Day 3 and day 5 morphological predictors of embryo viability

doi:10.1016/S1472-6483(10)61852-4

Reproductive BioMedicine Online

Volume 6, Issue 3, 2003, Pages 323-331

https://doi.org/10.1016/S1472-6483(10)61852-4 Get rights and content

Abstract

Controlling multiple pregnancies in patients undergoing artificial reproductive procedures requires consideration of single embryo transfers. Therefore, refinements for embryo evaluation are needed that select for the most developmentally competent embryo. The present study was designed to identify day 3 and day 5 morphological predictors of viability following transfers in which the morphology and fate of each embryo was precisely determined. Assessments on day 3 included cell number, and the extent of fragmentation and asymmetry, and on day 5, the developmental stage. Embryos resulting in a viable fetus at 11 weeks gestation were considered developmentally competent. The relationships among individual and collective embryo morphological characteristics were evaluated. Analysis of the interactions among morphological characteristics of embryos transferred on day 3 enabled identification of a multivariable selection order. Assessment of day 5 embryos revealed that expanding and expanded blastocysts exhibited comparable developmental potential that was superior to that of either morulae or early blastocysts. However, expanding or expanded blastocysts derived from 7-cell or 8-cell embryos were developmentally superior to those derived from other cleavage stages, regardless of fragmentation or asymmetry. Collectively, these findings further understanding of morphological predictors of viability, thereby improving the ability to select the most viable embryo for transfer.

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Cited by (153)

