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Hum. Reprod. Advance Access originally published online on May 11, 2007
Human Reproduction 2007 22(7):1973-1981; doi:10.1093/humrep/dem100
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© The Author 2007. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Limited value of morphological assessment at days 1 and 2 to predict blastocyst development potential: A prospective study based on 4042 embryos

F. Guerif1, A. Le Gouge2, B. Giraudeau2, J. Poindron1, R. Bidault1, O. Gasnier1 and D. Royere1,3

1 Service de Médecine et Biologie de la Reproduction, CHU Bretonneau, 2 Boulevard Tonnelle, 37000 Tours, France 2 INSERM CIC 202, Université François Rabelais de Tours, CHRU de Tours, France

3 Correspondence address. Tel: +33-247-474-746; Fax: +33-247-478-484; E-mail: royere{at}med.univ-tours.fr

BACKGROUND: Non-invasive and routine developmental markers are available to select the most viable embryo; however their respective values in terms of blastocyst development potential remain difficult to distinguish.

METHODS: During this prospective study, the sequential growth of 4042 embryos individually cultured from day 1 to day 5/6 was recorded. Pronuclear morphology on day 1, and early cleavage, cell number and fragmentation rate on day 2 were evaluated for each zygote. Additionally, blastocyst transfers were analysed with regard to their implantation ability and early embryo development parameters.

RESULTS: Once adjusted to each other, each of the four parameters remained related to blastocyst development. Early cleavage and cell number on day 2 were the most powerful parameters to predict the development of a good morphology blastocyst at day 5. Moreover, whereas transfers of a good morphology blastocyst were associated with high implantation and live birth rates, parameters of early development were not helpful in predicting their implantation ability.

CONCLUSIONS: The combination of all four parameters allowed the prediction of blastocyst development with an area under the receiver operating characteristics curve of 0.688, which represents a fairly low prediction of embryo viability. Such results indicate that it is necessary to search for additional criteria, including the ability of the blastocyst to develop.

Key words: blastocyst/early cleavage/implantation/embryo morphology/zygote scoring

Submitted on December 11, 2006; resubmitted on March 14, 2007; accepted on March 29, 2007.


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