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Human Reproduction, Vol. 7, No. 1, pp. 117-119, 1992
© 1992 European Society of Human Reproduction and Embryology

other

SHORT COMMUNICATION: The cumulative embryo score: a predictive embryo scoring technique to select the optimal number of embryos to transfer in an in-vitro fertilization and embryo transfer programme

C.V. Steer1,2,3, C.L. Mills1,4, S.L. Tan1,2, S. Campbell1 and R.G. Edwards1

1Bourn Hallam Medical Centre 112 Harley Street, London W1N 1AS, UK 2Department of Obstetrics and Gynaecology, King's College School of Medicine and Dentistry London SE5 8RX, UK

Correspondence: 3To whom correspondence should be addressed at: Department of Obstetrics and Gynaecology, North Middlesex Hospital, Stirling Way, Edmonton, N18 1BX

Correspondence: 4To whom reprint requests should be addressed

In order to achieve a clinical pregnancy rate higher than that achieved following initial adoption of in-vitro fertilization embryo transfers, more than one embryo is transferred. This has led to a substantial increase in unwanted multiple pregnancy rates with IVF as compared with natural conception. What is therefore required is a simple, clinically useful embryo scoring system, to reflect embryo developmental potential, which will enable the selection of the optimal number of embryos to transfer in order to achieve the maximum pregnancy rate with a low incidence of high order multiple pregnancies. We believe that the Cumulative Embryo Score (CES) achieves these aims. On the day of embryo transfer the grade of each embryo transferred was multiplied by the number of blastomeres to produce a score for each embryo, and summation of the scores obtained for all the embryos transferred gave the CES. The grouped pregnancy rates obtained rose as the CES increased to maximum of 42. A continued increase in the CES above 42 did not result in any further rise in the pregnancy rate. However, an analysis of all our IVF pregnancies showed that the multiple pregnancy rate continued to rise above a CES of 42. By restricting the CES per embryo transfer to 42, 78% of triplet pregnancies and 100% of the quadruplet IVF pregnancies could have been predicted and potentially avoided.

Key words: cumulative embryo score/IVF-ET/pregnancy/multiple pregnancy


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J. C.M. Dumoulin, E. Coonen, M. Bras, L. C.P. van Wissen, R. Ignoul-Vanvuchelen, J.M. Bergers-Jansen, J. G. Derhaag, J. P.M. Geraedts, and J. L.H. Evers
Comparison of in-vitro development of embryos originating from either conventional in-vitro fertilization or intracytoplasmic sperm injection
Hum. Reprod., February 1, 2000; 15(2): 402 - 409.
[Abstract] [Full Text] [PDF]

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R.L. Schild, S. Holthaus, J. d'Alquen, R. Fimmers, C. Dorn, H. van der Ven, and M. Hansmann
Quantitative assessment of subendometrial blood flow by three-dimensional-ultrasound is an important predictive factor of implantation in an in-vitro fertilization programme
Hum. Reprod., January 1, 2000; 15(1): 89 - 94.
[Abstract] [Full Text] [PDF]

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J. Gerris, D. De Neubourg, K. Mangelschots, E. Van Royen, M. Van de Meerssche, and M. Valkenburg
Prevention of twin pregnancy after in-vitro fertilization or intracytoplasmic sperm injection based on strict embryo criteria: a prospective randomized clinical trial
Hum. Reprod., October 1, 1999; 14(10): 2581 - 2587.
[Abstract] [Full Text] [PDF]

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S. Al-Hasani, L.C. Demirel, B. Schopper, M. Bals-Pratsch, N. Nikolettos, W. Kupker, M. Ugur, R. Sturm, and K. Diedrich
Pregnancies achieved after frozen–thawed pronuclear oocytes obtained by intracytoplasmic sperm injection with spermatozoa extracted from frozen–thawed testicular tissues from non-obstructive azoospermic men
Hum. Reprod., August 1, 1999; 14(8): 2031 - 2035.
[Abstract] [Full Text] [PDF]

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G.M. Jones and A.O. Trounson
The benefits of extended culture
Hum. Reprod., June 1, 1999; 14(6): 1405 - 1408.
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J. Tesarik and E. Greco
The probability of abnormal preimplantation development can be predicted by a single static observation on pronuclear stage morphology
Hum. Reprod., May 1, 1999; 14(5): 1318 - 1323.
[Abstract] [Full Text] [PDF]

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S. Geber and M. Sampaio
Blastomere development after embryo biopsy: a new model to predict embryo development and to select for transfer
Hum. Reprod., March 1, 1999; 14(3): 782 - 786.
[Abstract] [Full Text] [PDF]

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M. Ludwig, D.F. Finas, S. Al-Hasani, K. Diedrich, and O. Ortmann
Oocyte quality and treatment outcome in intracytoplasmic sperm injection cycles of polycystic ovarian syndrome patients
Hum. Reprod., February 1, 1999; 14(2): 354 - 358.
[Abstract] [Full Text] [PDF]

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J. C.M. Dumoulin, C. J.J. Meijers, M. Bras, E. Coonen, J. P.M. Geraedts, and J. L.H. Evers
Effect of oxygen concentration on human in-vitro fertilization and embryo culture
Hum. Reprod., February 1, 1999; 14(2): 465 - 469.
[Abstract] [Full Text] [PDF]

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I. Spyropoulou, C. Karamalegos, and V. N. Bolton
A prospective randomized study comparing the outcome of in-vitro fertilization and embryo transfer following culture of human embryos individually or in groups before embryo transfer on day 2
Hum. Reprod., January 1, 1999; 14(1): 76 - 79.
[Abstract] [Full Text] [PDF]

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D. R. Meldrum and D. K. Gardner
Two-Embryo Transfer -- The Future Looks Bright
N. Engl. J. Med., August 27, 1998; 339(9): 624 - 625.
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