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Morphological Assessment of Blastocyst Stage Embryos: Types of Grading Systems and Their Reported Outcomes

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Human Gametes and Preimplantation Embryos

Abstract

The benefits of single embryo transfer (SET) to mother and baby are well documented and SET is rapidly becoming the standard of care for several groups of patients, especially those <38 and oocyte donor programs. The advantages of blastocyst transfer have been well argued and growing data supports the move to day 5 transfer as an effective means of moving to SET while the transfer of embryos at the blastocyst stage has been shown to not only increase implantation rates, but decrease pregnancy losses. Given the high implantation potential of human blastocysts, and that when more than one blastocyst is transferred the incidence of twins is typically around 50 %, it is paramount that effective selection criteria are used to identify the blastocyst with the best chance of resulting in a pregnancy. Utilization of omics-based technologies in clinical in vitro fertilization (IVF) applications has reported promising results, and the analysis of the proteome/secretome, together with an increased understanding of the complex relationships regulating the metabolome, continues to be extremely valuable. However, there are still no routinely applicable techniques or analytical devices available and the omics-based technologies tend to reside in a few selected research laboratories. Consequently, IVF clinics worldwide continue to select embryos for transfer based on their developmental rate and morphological features as assessed by conventional light microscopy. It is envisaged that new suitable physiological-based tests will be used to augment morphometric analysis. The necessity for an accurate morphological grading system for blastocyst stage embryos predicting the implantation potential and the clinical outcome is evident. One of the clear advantages of examining the morphology of a blastocyst is that one can readily see the differentiation of the two cell types, the inner cells mass (ICM) and the trophectoderm (Td). This gives a distinct advantage over the analysis of cleavage stage morphology, as one can already determine whether the true embryonic tissue has formed successfully.

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Author information

Authors and Affiliations

  1. Assisted Reproduction Unit, American Hospital of Istanbul, 34365, Istanbul, Turkey

    Basak Balaban

  2. Department of Zoology, University of Melbourne, Melbourne, VIC, Australia

    David K. Gardner

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  1. Basak Balaban
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  2. David K. Gardner
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Correspondence to Basak Balaban .

Editor information

Editors and Affiliations

  1. University of Melbourne, Department of Zoology, Royal Parade, Melbourne, 3010, Victoria, Australia

    David K. Gardner

  2. Boston IVF, Second Ave. 130, Waltham, 02451, Massachusetts, USA

    Denny Sakkas

  3. Yale School of Medicine, Dept. of Ob/Gyn & Reproductive Sciences, Cedar St. 333, New Haven, 06510, Connecticut, USA

    Emre Seli

  4. Obstetrics & Gynaecology, University of Oxford, Nuffield Department of, Garsington Road, Oxford, OX4 2HW, Oxfordshire, United Kingdom

    Dagan Wells

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Balaban, B., Gardner, D.K. (2013). Morphological Assessment of Blastocyst Stage Embryos: Types of Grading Systems and Their Reported Outcomes. In: Gardner, D., Sakkas, D., Seli, E., Wells, D. (eds) Human Gametes and Preimplantation Embryos. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-6651-2_4

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  • DOI: https://doi.org/10.1007/978-1-4614-6651-2_4

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  • Online ISBN: 978-1-4614-6651-2

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