Fragmentation of embryos is associated with both necrosis and apoptosis

Objective To explore the association between embryo fragmentation and necrosis and apoptosis. Design A prospective study. Setting Mizmedi Hospital. Patient(s) None. Intervention(s) None. Main Outcome Measure(s) Staining with annexin V (a marker of apoptosis) and propidium iodide (PI, a marker of necrosis), DNA integrity and mitochondrial distribution, and a beneficial effect of fragment removal in human fragmented embryos. Result(s) Most of the mouse and human fragmented embryos were stained with PI but not with annexin V. The comet assay revealed severe DNA fragmentation of the fragmented human embryos but not of the unfragmented embryos. Fewer mitochondria were observed in the fragmented compared with the normal blastomeres, indicating a rapid depletion of ATP in the fragmented embryos. Microsurgical fragment removal from the embryos had a beneficial effect on their subsequent development. Conclusion(s) Fragments of human embryos exhibited various characteristics of necrosis, such as staining with PI, DNA fragmentation, rapid depletion of ATP, and harmful effects on neighboring blastomeres. We suggest that the fragmentation of embryos is closely associated with both necrosis and apoptosis. Whether this fragmentation is associated with primary or secondary necrosis remains to be elucidated.