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Traditional Embryo Morphology Evaluation: From the Zygote to the Blastocyst Stage

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In Vitro Fertilization

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Abstract

After in vitro fertilization, providers are repeatedly tasked with assessing embryos at various stages to make critical, time-sensitive patient care decisions at each stage of embryo culture using morphological assessments. At the zygote stage, assessment of normal fertilization must occur just before the brief window in which pronuclei are visible closes in order to determine which embryos are suitable to continue in culture. Cleavage-stage assessments must determine whether a patient should transfer early or pursue blastocyst culture before transfer or cryopreservation. Finally, blastocyst morphology assessments must be made to determine if and when embryos are optimally ready for trophectoderm biopsy for cases undergoing genetic screening, if and when embryos are optimally ready for cryopreservation, and, most importantly, which embryos are most likely to become a healthy pregnancy when selecting an embryo for transfer. While molecular and biochemical methods to assess human gamete and embryo reproductive potential are increasingly utilized, the assessment of morphology has been, and will remain, the most widely employed method for embryo selection as it is quick and inexpensive and, although not without faults, has consistently been shown to have predictive value.

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Author information

Authors and Affiliations

  1. Department of Reproductive Endocrinology and Infertility, Stanford University, Stanford, CA, USA

    Jonathan Kort

  2. Stanford University, Reproductive Endocrinology and Infertility, Sunnyvale, CA, USA

    Barry Behr

Authors
  1. Jonathan Kort
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  2. Barry Behr
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Corresponding author

Correspondence to Jonathan Kort .

Editor information

Editors and Affiliations

  1. Reproductive Biology Associates – Prelude, Atlanta, GA, USA

    Zsolt Peter Nagy

  2. Astra Fertility Group, Mississauga, ON, Canada

    Alex C. Varghese

  3. Cleveland Clinic, Cleveland, OH, USA

    Ashok Agarwal

Review Questions

Review Questions

  1. 1.

    How many hours after conventional insemination or intracytoplasmic sperm injection should the fertilization check be performed?

    • 10–12

    • 14–16

    • 16–18

    • 18–20

  2. 2.

    Which are the attributes of pronuclei assessed in most pronuclear scoring systems?

    • (A) Size

    • (B) Symmetry

    • (C) Location

    • (D) Position

    • (E) B, C, and D

  3. 3.

    True or False: Embryos undergoing cleavage from 1 to ≥3 cells have significantly higher implantation rates than other embryos.

  4. 4.

    What number of cells on day 3 of development correlates with higher rates of implantation?

    • (A) 4

    • (B) 4–6

    • (C) 7–9

    • (D) 10–12

  5. 5.

    Which micromanipulation technique may confound blastocyst grading?

    • (A) Intracytoplasmic sperm injection

    • (B) Laser-assisted hatching

    • (C) Trophectoderm biopsy

    • (D) Delayed stripping of cumulus cells

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Kort, J., Behr, B. (2019). Traditional Embryo Morphology Evaluation: From the Zygote to the Blastocyst Stage. In: Nagy, Z., Varghese, A., Agarwal, A. (eds) In Vitro Fertilization. Springer, Cham. https://doi.org/10.1007/978-3-319-43011-9_40

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