Blastocyst culture and transfer.

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Abstract
Human blastocyst culture without co-culture and subsequent embryo transfer is a tool now available to in-vitro fertilization (IVF) centres around the world. With the advent of new commercially available sequential culture media systems (P1 and blastocyst and S1 and S2), viable blastocysts may now be attained at a relatively high rate (on average ⩾50%) yielding high implantation rates (50%) when transferred into the uterus on day 5 or 6 of culture (Gardner et al., 1998; Behr et al., 1999). One issue that must be recognized is that we cannot compare old technology with new. There was a significant development in IVF media technology in the mid-1990s (Gardner et al., 1994; T.B.Pool, personal communication) and Gardner and Lane (1997) recently demonstrated in a mouse model that the previous assumption of simply forming a blastocyst does not equal viable blastocyst and proposed this for the human system. These developments were the first culture systems designed specifically for human embryo extended culture using the specific energy sources and amino acids with the specific intent of developing viable embryos since the introduction of human tubal fluid (HTF) in the 1980s (Quinn et al., 1985). Blastocyst development potential in vitro without co-culture is different now since these developments. The sequential media approach has not necessarily resulted in higher numbers of blastocysts but more importantly, blastocysts that are more viable as evidenced by the high implantation rates achieved (Behr et al., 1998).

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