchers collected 18 naturally conceived and 20 IVF concepti. In that cross, IVF fetuses were significantly smaller and IVF placentae significantly larger, with a lower fetal-to-placental weight ratio.
  • In the second cross, fetal weight did not differ among groups. In that cross, embryo transfer, superovulation plus transfer, and IVF placentae were all significantly larger than natural controls.
  • The authors report that embryo transfer alone increased placental weight by 50% compared with placentae after natural conception.
  • In the second cross, methylation at the H19/Igf2 and Peg3 imprinting control regions was normal in transfer and superovulation-plus-transfer placentae. IVF placentae showed changed methylation at several imprinted regions.
  • Three IVF fetuses in one cross had very low methylation at the H19/Igf2 imprinting control region in both brain and liver.

Interpretation

The work is an animal experiment in two mouse crosses (genetic backgrounds), with 15 to 20 fetuses and placentas per group, examined at the end of gestation. The design separates three steps of an IVF protocol. The authors note that human data are hard to interpret because patients also carry an underlying infertility diagnosis. In these mice, transfer steps enlarged the placenta and IVF placentae showed altered methylation. The study reports no health outcomes in offspring, and the authors state that the effect of the placental changes on function remains to be worked out. Results in mice do not establish the size of any effect in people.

RRM Context

Human studies link IVF pregnancies to low birth weight and abnormal placentation. This experiment points to procedure-related changes in the placenta itself. The authors call for further study of long-term health in ART-conceived offspring. Restorative reproductive medicine works to find and treat why conception fails.

Abstract

Assisted reproductive technologies (ART) are associated with several complications including low birth weight, abnormal placentation and increased risk for rare imprinting disorders. Indeed, experimental studies demonstrate ART procedures independent of existing infertility induce epigenetic perturbations in the embryo and extraembryonic tissues. To test the hypothesis that these epigenetic perturbations persist and result in adverse outcomes at term, we assessed placental morphology and methylation profiles in E18.5 mouse concepti generated by in vitro fertilization (IVF) in two different genetic backgrounds. We also examined embryo transfer (ET) and superovulation procedures to ascertain if they contribute to developmental and epigenetic effects. Increased placental weight and reduced fetal-to-placental weight ratio were observed in all ART groups when compared with naturally conceived controls, demonstrating that non-surgical embryo transfer alone can impact placental development. Furthermore, superovulation further induced overgrowth of the placental junctional zone. Embryo transfer and superovulation defects were limited to these morphological changes, as we did not observe any differences in epigenetic profiles. IVF placentae, however, displayed hypomethylation of imprinting control regions of select imprinted genes and a global reduction in DNA methylation levels. Although we did not detect significant differences in DNA methylation in fetal brain or liver samples, rare IVF concepti displayed very low methylation and abnormal gene expression from the normally repressed allele. Our findings suggest that individual ART procedures cumulatively increase placental morphological abnormalities and epigenetic perturbations, potentially causing adverse neonatal and long-term health outcomes in offspring.

Topics

By this author

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Assisted Reproduction › Safety and Risks › Procedure-Attributable Risk
Eric de Waal, Lisa A Vrooman, Erin Fischer, Teri Ord, Monica A Mainigi, Christos Coutifaris, Richard M Schultz, Marisa S Bartolomei
E Waal, L Vrooman, E Fischer, T Ord, M Mainigi, C Coutifaris, Rick Schultz, Dick Schultz, Rich Schultz, R Schultz, M Bartolomei
PMID 26401051 26401051 DOI 10.1093/hmg/ddv400 10.1093/hmg/ddv400 de Waal et al. 2015, de Waal 2015