Introduction
Materials and methods
Information sources
Definition of outcome measures
Statistical analysis
Results
Zygote morphology scoring systems used
Authors | Design | Age (yrs) | Zygotes (n.) | ART procedure | TOPI | Zygote score | Outcome measures | ||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
EQ | CS | BS | IR | PR | D/LBR | ECS | |||||||
Scott et al. 2000 [10] | P | <43 | 3,701 | IVF/ICSI | NA | Modified from Scott and Smith, 1998 | Yes | NA | Yes | Yes | Yes | NA | NA |
Wittemer et al. 2000 [11] | P | NA | 1,000 | IVF/ICSI | 18h | Modified from Tesarik and Greco, 1999 | Yes | NA | NA | NA | Yes | NA | NA |
Tesarik et al. 2000 [12] | R | NA | 350 | ICSI | 14–17h | Tesarik and Greco, 1999 | Not | Not | NA | Yes | Yes | NA | NA |
Ludwig et al. 2000 [13] | P | NA | 405 | IVF/ICSI | 16–18h | Scott and Smith, 1998 | Yes | NA | NA | NA | Yes | NA | NA |
Balaban et al. 2001 [14] | R | NA | 86 | ICSI | 14–17h | Tesarik and Greco, 1999 | Yes | Yes | Yes | Yes | Yes | NA | NA |
Salumets et al. 2001 [15] | P | NA | 2,284 | IVF/ICSI | 16–18h | Scott and Smith, 1998/Tesarik and Greco, 1999 | Not | Yes*
| NA | Not | Not | NA | NA |
Montag et al. 2001 [16] | P | NA | 1,114 | IVF/ICSI | 16–20h | Modified from Tesaik and Greco, 1999 | NA | NA | NA | Yes | Yes | NA | NA |
De Placido et al. 2002 [17] | R | NA | 1,171 | ICSI | 16–20h | Combination of Sadowy, 1998, Scott and Smith, 1998, Tesarik and Greco, 1999, Scott, 2000, and Wittemer, 2000 | Not | Not | NA | Not | Not | NA | NA |
Zollner et al. 2002 [18] | P | 33.4±4.1 | 1,119 | IVF/ICSI | 16–18h | Number, juxtaposition and size of PN, number and alignment of NPBs | NA | Yes | Yes°° | NA | NA | NA | NA |
Gianaroli et al. 2003 [19] | P | ≥36 | 631 | IVF/ICSI | 16h | Gianaroli, 2003 | Yes | Yes | NA | Yes | Yes | NA | Yes |
Chen et al. 2003 [20] | P | 368 | IVF | 18–21h | Modified from Scott, 2000 | Not | NA | NA | NA | NA | NA | Yes | |
Nagy et al. 2003 [21] | P/R | 25–40 | 912 | ICSI | 12–21h§
| Size of PN, number and polarization of NPBs | Yes° (only in day 3) | Yes° (only in day 2) | NA | Yes#
| Yes#
| NA | NA |
Scott et al. 2003 [22] | R | <43 | 3,882 | IVF/ICSI | 16–18h | Scott, 2000 | NA | Yes | Yes | NA | NA | NA | NA |
Lan et al. 2003 [23] | R | NA | 1,894 | IVF/ICSI | 16–18h | Scott, 2000 | Yes | Yes | Yes | Yes | Yes | NA | NA |
Gámiz et al. 2003 [24] | P | NA | 888 | ICSI | 16–18h | Size of PN, number, distribuiton and synchrony of NPBs | NA | Yes***
| NA | NA | NA | NA | Yes***
|
Jaroudi et al. 2004 [25] | P | NA | 131 | IVF/ICSI | 15–18h | Tesarik, 2000 | Not | NA | NA | NA | Not | NA | NA |
Kattera et al. 2004 [26] | P | 35.4±3.6 (IVF) 35.1±3.4 (ICSI) | 2,714 | IVF/ICSI | 18–20h | PN orientation | Yes | Yes | NA | Not | Not | NA | NA |
Balaban 2004 [27] | R | NA | 309 | IVF/ICSI | 17h | Modified from Tesarik and Greco, 1999 | Yes | Yes | Yes | NA | NA | NA | Yes |
Payne et al. 2005 [28] | P | ≤42 | 552 | IVF/ICSI | 16–18h | Scott, 2000 | Not | Not | NA | Not | Not | NA | NA |
Edirisinghe et al. 2005 [29] | P | ≥37 | 952 | IVF/ICSI | 16–18h | Scott, 2000 | Yes | Yes | NA | NA | NA | NA | Yes |
James et al. 2006 [30] | R | NA | 3,333 | IVF/ICSI | 16–18h | Combination of Sadowy, 1998 and Scott, 2000 | Not | NA | NA | Not | Not | Not | NA |
Sjöblom et al. 2006 [31] | R | NA | 1,961 | IVF/ICSI | 16–18h | PBs, NPBs and PN | NA | NA | Yes | NA | NA | NA | NA |
Chen et al. 2006 [32] | P | 35.7±3.7 (IVF) 35.5±3.4 (ICSI) | 1,186 | IVF/ICSI | 18–20h | PN, PBs and NPBs | NA | Yes | NA | Not | Not | NA | NA |
