An embryo cleavage pattern based on the relative blastomere size as a function of cell number for predicting implantation outcome

Capsule:
The embryo’s cleavage pattern provides valuable supplementary information to the standard evaluation for selecting embryos by cleavage rate and fragmentation, enhancing the likelihood for successful implantation.

Authors:
Roee Sela, D.V.M., Liat Samuelov, M.D., Benny Almog, M.D., Tamar Schwartz, B.Sc., Tania Cohen, M.Sc., Ami Amit, M.D., Foad Azem, M.D., Dalit Ben-Yosef, Ph.D.

Volume 98, Issue 3, Pages 650-656.e4, September 2012

Abstract:

Objective:
To analyze whether the cleavage pattern redefined for all cleavage stages according to the relative blastomere size as a function of cell number has an additive value in predicting implantation potential of day 2-3 embryos.

Design:
Retrospective analysis of standard embryo morphological parameters (cleavage rate and degree of fragmentation) supplemented by cleavage pattern findings of 347 implanted embryos compared to those of a matched control group of 307 embryos that failed to implant.

Setting:
University-based tertiary medical center.

Patient(s):
Two hundred and nine women with successful implantation and 181 controls matched for age and demographic parameters with failed implantation.

Interventions:
In vitro fertilization (IVF), embryo assessment, and embryo transfer

Main Outcome Measures:
Determination of cleavage patterns in synchronized and unsynchronized cleaving embryos and correlations to implantation outcomes.

Results:
Significantly more embryos of the implanted group were of good cleavage pattern compared to the non-implanted group (88% vs. 70%; P70%) when the cleavage pattern was assessed on both days 2 & 3.

Conclusions:
When combined with measurements of the cleavage rate and degree of fragmentation, the cleavage pattern refines our ability to predict the likelihood of implantation, representing a definitive tool in the selection of top-quality embryos.

  • Micah Hill

    Congratulations to the authors on the nice paper. The need to improve the ability to successfully predict embryo implantation is an area of great importance. While the addition of the cleavage pattern improved the ability to predict implantation, the area under the curve only modestly changed (.678 to .707). The data highlighted how even under the best model, predicting implantation is still challenging. I had 2 questions:
    1. in the multivariate regression models, with many of these parameters being potentially interrelated, did cleavage pattern remain statistically significant?
    2. I was curious why the authors chose to perform a retrospective case controlled study as the design (instead of a retrospective cohort)?

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