Improvement instead of stability in embryo quality between day 3-5: A possible extra predictor for blastocyst selection (original) (raw)
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Evaluation of day one embryo quality and IVF outcome – a comparison of two scoring systems
Reproductive Biology and Endocrinology, 2009
The aim of our retrospective study was to compare the clinical usefulness of two non-invasive embryo scoring systems based either on a simplified pronuclear morphology of the zygote or on early cleavage rate, as well as their combination, for the selection of embryos with the best implantation potential in embryo transfer (ET).
Geburtshilfe Und Frauenheilkunde, 2020
Background The number and the quality of embryos transferred are important predictors of success in in vitro fertilization (IVF) cycles. In the presence of more than one good quality embryo on the transfer day, double-embryo transfer (DET) can be performed with these embryos, but generally, different quality embryos are present in the available transfer cohort. We aimed to investigate the effect of transferring a poor quality embryo along with a good quality embryo on IVF outcomes. Methods In this study, 2298 fresh IVF/intracytoplasmic sperm injection (ICSI) cycles with two good quality embryos (group A), one good and one poor quality embryo (group B), and single good quality embryo (group C) transfers were examined. All groups were divided into two subgroups according to the transfer day as cleavage or blastocyst stage. Clinical pregnancy and live birth rates were the primary outcomes. Results In the cleavage stage transfer subgroups, the clinical pregnancy rates were lower in the single-embryo transfer (SET) subgroup compared with DET subgroups, but the difference was not statistically significant compared with DET with mixed quality embryos. The live birth rates were comparable between the three groups. In the blastocyst transfer subgroups, the clinical pregnancy and live birth rates were significantly higher in DET with two good quality embryos than DET with mixed quality embryos and SET groups. Multiple pregnancy rates were higher in both DET groups in terms of transfer day (p = 0.001). Conclusion DET with mixed quality embryos results with lower clinical pregnancy and live birth rates compared with DET with two good quality embryos at the blastocyst stage. At cleavage stage transfer, there is no difference in live birth rates between the two groups. ZUSAMMENFASSUNG Hintergrund Anzahl und Qualität von transferierten Embryos sind wichtige Prädiktoren für den Erfolg bei In-vitro-Fertilisations-(IVF-)Zyklen. Wenn mehr als ein Embryo von guter Qualität am Transfertag vorhanden ist, kann ein Doppelembryonentransfer (DET) mit diesen Embyros vorgenommen werden. Generell sind aber die verfügbaren Embryos von sehr 844
Fertility and Sterility, 1995
Objective: To define statistical thresholds for the number and morphological score of embryos transferred that would be predictive of reproductive success in an IVF program. Design: A retrospective review of patient records. Setting: The Mount Sinai Medical Center Assisted Reproductive Technologies Program. Participants: One hundred women who underwent IVF-ET for a diagnosis oftubal occlusion and later delivered viable infants. Results: The mean number of embryos transferred before achieving live birth was 10.7 ± 7.9 (mean ± SD), with one half of patients achieving success within the first seven embryos transferred, and 95% achieving success within 25 embryos. For high quality embryos, the numbers were 7.5 ± 6.3,5, and 17, respectively, and, for the cumulative embryo score, a measure of both embryo morphology and metabolic activity, were 114.2 ± 86.0,83, and 280, respectively. Greater than 50% of live births occurred within the first two ET attempts. Conclusions: Although more than half of patients achieved reproductive success within the first two ETs and the first five high quality embryos transferred, after this threshold, fecundity declined rapidly. The calculation of cumulative embryo scores offered additional prognostic information. While all prior attempts to define IVF-ET failure have done so by including patients who did not become pregnant, we have found an analysis of our successes to be a useful adjunct in counseling patients.
Human Reproduction
In order to achieve a clinical pregnancy rate higher than that achieved following initial adoption of in-vitro fertilization embryo transfers, more than one embryo is transferred. This has led to a substantial increase in unwanted multiple pregnancy rates with IVF as compared with natural conception. What is therefore required is a simple, clinically useful embryo scoring system, to reflect embryo developmental potential, which will enable the selection of the optimal number of embryos to transfer in order to achieve the maximum pregnancy rate with a low incidence of high order multiple pregnancies. We beHeve that the Cumulative Embryo Score (CES) achieves these aims. On the day of embryo transfer the grade of each embryo transferred was multiplied by the number of blastomeres to produce a score for each embryo, and summation of the scores obtained for all the embryos transferred gave the CES. The grouped pregnancy rates obtained rose as the CES increased to maximum of 42. A continued increase in the CES above 42 did not result in any further rise in the pregnancy rate. However, an analysis of all our rVT pregnancies showed that the multiple pregnancy rate continued to rise above a CES of 42. By restricting the CES per embryo transfer to 42, 78% of triplet pregnancies and 100% of the quadruplet IVF pregnancies could have been predicted and potentially avoided.
