Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-cd9895bd7-q99xh Total loading time: 0 Render date: 2024-12-23T17:41:28.947Z Has data issue: false hasContentIssue false

Chapter 10 - Static Morphological Assessment for Embryo Selection

Published online by Cambridge University Press:  26 April 2023

By
Thomas Ebner
Edited by
Catherine Racowsky ,
Jacques Cohen  and
Nicholas Macklon
Catherine Racowsky
Affiliation:
Hôpital Foch, France
Jacques Cohen
Affiliation:
IVF 2.0, New York
Nicholas Macklon
Affiliation:
London Women's Clinic
Get access

Summary

This chapter evaluates the relevance of static evaluations for the morphological assessment of human embryos at each developmental milestone during the preimplantation period. The value of pronuclei scoring, including consideration of the number and disposition of nucleoli, as well as the presence of the cytoplasmic halo is described. Focused attention is given to the cleavage stage with respect to the stage-appropriateness of the number and size of the cells, and the extent of cytoplasmic fragmentation. Consideration is given to the timing and degree of compaction as the morula develops, and the quality of the blastocyst regarding its extent of expansion and the priority that should be given to trophectoderm quality over that of the inner cell mass. It is concluded that although static assessment at each stage of development may provide small stage-specific increments of benefit to identifying the most viable embryo in a cohort, available evidence does not support such cumulative static scoring and there are potential risks to this approach due to disturbance of the culture environment each time the embryo is removed from the incubator.

Type
Chapter
Information
Manual of Embryo Selection in Human Assisted Reproduction , pp. 100 - 112
Publisher: Cambridge University Press
Print publication year: 2023

