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Hum. Reprod. Advance Access originally published online on February 17, 2006
Human Reproduction 2006 21(6):1599-1604; doi:10.1093/humrep/del013
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© The Author 2006. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. 1599 For Permissions, please email: journals.permissions@oxfordjournals.org
The online version of this article has been published under an open access model. Users are entitled to use, reproduce, disseminate, or display the open access version of this article for non-commercial purposes provided that: the original authorship is properly and fully attributed; the Journal and Oxford University Press are attributed as the original place of publication with the correct citation details given; if an article is subsequently reproduced or disseminated not in its entirety but only in part or as a derivative work this must be clearly indicated. For commercial re-use, please contact journals.permissions@oxfordjournals.org

The limited importance of pronuclear scoring of human zygotes

Aidita N. James1,5, Sasha Hennessy1, Brett Reggio1, Klaus Wiemer1,2, Frederick Larsen3 and Jacques Cohen1,4

1 The A.R.T. Institute of Washington, Inc. at Walter Reed Army Medical Center, Washington, DC, 2 Northwest Center for Reproductive Sciences, Kirkland, WA, 3 Department of Obstetrics and Gynecology, Walter Reed Army Medical Center, Washington, DC and 4 Tyho-Galileo Research Laboratories and Reprogenetics, West Orange, NJ, USA

5 To whom correspondence should be addressed at: The A.R.T. Institute of Washington, Inc. at Walter Reed Army Medical Center, PO Box 59727, Washington, DC 20012, USA. E-mail: aida.james{at}na.amedd.army.mil

BACKGROUND: Several studies have shown a correlation between the pronuclear morphology score (PNMS) and subsequent embryo development and implantation. Embryos with poor pronuclear score, elsewhere referred to as Z3 and Z4, are often not transferred or cryopreserved because it is believed that they have poor pregnancy potential. The objective of this study is to report our data on the use of the pronuclear score and its effect on pregnancy outcome. METHODS: Retrospective analysis of IVF/ICSI-embryo transfer cycles completed over the course of 1 year (n = 334). Comparisons were made only in those groups of patients in whom cohorts of similarly scored PNMS embryos were transferred. The proportion of such homologous cohorts was 104/334 (31%). All other replacements were excluded from final analysis as they were dissimilar as far as PNMS is concerned. Pregnancy outcomes were evaluated. RESULTS: The incidence of live birth resulting from the transfer of single pronuclear score homologous embryo types was 56 (14/25), 41 (13/32), 54 (23/43) and 0% (0/4) for PNMS scores 1, 2, 3 and 4, respectively. There was no correlation between PNMS category of the embryos transferred and live birth rates (P = 0.139). CONCLUSIONS: PNMSs of 1, 2 or 3 do not correlate with live birth rates when assessing unique PNMS embryo transfers. In particular, previously considered poor (type 3) embryos can result in pregnancy with normal live birth rates. Whether type 4 embryos are compatible with normal development remains to be shown.

Key words: embryo/live birth/pronuclear morphology scores/Z score/zygote


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