Abstract
Purpose
The aim of this study was to create a predictive model for high-quality blastocyst progression based on the traditional morphology parameters of embryos.
Methods
A total of 1564 embryos from 234 women underwent conventional in vitro fertilization and were involved in the present study. High-quality blastocysts were defined as having a grade of at least 3BB, and all embryos were divided based on the development of high-quality blastocysts (group HQ) or the failure to develop high-quality blastocysts (group NHQ). A retrospective analysis of day-3 embryo parameters, focused on blastomere number, fragmentation, the presence of a vacuole, symmetry, and the presence of multinucleated blastomeres was conducted.
Results
All parameters were related to high-quality blastocysts (p < 0001) in t tests, chi-square tests, or Fisher tests. The individual scores for all parameters were determined according to their distributions and corresponding rates of forming high-quality blastocysts. Parameters are indicated by s_bn (blastomere number), s_f (fragmentation), s_pv (presence of a vacuole), s_s (symmetry), and s_MNB (multinucleated blastomeres). Subsequently, univariate and multivariate logistic regression analyses were conducted to explore their relationship. In the multivariate logistic regression analysis, a predictive model was constructed, and a parameter Hc was created based on the s_bn, s_f, and s_s parameters and their corresponding odds ratios. The value of Hc in group HQ was significantly higher than that in group NHQ. A receiver operating characteristic curve was used to test the effectiveness of the model. An area under the curve of 0.790, with a 95% confidence interval of 0.766–0.813, was calculated. A dataset was used to validate the predictive utility of the model. Moreover, another dataset was used to ensure that the model can be applied to predict the implantation of day-3 embryos.
Conclusions
A predictive model for high-quality blastocysts was created based on blastomere number, fragmentation, and symmetry. This model provides novel information on the selection of potential embryos.
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References
Milewski R, Kuć P, Kuczyńska A, Stankiewicz B, Łukaszuk K, Kuczyński W. A predictive model for blastocyst formation based on morphokinetic parameters in time-lapse monitoring of embryo development. J Assist Reprod Genet. 2015;32(4):571–9.
Motato Y, LSM J d, Escriba MJ, Meseguer M. Morphokinetic analysis and embryonic prediction for blastocyst formation through an integrated time-lapse system. Fertil Steril. 2015;105(2):376–84.
Machtinger R, Racowsky C. Morphological systems of human embryo assessment and clinical evidence. Reprod BioMed Online. 2013;26(3):210–21.
Racowsky C, Vernon M, Mayer J, Ball GD, Behr B, Pomeroy KO, et al. Standardization of grading embryo morphology. J Assist Reprod Genet. 2010;94(3):1152–3.
Adler A, Lee H, McCulloh DH, Ampeloquio E, Clarke-Williams M, Wertz BH, et al. Blastocyst culture selects for euploid embryos: comparison of blastomere and trophectoderm biopsies. Reprod BioMed Online. 2014;28(4):485–91.
Surrey ES, Schoolcraft WB. Blastocyst versus cleavage stage embryo transfer: maximizing success rates. In: Sauer MV, editor. Principles of oocyte and embryo donation. London: Springer; 2013. p. 129–39.
Sasikala N, Rajapriya A, Mahalakshmi S, Janani DM, Archana B, Parameaswari PJ. Blastocyst culture depends on quality of embryos on day 3, not quantity. Middle East Fertil Soc J. 2015;20(4):224–30.
Yin H, Jiang H, He R, Wang C, Zhu J, Luan K. The effects of fertilization mode, embryo morphology at day 3, and female age on blastocyst formation and the clinical outcomes. Syst Biol Reprod Med. 2015;(1):61, 1–7.
Minasi MG. Current aspects of blastocyst culture, biopsy and vitrification. Curr Trends Clin Embriol. 2014;1(1):27–33.
Thum MY, Wells V, Abdalla H. Patient selection criteria for blastocyst culture in IVF/ICSI treatment. J Assist Reprod Genet. 2010;27(9–10):555–60.
Anckaert E, Smitz J, Schiettecatte J, Klein BM, Arce JC. The value of anti-mullerian hormone measurement in the long GnRH agonist protocol: association with ovarian response and gonadotrophin-dose adjustments. Hum Reprod. 2012;27(6):1829–39.
Huang B, Ren X, Wu L, Zhu L, Xu B, Li Y, et al. Elevated progesterone levels on the day of oocyte maturation may affect top quality embryo IVF cycles. PLoS One. 2016;11(1):e0145895.
Gallardo EF, Spiessens C, D’Hooghe T, Debrock S. Effect of embryo morphology and morphometrics on implantation of vitrified day 3 embryos after warming: a retrospective cohort study. Reprod Biol Endocrinol. 2016;14(1):40.
Paternot G, Debrock S, D’Hooghe T, Spiessens C. Computer-assisted embryo selection: a benefit in the evaluation of embryo quality? Reprod BioMed Online. 2011;23(3):347–54.
