Day-3 embryo morphology predicts euploidy among older subjects

Moayeri, Sharon E.; Allen, Rene B.; Brewster, Wendy R.; Kim, Moon H.; Porto, Manuel; Werlin, Lawrence B.

doi:10.1016/j.fertnstert.2007.01.169

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Volume 89, Issue 1 , Pages 118-123, January 2008

Day-3 embryo morphology predicts euploidy among older subjects

Sharon E. Moayeri, M.D., M.P.H.
- Department of Obstetrics and Gynecology, Stanford University Medical Center, Stanford, California
- Reprint requests: Sharon E. Moayeri, Stanford University, PCOR, 117 Encina Commons, Room 210, Mail code: 6019, Stanford, California, 94305 (FAX: 650-723-1919).
Rene B. Allen, M.D.
- Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California
Wendy R. Brewster, M.D., Ph.D.
- Department of Obstetrics and Gynecology, University of California Irvine Medical Center, Orange, California
Moon H. Kim, M.D.
- Department of Obstetrics and Gynecology, University of California Irvine Medical Center, Orange, California
Manuel Porto, M.D.
- Department of Obstetrics and Gynecology, University of California Irvine Medical Center, Orange, California
Lawrence B. Werlin, M.D.
- Coastal Fertility Medical Center, Irvine, California

Received 30 October 2006; received in revised form 29 January 2007; accepted 29 January 2007. published online 24 April 2007.

Objective

To evaluate whether day-3 embryo morphology predicts euploidy.

Design

Retrospective.

Setting

Private IVF center.

Patient(s)

Subjects (n = 144) undergoing in vitro fertilization and preimplantation genetic diagnosis (PGD).

Intervention(s)

Translate day-3 embryo characteristics into a standardized score.

Main Outcome Measure(s)

Day-3 embryo morphology score and PGD fluorescence in situ hybridization results for chromosomes: 13, 15, 16, 17, 18, 21, 22, X, and Y.

Result(s)

Of 1,043 biopsied blastomeres, 67% (n = 696) were chromosomally abnormal. Women with advanced maternal age (AMA) were 1.3 times more likely to have chromosomal errors (95% CI 1.1–1.4) than younger subjects (<38 years old). Morphology predicted PGD results in the AMA group (n = 553), but not in younger women. Fragmentation predicted euploidy in both the younger and the AMA group, but cell number did not.

Conclusion(s)

Day-3 embryo morphology selects for euploidy among AMA subjects but not among younger women who may have other factors responsible for embryo dysmorphism. However, cellular fragmentation is a sensitive proxy for selecting chromosomally normal embryos in both age groups. It is unclear that PGD-aneuploidy screening is a better tool for selecting which embryos to transfer than the standard approach of using day-3 embryo features, particularly among older women, a group for whom this technology is targeted.

Key Words: PGD, embryo morphology, aneuploidy, IVF, embryo selection