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A New Day 4 Grading System to Assess Embryo Quality in Frozen Embryo Transfer Cycles

  • Reproductive Biology: Original Article
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Abstract

To present a new day 4 (D4) embryo grading system to assess embryos in frozen–thawed embryo transfer (FET) cycles. A new grading system (grades A–E) was developed from the 2011 ESHRE Istanbul Consensus for D4 embryos in FET cycles. Embryos with complete compaction were classified as grade A; those with partial compaction were assigned as grade B; and those without compaction were classified as grades C, D, and E according to their different blastomere number ratio (BNR; number of embryo blastomeres on D4/number of embryo blastomeres on D3, D4/D3). Embryos with a BNR of ≥ 1.5 were defined as grade C, those with a BNR of ≥ 1.2 and < 1.5 were defined as grade D, and those with a BNR of ≥ 1.0 and < 1.2 were defined as grade E. Using this proposed grading model, 5460 embryos with known implantation data were retrospectively analyzed after D4 transfer in FET cycles. The transferred embryos exhibited a similar declining trend in implantation and live birth rates from the top grade A to the lowest grade E. The in vitro fertilization group showed increased implantation rates of grade B and E embryos compared with the intracytoplasmic sperm injection group (grade B: 41.99%, 34.63%, χ2 = 5.84, p < 0.05 and grade E: 18.98%, 14.08, χ2 = 75.62, p < 0.01). Receiver-operating characteristic analysis revealed that our proposed model predicted the implantation outcomes and live birth rates of all embryos (area under the curve = 0.65; 95% confidence interval [CI],0.63–0.66; p < 0.01 and AUC = 0.73; 95%CI, 0.65–0.84; p < 0.001, respectively). This study demonstrates that the new grading system provided by us can be a useful tool for assisting embryo selection via changes in embryo morphology. D4 embryo transfer provides a simple and applicable method for FET cycles in daily practice.

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Acknowledgments

The authors would like to thank Shilong Xue, Xuehong Zhang, Xiaoling Ma, and Yiqing Wang at the reproductive medicine center of the first Hospital of Lanzhou University for their ongoing support and technical assistance. And the authors thank Caixia Ma for English language editing.

Funding

This study was supported by the Scientific Research Fund of the First Hospital of Lanzhou University (No. ldyyyn2018-11), the Major Scientific and Technological Project in Gansu Province (No. 092NKDA009), Lanzhou Chengguan District Science and Technology Project (No. 2019SHFZ0026) and the Lanzhou Talent Innovation and Entrepreneurship Project (No. 2016-RC-51).

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Authors and Affiliations

  1. Reproductive Medical Center, The First Hospital of Lanzhou University, Lanzhou, 730000, China

    Hong-Xing Li, Xiao-Juan Xu & Lin Liu

  2. Key Laboratory for Reproductive Medicine and Embryo of Gansu, Lanzhou, 730000, China

    Hong-Xing Li, Xiao-Juan Xu & Lin Liu

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  1. Hong-Xing Li
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  2. Xiao-Juan Xu
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  3. Lin Liu
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Correspondence to Hong-Xing Li.

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The authors declare that there are no conflicts of interest.

Ethics Approval and Consent to Participate

This study was approved by the Ethics Committee of the First Hospital of Lanzhou University (LDYYLL2019-42).

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Li, HX., Xu, XJ. & Liu, L. A New Day 4 Grading System to Assess Embryo Quality in Frozen Embryo Transfer Cycles. Reprod. Sci. 28, 1333–1338 (2021). https://doi.org/10.1007/s43032-020-00389-y

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  • DOI: https://doi.org/10.1007/s43032-020-00389-y

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