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Biennial Review of Infertility pp 143–169Cite as

Selecting the Most Competent Embryo

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Abstract

With improvements in implantation potential, and the compelling need to reduce the likelihood of multiple pregnancies resulting from in vitro fertilization (IVF), efforts have continued to focus on developing methods to select the most competent embryo for transfer. For the first 15 years or so of human IVF, embryo selection methodologies exclusively involved morphological assessment of the embryo at a single time-point, immediately prior to transfer. Despite considerable efforts to define those characteristics predictive of high implantation potential, the implantation rate of selected embryos is typically only around 30%. More recent attempts to improve selection have assessed characteristics of the oocyte along with those of the embryo at specific times during culture in order to derive a cumulative score. However, these studies have led to conflicting results regarding the worth of cumulative scoring. These conflicting results are likely associated with various study limitations including small sample sizes, a preponderance of retrospective studies combined with variation in timing of evaluations and, in some cases, the use of transfer cohorts in which not all embryos have known implantation fate. While culture to the blastocyst stage has been used in attempts to improve selection, this approach is beneficial for only selected, good prognosis patients, and it is unlikely that even the best current culture media precisely mimic the uterine environment.

Given the accepted limitations of morphological approaches, alternative selection methodologies are under development involving targeted analyses or profiling approaches. Targeted analyses involve quantification of known markers in the medium. While these analyses hold some promise, technologies are either cumbersome with turnaround times too long for prospective application, and/or have relatively low predictive value. Of greater potential, metabolomic profiling using spectroscopic analyses of spent media have rapid turnaround, require very small volumes of medium for analysis and may provide superior selection as compared with morphological assessment alone.

While we still depend on morphological assessment as our first line approach to embryo selection, it is likely that this may be used in conjunction with metabolomic profiling in the future. As we continue to strive towards identifying the single most competent embryo in any cohort, the aim will be to interface such technologies with the cutting-edge areas of genomic and proteomics research. These are exciting times in the field of IVF, and much future research is required to fine-tune these promising technologies.

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Acknowledgements

We thank Dr. Gena Ratiu for assistance in taking the photographic images, and Mr. Brian C. Bator for preparation of the photographic plates.

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  1. Department of Obstetrics and Gynecology, ASB 1 + 3, Rm 082, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA, 02115, USA

    S. Temel Ceyhan, Katharine V. Jackson & Catherine Racowsky

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    Ceyhan, S.T., Jackson, K.V., Racowsky, C. (2009). Selecting the Most Competent Embryo. In: Voorhis, B., Schlegel, P., Racowsky, C., Carrell, D. (eds) Biennial Review of Infertility. Humana Press. https://doi.org/10.1007/978-1-60327-392-3_10

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