International Journal of Scientific Research in Science and Technology, 2020
A grading system of human embryo is very important for embryo selection & predicting blastocyst formation from day - 1, day 2, & day – 3, were sequentially explained. We were designed a methods for grading of embryos from day – 1 (zygote as a pronuclear evaluation, PN), day – 2 (cleavage stage) and day - 3 (evaluation of developmental stage according to cell size and fragmentation) embryo according to cell size and degree of fragmentation and early compaction. In the first grading system pronuclear study and poly-spermy, Second grading system is based on the blastomere / cell number and the observation of fragmentation pattern and selection for embryo transfer, embryos vitrification and pregnancy outcome. Assessment of embryo quality in order to select the embryos that have higher chance to give pregnancy, it is critical goal in IVF cycle or assisted reproductive technologies. ET current trend in human infertility treatment with IVF / ICSI embryo transfer (IVF / ICSI ET) is to increase the chance of higher pregnancy and reduce the multiple pregnancies after multiple embryo transfer according to patient age and endometrium thickness as well as own ART Laboratory protocol. Morphological evaluation & grading of human embryo as a reliable and no-invasive method that provides valuable information & prediction of IVF/ICSI embryos which has developmental potential to reach till early compaction or blastocyst. This research paper describes the current status of morphological embryo evaluation from zygote to eight cell blastomeres or early compaction on late day 3. We found higher embryo development potential and early compaction during in-vitro embryo culture conditions and higher implantation rate in Grade A embryos in comparison transferred of Grade B embryos. Overall embryo development in-vitro and conceiving rate was seen 48.06 % after embryo transfer of both grades A and Grade B embryos in 233 patients in different age group with different endometrium thickness and multiple embryos transfer in one uterus depend on patient previous history. 935Embryos was selected from 2702 developing embryos for embryo transfer (ET) was performed in 233 patients. After this study we found implantation rate (IR) was 48.06% based on embryo quality, morphology and grade.
Facts, views & vision in ObGyn, 2010
Pilot study to analyse the efficacy and embryo morphology using a new human embryo culture medium (GM501) versus the conventional used medium (ISM1). Over a four-month period, all patients at the Leuven Institute of Fertility and Embryology (LIFE) were -randomly allocated to have their embryos cultured in either the standard sequential culture medium ISM1 (control) or in a new universal medium (GM501) (study group). Primary outcome parameters were clinical pregnancy and live birth rate. The secondary outcome parameter was the correlation of embryo fragmentation rate with pregnancy outcome. We did not observe any differences between the ISM1 control group and GM501 study group with regard to fertilization, pregnancy, implantation rates, ongoing pregnancy, and babies born. The number of embryos with a minimal fragmentation rate (less than 30%) was significantly higher in the GM501 study group. Although a significant higher embryo fragmentation rate was seen in In vitro culture of embr...
Human Reproduction, 2006
BACKGROUND: Evidence-based morphological embryo scoring models for ranking of implantation potential are still scarce, and the need for a precise model increases when aiming for singleton pregnancies. METHODS: Prospectively, 2266 IVF/ICSI double-embryo, day 2 transfers were studied. The five variables scored in 3-to 5-step scales for the embryos transferred are blastomere number (BL), fragmentation, blastomere size variation ('equality', EQ), symmetry of the cleavage and mononuclearity in the blastomeres (NU). The scoring results of embryos with an individual traceability from scoring to implantation, i.e. treatments resulting in either no implantation (n = 1385) or twin implantation (n = 228), were studied for prognostic potential. RESULTS: Although all five variables correlated highly with implantation potential, only BL, NU and EQ remained independently significant after regression analysis. The equation thus derived formed the basis for a 10-point integrated morphology cleavage (IMC) embryo score. A table with the scoring point for each possible combination of the embryo variables is presented. The scoring model was statistically validated on the singleton pregnancy group (n = 653). CONCLUSIONS: We suggest that this IMC embryo scoring, incorporating cleavage stage and information on the variation in blastomere size and the number of mononucleated blastomeres, may optimize embryo ranking and selection for day 2 transfers.
Predictive value of embryo grading for embryos with known outcomes
Fertility and Sterility, 2010
Objective: To compare pronuclear morphology (Z-score), day 3 embryo grade, and day 3 cell number in the prediction of successful implantation rates (IRs), including cycles in which all or none of the embryos implanted. Design: Retrospective analysis. Setting: University-based IVF center. Patient(s): Four hundred twenty-six fresh IVF day 3 transfers of 852 embryos in women <36 years of age from January 2000 to December 2003 in whom all or none of the embryos implanted. Main Outcome Measure(s): Evaluation of Z-scores, embryo morphology, cell number, and IR. Result(s): Day 3 parameters were more predictive than Z-scores. When early parameters were poor (Z-score) but late parameters were both good, the IR was 38%, compared with 4% when the Z-score was good but the late parameters were poor. Conclusion(s): Embryo grading systems are useful in the prediction of embryo implantation. In particular, cell number and embryo grade are more predictive than Z-scores. Therefore, late parameters have a better prognostic value than Z-scores when selecting embryos for transfer. (Fertil Steril Ò 2010;93:658-62. Ó2010 by American Society for Reproductive Medicine.)
Human Reproduction, 2003
BACKGROUND: It is of fundamental importance for IVF clinics to determine the most viable embryos for transfer. The challenge for ART clinics is to transfer fewer embryos, thereby minimizing the risk of multiple-infant births, while still maintaining the greatest chance of pregnancy for their patients. In this study, an investigation was made to determine if developmental markers on the day of fertilization (day 1) can predict good subsequent blastocyst development. METHODS AND RESULTS: A total of 1550 individually cultured 2PN embryos from 191 patients undergoing IVF/ICSI treatment at the Yale University Center for Reproductive Medicine and Infertility from February to December 2001 was included. The results showed a signi®cant positive relationship between earlycleaving 2-cell embryos and subsequent good quality b4-cell, b7-cell and blastocyst development (P < 0.05). PN symmetry (the relative size of the PN to each other), when checked at the time fertilization, is also a signi®cant indictor of good quality b4-cell, b7-cell stage embryos and blastocysts. Combined, a developing embryo showing PN symmetry with early cleavage and subsequent good b4-cell and b7-cell cleavage, has a one in two chance of developing into a good-quality blastocyst. CONCLUSION: Early embryo assessment can be used as an indicator of subsequent good blastocyst development.