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Quantitative grading of a human blastocyst: optimal inner cell mass size and shape

      Abstract

      Objective: To investigate the predictive value of quantitative measurements of blastocyst morphology on subsequent implantation rates after transfer.
      Design: Prospective observational study.
      Setting: Private assisted reproductive technology center.
      Patient(s): One hundred seventy-four IVF patients receiving transfers of expanded blastocyst-stage embryos on day 5 (n = 112) or day 6 (n = 62) after oocyte retrieval.
      Intervention(s): None.
      Main Outcome Measure(s): Blastocyst diameter, number of trophectoderm cells, inner cell mass (ICM) size, ICM shape, and implantation and pregnancy rates.
      Result(s): Blastocyst diameter and trophectoderm cell numbers were unrelated to implantation rates. Day 5 expanded blastocysts with ICMs of >4,500 μm2 implanted at a higher rate than did those with smaller ICMs (55% vs. 31%). Day 5 expanded blastocysts with slightly oval ICMs implanted at a higher rate (58%) compared with those with either rounder ICMs (7%) or more elongated ICMs (33%). Implantation rates were highest (71%) for embryos with both optimal ICM size and shape. Pregnancy rates were higher for day 5 transfers of optimally shaped ICMs compared with day 5 transfers of optimally sized ICMs.
      Conclusion(s): Quantitative measurements of the inner cell mass are highly indicative of blastocyst implantation potential. Blastocysts with relatively large and/or slightly oval ICMs are more likely to implant than other blastocysts.

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      References

        • Alves da Motta E.L
        • Alegretti J.R
        • Baracat E.C
        • Olive D
        • Serafini P.C
        High implantation and pregnancy rates with transfer of human blastocysts developed in preimplantation stage one and blastocyst media.
        Fertil Steril. 1998; 70: 659-663
        • Gardner D.K
        • Schoolcraft W.B
        • Wagley L
        • Schlenker T
        • Stevens J
        • Hesla J
        A prospective randomized trial of blastocyst culture and transfer in in-vitro fertilization.
        Hum Reprod. 1998; 13: 3434-3440
        • Gardner D.K
        • Vella P
        • Lane M
        • Wagley L
        • Schlenker T
        • Schoolcraft W.B
        Culture and transfer of human blastocysts increases implantation rates and reduces the need for multiple embryo transfers.
        Fertil Steril. 1998; 69: 84-88
        • Jones G.M
        • Trounson A.O
        • Gardner D.K
        • Kausche A
        • Lolatgis N
        • Wood C
        Evolution of a culture protocol for successful blastocyst development and pregnancy.
        Hum Reprod. 1998; 13: 169-177
        • Cruz J.R
        • Dubey A.K
        • Patel J
        • Peak D
        • Hartog B
        • Gindoff P.R
        Is blastocyst transfer useful as an alternative treatment for patients with multiple in vitro fertilization failures?.
        Fertil Steril. 1999; 72: 218-220
        • Gorrill M.J
        • Kaplan P.F
        • Patton P.E
        • Burry K.A
        Initial experience with extended culture and blastocyst transfer of cryopreserved embryos.
        Am J Obstet Gynecol. 1999; 180: 1472-1474
        • Milki A.A
        • Hinckley M.D
        • Fisch J.D
        • Dasig D
        • Behr B
        Comparison of blastocyst transfer with day 3 embryo transfer in similar patient populations.
        Fertil Steril. 2000; 73: 126-129
        • Ebner T
        • Moser M
        • Yaman C
        • Feichtinger O
        • Hartl J
        • Tews G
        Elective transfer of embryos selected on the basis of first polar body morphology is associated with increased rates of implantation and pregnancy.
        Fertil Steril. 1999; 72: 599-603
        • Tesarik J
        • Greco E
        The probability of abnormal preimplantation development can be predicted by a single static observation on pronuclear stage morphology.
        Hum Reprod. 1999; 14: 1318-1323
        • Ludwig M
        • Schöpper B
        • Al-Hasani S
        • Diedrich K
        Clinical use of a pronuclear stage score following intracytoplasmic sperm injection.
        Hum Reprod. 2000; 15: 325-329
        • Wittemer C
        • Bettahar-Lebugle K
        • Ohl J
        • Rongières C
        • Nisand I
        • Gerlinger P
        Zygote evaluation.
