Time lapse deselection model for human day 3 in vitro fertilization embryos The combination of qualitative and quantitative measures of embryo growth

Capsule:
This study presents a deselection model for human in vitro fertilization embryos independent of the insemination method, the qualitative component being more accurate when coupled with a quantitative component.

Authors:
Yanhe Liu, M.Sc., Vincent Chapple, M.B., B.S., F.R.A.N.Z.C.O.G., Katie Feenan, M.Sc., Peter Roberts, Ph.D., Phillip Matson, Ph.D.

Volume 105, Issue 3, Pages 656-662

Abstract:

Objective:
To present a time-lapse deselection model involving both qualitative and quantitative parameters for assessing embryos on day 3.

Design:
Retrospective cohort study and prospective validation.

Setting:
Private IVF center.

Patient(s):
A total of 270 embryos with known implantation data (KID) after day 3 transfer from 212 IVF/intracytoplasmic sperm injection (ICSI) cycles were retrospectively analyzed for building the proposed deselection model, followed by prospective validation using an additional 66 KID embryos.

Intervention(s):
None.

Main Outcome Measure(s):
Morphological score on day 3, embryo morphokinetic parameters, abnormal cleavage patterns, and known implantation results.

Result(s):
All included embryos were categorized either retrospectively or prospectively into 7 grades (A+, A, B, C, D, E, F). Qualitative deselection parameters included poor conventional day 3 morphology, abnormal cleavage patterns identified via time-lapse monitoring, and <8 cells at 68 hours postinsemination. Quantitative parameters included time from pronuclear fading (PNF) to 5-cell stage and duration of 3-cell stage. KID implantation rates of embryos graded from A+ to F were 52.9%, 36.1%, 25.0%, 13.8%, 15.6%, 3.1%, and 0 respectively (area under the curve [AUC] = 0.762; 95% confidence interval [CI], 0.701–0.824), and a similar pattern was seen in either IVF (AUC = 0.721; 95% CI, 0.622–0.821) or ICSI embryos (AUC = 0.790; 95% CI, 0.711–0.868). Preliminary prospective validation using 66 KID embryos also showed statistically significant prediction in Medicult (AUC = 0.750; 95% CI, 0.588–0.912) and Vitrolife G-Series (AUC = 0.820; 95% CI, 0.671–0.969) suites of culture media. Conclusion(s):
The proposed model involving both qualitative and quantitative deselection effectively predicts day 3 embryo implantation potential and is applicable to all IVF embryos regardless of insemination method by using PNF as the reference starting time point.

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