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Hum. Reprod. Advance Access originally published online on February 21, 2008
Human Reproduction 2008 23(7):1505-1510; doi:10.1093/humrep/dem419
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© The Author 2008. 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

Day 4 embryo selection is equal to Day 5 using a new embryo scoring system validated in single embryo transfers

Deanne Feil1,2,3, Richard C. Henshaw2 and Michelle Lane1,2

1 Department of Obstetrics and Gynaecology, Research Centre for Reproductive Health, The University of Adelaide, Adelaide, Australia 2 Repromed, Adelaide, Australia

3 Correspondence address. E-mail: deanne.feil{at}adelaide.edu.au

BACKGROUND: Single embryo transfers (SETs) require the most viable embryo from a cohort to be selected. Day 4 embryos may provide a selection advantage similar to blastocyst transfer as embryos are replaced post-embryonic genome activation and into the uterus where they would normally reside. However, there is currently no adequate morphological system to assess Day 4 embryos. Therefore, we developed an assessment system for Day 4 embryos and retrospectively assessed Day 4 SET success rates compared with Day 5 SETs.

METHODS: Embryos (n = 996 after IVF or ICSI) were assessed on Day 4 of development, prior to implementing Day 4 embryo transfers, to obtain a descriptive range of embryo morphologies observed at this time point. A morphological scoring system was developed from this. All patients having an SET after extended culture (Day 4, n = 124 or Day 5, n = 193), at Repromed, Adelaide, Australia, during June 2006–January 2007 were analysed for pregnancy outcome. Ongoing pregnancy was determined by fetal cardiac activity at 6–8 weeks after oocyte collection.

RESULTS: Day 4 and 5 SETs resulted in similar ongoing pregnancy rates of 38.7% and 32.1%, respectively.

CONCLUSIONS: A Day 4 scoring system was successfully developed and implemented. Day 4 SETs were found to be a viable option or alternative to Day 5 SETs with no difference in pregnancy rates.

Key words: single embryo transfer/blastocyst culture/embryo selection/IVF/ICSI

Submitted on April 6, 2007; resubmitted on December 6, 2007; accepted on December 13, 2007.


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