        Hum Reprod. 2000; 15: 2591-2597
        • Claman P
        • Armant D.R
        • Seibel M.M
        • Wang T.A
        • Oskowitz S.P
        • Taymor M.L
        The impact of embryo quality and quantity on implantation and the establishment of viable pregnancies.
        J In Vitro Fert Embryo Transfer. 1987; 4: 218-222
        • Staessen C
        • Camus M
        • Bollen N
        • Devroey P
        • Van Steirteghem A.C
        The relationship between embryo quality and the occurrence of multiple pregnancies.
        Fertil Steril. 1992; 57: 626-630
        • Lewin A
        • Schenker J.G
        • Safran A
        • Zigelman N
        • Avrech O
        • Abramov Y
        • et al.
        Embryo growth rate in vitro as an indicator of embryo quality in IVF cycles.
        J Assist Reprod Genet. 1994; 11: 500-503
        • Giorgetti C
        • Terriou P
        • Auquier P
        • Hans E
        • Spach J.L
        • Salzmann J
        • et al.
        Embryo score to predict implantation after in-vitro fertilization.
        Hum Reprod. 1995; 10: 2427-2431
        • Shoukir Y
        • Campana A
        • Farley T
        • Sakkas D
        Early cleavage of in-vitro fertilized human embryos to the 2-cell stage.
        Hum Reprod. 1997; 12: 1531-1536
        • Ziebe S
        • Petersen K
        • Lindenberg S
        • Andersen A.G
        • Gabrielsen A
        • Andersen A.N
        Embryo morphology or cleavage stage.
        Hum Reprod. 1997; 12: 1545-1549
        • Vilska S
        • Tiitinen A
        • Hydén-Granskog C
        • Hovatta O
        Elective transfer of one embryo results in an acceptable pregnancy rate and eliminates the risk of multiple birth.
        Hum Reprod. 1999; 14: 2392-2395
        • Desai N.N
        • Goldstein J
        • Rowland D.Y
        • Goldfarb J.M
        Morphological evaluation of human embryos and derivation of an embryo quality scoring system specific for day 3 embryos.
        Hum Reprod. 2000; 15: 2190-2196
        • Alikani M
        • Cohen J
        • Tomkin G
        • Garrisi G.J
        • Mack C
        • Scott R.T
        Human embryo fragmentation in vitro and its implications for pregnancy and implantation.
        Fertil Steril. 1999; 71: 836-842
        • Jackson K.V
        • Ginsburg E.S
        • Hornstein M.D
        • Rein M.S
        • Clarke R.N
        Multinucleation in normally fertilized embryos is associated with an accelerated ovulation induction response and lower implantation and pregnancy rates in in vitro fertilization-embryo transfer cycles.
        Fertil Steril. 1998; 70: 60-66
        • Palmstierna M
        • Murkes D
        • Csemiczky G
        • Andersson O
        • Wramsby H
        Zona pellucida thickness variation and occurrence of visible mononucleated blastomers in preembryos are associated with a high pregnancy rate in IVF treatment.
        J Assist Reprod Genet. 1998; 15: 70-75
        • Pelinck M.J
        • De Vos M
        • Dekens M
        • Van der Elst J
        • De Sutter P
        • Dhont M
        Embryos cultured in vitro with multinucleated blastomeres have poor implantation potential in human in-vitro fertilization and intracytoplasmic sperm injection.
        Hum Reprod. 1998; 13: 960-963
        • Gerris J
        • De Neubourg D
        • Mangelschots K
        • Van Royen E
        • Van De Meerssche M
        • Valkenburg M
        Prevention of twin pregnancy after in-vitro fertilization or intracytoplasmic sperm injection based on strict embryo criteria.
        Hum Reprod. 1999; 14: 2581-2587
        • Van Royen E
        • Mangelschots K
        • De Neubourg D
        • Valkenburg M
        • Van de Meerssche M
        • Ryckaert G
        • et al.
        Characterization of a top quality embryo, a step towards single-embryo transfer.
        Hum Reprod. 1999; 14: 2345-2349
        • Conaghan J
        • Hardy K
        • Handyside A.H
        • Winston R.M
        • Leese H.J
        Selection criteria for human embryo transfer.
        J Assist Reprod Genet. 1993; 10: 21-30
        • O’Neill C
        • Saunders D.M
        Assessment of embryo quality.
        Lancet. 1984; 2: 1035
        • O’Neill C
        • Gidley-Baird A.A
        • Pike I.L
        • Saunders D.M
        Use of a bioassay for embryo-derived platelet-activating factor as a means of assessing quality and pregnancy potential of human embryos.