Gardner DK, Schoolcraft WB. Towards reproductive certainty: infertility and genetics beyond. In: Jansen R, Mortimer D, editors. In vitro culture of human blastocysts. Carnforth: Parthenon Press; 1999. p. 378–88.
Smuts MP, Miller M, Ramdas-Navale K, Aoki VW. Improved high-quality blastocyst formation rates result from in vitro embryo culture in the cook MINC incubator platform. Fertil Steril. 2008;89(4):Suppl 21.
Cetinkaya M, Pirkevi C, Yelke H, Colakoglu YK, Atayurt Z, Kahraman S. Relative kinetic expressions defining cleavage synchronicity are better predictors of blastocyst formation and quality than absolute time points. J Assist Reprod Genet. 2015;32(1):27.
Sang MK, Sang WL, Jeong HJ, San HY, Min WK, Jin HL, et al. Clinical outcomes of elective single morula embryo transfer versus elective single blastocyst embryo transfer in IVF-ET. J Assist Reprod Genet. 2012;29(5):423.
Marhuenda-Egea FC, Martínez-Sabater E, Gonsálvez-Alvarez R, Lledó B, Ten J, Bernabeu R. A crucial step in assisted reproduction technology: human embryo selection using metabolomic evaluation. Fertil Steril. 2010;94(2):772.
Aziminekoo E, Mohseni Salehi MS, Kalantari V, Shahrokh Tehraninejad E, Haghollahi F, Hossein Rashidi B, et al. Pregnancy outcome after blastocyst stage transfer comparing to early cleavage stage embryo transfer. Gynecol Endocrinol. 2015;31(11):880–4.
Mcclelland S, Melzer K, Mcculloh DH, Grifo JD. A comparison of pregnancy outcomes between day 3and day 5/6 fresh embryo transfers: does day of embryo transfer (ET) really make a difference? J Assist Reprod Genet. 2015;32(2):1–6.
Jaroudi S, Alfarawati S, Poli M, Wells D, Fragouli E. The effect of aneuploidy on embryo morphology and preimplantation development from the cleavage to the blastocyst stage. Fertil Steril. 2012;98(3):S164.
Bungum M, Bungum L, Humaidan P, Andersen CY. Day 3 versus day 5 embryo transfer: a prospective randomized study. Reprod BioMed Online. 2003;7(1):98–104.
Martins WP, Nastri CO, Rienzi L, van der Poel SZ, Gracia C, Racowsky C. Blastocyst vs cleavage-stage embryo transfer: systematic review and meta-analysis of reproductive outcomes. Ultrasound Obstet Gynecol. 2017;49(5):583.
De Vos A, Van Landuyt L, Santosribeiro S, Camus M, Van de Velde H, Tournaye H, et al. Cumulative live birth rates after fresh and vitrified cleavage-stage versus blastocyst-stage embryo transfer in the first treatment cycle. Hum Reprod. 2016;31(11):2442.
Fernándezshaw S, Cercas R, Braña C, Villas C, Pons I. Ongoing and cumulative pregnancy rate after cleavage-stage versus blastocyst-stage embryo transfer using vitrification for cryopreservation: impact of age on the results. J Assist Reprod Genet. 2015;32(2):177–84.
Levi-Setti PE, Cirillo F, Smeraldi A, Morenghi E, Mulazzani GEG, Albani E. No advantage of fresh blastocyst versus stage embryo transfer in women under the age of 39: a randomized controlled study. J Assist Reprod Genet. 2017;34(11):1–9.
Phan V, Littman E, Harris D, La A. Correlation between aneuploidy and blastocyst quality. Asian Pac J Reprod. 2014;3(4):253–7.
Gardner DK, Lane M, Stevens J, Schlenker T, Schoolcraft WB. Blastocyst score affects implantation and pregnancy outcome: towards a single blastocyst transfer. Fertil Steril. 2000;73(6):1155.
Alpha Scientists in Reproductive Medicine and ESHRE Special Interest Group of Embryology. Istanbul consensus workshop on embryo assessment: proceedings of an expert meeting. Reprod BioMed Online. 2011;22(6):632–46.
Racowsky C, Vernon MJ, Ball GD, Behr B, Pomeroy KO, Wininger D, et al. Standardization of grading embryo morphology. Fertil Steril. 2010;27(8):437–9.
Lan K, Huang F, Lin Y, Kung F, Hsieh C, Huang H, et al. The predictive value of using a combined Z-score and day 3 embryo morphology score in the assessment of embryo survival on day 5. Hum Reprod. 2003;18(6):1299.
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This study was approved by the Institutional Review Board of Dali University.
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Yu, Ch., Zhang, Rp., Li, J. et al. A predictive model for high-quality blastocyst based on blastomere number, fragmentation, and symmetry. J Assist Reprod Genet 35, 809–816 (2018). https://doi.org/10.1007/s10815-018-1132-6
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DOI: https://doi.org/10.1007/s10815-018-1132-6