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Alpha Scientists in Reproductive Medicine and ESHRE Special Interest Group of Embryology. The Istanbul consensus workshop on embryo assessment: proceedings of an expert meeting. Hum Reprod. 2011;26:1270–83.Google Scholar
Edwards, RG, Purdy, JM, Steptoe, PC, Walters, DE. The growth of human preimplantation embryos in vitro. Am J Obstet Gynecol. 1981;141:408–16.CrossRefGoogle ScholarPubMed
Scott, LA, Smith, S. The successful use of pronuclear embryo transfers the day following oocyte retrieval. Hum Reprod. 1998;13:1003–13.CrossRefGoogle ScholarPubMed
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;14:1318–23.CrossRefGoogle ScholarPubMed
Scott, LA, Alvero, R, Leondires, M. The morphology of human pronuclear embryos is positively related to blastocyst development and implantation. Hum Reprod. 2000;15:2394–403.Google Scholar
Ebner, T, Moser, M, Sommergruber, M, Gaiswinkler, U, Wiesinger, R, Puchner, M, Tews, G. Presence, but not type or degree of extension, of a cytoplasmic halo has a significant influence on preimplantation development and implantation behaviour. Hum Reprod. 2003;18:2406–12.CrossRefGoogle ScholarPubMed
Senn, A, Urner, F, Chanson, A, Primi, MP, Wirthner, D, Germond, M. Morphological scoring of human pronuclear zygotes for prediction of pregnancy outcome. Hum Reprod. 2006;21:234–9.CrossRefGoogle ScholarPubMed
Luna, M, Copperman, AB, Duke, M, Ezcurra, D, Sandler, B, Barritt, J. Human blastocyst morphological quality is significantly improved in embryos classified as fast on day 3 (≥10 cells), bringing into question current embryological dogma. Fertil Steril. 2008;89:358–63.CrossRefGoogle ScholarPubMed
Shebl, O, Haslinger, C, Kresic, S, Enengl, S, Reiter, E, Oppelt, P, Ebner, T. The hare and the tortoise: extreme mitotic rates and how these affect live birth. Reprod Biomed Online. 2021;42:332–9.CrossRefGoogle ScholarPubMed
Ciray, HN, Campbell, A, Agerholm, IE, Aguilar, J, Chamayou, S, Esbert, M, Sayed, S. Proposed guidelines on the nomenclature and annotation of dynamic human embryo monitoring by a time-lapse user group. Human Reprod. 2014;29:2650–60.CrossRefGoogle ScholarPubMed
Ebner, T, Maurer, M, Shebl, O, Moser, M, Mayer, RB, Duba, HC, Tews, G. Planar embryos have poor prognosis in terms of blastocyst formation and implantation. Reprod Biomed Online. 2012;25:267–72.CrossRefGoogle ScholarPubMed
Munné, S. Chromosome abnormalities and their relationship to morphology and development of human embryos. Reprod Biomed Online. 2006;12:234–53.CrossRefGoogle ScholarPubMed
Pons, MC, Carrasco, B, Parriego, M, Boada, M, González-Foruria, I, Garcia, S, et al. Deconstructing the myth of poor prognosis for fast-cleaving embryos on day 3. Is it time to change the consensus? J Assist Reprod Genet. 2019;36:2299–305.Google Scholar
Johannson, M, Hardarson, T, Lundin, K. There is a cutoff limit in diameter between a blastomere and a small anucleate fragment. J Assist Reprod Genet. 2003;20:309–13.Google Scholar
Hardarson, T, Hanson, C, Sjögren, A, Lundin, K. Human embryos with unevenly sized blastomeres have lower pregnancy and implantation rates: indications for aneuploidy and multinucleation. Hum Reprod. 2001;16:313–18.CrossRefGoogle ScholarPubMed
Hnida, C, Engenheiro, E, Ziebe, S. Computer-controlled, multilevel, morphometric analysis of blastomere size as biomarker of fragmentation and multinuclearity in human embryos. Hum Reprod. 2004;19:288–93.CrossRefGoogle ScholarPubMed
Alikani, M, Cohen, J, Tomkin, G, Garrisi, GJ, Mack, C, Scott, RT. Human embryo fragmentation in vitro and its implications for pregnancy and implantation. Fertil Steril. 1999;71:836–42.Google Scholar
Ebner, T, Yaman, C, Moser, M, Sommergruber, M, Pölz, W, Tews, G. Embryo fragmentation in vitro and its impact on treatment and pregnancy outcome. Fertil Steril. 2001;76:281–5.CrossRefGoogle ScholarPubMed
Munné, S, Alikani, M, Tomkin, G, Grifo, J, Cohen, J. Embryo morphology, developmental rates, and maternal age are correlated with chromosome abnormalities. Fertil Steril. 1995;64:382–91.CrossRefGoogle ScholarPubMed
Van Royen, E, Mangelschots, K, Vercruyssen, M, De Neubourg, D, Valkenburg, M, Ryckaert, G, Gerris, J. Multinucleation in cleavage stage embryos. Hum Reprod. 2003;18:1062–9.Google ScholarPubMed