        Fertil Steril. 1987; 47: 969-975
        • Braude P
        • Bolton V
        • Moore S
        Human gene expression first occurs between the four- and eight-cell stages of preimplantation development.
        Nature. 1988; 332: 459-461
        • Scholtes M.C
        • Zeilmaker G.H
        A prospective, randomized study of embryo transfer results after 3 or 5 days of embryo culture in in vitro fertilization.
        Fertil Steril. 1996; 65: 1245-1248
        • Jones G.M
        • Trounson A.O
        • Lolatgis N
        • Wood C
        Factors affecting the success of human blastocyst development and pregnancy following in vitro fertilization and embryo transfer.
        Fertil Steril. 1998; 70: 1022-1029
        • Rijnders P.M
        • Jansen C.A
        The predictive value of day 3 embryo morphology regarding blastocyst formation, pregnancy and implantation rate after day 5 transfer following in-vitro fertilization or intracytoplasmic sperm injection.
        Hum Reprod. 1998; 13: 2869-2873
        • Shoukir Y
        • Chardonnens D
        • Campana A
        • Bischof P
        • Sakkas D
        The rate of development and time of transfer play different roles in influencing the viability of human blastocysts.
        Hum Reprod. 1998; 13: 676-681
        • Huisman G.J
        • Fauser B.C
        • Eijkemans M.J
        • Pieters M.H
        Implantation rates after in vitro fertilization and transfer of a maximum of two embryos that have undergone three to five days of culture.
        Fertil Steril. 2000; 73: 117-122
        • Shapiro B.S
        • Harris D.C
        • Richter K.S
        Predictive value of 72-hour blastomere cell number on blastocyst development and success of subsequent transfer based on the degree of blastocyst development.
        Fertil Steril. 2000; 73: 582-586
        • Shapiro B.S
        • Richter K.S
        • Harris D.C
        • Daneshmand S.T
        A comparison of day 5 and day 6 blastocyst transfers.
        Fertil Steril. 2001; 75: 1126-1130
        • Balaban B
        • Urman B
        • Sertac A
        • Alatas C
        • Aksoy S
        • Mercan R
        Blastocyst quality affects the success of blastocyst-stage embryo transfer.
        Fertil Steril. 2000; 74: 282-287
        • Yoon H.-G
        • Yoon S.-H
        • Son W.-Y
        • Im K.-S
        • Lim J.-H
        High implantation and pregnancy rates with transfer of human hatching day 6 blastocysts.
        Fertil Steril. 2001; 75: 832-833
        • Hartshorne G.M
        • Elder K
        • Crow J
        • Dyson H
        • Edwards R.G
        The influence of in-vitro development upon post-thaw survival and implantation of cryopreserved human blastocysts.
        Hum Reprod. 1991; 6: 136-141
        • Scott L
        • Alvero R
        • Leondires M
        • Miller B
        The morphology of human pronuclear embryos is positively related to blastocyst development and implantation.
        Hum Reprod. 2000; 15: 2394-2403
        • Lane M
        • Gardner D
        Differential regulation of mouse embryo development and viability by amino acids.
        J Reprod Fertil. 1997; 109: 153-164
        • Renard J
        • Philippon A
        • Menezo Y
        In vitro uptake of glucose by bovine blastocysts.
        J Reprod Fertil. 1980; 58: 161-164
        • Gardner D.K
        • Leese H.J
        Assessment of embryo viability prior to transfer by the noninvasive measurement of glucose uptake.
        J Exp Zool. 1987; 242: 103-105
        • Lane M
        • Gardner D.K
        Selection of viable mouse blastocysts prior to transfer using a metabolic criterion.
        Hum Reprod. 1996; 11: 1975-1978
        • Gardner D.K
        • Lane M
        • Stevens J
        • Schlenker T
        • Schoolcraft W.B
        Blastocyst score affects implantation and pregnancy outcome.
        Fertil Steril. 2000; 73: 1155-1158
        • Dokras A
        • Sargent I.L
        • Barlow D.H
        Human blastocyst grading.
        Hum Reprod. 1993; 8: 2119-2127
        • Shea B.F
        Evaluating the bovine embryo.
        Theriogenology. 1981; 15: 31-42
        • Lindner G.M
        • Raymond W
        • Wright J
        Bovine embryo morphology and evaluation.
        Theriogenology. 1983; 20: 407-416