Effect of embryo stage at transfer on placental histopathology features in singleton live births resulting from fresh embryo transfers
2021, Fertility and Sterility
To evaluate the effect of embryo stage at transfer on placental histopathology and perinatal outcome in singleton live births resulting from fresh embryo transfers (ETs).
Retrospective cohort study.
Not applicable.
The study population included all live births after fresh ETs during the period from 2009 to 2017.
None.
Primary outcomes included anatomic, inflammatory, vascular malperfusion, and villous maturation placental features. Secondary outcomes included fetal, maternal, and perinatal complications.
A total of 677 live births were included in the final analysis and were allocated to the cleavage-stage (n = 252) and blastocyst (n = 425) ET groups. After the adjustment for confounding factors, the blastocyst group was found to be associated with a higher incidence of circummarginate membranes insertion (odds ratio [OR] 1.9, 95% confidence interval [CI] 1.2–3.4), delayed villous maturation (OR 8.5, 95% CI 1.2–69.3), chorangiosis (OR 2.0, 95% CI 1.2–3.8), parenchymal calcifications (OR 10.6, 95% CI 1.4–80.2), and intrapartum nonreassuring fetal heart rate tracing (OR 2.4, 95% CI 1.3–4.5). Compared with cleavage-stage ETs, live births resulting from the blastocysts were associated with a lower incidence of velamentous cord insertion (OR 0.5, 95% CI 0.3–0.9), retroplacental hematoma (OR 0.3, 95% CI 0.1–0.8), subchorionic thrombi (OR 0.3, 95% CI 0.1–0.8), and avascular villi (OR 0.2, 95% CI 0.03–0.7).
Live births resulting from fresh cleavage-stage and blastocyst ETs have different placental histopathology features, with a higher rate of intrapartum nonreassuring fetal heart rate tracing in the blastocyst group.
Efecto de la etapa del estadio en la transferencia embrionaria sobre las características histopatológicas de la placenta en nacidos vivos únicos resultantes de transferencias de embriones frescos.
Evaluar el efecto del estadio de transferencia embrionaria en la histopatología placentaria y el resultado perinatal en partos de un solo bebé resultantes de transferencias de embriones frescos (ET).
Estudio de cohorte retrospectivo.
No aplicable.
La población de estudio incluyó a todos los nacidos vivos después de TE en fresco durante el período de 2009 a 2017.
Ninguna.
las medidas primarias de resultado incluyeron características anatómicas, inflamatorias, de mala perfusión vascular y de maduración de las vellosidades de la placenta. Los resultados secundarios incluyeron complicaciones fetales, maternas y perinatales.
Un total de 677 partos vivos se incluyeron en el análisis final y se asignaron a los grupos ET de etapa de clivaje (n = 252) y blastocisto (n = 425). Después del ajuste por factores de confusión, se encontró que el grupo de blastocisto se asoció con una mayor incidencia de inserción de membranas circunmarginadas (razón de probabilidades [OR] 1,9; intervalo de confianza [IC] del 95%: 1,2-3,4), maduración vellositaria retrasada (OR 8,5, IC del 95%: 1,2 a 69,3), corangiosis (OR 2,0; IC del 95%: 1,2 a 3,8), calcificaciones parenquimatosas (OR 10,6; IC del 95%: 1,4 a 80,2) y trazado de la frecuencia cardíaca fetal no tranquilizadora durante el parto (OR 2,4; IC del 95%: 1,3 –4,5). En comparación con los TE en etapa de clivaje, los nacidos vivos resultantes de los blastocistos se asociaron con una menor incidencia de inserción del cordón umbilical (OR 0,5; IC del 95%: 0,3 a 0,9), hematoma retroplacentario (OR 0,3; IC del 95%: 0,1 a 0,8), trombos subcoriónicos (OR 0,3; IC del 95%: 0,1 a 0,8) y vellosidades avasculares (OR 0,2; IC del 95%: 0,03 a 0,7).
Los nacidos vivos que resultan de ET frescas en etapa de clivaje y de blastocisto tienen diferentes características de histopatología placentaria, con una tasa más alta de seguimiento de la frecuencia cardíaca fetal intraparto no tranquiizadora en el grupo de blastocisto.
Improvement instead of stability in embryo quality between day 3-5: A possible extra predictor for blastocyst selection
2020, European Journal of Obstetrics and Gynecology and Reproductive Biology
The aim of this study was to evaluate the predictive value of the dynamic morphological development process between cleavage-stage and blastocyst-stage embryos.
A retrospective study was executed between 2015 and 2017 at Ghent University Hospital. A total of 996 first fresh IVF/ICSI cycles resulting in a single embryo transfer on day 5 were included. Embryos were scored on day 3 and day 5 as excellent, good, moderate or poor based on Alpha/ESHRE guidelines and Gardner and Schoolcraft scoring-system. If embryos changed category between day 3 and 5, the number of steps (between excellent; good; moderate; poor) in positive and negative direction was expressed.
On day 5, the ongoing pregnancy rate (OPR) of excellent embryos was 37.4 %. Univariate analyses showed that on day 5, both a higher cell stage, better inner cell mass and better trophectoderm were significantly associated with an ongoing pregnancy. In case of deterioration in quality of individual embryos between day 3 and day 5, the OPR was significantly lower. Conversely, improvement of embryo quality between day 3 and day 5 showed higher ongoing pregnancy rates (overall OPR of good day-3 embryos improving to excellent day-5 embryos: 30 %; moderate day 3 to excellent day 5: 50 %; poor day 3 to excellent day 5: 42 %; poor day 3 to good day 5: 20 %; poor day 3 to moderate day 5: 16 %). When embryos improved from poor on day 3 to excellent day 5 the OPR was significantly higher in comparison with embryos that did not change in quality scoring during development (steady embryos) (OR: 1.785, p < 0.05).
Our results suggest that it is more likely to achieve an ongoing pregnancy when transferring an embryo that has improved in quality between days 3 and 5 as opposed to one that has remained stable.
The BlastGen study: a randomized controlled trial of blastocyst media supplemented with granulocyte–macrophage colony-stimulating factor
2020, Reproductive BioMedicine Online
Does Embryogen®/BlastGen™ culture medium improve live birth rates compared with standard culture medium for women undergoing IVF and intracytoplasmic sperm injection (ICSI) with poor prognosis.
Randomized clinical trial. A total of 100 couples undergoing IVF/ICSI were randomly allocated to having their inseminated oocytes incubated in either Embryogen®/BlastGen™ sequential culture media or standard Cleavage/Blastocyst sequential culture media for 5 days (ClinicalTrials.gov Identifier: NCT02305420).
No statistically significant difference in live birth rate was found between the control group and the Embryogen®/BlastGen™ group (17 [34%] versus 11 [22%], respectively) (OR 0.55; 95% CI 0.22 to 1.32; P = 0.18). After adjustment for maternal age, body mass index and fertilization procedure, the blastulation rate reduced (40.6 ± 26.5 versus 24.6 ± 26.7; RR 0.70, CI 0.52 to 0.95; P < 0.05), and grade of the embryo transferred (OR 0.35, CI 0.16 to 0.77; P < 0.01) when Embryogen®/BlastGen™ medium was used.
A significant reduction in day-5 embryo outcome parameters was found using Embryogen®/BlastGen™ compared with standard medium, and insufficient evidence of a difference in pregnancy outcomes. Taking into consideration the small samples size, study limitations and strict inclusion criteria of this single-centre study, further research is needed to determine the efficacy of Embryogen®/BlastGen™ medium in couples undergoing IVF/ICSI.
Beyond appearance: Can morphologically low-grade euploid blastocysts yield successful pregnancies?
2024, Reproductive Medicine and Biology
Does cleavage stage morphology increase the discriminatory power of prediction in blastocyst transfer outcome?
2024, Journal of Assisted Reproduction and Genetics
Neurotrophin-4 promotes in vitro development and maturation of human secondary follicles yielding metaphase II oocytes and successful blastocyst formation
2024, Human Reproduction Open

