부산대학교 도서관

Microbial contamination of embryo culture systems is occasional yet problematic in terms of potential impact on embryo development and the dilemma of how to manage such cases. Contamination may result in arrested development or attrition of embryos therefore cancellation of treatment. In some cases, however, depending on the identity of the invading microorganism, embryo development can continue with apparently morphologically normal progression. In this case presence of contamination did not appear to compromise embryo development and, following appropriate clinical guidance, the patient successfully delivered a healthy child following a frozen embryo transfer cycle. Limited evidence exists in the literature for such cases; this case study offers an example of a successful outcome to aid with informing and managing patients facing this scenario. Contamination of embryo culture was observed from approximately 27hpi. Aliquots of contaminated culture medium were sent for testing. The prepared semen sample used for treatment was also tested. Embryo culture continued following regular washing in fresh equilibrated medium from days 3-6. 9 embryos were cryopreserved on days 4 and 5 of culture. Clinical management of the patient involved counselling to discuss risks and establishment of a medical plan to ascertain if a frozen embryo transfer could proceed involving administration of antibiotics. The results of the microbial testing identified enterococcus faecalis as the sole present bacterium (>99% identity). The testing determined the semen sample used for treatment to be the source of the contaminant. A frozen embryo transfer treatment cycle resulted in the live birth of a healthy female child with normal birth weight and no complications during pregnancy or birth. In this case presence of enterococcus faecalis in the embryo culture system did not hinder embryo development, implantation potential nor foetal development. Fortunately, bacterial contamination in established embryo culture systems is rare. With the lack of evidence in the literature this case presents an example where, following discussion regarding the ethics and clinical management of the patient, the decision to transfer an embryo exposed to the bacterium resulted in a successful outcome. This evidence may assist clinics faced with a similar scenario, while ensuring patients are counselled appropriately. [ABSTRACT FROM AUTHOR]