Gianaroli et al. 2007 [33] | R | 38.2±3.7 (IVF) 39.0±3.5 (ICSI) | 2,535 | ICSI | 16h | Gianaroli, 2003 | Yes | NA | NA | Yes | NA | NA | Yes |
Arroyo et al. 2007 [34] | P | 33.1±2.93 (IVF) <39 (ICSI) | 569 | IVF/ICSI | 14–23h | Tesarik and Greco, 1999 / Scott, 2000 | Yes | NA | NA | Not | Not | NA | NA |
Guerif et al. 2007 [35] | P | NA | 4,042 | IVF/ICSI | 18–20h | Modified from Tesarik and Greco, 1999 | NA | NA | Not | NA | NA | NA | NA |
Scott et al. 2007 [36] | P | <38 | 2,528 | IVF/ICSI | 17–18h | Scott, 2000 | NA | NA | NA | Yes | Yes | Yes | NA |
Depa–Martynow et al. 2007 [37] | P | NA | 787 | IVF | 16–18h | Scott, 2000 | Yes | NA | NA | NA | NA | NA | NA |
Nicoli et al. 2007 [38] | R | 23–41 | 1,032 | IVF/ICSI | 18–20h | Modified from Scott, 2000 and Gianaroli, 2003 | Not | NA | NA | Not | Not | NA | NA |
Álvarez et al. 2008 [39] | R | 35.0±3.5 | 883 | IVF/ICSI | 16–18h | Tesarik and Greco, 1999 | Yes | NA | NA | Yes | Yes | NA | NA |
Liu et al. 2008 [40] | P | 30.4±3.71 (IVF) 30.1±3.79 (ICSI) | 2,836 | IVF/ICSI | 16–20h | Scott, 2000 | Yes | Yes | NA | Yes | Not | NA | NA |
Qian et al. 2008 [41] | P | NA | 973 | IVF/ICSI | 18–18h | Scott, 2000/Lan, 2003 | Not | NA | NA | NA | NA | NA | NA |
Brezinova et al. 2009 [42] | R | <39 | 1,954 | IVF/ICSI | 16–20h | Modified from Tesarik and Greco, 1999 | NA | NA | NA | Not | Not | NA | NA |
Maille et al. 2009 [43] | P | 40.1±1.3 (IVF) 27.1±1.4 (ICSI) | 301 | ICSI | 16–18h | Gianaroli, 2003 | Not | Yes **
| NA | Yes | Yes **
| NA | NA |
Zamora et al. 2010 [44] | P | NA | 2,105 | IVF/ICSI | 16–18h | PN size, NPBs and PBs | NA | Yesç
| NA | NA | NA | NA | NA |
Weitzman et al. 2010 [45] | P | <36 | 852 | IVF/ICSI | 18–20h | Tesarik and Greco/Scott, 2000 | NA | NA | NA | Not | NA | NA | NA |
Nicoli et al. 2010 [46] | R | 35.9±4.0 | 1,078 | IVF/ICSI | 18–20h | Gianaroli, 2003 | Not | Not | NA | NA | Not | Not | NA |
Bar–Yoseph et al. 2011 [47] | R | 31.1±5.0 | 1,516 | IVF/ICSI | 17–18h | Scott, 2000 | NA | NA | NA | Not | NA | NA | NA |
Aydin et al. 2011 [48] | P | 29.8±3.5 | 487 | ICSI | 16–18h | Modifed from Tesarik and Greco, 1999/Scott, 2000 | NA | Not | NA | NA | NA | NA | NA |
Nicoli et al. 2013 [49] | R | 36.6±3.9 | 755 | IVF/ICSI | 18–20h | Gianaroli, 2003 | NA | NA | NA | NA | Not | Not | NA |
Original scores
Modified scores
Modified Tesarik and Greco scoring systems
Modified Scott scoring systems
Modified scoring systems derived from combination of multiple original scoring systems
ESHRE scoring system
Zygote morphology and outcome measures
Outcome | Correlation (studies; n., %) | No correlation (studies; n., %) | OR (95% CI) |
P
|
---|---|---|---|---|
Embryo quality | 15/25 (60) | 10/25 (40%) | 2.25 (0.73 to 6.98) | 0.160 |
Cleavage stage | 15/20 (75%) | 5/20 (26.3%) | 9.0 (2.15 to 37.66) | 0.003 |
Blastocyst stage | 7/8 (87.5%) | 1/8 (12.5%) | 49.0 (2.53 to 948.67) | 0.010 |
Implantation rate | 12/23 (52.2%) | 11/23 (47.8%) | 1.19 (0.37 to 3.79) | 0.768 |
Pregnancy rate | 12/25 (48%) | 13/25 (52%) | 0.85 (0.28 to 2.58) | 0.777 |
Delivery/Live birth rate | 1/4 (25%) | 3/4 (75%) | 0.11 (0.005 to 2.73) | 0.179 |
Embryonic chromosome status | 6/6 (100%) | 0/6 (0%) | 169.0 (2.89 to 9876.12 | 0.013 |
Outcome | Spearman’s correlation (r) |
P
|
---|---|---|
Embryo quality | 0.712 | 0.280 |
Cleavage stage | 0.546 | 0.340 |
Blastocyst stage | 0.659 | 0.417 |
Implantation rate | 0.378 | 0.543 |
Pregnancy rate | 0.129 | 0.047 |
Delivery/live birth rate | 0.713 | 0.434 |
Embryonic chromosome status | 0.815 | 0.923 |