Balakier, H, Sojecki, A, Motamedi, G, Librach, C. Impact of multinucleated blastomeres on embryo developmental competence, morphokinetics, and aneuploidy. Fertil Steril. 2016;106:608–614.e2.Google Scholar
Alikani, M, Calderon, G, Tomkin, G, Garrisi, J, Kokot, M, Cohen, J. Cleavage anomalies in early human embryos and survival after prolonged culture in-vitro. Hum Reprod. 2000;15:2634–43.CrossRefGoogle ScholarPubMed
Rhenman, A, Berglund, L, Brodin, T, Olovsson, M, Milton, K, Hadziosmanovic, N, Holte, J. Which set of embryo variables is most predictive for live birth? A prospective study in 6252 single embryo transfers to construct an embryo score for the ranking and selection of embryos. Hum Reprod. 2015;30:28–36.CrossRefGoogle ScholarPubMed
Coticchio, G, Lagalla, C, Sturmey, R, Pennetta, F, Borini, A. The enigmatic morula: mechanisms of development, cell fate determination, self-correction and implications for ART. Hum Reprod Update. 2019;25:422–38.CrossRefGoogle ScholarPubMed
Tao, J, Tamis, R, Fink, K, Williams, B, Nelson-White, T, Craig, R. The neglected morula/compact stage embryo transfer. Hum Reprod. 2002;17:1513–18.CrossRefGoogle ScholarPubMed
Ebner, T, Moser, M, Shebl, O, Sommergruber, M, Gaiswinkler, U, Tews, G. Morphological analysis at compacting stage is a valuable prognostic tool for ICSI patients. Reprod Biomed Online. 2009;18:61–6.CrossRefGoogle ScholarPubMed
Gardner, DK, Lane, M, Stevens, J, Schlenker, T, Schoolcraft, WB. Blastocyst score affects implantation and pregnancy outcome: towards a single blastocyst transfer. Fertil Steril. 2000;73:1155–8.Google Scholar
Dumoulin, JCM, Derhaag, JG, Bras, M, Van Montfoort, APA, Kester, ADM, Evers, JLH, et al. Growth rate of human preimplantation embryos is sex dependant after ICSI but not after IVF. Hum Reprod. 2005;20:484–91.Google Scholar
Hardy, K, Handyside, AH, Winston, RM. The human blastocyst: cell number, death, and allocation during late preimplantation development in vitro. Development. 1989;107:597–604.CrossRefGoogle ScholarPubMed
Richter, KS, Harris, DC, Daneshmand, ST, Shapiro, BS. Quantitative grading of human blastocyst: optimal inner cell mass size and shape. Fertil Steril. 2001;76:1157–67.Google Scholar
Ebner, T, Tritscher, K, Mayer, RB, Oppelt, P, Duba, HC, Maurer, M, et al. Quantitative and qualitative trophectoderm grading allows for prediction of live birth and gender. J Assist Reprod Genet. 2016;33:49–57.CrossRefGoogle ScholarPubMed
Santos Filho, E, Noble, JA, Poli, M, Griffiths, T, Emerson, G, Wells, D. A method for semi-automatic grading of human blastocyst microscope images. Hum Reprod. 2012;27:2641–8.Google ScholarPubMed
Ahlström, A, Westin, C, Reismer, E, Wikland, M, Hardarson, T. Trophectoderm morphology: an important parameter for predicting live birth after single blastocyst transfer. Hum Reprod. 2011;26:3289–96.CrossRefGoogle ScholarPubMed
Bakkensen, JB, Brady, P, Carusi, D, Romanski, P, Thomas, AM, Racowsky, C. Association between blastocyst morphology and pregnancy and perinatal outcomes following fresh and cryopreserved embryo transfer. J Assist Reprod Genet. 2019;36:2315–24.CrossRefGoogle ScholarPubMed
Balaban, B, Urman, B, Isiklar, A, Alatas, C, Aksoy, S, Mercan, R, et al. The effect of pronuclear morphology on embryo quality parameters and blastocyst transfer outcome. Hum Reprod. 2001;16:2357–61.Google Scholar
Lan, KC, Huang, FJ, Lin, YC, Kung, FT, Hsieh, CH, Huang, HW, et al. The predictive value of using a combined Z-score and day 3 embryo morphology score in the assessment of embryo survival on day 5. Hum Reprod. 2003;18:1299–1306.CrossRefGoogle ScholarPubMed
Racowsky, C, Ohno-Machado, L, Kim, J, Biggers, JD. Is there an advantage in scoring early embryos on more than one day? Hum Reprod. 2009;24:2104–13.CrossRefGoogle ScholarPubMed
Berger, DS, Zapantis, A, Merhi, Z, Younger, J, Polotsky, AJ, Jindal, SK. Embryo quality but not pronuclear score is associated with clinical pregnancy following IVF. J Assist Reprod Genetics. 2014;31:279–83.Google Scholar
Racowsky, C, Combelles, CMH, Nureddin, A, Pan, Y, Finn, A, Miles, L, et al. Day 3 and day 5 morphological predictors of embryo viability. Reprod Biomed Online. 2003;6:323–31.CrossRefGoogle ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×