View all citing articles on Scopus

Catherine Racowsky, PhD, HCLD is an associate professor of Obstetrics and Gynecology at Harvard Medical School and Director of the ART Laboratory at Brigham and Women's Hospital (BWH) in Boston, Massachusetts. Prior to assuming her current position at BWH, Dr Racowsky was the Director of the ART Laboratory at University Medical Centre in Tucson, Arizona. She graduated with a BA in Zoology at the University of Oxford, and received her doctorate in Reproductive Physiology from the University of Cambridge in England. Dr Racowsky has served on several major medical committees and professional societies. She has done community service work in the field and has received many awards and honours, her most recent being a Partners Healthcare 2000 Excellence Award for leadership and innovation. In the past 25 years, Dr Racowsky has authored numerous peer-reviewed papers, news releases and chapters in books, and has also been an invited speaker at many regional, national and international programmes on various topics related to the IVF laboratory. Her research interests include oocyte maturation in vitro, oocyte freezing and clinical embryology. Dr Racowsky has been actively involved in teaching and has served on a number of editorial boards including Biology of Reproduction and Reproductive Toxicology.

: Paper based on contribution presented at the Serono Symposium ‘Toward Optimizing ART: a Tribute to Howard and Georgeanna Jones’ in Williamsburg, VA, USA, April 2002.

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ArticleDay 3 and day 5 morphological predictors of embryo viability

Abstract

Section snippets

Fertility and Sterility

Fertility and Sterility

Reproductive BioMedicine Online

Fertility and Sterility

Fertility and Sterility

Reproductive BioMedicine Online

Fertility and Sterility

Fertility and Sterility

Fertility and Sterility

Fertility and Sterility

Fertility and Sterility

Fertility and Sterility

Fertility and Sterility

Fertility and Sterility

Fertility and Sterility

Fertility and Sterility

Cleavage anomalies in early human embryos and survival after prolonged culture in-vitro

Human Reproduction

The relationship between chromosomal abnormality in the human preimplantation embryo and development in vitro

Reproduction Fertility and Development

Temporal and spatial aspects of fragmentation in early human embryos: possible effects on developmental competence and association with the differential elimination of regulatory proteins from polarized domains

Human Reproduction

A formula for scoring human embryo growth rates in in vitro fertilization: its value in predicting pregnancy and in comparison with visual estimates of embryo quality

Journal of In Vitro Fertilization and Embryo Transfer

High outcome predictability after IVF using a combined score for zygote and embryo morphology and growth rate

Human Reproduction

Article
Day 3 and day 5 morphological predictors of embryo viability