When looks are deceiving—the challenge facing embryo quality prognosticators

Excerpt

The quest for biomarkers of embryo quality is as seasoned as the practice of human ARTs itself. Reaching back into the annals of IVF reminds us of the attempts of the late Bob Edwards and his progeny during the 1980s that placed the property of fragmentation at the disposal of budding embryologists charged with identifying those embryos most suitable to transfer—and, hopefully, endowed with the most potential to give rise to a term pregnancy. As Bob showed, not so reliable was this admittedly “ugly” identifier as a predictor of implantation, let alone pregnancy. And then there were the primordial and laudable efforts of Lucinda Veeck and her colleagues to catalogue the entire range of morphological variation in oocytes, sperm, and embryos proffered to prognosticators for the next decade of human ARTs, one that brought with it measurable advances in ovarian stimulation and ICSI, placing “in the dish” many more embryos to transfer to the delight of patients and clinicians than could have been anticipated 10 years before. But, truth be told, embryo selection remains a vague and frustrating exercise, heightening the need for something less subjective and more objective even in the face of an “embryonic embarrassment of riches.” …